On April 21st I wrote an article about TMJ, jaw pain that makes it painful to open your mouth and that causes a clicking where the two bones of your jaw meet at the back of your jaw.
I received an email from a client of mine, Louis Bellotti DMD who is a Prosthodontist. As an expert in the field he had comments that are way beyond my scope of practice. I’m a licensed massage therapist, and I only deal in the muscular component to painful conditions, but his comments were so important that I’m copying his email and posting them here for you to be able to read. I can’t answer any questions about his statements, but he was kind enough to say that I can give credit to him for the information. He’s very busy, but he’s also concerned that people have the complete answer to jaw pain.
I read your article and liked it. May I comment: I do not like the term TMJ. I inform patients it is called temporomandibular syndrome and I do not like that term because a syndrome is a collection of symptoms with no known etiology. I realize there is an etiology and it can be treated.
Your title is jaw and temple pain with no mention of the temples (my comment: that was an oversight, I’ll write on it this week). Aside from the masseters, the anterior fibers of the temporalis also raise the jaw and develop knots simultaneously and also need to be treated.
Stress, tension, anxiety, pernicious habits, and imbalanced occlusion of natural or man made dental restorations are major instigators of clenching. Gum chewing is the worst as constant contractions are made which develop huge masseters and temporalis muscles. It took a long time to build them up, and it will take a long time for them to atrophy but only if the patient stops the repetitive noxious behavior or seeks consult with their dentist.
Prosthodontists have advanced training in this. I utilize several modalities aside from what you discussed. One is the NTSSI Device and the other is the Bruxcare. The NTSSI I construct in my office and the Bruxcare I dispense. Sometimes both are utilized. The internet will shed more information. While the NTSSI changes the fulcrum to attenuate the forces, it does not get rid of the cause. It treats symptoms only and does not get to the cause.
The Bruxcare establishes that the patient is, indeed clenching, as often they do not think so, and thru self bio-feedback train themselves not to clench. It has been scientifically proven that clenching occurs while sleeping, predominantly as you enter sleep and awaken. In deep restorative sleep or REM sleep, you do not clench. Differentiation also has to be made if the patient is clenching or bruxing or both and this can be determined with visualization of the envelope of mandibular motion and teeth wear patterns.
Many times it is due to 3rd molars, worn teeth, or dental restorations that are not optimally designed. Self treatment of the trapezious, sternocleidomastoid, scalenes, infra and supraspinatus muscles also help the TMJ issues to decrease the cascading chain of muscle spasm and can not be ignored.
If you live in close to Ft. Lee, NJ, you may like to visit with Dr. Bellotti, his contact information is:
Louis Bellotti DMD Prosthodontist
481 Edsall Blvd.
Fort Lee New Jersey 07024