111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
After TMJ Treatment
I appreciate life more than most people
I know. l didn't have a life before
—a 34-year-old musician
It's like starting all over again. But
—a 40-year-old psychotherapist
Many patients enter TMJ therapy doubting that
they will ever be pain-free. One patient had been through
two surgeries, a year of orthodontia, a year of wearing a
splint, and physical therapy. "Whatever you do, it will
only last two weeks," she said. However, she did agree
to start TMJ therapy again, even though she was convinced
that it would benefit her for only two weeks. After about
eight weeks of Phase I treatment, she was symptom-free for
about sixteen consecutive days; after that, her progress was
rapid. When she was finally convinced that her life could
be pain- free, she said, "I think I'll make plans for
three weeks from now."
In a nutshell, the biggest change many TMJ
patients experience is being able to plan life more than one
day ahead. Many have become used to thinking about work and
play in terms of the pain they are in, or may be in. When
they no longer have to consider the pain in their plans, an
enormous burden is lifted. Many are so accustomed to that
burden that they have forgotten what it was like to live in
freedom from constant pain.
Patients who are beginning recovery in Phase
I often complain about having to come in for weekly visits.
Some will comment on the difference in their attitude. "I
was so glad to get here when we first started," one patient
said. "But now it's such a bother. I'm too busy catching
up with my life."
Many stereotypes exist about people in pain—they
are hypochondriacs, they use pain to control people, they
are in pain because they are depressed, they need the pain
as a way to avoid responsibility. Certainly these stereotypes
may apply to some people. A minute number of patients have
had some kind of need to have the pain. But in the eighteen
years I have been treating TMJ these people have been so few
that I can barely remember them.
Remember Sandy Gilbert? Her husband carried
a beeper so that she could reach him. She often had to call
him to come and rescue her when a headache struck. Most of
the people who knew her, except her husband, believed she
was trying to control her husband with pain.
About two months into treatment, Ms. Gilbert
told her husband to throw the beeper away. "It was the
happiest day of my life," she said. "I hated the
beeper, and I hated what people were saying about me."
For Ms. Gilbert, a new life opened up when she was pain-free.
She began spending time with her daughters and grandchildren.
"We went shopping for a whole day, and I didn't think
about pain once," she said. "I haven't done that
for years. Even holidays were planned around 'mother's condition,'
and the family got tired of it."
Sarah Johnson started looking for a teaching
job as soon as her treatment was over. "Imagine. I was
worried that I really was depressed. Now I know that it was
truly the pain that finally got me down," she said. Ms.
Johnson had been through so much that it would have been normal
for her to have a long re-entry period. However, that was
not the case. She typifies many patients who have lived in
agonizing pain. When the pain is over, they jump back into
life— usually with both feet.
REBUILDING MARRIAGES AND LIVES
Some patients have experienced destroyed marriages.
In a sense they have a double tragedy. They have lived in
physical pain, and also had a spouse who either couldn't understand
what they were going through or couldn't live with the problems.
This is perfectly understandable. Living with a person in
chronic pain means living a "handicapped" life as
Ray Foreman had to rebuild almost everything
in his life. He'd lost his wife, his social life, and a successful
business. Mr. Foreman began psychotherapy during treatment.
"I think I am in a depression," he said. "I've
lost a lot, and I want help getting some of it back."
He felt an enormous amount of anger toward his ex-wife, and
while he couldn't recapture that relationship, he was able
to be on friendly terms with her after he had some help.
A patient like Mr. Foreman literally has to
rebuild everything. Often a patient like this can benefit
from some kind of psychological counselling. He knew the depression
wasn't causing his pain, because his pain was gone by the
time he began to get help for the depression. It took him
almost two years to rebuild a social life, start another business,
and, in short, live normally. "I was so isolated that
I felt like I had to become a 'social animal' all over again.
I was uncomfortable with people for quite a while," he
Another patient had given custody of her child
to her ex-husband. After treatment was complete, she was able
to negotiate joint custody of their son, an arrangement agreeable
to the father. "He wasn't being vindictive when he took
custody," she explained. "I was unable to take care
of him. He's relieved too that I'm well enough to take care
of our child." The kind of relief and joy a patient like
this feels is almost impossible to describe.
Most patients' recovery isn't that dramatic.
Many patients notice smaller things—an ability to sleep
well is a common one. If sleep has been disturbed by pain,
the patient often adjusts to the disturbance and may not even
mention it during the initial evaluation. But a month or two
into treatment, the patient may say, "I can sleep so
much better than I used to. I just noticed this."
Sometimes patients begin doing things they
couldn't do before treatment. Joy Rubin, the patient with
restricted neck motion, had at one time been an avid tennis
player. One of the first things she did was dust off her racket
and get back to the courts. Former runners go back to the
track, and weight lifters go back to the gym. The patients
are asked to resume these activities slowly in case symptoms
are retriggered. It's important always to treat the jaw mechanism
carefully, because we know that these muscles are vulnerable
Sometimes patients have to be cautioned against
trying to do too many things at once. Some patients want to
take up two or three physical activities immediately, when
they really should add activities one at a time. If for some
reason symptoms are re-triggered by weight lifting, jogging,
or scuba diving, it's better to be able to isolate the activity.
The chances of re-triggering TMJ symptoms are slim, but muscles
that have been in spasm should be treated with some caution.
This is especially true during attempts to solve the problem
permanently in Phase II. During Phase II, spasms may be triggered
inadvertently either by physical activity or by stressing
the jaw during the dental treatment itself.
FUTURE DENTAL AND MEDICAL CARE
Once a TMJ patient has had treatment, any future
dental work needs to be carried out according to the concepts
underlying the Phase II definitive work. Dentists need to
be aware of the delicate gearing scheme created and that it
was done with special care to avoid stressing the jaw. Dental
work can re-trigger TMJ symptoms.
In patients with combination headaches, once
the TMJ component has been taken care of, the patient can
go on to have further diagnostic evaluations and treatment.
In the case of a patient who is being treated for allergies,
the search for "forbidden" food becomes much easier.
A patient who suspected an allergy to dairy products found
out that she truly was sensitive to that family of foods.
The coming and going of TMJ symptoms had stopped, and gradually
it became possible to test more foods. Some were removed and
others reintroduced into her diet.
Many patients suffering from true migraines
notice having fewer of them after TMJ treatment. Although
it's unclear why TMJ headaches trigger other kinds, this phenomenon
occurs over and over. Patients who are sensitive to chemicals
commonly found in foods—MSG or preservatives, for example—can
see patterns, and cause and effect, in their headaches. Before
the TMJ component was removed, isolating causes was often
much too confusing.
Patients who have used many self-help techniques
often continue them or discontinue them based on how much
the techniques have enhanced their lives overall. People who
have taken up yoga, meditation, massage, or exercise programs
often keep them up because they find them enjoyable and beneficial
in other ways. Sometimes they find they get more pleasure
from the activities when they view these measures as optional
rather than mandatory. "I was down on myself if I missed
a relaxation class," one woman said. "I felt so
responsible for my own pain."
We also warn patients about surgical treatment
after TMJ treatment. Sometimes surgery can trigger TMJ in
the first place because of the tube that is passed into the
windpipe when the patient is under general anaesthesia. This
tube takes over the patient's breathing during the surgery.
However, for the tube to be passed down the patient's throat,
his or her mouth must be opened very wide. The patient is
unconscious and can't tell the physicians that his or her
jaw is being stretched too wide and is being stressed.
Generally the same function can be served by
using a nasal-tracheal tube. This involves passing the tube
down the patient's nose, into the throat, and on to the windpipe.
The anaesthesiologist opens the patient's mouth briefly to
see where the tube is going, but the stress is for a much
shorter period of time.
When a patient who has had TMJ treatment is
going to have surgery, a nasal tube should be used rather
than an oral tube. Most physicians are co-operative once they
understand the reason for the request. The problem is seldom
insurmountable. However, the patient should remember to discuss
this with the physician. Sometimes people want to put their
experience with TMJ so far behind them that they forget to
consider their past vulnerability to muscle spasm.
Some routine observations about post-TMJ patients
haven't been scientifically documented. More research may
make it possible to quantify some effects of pain and its
removal. Many patients have reported an overall improvement
in their well-being. They sleep better and have fewer colds,
many report eating better, and some say they have less indigestion
or other digestive disturbances.
Nearly every person who sought treatment because
of debilitating pain reports having more energy after treatment.
Pain can be exhausting, and patients seldom realize how exhausting
until it's gone and they feel their normal energy return.
Patients have said they have tried new things—sports,
night classes, new careers, or having babies they had put
off having because they didn't feel they could handle parental
responsibility while in pain. And some patients establish
relationships and marriages they felt they couldn't handle
because of incapacitating pain.
Even patients whose symptoms and life losses
were less severe report having increased energy and ability
to live fully. Their new lease on life may be less dramatic,
but they still mention them throughout treatment and after.
Patients with less severe symptoms often say that they had
become used to living at an unnecessarily slow pace.
Patients who are lucky enough to have supportive
family members, spouses, and friends report a kind of renewal.
They routinely say things like, "My sense of humor is
back. We joke more now in our house. People aren't so careful
not to disturb me for fear of being snapped at." Others
will say that their sexual lives are more normal, too. "It
was a relief to know that I really did a have a normal sex
drive—it was just pain that got in the way," one
man said. The "not tonight, dear" joke has often
been attributed to women, but anyone who treats TMJ knows
that men, too, are unable to enjoy normal sex lives when pain
Some patients are able to take care of other
health concerns now that the pain is out of the way. For instance,
I've seen patients deal with weight problems they couldn't
handle before. Other patients take up much-needed exercise
programs for the first time. Pain had prevented them from
doing almost any physical activity, even though they had been
advised to start an exercise program as part of a treatment
for high blood pressure or heart disease.
In general the life of the ex-TMJ patient is
pleasant indeed. For a few people who were long-term TMJ sufferers,
it seems as if they are beginning life for the first time.
These people, as well as some shorter-term sufferers, even
look different. Their faces are more relaxed, they smile more,
and their eyes are brighter.