111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
Questions and Answers
Here are questions people have asked me over
and over again. It's my hope that the answers will clarify
your understanding of TMJ.
Is there such a thing as a TMJ
profile or a typical TMJ sufferer?
This is a common question, perhaps intended to narrow the
field of sufferers. The typical TMJ sufferer usually has headaches.
Beyond this, it's impossible to be specific.
Is it true that the majority of people who suffer from the
symptoms of TMJ, and headaches in general, are women?
It is true that in the popular literature that discusses headaches,
the majority of sufferers are women. The typical headache
sufferer depicted in advertisements for headache pain relievers
is usually a woman. However, headaches and other symptoms
of TMJ seem to be fairly evenly distributed between the sexes.
The majority of patients in my practice are women, but the
majority of patients in almost all dental or medical practices
tend to be women.
Women seem to know they need regular medical
visits such as gynecological checkups and breast exams, and
they make sure they get them. Women also tend to go to their
dentists for routine checkups. In my experience, men more
often wait until something is wrong. To treat dental problems
that, because of neglect, have become emergencies, I see many
more men than women.
There is still a kind of macho image that many
men feel they must live up to. Men will deny pain more often
than women. It's as if they see pain as something to be ashamed
I have heard of women complaining of a backache—a
possible symptom of TMJ—and when no cause is found,
they are labeled neurotic. Have you heard of men who suffer
from backaches? What we usually hear is, "I threw my
back out." (He might also attribute it to doing something
"macho" like lifting a heavy object.) There is still
pressure on men to disassociate themselves from conditions
that have for too long been linked with the so-called weaker
Does any one age group appear to be affected by
TMJ problems more than others?
I've treated patients as young as ten and as old as seventyeight.
However, the bulk of my patients are in the prime of life,
ages thirty to fifty. People wonder why, if a toothgearing
problem exists, symptoms didn't begin in the stressful period
of adolescence. While it's unknown why this disorder seems
to strike in the middle years, certain diseases and disorders
are common in childhood, others are common in older people.
Perhaps TMJ will be found to be a disorder common to those
in their prime. Perhaps it is simply related to the changes
in the topography of the teeth—wearing down, more tooth
replacement, and so forth. It may also be that the most active
years are when we're more susceptible to traumas of the head
and neck, which can trigger the problem. We can only hope
that more research will reveal the answer to this question.
Do certain racial or ethnic groups tend to have
higher incidence of TMJ than others?
Certainly none that we know of. TMJ appears to be about evenly
Is it common to have only middle-ear symptoms,
but no headaches, neck stiffness, or any other common symptoms?
This isn't common, but it happens occasionally. If you are
told that nothing is wrong with your ears, then TMJ would
be a logical condition to investigate. But when starting the
search for help, those with only middle-ear symptoms should
begin with medical specialists, and TMJ should be among the
last conditions to investigate.
My doctor says TMJ doesn't exist. Is this a common
attitude among physicians?
It is more common than it should be, but few physicians deny
the existence of TMJ. Rather, they might deny the high incidence
of the condition, and doubt that it could be the major cause
of headaches. Physicians have said it was hard to believe
that all that pain could be caused by muscle spasms, especially
small muscles like the external pterygoids.
Once TMJ is included on the list of possible
causes for headaches, and training programs for all the healing
arts are changed, patients will begin to be screened in physicians'
offices for this problem. Physicians can be TMJ sufferers
too, and if you ask such physicians whether they believe in
the condition, you will hear no denials. Anyone who has ever
been afflicted and then relieved of chronic pain caused by
TMJ becomes a fast believer.
My dentist says the label of TMJ is being put
on too many people, and that it's actually quite rare. Why
is there such a vast difference of opinion?
Dentists not trained in TMJ might hear this message from someone
they respect. Because they respect this individual, they may
take the message seriously and absorb it as if it were truth.
A dentist may hear the stories of a dentist who began to treat
TMJ but had poor results. Many times, when treatment for TMJ
fails, a judgment will be made that the condition probably
wasn't TMJ in the first place. Knowledge of and belief in
any concept often have more to do with exposure, training,
and experience, either one's own or that of colleagues, than
with the actual existence of a particular problem.
One dentist said I have TMJ. Another said I don't.
Should I seek another opinion? Could I be a borderline case?
Dentists vary in their knowledge of the field. A "borderline
case" is one in which the diagnosis is in question. Perhaps
the patient isn't symptomatic, or suffers from symptoms mild
enough that treatment isn't indicated at that time. Whenever
there is a question it is always best to seek a second knowledgeable
I believe I have TMJ. I suffer from all the symptoms,
and my dentist says I have a tooth-gearing problem. But I've
spent a lot of time and money in pain clinics learning how
to rise above the pain and live with it. I'm afraid to begin
a new kind of treatment for fear that I'll lose the ability
to cope with pain. Does this make sense?
It is certainly understandable that people are concerned about
repeated disappointments in therapy. At times, learning to
cope with pain seems like the most comfortable solution. However,
in a case like this one, the person should have an evaluation
for TMJ by a dentist who has a track record of successful
treatment. If such treatment is available, the patient should
go ahead with it. If someone had put a nail in your arm ten
years ago and no one knew how to remove the nail, would you
still keep the nail there when you have been shown that new
nail-removing techniques have become available? Most people
want to get rid of pain, not just cope with it. The techniques
pain clinics use are wonderful in situations where no cause
or cure can be found. There are other pain syndromes besides
TMJ, and these clinics have helped many people live more normal
I once had a bout with many of the symptoms of
TMJ. It lasted about six months, and then it gradually went
away and never came back. If I have the predisposition to
TMJ, am I a "condition waiting to happen"?
You probably are. When you became symptomatic, your threshold
or tolerance dropped, and when it went up, the symptoms went
away. Any person with such an episode should keep TMJ in mind
if these symptoms ever recur, or be mindful of the problem
if restorative dentistry is ever needed. Remember, extensive
dental work provided without knowledge of this problem can
Why do some people with a tooth-gearing problem
become symptomatic, while others with the same problem remain
We don't know why some people are susceptible and others are
not. We don't know why some people seem to be more susceptible
to having muscles in the head and neck go into spasm. In the
symptomatic person, we aren't sure why the susceptibility
varies from week to week, day to day, and even year to year.
We don't know why the tolerance threshold drops and symptoms
occur. The severity of the tooth gearing problem seems to
have little to do with the severity of symptoms.
My therapist says I grind my teeth at night because
of psychological conflicts. He says that when I work out my
problems, my aching jaws and headaches will go away. If I
have a tooth-gearing problem, how will correcting psychological
In a broad sense, solving psychological problems has little
effect on TMJ. Any effect is over a very long time, and the
tooth-gearing problem and, therefore, the potential to trigger
the symptoms remains. We know that grinding or gnashing of
teeth is one way humans—and other animals— manifest
stress. We can see this when a dog feels threatened or is
protecting its territory. So teeth grinding, or bruxism, as
it is called, may be a psychological phenomenom. However,
the physiological problem—the incorrect gearing of the
teeth—is not. TMJ treatment addresses the gearing problem.
Psychotherapy is recommended when a patient
is under extreme stress and is handling it poorly, or when
underlying problems are preventing a person from functioning
normally. Since TMJ is a physiological problem that is in
no way brought on by psychological problems, it is most important
to correct the tooth-gearing problem. Therapy can't correct
a mechanical problem like TMJ.
I see a chiropractor regularly, and my back problems
have greatly improved. However, while my headaches are better
right after a visit, they always come back. Why?
People with back, neck, and shoulder problems and headaches
commonly see practitioners such as massage therapists, osteopaths,
naprapaths, and chiropractors. They often receive symptomatic
relief for certain problems such as headaches, but nothing
is done to permanently correct the tooth-gearing problem.
They receive temporary relief because the therapies relax
the muscles temporarily and break the spasms. However, because
the causative reason has not been addressed, the spasms quickly
start again. TMJ treatment corrects the problem that triggers
the cycle of spasm and pain.
You seem to disapprove of drugs for anything.
Are you against using drugs in health care in general?
It often must appear that I am against using pain relieving
drugs in general because I don't use them in treating TMJ.
Actually, pain relievers can be valuable in numerous situations,
including dentistry. I wouldn't want to drill teeth without
using anesthesia. And medications of all kinds make modern
medical care possible. What is inappropriate is the use of
drugs in place of finding a reason for pain, for example,
as the only therapy for chronic headaches when TMJ hasn't
been explored. Too many patients are barely able to get through
a simple interview because their bodies and minds are numbed
with medication. Very often, the pain wasn't numbed, but the
patient had lost the ability to care about it—or anything
else in life. Sometimes patients don't even care that they
don't care. This is the kind of drug therapy I'm opposed to.
I have dentures, but I also have TMJ symptoms.
How can I have a tooth-gearing problem if I don't have my
Many of my patients have dentures. A few have the dentures
in the first place because they were told it would cure their
TMJ. Unfortunately, removal of the teeth doesn't break the
muscle spasms. If the spasms are present when the dentures
are fabricated, they will be made in the same pattern as the
original teeth, which caused the problem in the first place.
TMJ treatment should break the muscle spasms and allow the
jaw to reposition itself before adjustments are made to the
dentures or new ones fabricated. A symptomatic patient should
not have all his or her teeth removed as an initial treatment
for TMJ. It rarely, if ever, corrects the problem, leaving
the patient a "dental cripple."
If pain medications are rarely effective in treating
TMJ patients, why do so many patients continue to take them?
People in chronic pain are frightened and depressed. They
may at times feel as if they would try anything to help themselves.
Sometimes the medications make them care about or notice the
pain a little less than without them.
If I seek help for TMJ, I may need help with weaning
myself from the drugs I have been taking for ten years. Is
this often a difficult process for TMJ patients?
In general, I haven't found this to be a difficult problem.
Most of my patients are more psychologically addicted than
physically addicted. When they no longer have pain, they are
usually glad to break the dependency. However, in some cases
where the addiction is physical, or where dependency is established,
patients are referred to physicians who can help them with
this part of treatment. This is seldom a difficult phase of
Does TMJ run in families?
It is not documented, as it is for migraine, that TMJ runs
in families. However, about 80 percent of the population has
the predisposition for TMJ, and therefore it would appear
logical that a familial connection will be found.
I have a very sensitive gag reflex, and I can't
stand to have any foreign objects in my mouth. Would a nonremovable
splint be appropriate in a case like mine?
In a case such as yours, I would generally use a nonremovable
splint. However, using this type of splint involves slightly
more risk and is much more costly.
I have migraines that are manageable with medications.
I also have low blood sugar and often get headaches when I
don't watch my diet. I also have premenstrual headaches and
appear to be chemically sensitive. But, no matter what I change
in my lifestyle, I still end up with headaches that seem to
come and go for no reason. How would I find out if some of
these headaches are TMJ related?
A TMJ evaluation would indicate whether you have a predisposition
to the problem. There well may be a TMJ component, as it's
not unusual to have numerous types of headache triggers. The
TMJ treatment is like peeling away layers of an onion. When
the TMJ component is removed, the patient can continue to
evaluate other reasons for the pain. Often, once the TMJ-related
headaches are gone, the total number of headaches from other
causes may be significantly reduced.
My symptoms began after I was injured in an automobile
accident. I was once told that I have a predisposition to
TMJ. Is it possible that my symptoms would never have been
triggered if I hadn't been in that accident?
Yes. Many people go through an entire lifetime with a predisposition
to TMJ and never become symptomatic. However, trauma can jerk
or pull the muscles, creating a situation where it is easy
for them to go into spasm. Again, we do not know why the majority
of people with a predisposition to TMJ will never become symptomatic.
But we do know that injury often triggers the symptoms.
My daughter's headaches began after she had orthodontic
Teeth may not gear properly within the requirements of the
jaw for many reasons—nature, the way the jaw grows,
the way a person sleeps, dental work, injury, orthodontics,
and dentures. If the teeth don't gear properly, the patient
is always subject to TMJ. Sometimes orthodontics, as in this
case, will create a gearing problem. Sometimes orthodontics
are part of Phase II treatment, usually to get the teeth closer
to correct gearing, so we can do an equilibration to complete
the proper gearing on a minute level.
Does bruxism automatically indicate TMJ?
No. Bruxism is the body's attempt to even out discrepancies
in the teeth. The basic gearing problem may create the muscle
spasms, and it may create bruxing. Not all people with a gearing
problem brux, and not all people with a gearing problem experience
painful muscle spasms. We don't know why certain people will
begin to brux, and we don't know why this bruxing will trigger
painful symptoms. So, not all people who brux will have TMJ
Is bruxing the same as a gearing problem?
Bruxing, or tooth grinding, is the result of a gearing problem
in certain susceptible people. Often, the teeth that are causing
the interference are avoided, and the other teeth are worn
down. It's also important to remember that a person with a
severe gearing problem may or may not have TMJ symptoms, and
may or may not brux. Bruxism is both a cause and a symptom
of the problem.
Will equilibration damage or weaken the teeth?
Equilibration on natural teeth most often involves working
on the elevations of the teeth. This is advantageous because
the enamel coating is usually thicker on the elevated portions
of the teeth, and thinner in the "pits." Therefore
equilibration rarely damages or weakens a tooth. Occasionally
a patient will report increased sensitivity in a tooth that
has been worked on. Whenever possible, we try to work within
and on the fillings, inlays, and crowns. Sometimes we damage
these and then must go in and replace them, However, there
is seldom damage to the structure of a healthy natural tooth.
Will I be worse off if the TMJ treatment doesn't
One of the advantages of Phase I treatment, as described in
this book, is that it can be stopped at any time, usually
without any alterations in the patient's mouth. The patient
can be left in the same condition as before treatment started.
In this sense, a patient is certainly not worse off.
Unfortunately, many people seek TMJ treatment
after having had orthodontia, surgery, or equilibrations before
their symptoms were relieved. The rationale is that the alterations
are needed in order for symptoms to be relieved. This is faulty
thinking for the vast majority of cases. Until the jaw has
relaxed into its normal position and the muscles are out of
spasm, correcting the tooth-gearing problem is chancy. Some
people luck out, and their symptoms go away when definitive
treatment is done first, but the chances are slim.
I had mysterious tooth pain that was treated with
several root canals. I began grinding my teeth after the work
was done. Did I develop a tooth-gearing problem?
It is entirely possible that a tooth-gearing problem caused
the tooth pain in the first place. On the other hand, you
may have had solid reasons to have the root canals done—the
teeth may have actually been dying. Once the root canals were
done, you may have started to grind unconsciously in order
to correct a gearing problem exacerbated or possibly even
created by the dental work. It's impossible to look back and
gauge the exact sequence of events. People with undiagnosable
tooth pain or a bruxing habit should have TMJ screening.
I have had several bouts with TMJ symptoms, and
have had TMJ diagnosed by two dentists. The treatment for
my symptoms has been physical therapy. It has been quite effective,
and whenever my symptoms flare up, I go for treatments. Is
this maintenance therapy? If so, what's wrong with it?
Since TMJ has been diagnosed twice, we'll assume that you
indeed have the condition. The periodic treatments you have
sound like maintenance therapies in that they help you in
the short run, but after a period of time the symptoms return,
sending you back to the physical therapist. There is nothing
wrong with this in and of itself. If this were the only solution
to your problem, then it would be just fine, and if you were
in severe pain, a true lifesaver. However, it is possible
that you could be helped permanently, that your symptoms could
go away and not return. The underlying problem can be corrected
in the vast majority of cases. In the long run I don't see
that permanent treatment is any more costly in money, lost
time, and personal frustration than maintenance therapies.
However, seeking a permanent solution for TMJ is a personal
choice, and if you feel satisfied with the care you are getting,
then by all means, continue it.
I have ground my teeth down to about half their
original size by bruxing. How would you accomplish treatment
in a case like mine?
Phase I of treatment would be the standard therapy described
in this book. Phase II would involve correcting the tooth-gearing
problem permanently, and if the teeth are severely worn down,
it would most likely include reconstructive dentistry. We
would need to rebuild what we call the "vertical dimension,"
the distance between the chin and the nose, which is determined
by the length of the teeth when the jaw is closed. Remember
that the jaw is basically a hinge and can be stopped in any
position. People who have no teeth and do not wear dentures
have a much shorter distance between the chin and the nose
than those with teeth of normal size for them. When the teeth
are worn down, we estimate the correct vertical dimension
and build up the teeth, using plastic crowns, until we have
established the most normal gearing pattern possible. The
temporary crowns are then replaced with permanent ones.
My mother began having neck and shoulder problems
at about age seventy. Lately she has been complaining of headaches,
too. Is it common for a person to become symptomatic at such
a late time of life? Has she had TMJ all her life, but is
just symptomatic now?
There is no way to say for sure that your mother's headaches
and other symptoms are caused by TMJ in the first place. It
is important to begin by ruling out all other reasons for
the pain. If no other reason is found for the symptoms, then
TMJ would be a logical condition to investigate.
Only rarely do patients seek a TMJ evaluation
after becoming symptomatic in their later years. In these
few patients, it is likely that dental work has triggered
the onset of symptoms. Often people have spent years wearing
their teeth down, have old fillings, or have just become denture
wearers for the first time. There's no way of knowing whether
they were free of TMJ before their severe symptoms started.
Because certain kinds of complaints—headaches, stiff
shoulders, neck aches—are considered normal, a person
won't even report them unless they are debilitating or beginning
to be a regular occurrence.
Older people are more likely to have true joint
derangement than younger people. Arthritis in the joint and
problems with the disc aren't unusual either in older people.
After all, an older person has spent years using his or her
jaws. No matter what the signs and symptoms, it should always
be determined whether the muscles are in spasm before assuming
that surgery is the answer for pain around the joint.
I recently visited a headache clinic where I was
given many tests and evaluations. However, TMJ was not considered.
Would you recommend that TMJ be considered before I start
Absolutely! You may or may not have TMJ. It is important to
have TMJ included in any evaluation for the cause of headaches.
Eventually, TMJ will be on the list of possible, and common,
reasons for headaches. It is possible that you have more than
one kind of headache. It is also possible that treatment suggested
for you is symptomatic treatment, not a plan that treats the
cause of the headaches you are experiencing. Any clinic that
specializes in headaches should consider all causes. That
can be said unequivocally.
Are you against people with TMJ taking stress-management
courses, or learning meditation, or having regular massages?
Aren't these things good for all people, regardless of whether
they have a pain syndrome?
The things you mention are definitely good for people whether
or not they have TMJ, migraines, high blood pressure, or even
a bad cold. There is absolutely nothing wrong with any of
these courses, techniques, or philosophies. People who have
absolutely no symptoms of any disease or disorder can benefit
from stress management, massage, and similar care. Many people
find they are more productive when they schedule time for
relaxation, play, spiritual growth, and exercise. Patients
who are taking care of themselves in many ways often reenter
normal life much more easily than those who lack hobbies,
social lives, satisfying exercise programs, or even well-
What is disturbing is that so many people have
been lured into taking up many of these practices as a way
to manage TMJ. Sometimes the management therapies work in
the short run. Sometimes they make a semblance of normal life
possible for people who would otherwise walk around in severe
pain practically every minute of the day. These therapies
can't cure TMJ. TMJ is physiologically based; it is a tooth-gearing
problem that causes muscle spasms in a susceptible person.
No amount of relaxation therapy can correct a tooth-gearing
The patients described in this book who have
maintained a life, of sorts, by using these techniques were
doing the best they could with the information they had. But
when a patient seeks help for this problem and talks about
life based on self-help, it is clear that, when carried to
extremes, this life is stressful in itself.
When patients watch their diets so scrupulously
because of their "allergies" that they can't go
to restaurants with friends, when they are so afraid of their
"hypoglycemia" that they feel obligated to carry
food around with them and panic if they don't have it at the
"right" time, or when they won't stay out past midnight
on a Saturday night because it doesn't fit into their "program,"
then they are slaves to the stress management, diet, or whatever
is supposed to be helping. them.
People who have never lived with pain probably
think that those who live this way are rigid to excess. The
people who live this way usually think so, too. Most people
want to live within the mainstream of normal life.
When they are treated and their symptoms are
gone, many patients keep some of the programs that have helped
them. And why not? The programs are part of a healthful life
that no health practitioner would discourage. But these people
are also free to let go of practices they don't like or have
observed or practiced to extremes.
I've been told my back pain is caused by my stressful
lifestyle and that a certain amount of back pain is normal.
I get occasional headaches, sometimes with the back pain and
sometimes without it. Does this sound like TMJ?
An evaluation for TMJ is in order. The diagnosis implies that
there is no systemic or structural reason for the pain. If
TMJ is found to exist, treatment may eliminate spasms in the
back muscles by treating other muscles in the chain.
Is TMJ treatment the same for all patients regardless
of their symptoms? Is it true that patients with ear symptoms
are treated with the same techniques as those with shoulder
or back pain?
This is correct. TMJ treatment involves treating muscles in
the head—specifically the external pterygoids.. Remember:
I don't treat "headaches" or "middle-ear problems."
As a dentist, I treat tooth- gearing problems and muscle spasms.
And as a dentist, I don't treat back muscles specifically.
The key muscles involved in most of the symptoms of TMJ are
located in the mouth, an area that dentists can legitimately
treat. This is important because patients shouldn't say they
went to a dentist to have their bad backs treated. They went
to a dentist to have the tooth gearing problem, which caused
their symptoms, corrected. The relief of these other problems
happens in response to what I do with these key muscles.
If muscle-contraction headaches are the most
common type of headache, why has so little research been done
to find causes and treatment?
Headaches in general have not been the focus
of large amounts of research. This is largely because headaches
in and of themselves are not life-threatening and are considered
normal. And since most people have headaches at least once
in a while, headaches are considered a manageable disorder.
Vascular headaches have been considered more "glamorous"
than muscle-contraction headaches, and what research has been
done has usually been concentrated on the "migraine-type"
If research were to be done on TMJ headaches,
it would be logical to try to discover what makes people susceptible
to muscle spasms. If we knew this, we would be able to discover
why some people with tooth-gearing problems never become symptomatic
and why others do.
Are there any rare symptoms of TMJ?
Occasionally a patient will talk about having very dry eyes.
It is rare enough not to be included in the list of major,
or common, symptoms. Some people mention just the opposite—eyes
that tear very easily. A few people believe they have sinus
problems because they get a stuffy nose along with their headaches.
When the tooth-gearing problem is gone, many people who reported
the stuffy-nose symptom often never get any headaches again.
Thus, the headaches were probably not sinus headaches, but
rather a reaction some people have to TMJ headaches.
I started wearing an athletic mouth guard when
I jog, and my symptoms have improved. Should I seek treatment
You should certainly have an evaluation for TMJ. Whether you
need treatment depends on how severe the symptoms are and
how you feel your life is affected. Some athletes find their
symptoms are worse with the mouth guard. There isn't any way
to predict who will get worse or better with mouth guards.
My doctor says TMJ is just another fad disease,
and interest in it will die in a year or two. How would you
I would agree that interest in TMJ is high right now. Many
people who had no idea why they were in pain are discovering
the true answer. However, the disease is certainly not a fad.
It's been around a long time, most likely ever since humans
started to walk around on two legs. As more and more people
begin to get appropriate treatment, and the "horror stories"
on the way to diagnosis become fewer, then public interest
will drop. I certainly hope so, because that will mean more
people are getting proper treatment for the disorder.