111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
I don't want headaches to drive me to
the couch. I'd like to live a normal life—work, play,
eat, and sleep. I don't want to think about pain every minute.
—a 51-year-old lawyer
My life became a cycle of trying to avoid
pain, and failing at that too often, I spent my time getting
rid of the pain. It was a hellish life.
—a 30-year-old nurse
Some people with mild to moderate TMJ symptoms
are able to help themselves prevent or manage pain or discomfort.
Unfortunately, self-help measures are totally successful in
only a minority of cases. People who seek various "home
remedies" or self-administered pain relief techniques
usually have already sought help from health care professionals.
Often they have been unable to obtain help; many were given
descriptive diagnoses, rather than diagnoses linked to the
cause of the problem. When the cause of pain can't be detected,
the patient is often left alone to cope.
Some people who have attempted self-help have
been given a diagnosis of TMJ, but for any number of reasons—
including financial concerns, other health problems that take
priority, or geographical location—do not seek treatment
to get rid of the cause of their pain. Many people with TMJ
experience symptoms erratically. They go along year after
year, having temporary bouts with pain, and manage to cope.
Since TMJ is not life-threatening, the decision to seek treatment
is private and personal. Those who suffer minor and infrequent
symptoms often feel, reasonably, that their problem is not
serious enough to warrant treatment at that time. But at least
they know that a permanent solution to their problems is available
if symptoms worsen.
People who do not choose treatment often wonder
what they can do for themselves to attempt to prevent or relieve
TMJ symptoms. The suggestions given here may work in particular
cases. If they don't prevent or relieve symptoms, then you
are one of the majority. This is important to remember. Patients
often feel that if self-help measures don't work, TMJ isn't
really their problem; they even may believe that the pain
is of psychological origin. This only adds to their stress.
Give these suggestions a try if you wish, but do not fall
into the trap of believing there is no reason for your pain.
The secret of success in treating pain syndromes is proper
It's certainly logical for people to try over-the-counter
pain relievers for minor problems. It's important to remember
that aspirin, acetaminophen, and ibuprofen may mask minor
symptoms, but will not cure the real problem. These pain relievers
just raise the person's threshold for being bothered by the
Those who do find relief with over-the-counter
pain killers usually find they're- most effective if taken
when the pain first starts. However, for most people with
other than very mild TMJ symptoms, this self-help measure
is of little use. Most patients report that they take them
more out of hope that they will get some relief rather than
from the experience of finding help through them. One patient
said, "The chances of any pain relievers working are
about one in ten, but I try them despite the odds."
It's a common—but not advisable—practice
to keep leftover prescription pain relievers in the home medicine
cabinet. Patients have commented that these rarely are of
any use. In general, neither over-the-counter nor prescription
drugs are particularly helpful for TMJ symptoms.
KEEPING THE TEETH APART
TMJ-related muscles spasms are triggered when
the teeth touch each other or are ground together in an abnormal
gearing relationship. Consequently, one of the most important
home prevention methods is to avoid letting your teeth touch
each other. This is much easier said than done, however. The
teeth close every time you swallow, and the swallowing reflex
occurs about 2,000 times a day. Teeth also naturally touch
when you are under stress, or when you pick up something heavy.
Although it is possible to consciously try
to keep the teeth apart during the day just by using willpower,
many TMJ sufferers find an "artificial" method helpful.
If you want to try this method, take a small cotton ball,
or cotton roll like those used in dentistry, or a tightly
rolled piece of tissue, and hold it between your teeth on
one side. You can use your tongue and cheek to keep the cotton
ball or tissue from falling off the biting surfaces of the
It might seem that the purpose of the ball
in this location is to physically keep the teeth from touching.
Actually, its purpose is to let you know when your teeth are
beginning to close down on each other. It feels unusual to
try to close the teeth when there is an obstruction. This
feeling triggers awareness, and when this technique is successful,
the user is often able to keep the teeth apart a significant
portion of the day.
This technique may sound impractical. It takes
some practice and perseverance, but it is actually one of
the most effective self-help techniques available. People
who use it trade off a dry feeling in their mouths for relief
or prevention. They also learn to work and concentrate with
a foreign object in their mouths. Sometimes people report
that the tissue dissolves quickly. This happens when the tissue
isn't tightly rolled.
Some years ago a patient who didn't want to
pursue treatment at the time of diagnosis tried this technique.
She found it impractical for herself, because she couldn't
work with the public in her sales job with a mouth full of
cotton. However, she suggested it to her husband, a computer
programmer, who experienced a headache every afternoon. He
attributed his headaches to the stress of deadlines and the
intense concentration his work required. He found the cotton-roll
technique helpful because he could avoid clenching his teeth
as the pressure of the day built.
Because he found the technique so successful,
he told others in the office about it. Before long, the company
nurse noticed a steady stream of workers coming in after lunch
asking for cotton rolls. She became curious about the reasons
for the run on the cotton-roll supply, and her investigation
eventually led her to call my office. Her response to my explanation
was, "It must work, because I'm having fewer requests
This self-help technique became a company joke,
and those who used it were the objects of much teasing. Other
people, not familiar with the strain of regular headaches,
couldn't understand how anyone could tolerate such an inconvenience.
Only those who understand this kind of pain know that in this
case anyway, the prevention is much more convenient than tolerating
the discomfort of a headache.
Warning: This technique
must not be used during sleeping hours, because there is a
great danger that the cotton ball, tissue, or other home device
will be either swallowed accidentally, or drawn into the lungs
or air passages connecting the lungs. These are extremely
dangerous situations. Do not use this technique any time you
have a condition that suppresses your cough or gag reflex,
or when exercising strenuously. Also do not use it when there
is even a slight possibility of dozing or losing alertness,
as when drinking alcohol, using any drug, watching television,
or lying down to relax. Use this technique only when you are
going about routine activities fully awake, alert, and aware.
The cotton-ball or tissue technique may be
successful during the day, but because of the danger involved,
keeping the teeth from touching is a much more difficult problem
during the night. The best technique, and perhaps the only
one with some success at night, is simply to sleep on your
back with a small pillow beneath your neck. Your neck arches
and extends your head backward. Before you try it, ask your
physician if there is any reason this sleeping position is
inappropriate for you. Unfortunately, most people find this
position nearly impossible, because they naturally and unconsciously
move to their sides and stomachs during the night.
It may seem surprising that sleeping position
is related to TMJ problems, but picture the body in various
sleeping postures. Except when you sleep on your back, your
jaw must rest on something—your arm, the pillow, or
the mattress. This can push the teeth together, and may also
force the jaw into an abnormal and strained position.
Using an artificial method during the day—the
tissue or cotton ball—and sleeping on your back at night
may help prevent the onset of symptoms or relieve them should
they occur. This applies to all the TMJ symptoms, not just
headaches. Virtually all TMJ symptoms are the result of the
teeth touching in an abnormal gearing scheme. The resulting
muscle spasms produce the complement of symptoms discussed
in this book, including extremity numbness, middle-ear symptoms,
and shoulder pain.
Some common habits can contribute to TMJ problems.
Most people aren't aware that these habits can exacerbate
symptoms or trigger them in the first place.
Anyone with a susceptibility to TMJ problems
should avoid chewing gum. It can create problems in two ways.
First, it tends to overwork the very muscles causing the pain.
In the process of chewing gum, the teeth generally do not
touch each other directly. This tends to trick the neuromuscular
system into relaxing, making the system vulnerable to the
spasm-triggering mechanism or the still present gearing problem
when the gum is no longer in the mouth.
Many patients have complained about experiencing
almost constant headaches that began after they stopped smoking
cigarettes. They started to chew gum to help themselves cope
with the withdrawal period. Most patients first attributed
these headaches to nicotine withdrawal, then realized that
this was not the case, since the headaches didn't go away
in a short period of time. Rather, the gum chewing itself
became a habit, and the constant movement of the jaw plus
the "tricking" of the neuromuscular system brought
on TMJ symptoms. Breaking the gum-chewing habit was enough
to relieve symptoms in many of these patients.
Other small, often unconscious habits may contribute
to TMJ problems. Chewing on pens or pencils is one example.
One patient said this habit was as hard to break as giving
up cigarettes, but once she did, the frequency and severity
of her symptoms declined. Chewing and clamping down on pipes
and cigars can have the same unbalancing effect on the jaw.
When the jaw is out of balance, the temporomandibular joint
is stressed, possibly triggering symptoms.
If you have any of the symptoms of TMJ—
even mild ones—try to be more conscious of how many
times you rest your head, chin, or jaw on the heel of your
hands. The jaw sits on your hands in a position that can add
to the pressure on your teeth and then trigger the pain mechanism.
Curbing this habit can help, although patients report that
it's difficult to do.
The telephone, a tool we consider indispensable
in modern life, can also greatly contribute to TMJ problems:
This occurs when the receiver is held between the shoulder
and the ear in order to free both hands. In this position,
the telephone rests on, and stresses, the lower jaw. This
unnatural pressure may trigger TMJ problems. The neck muscles
are also strained, and this may exacerbate the muscle spasms.
Unfortunately, there are devices available that aid in and
promote this cradling position and contribute to TMJ problems
in susceptible people. Probably no major problems will result
from cradling a telephone receiver with or without a device,
for a minute or two once in a while. However, some people
use these devices to extremes. Distorting the position of,
and putting pressure on, the lower jaw, head, and neck significantly
contribute to TMJ problems.
Fortunately for people who must use the telephone
with both hands free, the cradling problem is easily solved
without adding strain on the head, neck, and jaw. Speaker
telephones, which don't even need to be held, are now widely
available. Another helpful device is a headset similar to
those used by telephone operators and pilots. These lightweight
headsets do not put any strain on the muscles in the head
and neck, nor do they stress the jaw.
Eating foods with certain textures may trigger
or worsen TMJ symptoms. Hard, crunchy foods like Corn Nuts
or hard candy or chewy caramels can be extremely stressful
to the jaw. Chewing on ice can have the same effect. A few
foods have mixed consistencies and the jaw is "tricked"
into thinking the food is soft. Because the jaw is confused,
it doesn't protect itself against the hard pieces of food
that are mixed with the soft; the jaw is "surprised"
when it encounters them, and muscle spasms may be triggered.
An example of this is a walnut or a shell inside a soft cookie.
A small piece of bone in a hamburger is another example, and
these situations can be significant triggers for TMJ symptoms.
The pressures and unbalancing effects on the
jaw necessary to break apart hard foods can stress the temporomandibular
joint, and the neuromuscular system may respond to the stress
by triggering spasms. Additionally, the teeth and fillings
may be damaged by the force of the confused jaw mechanism.
Eliminating hard foods is often advisable for
TMJ sufferers because it gives the jaw mechanism a chance
to rest. There is a literal rule of thumb advisable for TMJ
patients: They should open their mouths no wider than necessary
to accommodate a thumb.
Many people try to reduce their symptoms through
stress reduction techniques. Physical exercise is one of the
most widely accepted ways to handle stress, yet many types
of exercise will increase the tendency to clamp down on the
teeth or tighten the jaw. Bicycle riding, jogging, weight
lifting, using exercise equipment, aerobic dancing, and skiing
can often trigger or worsen symptoms. This is particularly
frustrating for patients who take up these activities with
high hopes of reducing their symptoms. One young woman recently
reported that she tried one exercise after another in an attempt
to relieve stress. At one point she was engaging in some kind
of exercise every day—riding many miles on her bicycle,
taking workout classes, jogging on an indoor track—and
her symptoms kept getting worse. "I'm thin, trim, and
strong," she said, "but I live with constant pain."
If TMJ sufferers take special care to consciously
keep the teeth apart, exercise can be enjoyable and possibly
beneficial to TMJ as well. However, the artificial method
of keeping the teeth apart with tissue or cotton is inappropriate—even
Some patients have said that they are able
to walk briskly and consciously keep their upper and lower
teeth from touching. Brisk walking is an excellent conditioning
exercise, and many people find it relaxing as well. Some people
can jog and still keep their teeth apart, but most runners
say this is difficult.
When people decide to get treatment for TMJ,
one of the rewards is the ability to take up activities that
once triggered or worsened their symptoms. Once treatment
eliminates the cause of the problem, the person can use strenuous
exercise for any desired reason—pleasure, stress management,
weight reduction—without causing painful symptoms.
Some people who suffer from frequent mild to
moderate headaches and neck and shoulder stiffness may find
that relaxation techniques are sometimes helpful in preventing
the onset of symptoms. Some people are more vulnerable to
the effects of stress than others, and keeping stress levels
low and manageable may help.
Most TMJ patients report that severity and
frequency of symptoms rise and fall with changes in stress.
Other patients report that symptoms apparently have nothing
to do with stress. This area of health care still needs much
exploration, and it's difficult to measure how stress affects
conditions like TMJ.
Sometimes attempts to prevent or relieve symptoms
can become a vicious self-defeating cycle, and the person
in pain ends up full of self-blame and a sense of failure.
The effort to relieve stress and practice good self-care techniques
can become an enormous stress in itself.
Vickie Green was a patient whose life became
a cycle of self-care and stress management that dominated
all of her daily life. She had a rigid routine that she had
developed over several years of trying to avoid pain.
Ms. Green often woke up with a mild headache,
but even if she didn't, she took a long hot shower using a
pulsating shower head to simulate massage. "If I had
a headache, the long shower helped keep it from getting worse,"
she said. "If I didn't have one, I hoped the shower would
prevent it. I stayed in the shower long enough to feel like
Ms. Green also played a relaxation tape before
she left for work in the morning, was scrupulous about her
diet, drank only herbal teas, and had long since given up
cigarettes and any drink containing caffeine. "I watched
every single thing I put in my mouth and ate a minimum of
six times a day. I ended up avoiding certain restaurants because
I didn't want any added sugar or food with preservatives,"
she said. "I had been told that low blood sugar could
cause my headaches, or preservatives, or too much sugar, or
even other people's cigarette smoke, so it was difficult to
socialize with people and go places that are a normal part
Ms. Green played another progressive relaxation
tape in the women's lounge at her office during her lunch
hour. Two or three times a week, she had a massage after work;
other nights she took yoga classes. When she came home, she
stood in a hot shower again and played still another relaxation
tape when she went to bed.
Much of what Ms. Green did in her self-care
program constitutes a healthful lifestyle. No health care
practitioner would discourage any of these things in and of
themselves. "If this regimen had worked all the time,
I may have just kept it up for the rest of my life. But after
three or four years of this, I still have pain." The
cycle of stress management and pain prevention had left this
patient unable to have a meaningful social life. Those few
people still left in her life saw this regimen as neurotic,
and she herself was sick of the self-absorption.
Ms. Green's case may sound unusual, but it
isn't. I've heard this kind of story over and over again.
Another patient, Joe Sterling, had a similar self-care regimen,
which included regular visits with a hypnotist and meditation
classes. If he skipped one of his classes or hypnosis sessions,
he ended up filled with self-defeat. He ended up blaming his
pain on his own inability to deal with what most people would
consider normal stresses of life.
These examples aren't meant to discourage anyone
from pursuing a healthful lifestyle. In fact, patients should
engage in any activity that enhances their lives and contributes
to their overall well-being. But in Ms. Green's case, she
practiced the activities so obsessively and rigidly that they
prevented her from living a "real" life. Mr. Sterling
ended up deeply depressed because he thought he was too weak
to handle life.
Because of cases like those described, bear
in mind that self-help measures do not always work for TMJ
sufferers. And even when they do, they should not necessarily
be viewed as a substitute for treatment, especially when the
measures themselves lead to self-absorption, depression, and
excessively rigid living.
HEAT AND COLD
Once symptoms begin, there is one home remedy
that can sometimes break the muscle-spasm cycle and relieve
symptoms. Although this method is not used in my office treatment
protocol, it is sometimes used by pain clinics and physical
therapists. It is a practical method to use at home.
This method alternates the use of heat and
cold therapy. The goal of the combination of heat and cold
therapy is to irritate the muscle thermally in an attempt
to break the spasm cycles. Anyone trying this method should
use moist heat and ice alternately—hot packs for twenty
minutes, cold packs for twenty minutes, nothing for twenty
minutes. This hourly sequence can be repeated as needed.
Although it is less effective and penetrating,
sometimes dry heat will accomplish what moist heat can. If
wrapping hot moist towels around the head and neck is impractical,
then a heating pad can be used. Sometimes using heat or cold
alone will relieve muscle-spasm pain.
People have to decide for themselves at what
point TMJ symptoms are manageable and at what point they are
seriously interfering with their lives. This is an individual
decision, but when life becomes an endless cycle of preventing
symptoms or coping with them, seeking help is probably advisable.