What should I do with this TMJ pain?

June 21, 2006 7:20 AM

Please give me your input on a TMJ quasi-emergency.

Long story short, I have TMJ problems. Both joints have clicked, crunched and popped since early high school, partially a result of bruxism (itself likely from stress as the past decade has been a rough one), partially as a result of a skeletal malformation (severaly short maxilla)/underbite I'd had since birth. In my last year of high school, I had surgery to lengthen the maxilla, thus giving me a proper overbite. In the three years since, my basic treatment to deal with the residual problems has been to wear my night-guard, which I'm iffy on - I'll do it for stretches, and then forget for months. (Yeah, I'm a fuck-up/irresponsible.) About a week ago, my left TMJ has gotten much more intense suddenly: I can't move my jaw completely to the left without searing pain, and when I bite, my left ear/TMJ aches. When I move my jaw up and down in "that way" which aggravates the joints (I'm guessing most TMJ people will know of what I speak), there is pain almost exclusively on the left side.

I'm totally ashamed to go to the doctor and have it apparent my retainer-wearing has been iffy, and I've taken in the past few days to not only wearing the retainer at night, but ocassionally during the day. While the pain might be slightly better now, it's only slightly. I know this is probably a pathetic question, but, do I keep with the retainer and see if it improves? For how long? Do I contact the doctor (who I won't see until, in a perfect world, a week from now at the earliest)? I probably just need someone to tell me something obvious, but this is an ultra-tough time in my life right now, and I barely have time to deal with judging these sort of things.

posted by Ash3000 to health & fitness (12 comments total)

Have you ever been on muscle relaxers to help with the bruxism? Any other treatments [even if they didn't work] in the past?
posted by starbaby at 7:22 AM on June 21, 2006

I just realized I gave no timeframe on this - I'm now about to start my final year of college, which means that the surgery was a little over three years ago.

Nope, no muscle relaxers - first, a TERRIBLE dentist who kept on pushing braces despite the skeletal malocclusion, then a good orthagnathic doctor who oversaw the surgery and the night-guard/retainer.
posted by Ash3000 at 7:28 AM on June 21, 2006

Well, I'd say that since you've had the surgery, and you have a retainer to help keep it from screwing your mouth up [grinding down your teeth, etc.], you can focus on the pain, now. I don't know if this will work for you, but my doctor put me on muscle relaxers to take every night. I don't grind my teeth, and the pain is almost completely gone. When it does hurt, I just need a couple tylenol arthritis type pills and I'm good. And I don't have a mouthguard or any of that stuff.

Are you by any chance in summer courses? Could you maybe visit the campus clinic?
posted by starbaby at 7:54 AM on June 21, 2006

This is nothing to be ashamed of -- there are many, many people out there who have taken far worse care of their teeth than you, so to your dentist, this is likely nothing.

FWIW, here's what I'd do: Ice the aching muscle as much as I could stand during the day. Take ibuprofen. See the doc as scheduled and say, "This retainer is not working for me" and describe why. Retainers suck. Nobody likes wearing them and dentists probably have ways to make it more palatable (no pun intended ;-)
posted by selfmedicating at 8:23 AM on June 21, 2006

Sounds like the pain is acute enough that stretches might not be feasible now, but consider this for the future--You should stretch your jaw muscles frequently. If you spend all night grinding them shut you can give yourself some relief by opening your jaw as wide as you can bear and hold it for 8-10 seconds. Treat it like an exercise and do several reps, a couple times a day. Muscles go two directions, and you need to remind your jaw that open is one of them.

Searing pain in your jaw needs to be looked at by someone with expertise, but you should pop some ibuprofen/aspirin/tylenol right away.
posted by mcstayinskool at 8:37 AM on June 21, 2006

Do not let guilt or shame keep you from going and seeing your doctor/dentist. I can guarantee they would rather you swallow your pride and go now rather than wait until your problems develop into something more serious.

And you made my own TMJ seem totally insignificant by comparison (I get a pop every now and again, I got hit in the face with a croquet mallet as a kid).
posted by fenriq at 8:40 AM on June 21, 2006

I had a similar TMJ attack -- probably because of major stress, which sounds a lot like your problem here -- during my junior year of college. After a week of trying to relax, taking painkillers, and an essentially liquid diet, I went to the orthodontist. He examined my jaw, modified my retainer, and said, "Wear this all the time for one week, then just at night." Literally within hours, the attack cleared up.

Moral of the story: Go to the doctor, embarrassed or not, because s/he can almost certainly help.
sympathetic and find a way to help you reduce stress, which will really, really help, since most TMJ attacks like this are caused by stress.
posted by dseaton at 8:52 AM on June 21, 2006

Yes please go to the dentist, who can refer you to a maxiofacial specialist if necessary. Don't be embarassed. You can always say you lost it for a while. Or that it annoyed you so you didn't wear it. (My old bite guard was so thick and obtrusive that I actually used to take it out in my sleep! My new one fits on the bottom, not the top, and is much more comfortable.)
posted by radioamy at 9:36 AM on June 21, 2006

I've had similar problems for a long time, including two events where my jaw locked in a slighty open position. Moving it at all hurt a lot. I found heat pads to work better than ice.

You should stretch your jaw muscles frequently. If you spend all night grinding them shut you can give yourself some relief by opening your jaw as wide as you can bear and hold it for 8-10 seconds. Treat it like an exercise and do several reps, a couple times a day. Muscles go two directions, and you need to remind your jaw that open is one of them.

Oh my god this would be very bad advice for me. Your jaw is a very complex joint that is set up quite differently from most joints and muscles in your body. I find that stressing it in this way causes more pain and prevents it from healing itself. To me this seems like recommending to someone who pulled a back muscle to lift heavy boxes every day rather than get in bed and let it heal.

Having my retainer adjusted DID help a lot--go do it.
posted by underwater at 10:46 AM on June 21, 2006

Oops. I just looked back and realized that I completely botched the editing of my comment. It should say:

Also talk to your professors about what's going on. They'll almost certainly be sympathetic and find a way to help you reduce stress, which will really, really help, since most TMJ attacks like this are caused by stress.

Sorry 'bout that!
posted by dseaton at 10:59 AM on June 21, 2006

Please don't let your guilt over your self-care regimen keep you from going to a doctor when you're in pain. I second the recommendations for stretching and pain relief (ice as well as drugs), but go ahead and call for that appointment.

also a TMJ sufferer, surgeries in 92-93
posted by olecranon at 1:26 PM on June 21, 2006

I had this happen about 15 years ago to me, along with the not being able to open my mouth more than about an inch between the teeth. I ended up seeing a maxiofacial specialist who took some x-rays. By the time I actually saw him my jaw had "unlocked" again, but it would come & go.

Turns out there's a piece of cartilage that sits between your jaw & skull on each side which is held in place by a ligament, and on one side for me, that piece of cartilage tends to slip out of place -- bruxism, too much chewing gum, too much stress, all of those things no doubt contributed to the ligament stretching out & not retract the cartilage completely.

I haven't had a recurrance in a long time, but I'm more aware of when my jaw starts getting sore from stress or whatever these days & I do what I can to relieve whatever is causing my jaw to ache...

Call for an appointment -- they don't want you feeling guilty, they want to help you feel better.
posted by susanbeeswax at 9:47 PM on June 21, 2006