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Self-Help

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 diagnosis.

PAIN KILLERS

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 discomfort.

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 teeth.

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 for aspirin."

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.

BREAKING HABITS

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.

TELEPHONE USE

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.

DIET

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.

STRESS MANAGEMENT

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 dangerous—during exercise.

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 a prune."

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 of life.

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.