Treating TMJ Issues: you can learn to stop clenching

In every TMJ consultation that I do, I ask about clenching. I consider it to be an important factor that contributes to jaw tension, which I treat with manual therapy.

Clenching is a habit that people do unconsciously, and most of the people who come to me for TMJ relief consultations and sessions clench and/or grind their teeth, which is called bruxism.

How does this habit start?

Common sense tells us that clenching comes from stress. If you clench, do you do it when you’re feeling relaxed and happy? Probably not!

It seems likely to be a response that represses free speech, or perhaps it started that way and then became a habitual response to stress.

People of all ages past infancy do it, even as young as three, I’ve heard anecdotally.

We’ve probably all experienced an authority figure (parent, teacher, boss, partner, etc.) who doesn’t want to hear what we have to say and who has the power to shut us down — unless we are willing to experience the consequences…which could be getting fired, isolation, abuse, punishment, abandonment, or violence.

We still think the thoughts, we still feel the emotions, but now we also have to shut up and hold our feelings/thoughts in, unexpressed. We feel threatened and want to feel safe. This creates even more stress.

We may learn that clenching our teeth keeps us safe by keeping our mouth shut…but at a cost to our own well-being.

(If you want to get better at interpersonal communication, I recommend Marshall Rosenberg’s Nonviolent Communication approach.)

We have to use our jaw muscles to clench, and overuse of these muscles creates the chronic tension in these muscles that so many with jaw issues complain about.

The pressure of clenching can cause teeth to crack and break. The dental solution is to replace broken teeth with crowns or implants. These are expensive procedures requiring a lot of time in the dental chair with your mouth wide open, which is tough on already chronically tense jaw muscles.

So what’s the alternative?

I teach what I call Relaxed Resting Mouth Position, aka RRMP. It’s very simple:

  • Close your lips and breathe through your nose.
  • Keep your teeth slightly apart.
  • Curl your tongue up so that the tip touches your upper palate behind your front teeth.

If you clench, try it now and see what you notice. How does it feel? How might it feel if it became habitual?

What if this could become your new default relaxed resting mouth position?

You can teach yourself to do this when you’re not otherwise using your mouth.

Any time you want to change a habit, first you need to become more conscious of your behavior. Then you need a healthier alternative to replace the unwanted behavior.

Repetition replaces bad habits with good habits. Enough repetition rewires your neurology.

How can I learn RRMP?

The way I teach it in my office (and now online) is to give people a few coffee stir sticks, 5-7 of them.

They can put one between their teeth, either flat or on edge, so their teeth are slightly apart, and then close their lips with their tongue tip on the roof of the mouth. Not hard at all, just to get a feel for RRMP.

I then advise them to place the coffee stir sticks in the places they habituate: for instance, on the bathroom counter, bedside table, kitchen counter, desk, dashboard, coffee table, by the remote.

Online readers, you can go to a coffee shop (buy a drink, please), take a few, and do this yourself.

Be sure to tell the neat freaks in your household to leave them where they are!

Here’s where the change happens!

The most important part of changing this habit is that whenever you spot one of these coffee stir sticks — and they will get your attention because they look like clutter — ask yourself, ”What am I doing with my mouth?”

This makes you more conscious of your clenching habit.

If you find yourself clenching, immediately switch to Relaxed Resting Mouth Position. Tell yourself how much you look forward to this becoming your new default mouth position!

Do this again the next time you notice a coffee stir stick. And the next, and the next, and the next.

No one knows just how many repetitions it will take for RRMP to become your new habit. It may take 5 times a day for 3 weeks, or more, or less.

But with repetition, increasingly you will find that your mouth is already in RRMP when you see a coffee stir stick and notice what you’re doing with your mouth.

When you’re satisfied that RRMP has become your new default mouth position, you can put the coffee stir sticks away.

Why tongue on the roof of the mouth?

This appears to come from Eastern medicine and practices. I haven’t found anything in Western medicine about it.

In Taoist practices, the two most important meridians regulating the flow of energy in the body are located on our midlines.

The conception vessel runs along your midline on the front of your body, and the governing vessel runs along your midline on the back of your body, coming over the top of your head.

These meridians meet when you place your tongue on the roof of your mouth.

This practice connects these meridians, strengthening your energy, balancing yin and yang, resulting in a state of calm alertness.

Tongue tip on the roof of the mouth is used in meditation, qi gong, tai chi, kung fu, 4-7-8 breathing, yoga, and probably more.


Reasons people sought craniosacral biodynamics (spring 2022)

Here are some reasons people have come to me for Craniosacral Biodynamics sessions in the past few months. Most of the time, people had multiple issues going on. I’ve consolidated them into general categories.

You can see that the range is wide.

  • breathing issues
  • muscle tension and/or pain (neck, throat, shoulders, upper back, lower back, chest, jaw, face, hip, glute, calf)
  • muscle twitching
  • migraine, chronic headaches, chronic migraines
  • fatigue, chronic fatigue
  • restlessness
  • nerve energy, nerve damage
  • integration after trauma, recovery from multiple traumas, physical and emotional childhood trauma
  • re-regulation after long COVID, reset after multiple challenges during pandemic
  • sadness, grief
  • emotional upheaval, severe emotional shock after break-up, feeling unsettled from work
  • managing bipolar condition
  • empty feeling at solar plexus, chaotic feeling at solar plexus, engaging personal power instead of hiding
  • insomnia
  • better heart rate variability
  • stress, anxiety, wanting to feel secure and relaxed, anxiety about upcoming presentation
  • auto-immune issues
  • holding heaviness in part of body
  • adjusting to new nightguard
  • wonky atlas, cranium feels unbalanced
  • withdrawal from psychiatric drug while waiting for new one to kick in
  • reset after various health issues
  • addressing a layer of inertia
  • three past untreated concussions

You may be curious how one bodywork modality can work with so many different issues.

The simple reason is that Craniosacral Biodynamics augments your own system’s ability to heal, no matter the cause of dysfunction. Everything in your system has a pattern, and sometimes patterns become unbalanced or strained.

Practitioners trained in Craniosacral Biodynamics can help your system move these patterns toward resolution — if they are ready to change.

We all have multiple strain patterns, and there is always something ready to transform.

How does it work? During a session we both get very quiet and still. You sink into a state of deep relaxation. Some people fall asleep. Others stay awake enough to feel shifts occurring within.

I tune into your system, and with attention and support, it pauses, gathers potency (intelligent energy), and starts reorganizing the patterns that are ready to optimize.

This work continues after you leave my office.

Here’s my list for the winter of 2021-22.

Reasons people seek Craniosacral Biodynamics (winter 2021-22)

I was curious about the reasons people have sought me out for Craniosacral Biodynamics sessions, so I looked through my intakes for sessions given since December 1, 2021.

It’s now March 29, 2022, so this sample spans nearly four months.

The variety is broad. The range includes working with very specific conditions in the tissues, chronic issues, acute issues, energetic issues, mental and emotional issues, imbalances of all sorts, recovery from medical treatment, recovery from illness, stress, and issues caused by stress.

Adjusting to Invisalign braces

Anxiety

Bell’s Palsy

Chiari malformation

Chronic pain

Depression

Emotional overload

Energetic imbalance

Familial and ancestral imprints

Fatigue, exhaustion, depletion

Feeling compressed energetically

Headaches

Long-haul COVID

Mental stress

Muscle tension

Recharge from cancer treatment

Recovery from surgery

Regular self-care

Relaxation

Strain patterns, habitual tension

Tinnitus

Trauma, PTSD, C-PTSD, childhood abuse, neglect

What people are saying about Biodynamics…

~ LD, January 2022

I’d been having problems falling asleep and staying asleep. After yesterday’s session, I slept much better! ~ LL, November 2021


Facebook post and text from long-time client LM, October 2021

After trading biodynamic sessions with AA, October 2021

From long-time client LD, October 2021

Two texts from MG, October 2021

It’s such a gift 💝 thank you ~ JH, October 2021


“You did such a great job of helping me relieve the issue, I’m so grateful for the change you made in my life. You will always be at the top of my list for referrals for tmj relief and cranial sacral.” ~ BT, July 2021




I invite you to work with me!

MaryAnn Reynolds
Austin, Texas
maryannreynolds.as.me
512-507-4184 (text or voicemail)

Treating TMJ issues: asymmetries in the rest of the body affect the jaw joints

Jaw pain is rarely entirely in the jaw!

If you were building a tower, and one of the floors wasn’t level, it would affect the floors above it — unless you somehow compensated.

The Leaning Tower of Pisa is kind of like that, only it’s because it has settled unevenly on the ground beneath it. As they built it over the years, it would sink, stabilize, sink more…

The structure of the body is like that too — even when standing on level solid ground.

Because the jaw is near the top of the skeleton, imbalances below can affect the alignment and functionality of the temporomandibular joints (TMJs).

The primary cause of most jaw pain is asymmetrical hypertonicity. Thanks, TMJ Mastery teacher John Corry! That means that some of the muscles that affect the jaw are tighter than others.

I ask about structural anomalies in my TMJ consultations. I’m interested in whether one foot is flatter than the other, whether there’s a leg length discrepancy or a pelvic tilt or curvature of the spine.

I’ve been known to slide my hands under a client’s arches with them standing to see if their arches are symmetrical.

When a client is lying on my massage table, I can check for a leg length discrepancy.

I can also tune into their cranial rhythm and notice whether there’s asymmetry in the flexion and extension motions at the feet, which indicates asymmetry in the pelvis.

I also feel the space beneath the ears between the bones to see whether the skull is sitting symmetrically atop the spine.

When the skull and spine are out of alignment, it can contribute to multiple dysfunctions, with TMJ issues being one of them. (Ask me — I experienced intermittent right jaw clicking and my face drifting slightly to the left in meditation until a chiropractor realigned my AO joint, which also resolved issues that were all on my left side.)

1 shows the line between the mastoid processes. 2 shows the C1 vertebrae. From the sides, feel the convex bony area beneath your ears and come down up to 1/2″ to feel the ends of the C1 vertebrae. Notice if the space is symmetrical.


For more on this, including exercises you can do starting at 5:25, watch this video.

The last part of my evaluation for symmetry is to place the pads of my fingers (or have the client place their fingerpads) over the TMJs right in front of the ears and ask them to open and close repeatedly.

Often one side moves first.

Often one side feels closer to the ear than the other.

Sometimes one side sticks out more than the other.

One side may move with more ease than the other.

Try it on yourself. What do you notice?

None of this is super precise. I’m just getting a basic read on asymmetries in the client’s structure that may affect their TMJs.

Have you noticed that you have a dominant side? A side that feels stronger than the other? Most of your issues occurring on one side only?

Have you had a foot, ankle, leg, or hip injury? Can you still tell a difference between the injured side and the uninjured one? Can you balance as easily on your left foot as your right, or is one side weaker?

How’s your posture? How about your sleep posture?

Also, do you primarily chew on one side of your mouth?

Becoming more symmetrical can be a good long-term self-care project that can pay off with more ease of movement, less discomfort, better balance, injury prevention.

Symmetry is an ideal, like perfection. Most of us are doing the best we can. There’s always going to be some asymmetry in the body (our abdominal organs are asymmetrical), but we can definitely address our most dysfunctional areas.

The functional movement screen is a set of 7 movements you do with a trainer, who scores you and can prescribe workouts that strengthen your weaknesses.

FMS was developed to identify athletes who were prone to injury before they got injured. It can work for ordinary people too.

Here’s a link to view the screening movements. You can find a trainer near you online.

Practices of non-linear movement can help if done regularly over a long period. These movements work both sides of the body and increase neuroplasticity in the brain. They increase flexibility and balance and fluidity. And they are fun! Examples:

  • yoga, especially alignment-oriented types like Iyengar and Anusara
  • qi gong
  • tai chi
  • Gyrokinesis
  • martial arts
  • dance

The type of bodywork that directly addresses asymmetries is called structural bodywork. There are two main schools of training: Rolfing Structural Integration and Anatomy Trains Structural Integration. Neuromuscular therapy also assesses posture and gait pattern and can address imbalances.


Treating TMJ issues: restless legs and sleep bruxism

A new clue about bruxism.

A neurology practice noted that of its patients who had restless legs syndrome (RLS), 60% also had bruxism (grinding teeth during sleep). Eighty-three percent had RLS and migraines, and 52% had RLS, migraines, and bruxism.

Do you relate?

The lead neurologist for this study speculated there is a gene that links these conditions.

It gets more interesting. Both restless legs syndrome and bruxism are involuntary movements occurring during sleep. Is bruxism “restless jaw syndrome?”

I’m always happy to see new research about TMJ-related issues, especially because there are so many factors that play a role in jaw dysfunction and pain.

This may be something to show your doctor, or you may be interested in taking a supplement or adding foods to your diet that help your body produce more dopamine (more info below).

More about bruxism.

Bruxism includes clenching and grinding the teeth. Some distinguish these as “waking bruxism” and “sleep bruxism”.

They may have different causes.

Sleep bruxism, in contrast to daytime clenching, is harder to treat because it occurs when you’re unaware of your behavior and unable to change it.

Waking bruxism is a habit that can change with awareness and practice. I’ve helped many clenchers learn how to relax their mouth position.

Some things I’ve noted about bruxism in my manual therapy practice:

  • Many people don’t know they grind during sleep until a dentist tells them they have damaged teeth.
  • Sometimes the noise of grinding during sleep is loud enough to wake up family members or housemates, and that’s how people learn they have sleep bruxism.
  • People who grind at night often wake up with jaw, face, or neck pain, earaches, and/or headaches.
  • Bruxism often results in the need for expensive dental work: mouthguards or splints to prevent further damage, crowns to fortify cracked or broken teeth, and sometimes implants.
  • Over time, bruxism can seriously damage the temporomandibular joints to the point of requiring surgery. It’s so much better to address jaw issues before it gets that bad.

Dentists and jaw issues.

Many people expect dentists to be experts on jaw issues, yet their domain is treating the teeth and gums.

Learning about the TMJ has not been a required course in dental school until 2021-22.

General practice dentists can prevent further tooth damage with appliances like mouthguards and splints. They can repair existing tooth damage or replace teeth with implants.

Some dentists may try to adjust the positioning of the TMJs, and a few more recently-trained dentists also address airway issues (like sleep apnea, which may accompany sleep bruxism) in their work.

Dentists do not address stress or tension in the jaw muscles, which contribute so much to jaw pain. Any overworked muscle will tighten, be painful, and perhaps spasm. The jaw muscles are no different. Sometimes they get taut bands within the muscle tissue that limit range of motion.

Working with muscles is the domain of massage therapists.

I receive referrals for TMJ Relief consultations and sessions from some of the best dentists and hygienists in Austin, as well as former clients.

Solutions to try.

If you grind your teeth during sleep, it is possible to stop by using hypnotherapy or EFT (tapping).

I often recommend a recorded hypnotherapy session for bruxism that’s available on YouTube to listen to before sleep.

I don’t know if it works for everyone, but it’s soothing — I always fall asleep before it ends.

Less stress is always desirable.

I’ve also heard from someone who did this that starting a regular meditation practice can reduce or stop bruxism completely over time. There are many types of meditation. If you want to try this, choose a type of meditation that is relaxing and includes body awareness. Mindfulness-Based Stress Reduction is taught online.

As mentioned above, dopamine agonists are prescribed for low dopamine levels.

Dopamine is released when your brain is expecting a reward — when you anticipate a pleasurable activity such as eating a delicious meal, spending time with someone you love, or receiving a big check.

It’s sometimes called “the happy hormone” because it affects your enthusiasm, motivation, and focus.

If you suffer from bruxism, before going the pharmaceutical route with dopamine agonist drugs, you may want to consider nutrition — consuming foods or taking supplements that raise your dopamine levels.

In particular the amino acid tyrosine increases dopamine.

I found a few links that may be helpful:


Treating TMJ issues: portrait of a typical patient

Based on patients I’ve seen for jaw pain since 2013, I created this portrait of a typical patient. And of course, I’ve seen other patients who don’t fit these criteria.

She’s female. It’s been said that women are nine times more likely to suffer from jaw pain.

She first experienced jaw pain in her teen years.

She’s suffered for at least a decade, sometimes two decades or longer.

She clenches and/or grinds her teeth.

A dentist has prescribed an appliance to prevent damage to her teeth. The chances are 50/50 that she uses it as prescribed.

I wish I knew more about this.

Her pain level fluctuates, increasing with stress, and she usually hasn’t gone more than 6 months free from jaw pain since onset.

Her neck and shoulders are tight. Sometimes she has headaches, migraines, or ear pain.

She may also have pelvic alignment issues.

She has sought help from physical therapists, chiropractors, acupuncturists, and/or massage therapists.

She’d like to find lasting relief from her jaw and related issues.

Can you relate? How do you fit this profile, and how are you different?


Treating TMJ Issues: some medications cause jaw clenching

I’ve learned that some widely used medications can cause jaw clenching and grinding as side effects.

The best known are in a class called SSRIs, selective serotonin reuptake inhibitors, commonly prescribed for depression and/or anxiety.

I’m sure you’ve heard of Prozac (generic name fluoxetine). Here are some other SSRIs that can cause bruxism. There may be others:

  • Zoloft (sertraline)
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Paxil and Pexeva (paroxetine and paroxetine CR)
  • Viibryd (vilazodone)
  • Luvox (fluvoxamine and fluvoxamine CR)

Do not stop taking them without a doctor’s supervision, as you may have withdrawal symptoms, possibly dangerous.

This is a known problem. This link to an abstract of a 2017 journal article for psychiatrists has more. I don’t have access without paying a lot of money, but you can share this link with your psychiatrist if this applies to you, and there may be updates on this topic.

https://pubmed.ncbi.nlm.nih.gov/28492455/

In general, if you take any of these medications and you are clenching or grinding your teeth, talk to your doctor about alternatives. From the abstract: “Alternative classes of antidepressants reviewed include serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, and monoamine oxidase inhibitors. Findings indicate that dopamine agonists and buspirone are currently the most effective medications to treat the side effects of SSRI-induced bruxism, but results regarding the effectiveness of specific antidepressants that avoid bruxism altogether remain inconclusive.” (My italics.)

One more bit of info: I had a new TMJ Relief patient who was taking an SSRI. I treated her and gave her the info above.

Unlike others I’ve treated, she didn’t notice a difference in how her jaws felt and moved at the end of her first session.

However, she emailed me the next day to tell me that for the first time in a while, she woke up without severe jaw pain and headache.

So even if you are taking one of these SSRIs and have jaw pain, one of my TMJ Relief sessions can help.

Treating TMJ Issues: choose a practitioner who works on your lateral pterygoids

Recently I’ve had two clients come in for TMJ relief sessions who have previously seen multiple practitioners who worked inside their mouths. Between them, they have seen chiropractors, chiropractic neurologists, Rolfers, dentists trained by the Las Vegas Institute (LVI), and/or other massage therapists.

Each of these clients told me “No one has ever touched me there” after I worked on releasing tension in their lateral pterygoid muscles.

These small muscles are hard to access, being nearly surrounded by bones and tendons (cut away in the image below so you can see the upper and lower branches of the lateral pterygoid).

They are not easily accessible on everyone, being overlaid by the coronoid process of the mandible and the temporalis tendon, but they can definitely be influenced.

In my experience of giving over a thousand TMJ Relief sessions, many TMJ issues are due to an imbalance in muscle tension among the nine muscles that are directly involved in moving the mandible and numerous others that connect to the bones of the mouth and jaw.

The lateral pterygoids are often the muscles most responsible for releasing jaw tension and relieving clicking and popping noises on opening and/or closing.

Notice that the upper head of the lateral pterygoid is attached to the articular disc that separates the temporal bone and the mandible —the two bones of the temporomandibular joints.

When this disc does not move smoothly with the mandible when the jaw opens and closes in a hinge-and-glide motion, a clicking, popping, or crunching noise often occurs.

anatomy of the jaw muscles

It’s not that the other jaw muscles don’t contribute. They do. I’ve found tension in the temporalises, trigger points and taut bands in the masseters, and taut bands in the medial pterygoids, not to mention strain patterns from lower in the body.

In sessions, I work on the lateral pterygoids after working on the medial pterygoids. They can take time to access and can be sensitive, because most new TMJ Relief clients have never been touched there.

It helps to have small pinky fingers, and even then the area is so tight that sometimes I need to ask a client to shift their jaw to one side to get my finger near the muscle and joint.

Most of my TMJ clients are not aware when they come in that there are even jaw muscles there!

When I massage a lateral pterygoid, it can be a revelation. “That’s the place!” clients exclaim when I remove my finger.

Once I get there, I don’t need to stay long to make a difference. I invite my TMJ clients to move their jaws after I work on each muscle pair. Releasing tension here helps create a sense of spaciousness and ease around the joint.

To feel it for yourself, retract your mandible backward as far as you can. In other words, pull your chin in. You should feel some muscle activation in front of your ears and even in your ears. Kd

If jaw pain and tension (and clicking or popping) are your major complaint, and you’d like a sense of ease and spaciousness in your jaws, schedule a free 15-minute Discovery Call or a TMJ Relief session on my online scheduler. (I live and work in the Austin, Texas, area.)

Treating TMJ issues: types, causes, and exercises

I have discovered an excellent source of information about TMJ pain and dysfunction. It’s a great website called Be My Healer offered by a doctor of physical therapy, Sophie Xie.

She’s got a couple of posts about TMJ issues. I am impressed with the quality of her posts in terms of credible information, writing to a lay audience, and her images. You go, Dr. Sophie Xie!

First, this article helps distinguish between types and causes of TMJ dysfunction. In short:

  • Type 1 is arthrogenous TMJ, meaning the problem is related to the functioning of the bony temporomandibular joint. There are two causes: arthritis and disc displacement. She recommends the best treatments for each cause. (Exercises* can help .)
  • Type 2 is myogenous, meaning muscle-related. Causes include bruxism (clenching and/or grinding), muscle imbalance (such as forward head posture, chewing on the same side, playing the violin), and systemic influence causing muscle tension (such as chronic stress, fibromyalgia, PMS).

Dr. Sophie Xie writes, “TMJ massage therapy can help by releasing the tense mastication muscle and provide pain and stress relief. However, you will need to call around to find a massage therapist who is specialized in intraoral release to receive the most targeted treatment.”

Here’s me raising my hand, signaling “Pick me!” I can help with all of the muscle-related types of TMD. I offer intra-oral work, help relieve forward-head posture, and help you relax from stress.

Again, exercises* can also help.

  • Type 3 is idiopathic, referring to a single cause: trauma impacting the joint  from accidents, injuries, dental treatments, even violent laughing or yawning.

Dr. Sophie Xie writes, “Post-traumatic TMJ pain is highly preventable. Early intervention such as physical therapy and massage therapy are excellent in preventing scar formation and muscle stiffness​. Gentle and progressive jaw stretching and exercises* will build a strong muscle function to keep chronic and repetitive TMJ pain away.”

Again, I can help.

*In her post Say goodbye to TMJ pain with these 5 convenient jaw exercises, Dr. Sophie Xie describes and shows (with delightful illustrations) exercises to strengthen and balance your jaw muscles.

She writes, “Most people experience significant TMJ pain reduction with daily exercises after 5-6 weeks. You should experience even faster results if you are also combining TMJ massage therapy with a nightly mouth guard.”

Her website has a contact page if you want to work with her. (I believe she’s practicing in Washington state.)

If you are in Austin, Texas, I’m happy to help.