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.

These clients both told me, “No one has ever touched me there,” after I worked on releasing tension in their lateral pterygoid muscles.

That surprised me.

These small muscles are hard to access, being nearly surrounded by bones (cut away in the image below so you can see the two-headed lateral pterygoid muscle) and not directly accessible on everyone, being overlaid by the temporalis tendon and the medial pterygoid.

You can get close enough to influence it, however.

In my opinion, the lateral pterygoids are often the keys for releasing jaw tension and also for relieving clicking and popping noises. Notice that the upper head is attached to the articular disc that separates the temporal bone and the mandible —the two bones of the TMJs (acronym for temporomandibular joints).

When this disc does not move smoothly with the mandible when the jaw opens and closes, clicking, popping, and sometimes a crunching noise can occur.

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 in the masseters, and taut bands in the medial pterygoids.

I usually save the lateral pterygoids for last when working on someone’s internal jaw muscles, because they are harder to access and can also be sensitive.

It helps to have tiny pinky fingers, and even then sometimes I need to ask a client to shift their jaw to one side to get near the muscle and joint.

Most of my TMJ clients are not aware when they come in that there are even jaw muscles here! The masseters usually get all the glory, and I’m touching a place that never gets touched. No wonder this area can be sensitive.

When I get near 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. Releasing tension in this muscle creates a sense of spaciousness around the joint.

If jaw pain and tension are your major complaint, and you’d like a sense of spaciousness in your jaws (if you can even imagine how great that would feel), find a practitioner that works on the lateral pterygoids, or come see me.

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.


Treating TMJ issues: de-stress quickly with these breathing techniques

Learning how to de-stress yourself is huge. Everyone experiences stress. It’s just part of life.

Stress becomes an issue when there’s too much of it, and your system has trouble rebounding resiliently to a calm, alert state.

How is this relevant to TMJ issues? So much TMJ misery is related to chronic and acute stress. It’s one of the major contributors to TMJ issues. People clench and grind due to stress, and stress is always accompanied by muscle tension, which causes a lot of jaw issues. 

Staying stressed for too long is bad for your well-being. It affects your digestion (including absorption of nutrients and detoxification) and creates unnecessary wear and tear on your vital organs.

I’m talking about bad stress as opposed to good stress, such as the anxiety before a performance that makes you a better performer, or the adrenaline you feel when a bad driver nearly hits you that helps you react quickly and successfully avoid being hit.

In my opinion, bad stress includes most news about politics (just donate money and volunteer for candidates you like) and traumatic events (there’s always something awful happening in the world).

Also, the desire to control others’ behavior can bring about bad stress. Better to focus on accepting them as they are and work on a healthy path for yourself.

Maybe they’ll witness you and want to change themselves.

You can still care and have a constructive strategy to manage stressors.

You can do these things from a calm, alert state. Imagine that.

The beauty of using a little breathwork to get yourself out of an unhelpful state of stress (any stressor that does not require immediate action) is that breathwork bypasses your mind.

Has “you need to calm down” ever helped anyone to actually calm down, whether it’s yourself or someone else telling you this?

Breathwork is also quick. You can simply do a little breathwork when stressed, and your system starts shifting into parasympathetic mode.

A note to the chronically stressed: here’s how to tell when you’re in a parasympathetic state. Your whole body starts to feel a softness and relaxation because you have let your guard down. You notice your that breathing has changed, to becoming slower, deeper, with longer pauses. 

If this is hard, because maybe you’ve been carrying the guarding that often occurs after a trauma, try this: Imagine yourself in a completely safe environment where you don’t have to be guarded against anything. Maybe you are surrounded by softness, or floating in body-temperature water. You may have any objects (real or imaginary) that bring you comfort. 

Let go of your thoughts and just be. 

The more you practice breathwork and conscious relaxation, even when not stressed, the more it gets wired into your neurology.

The physiological sigh

The physiological sigh is breathwork technique that’s getting a lot of attention now. It’s been recognized for 80 years as a behavior people do automatically when claustrophobic and in other stressful situations.

Now you can put it to work for yourself when you need to de-stress yourself.

I learned about it from Dr. Andrew Huberman, a Stanford University professor who runs a neurobiology lab and has a podcast.

In brief, it’s two inhalations through the nose, and one longer exhalation through the mouth. (I think of it as the “sniff sniff ahhhhh” breath.)

Here’s a video demonstrating technique.

Dr. Huberman says sometimes people fall asleep if they do it 15 times in a row, but just three of these physiological sighs are enough to start slowing your heartbeat down in 20-30 seconds.

I nearly always yawn when I start doing physiological sighs.

4-7-8 breathing

Another fairly quick breathwork technique for reducing stress is the 4-7-8 breathing (the Relaxing Breath). Dr. Andrew Weil, who has been practicing and writing about holistic health and integrative medicine for 30 years, came up with it.

Dr. Weil recommends doing four of these breath cycles at least twice a day for two months to get the benefits. This wires it into your neurology.

He recommends slowing the cycle down, with the limiting factor being how long you can comfortably hold your breath.

It can also help with cravings and falling asleep.

In essense, you are retraining your nervous system to be more relaxed.

You may become less stressed from using either or both of these techniques and still benefit from receiving a TMJ Relief session to retrain your jaw muscles into relaxation. The breathwork will help your body retrain itself more quickly and prevent relapses.

If you’re ready to have that conversation with me, please connect. I’d love to hear from you.


Treating TMJ issues: the effects of stress

For decades, the news has cautioned us about the ill effects of stress on our health, longevity, and happiness. But what is stress and how do you know when you are experiencing it? What does it have to do with jaw pain and dysfunction? Most of all, what can you do about it?

Stress is your body’s response to threats, real or imagined. You become alert, focused, and energized, ready for action. It is a physiological response designed to protect you in dangerous situations, to get you away from the danger or to confront it. Something in us is always scanning for danger and ready to respond.

It also gives you the energy to meet life’s challenges, for example, taking a test, interviewing for a job, making an important presentation, having a difficult conversation, scoring a point, winning a game, driving safely. Doing anything difficult where you care about the outcome requires some extra energy and focus.

So stress isn’t inherently bad — but too much stress can damage your health and quality of life. In the fight-or-flight response (sympathetic dominance of the autonomic nervous system), your body releases stress hormones. Your heart rate goes up, your blood pressure rises, your muscles tense, your breathing quickens, and your senses become sharper, all so you can respond to the situation.

We’re designed to respond this way in extraordinary situations, and the rest of the time (which ideally would be most of the time), to live peacefully, nourishing ourselves, cooperating with the group, resting, relaxing, having fun, and enjoying our lives (parasympathetic dominance, or rest-and-digest mode).

Physiologically, the heart rate slows, breathing slows, blood pressure goes down, muscles relax, and attention becomes broader. In this state, your system has more resources for digesting and assimilating your food and repairing damage.

The switch from rest-and-digest to fight-or-flight occurs quickly and automatically, bypassing your conscious mind. You become aware afterwards that your state has changed.

This is a good exercise: How do you know you are experiencing stress? What tips you off? Do you notice a sudden sharp inhalation and muscle tension? (That’s what I notice.) Do you feel your heart pounding? Do you notice that your mind suddenly becomes focused and alert?

Another good exercise: How do you know you’re okay? Is there a kinesthetic signature that lets you know you are relaxed? I feel a peaceful, happy feeling in my chest. What do you notice?

What does stress have to do with jaw pain and dysfunction? Almost every bit of information available about the causes of TMD connects it to stress. Muscle tension is a universal response to stress. The jaw muscles tighten.

Most everyone experiences stress, but not everyone experiences jaw symptoms. No one seems to know why this is. Here are some of my observations and hypotheses.

  • I’ve observed that most people carry way more muscle tension from stress in their upper bodies, in the upper back, shoulders, neck, jaw, and/or face. For some, all of those places get tense. For others, only one or two get tense.
  • The jaw is the only part involved in chewing and talking. Chewing doesn’t have any associations with threats or danger that I can think of. If the food tastes good and is safe and your teeth and jaws are healthy, chewing is a pleasure.
  • Talking can be dangerous. Some clients have directly related the onset of their jaw symptoms with feeling unsafe about freely expressing themselves about a difficult situation they had with another human being. This could have happened long, long ago, with the unpleasant memory being repressed.
  • Some people have had so much stress and/or trauma in their lives, it’s become chronic. They don’t know how to deeply relax.

Maybe some people are predisposed to have jaw issues. It could be from the strains of their birth and an attempt to reshape the head. It could be a learned strain pattern that runs in their family. It could be from a lack of nutrients that help form healthy jaws (read more about the work of Weston A. Price, DDS, on this topic). I’m sure there are many other possibilities.

I do know that for everyone, help is available. You can release (or get help releasing) the tension in your jaw muscles. You can examine your past, with psychotherapeutic help or by journaling or talking to a trusted friend. You can learn to deeply relax, and it’s a pleasure. And that’s a good topic for tomorrow.