teaching Archives - MaryAnn Reynolds, MS, LMT, BCTMB

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.

What to do if you have jaw issues? I offer a 30-minute in-person TMJ consultation to gather information and evaluate your issues. I teach clenchers an alternative to clenching as well as the above information to stop grinding.

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.

I offer a combination TMJ Consultation plus TMJ Relief session in person in Austin, Texas. The consultation serves as an intake, so I have a better idea of what your issues are and how we’ll measure progress. Your consultation is free when combined with your first TMJ Relief session. This is a two-hour session.

To be fair, when you’ve had TMJ issues for a long time, or they are acute, you may need multiple sessions to retrain your system to retain the ease and alignment, along with doing your homework to stop clenching or grinding your teeth.

I offer a package of four TMJ Relief sessions for 10 percent off single sessions, best done a week or two apart. These sessions are 90 minutes and integrate various bodywork modalities — including work in your mouth — so that you feel great when you get off the table. They are best done over 4 to 6 weeks.

If you’re really adventurous, you can schedule a 75-minute Self-Treatment for TMJ Issues session on Zoom where we’ll do an intake and I will teach you how to work on releasing the tension patterns that cause problems, including working in your own mouth. You’ll need clean hands and short nails. It’s really not that hard! Learn more about it here.

My Practice, self-care

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.

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.

self-care

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 TMJ disorders is not required in dental school. It’s an elective.

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.

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:

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.

My Practice

Treating TMJ issues: the role of the sphenoid bone

The sphenoid bone is one of the most fascinating bones in the body. If you were looking at someone and could see their bones, the sphenoid would be behind their eyes and in front of their ears, with the outermost parts (the greater wings) accessible at the temples, and the lowermost parts (the pterygoid processes) being what your internal jaw muscles attach to behind your upper back teeth.

The word sphenoid comes from the Greek for wedge-shaped. Its shape has been likened to a moth, a bat, a butterfly, and a wasp. It definitely has wings!

Here’s a picture of it, as viewed from the front.

It’s a central cranial bone that does many important things:

it connects to your internal jaw muscles
muscles involved in swallowing are attached to it
it helps form the orbits of your eyes
your optic nerves meet, cross, and pass through it
your pituitary (master gland) sits on top of it (in the “sella Turcica” — Turkish saddle!)
it contains two air sinuses, the sphenoidal sinuses, which open into the nasal cavity through the ethmoid bone
it has openings for major blood vessels and nerves of the head and neck
the tentorium cerebelli, part of the membranous system surrounding the central nervous system, attaches to it

The sphenoid has been called the keystone bone of the skull. It touches 12 other cranial bones: the two parietals, two temporals, two zygomas, two palatines, and the frontal, occipital, ethmoid, and vomer.

The occiput is considered the base of the cranium. The place where the sphenoid and occiput meet is called the sphenobasilar joint (SBJ).

You can see the SBJ in the middle of the image below where the orange and yellow bones meet.

The alignment of this joint is important. William Sutherland, DO, father of cranial osteopathy, believed that the alignment of the entire skeletal system is influenced by the SBJ.

Misalignment of the SBJ obviously affects other cranial bones, which fit closely together, something like a spherical jigsaw puzzle.

If the SBJ is out of alignment, it affects the temporal bones, the upper bones of the temporomandibular joints (TMJs), colored reddish-pink in the image above.

Your internal jaw muscles attach to your sphenoid. In my TMJ Relief sessions, the clinical intraoral work relieves tension in these muscles, helping to release tension affecting the sphenoid and SBJ.

If the bones of the joints are not aligned well, it can also affect the endocrine, nervous, and cardiovascular systems.

Alignment of the SBJ is also a consideration in migraines, headaches, sinus problems, head/neck/back pain, scoliosis, eye movement, and problems with behavior, personality, learning, coordination, hormones, and emotions.

Craniosacral therapists pay a lot of attention to it and can gently help it find better alignment.

Getting this bone and joint properly aligned creates an often-subtle shift that ripples out into more ease and better health.

These habits are major contributors to TMJ issues, and you can change them.

If you’re not in Austin, I can do the above as well as help you learn what to ask about when seeking TMJ relief near you. Just let me know if you need a phone or Zoom consultation.