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). They found that 52% had RLS, bruxism, and migraines.

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 more research about TMJ-related issues, especially because there are so many factors that play a role in jaw dysfunction and pain.

More about bruxism.

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

They may have different causes, in my opinion.

Sleep bruxism, in contrast to daytime clenching, is hard to treat because it occurs when 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.
  • Bruxism often requires expensive dental work: mouthguards or splints to prevent further damage, and crowns to fortify cracked or broken teeth.
  • Sometimes the noise of grinding during sleep is loud enough to wake up family members, 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.
  • Over time, bruxism can damage the temporomandibular joints, possibly requiring surgery.

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.

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

Some dentists may try to adjust the positioning of the TMJs, and a few dentists also address airway issues (like sleep apnea, which also 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.

Some dentists and hygienists in the Austin area refer people with jaw pain or issues opening wide to me. (New alternative to manual therapy during the COVID pandemic: my upcoming online course, Self-Help for Jaw Pain.)

Solutions to try.

If you grind your teeth during sleep, it is possible to stop by using hypnotherapy and EFT.

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.

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:

Educating dental office staff about treating jaw issues

Last year, I took a some classes about making presentations, and I focused on educating dental office staff about what I do in my TMJ Relief work.

Last week, I participated in a lunch-and-learn at the office of my wonderful dentist, Dr. Elizabeth Rayne. I talked about what I do and got to ask them some questions about what they do.

For instance, when people grind their teeth during sleep, they may not be aware of it. However, the dental office staff sees the results of grinding.

The staff then has to tell the patient that their sleep habit is damaging their teeth. Not good news to hear, especially when it means they need crowns.

Since my specialty as a massage therapist is in relieving muscle tension, after taking some advanced courses, I can help relieve tension in the jaw muscles and the pain it causes.

As someone who’s also trained in behavioral change (NLP), I can help people learn habit change.

Learning the techniques I use, getting advanced training, tweaking my protocol, and working on person after person since 2013 make up the manual therapy part of my work.

I’ve worked on people who have suffered for most of their lives, for twenty, thirty, even forty years.

That’s a lot of suffering. Being able to make a difference is hugely rewarding.

My work mission has broadened to include educating professionals and the public about manual therapy for jaw issues. At least half of my TMJ patients had never received manual therapy for jaw pain before they learned about me, through word of mouth. They didn’t know it existed.

I can relieve jaw pain, help people open wider, and help get their jaws aligned for better appliance fit. How would that affect a dental practice?

Readers, I f you know of any dental offices in the Austin area interested having me do a lunch-and-learn with staff, please connect. I will follow up.

Coming soon! A class for dental offices

I have been taking a fantastic class called NLP+Presentations. The first part was this past weekend, and the second part will be in mid-February.

I’m working on a presentation for dental offices. It will be an hour max, so it could be a lunch-and-learn or a training offered to staff early or late in the workday.

I probably don’t need to tell you that some people complain of jaw pain after receiving dental work.

Dental professionals need to accommodate them by offering frequent breaks from wide-open mouth position — some even use devices to keep the mouth cranked wide open.

Dental offices also experience cancellations when someone’s jaw pain has flared up and they can’t even imagine holding their mouth open for dental treatment.

In fact, dental professionals are often the first health care professionals to let someone know that their clenching and/or grinding habit is damaging their teeth.

Although they offer orthotic devices to protect teeth and/or try to realign the TMJs, and they can usually repair the tooth damage they encounter, they don’t work on the biggest cause of jaw pain — myofascial tension. In fact, most dentists receive little or no training in the jaw — their domain is teeth and gums.

As a massage therapist, my domain is the myofascial realm of muscles and soft tissues. I work on postural issues, shoulder and neck tension, decompression of cranial bones, and do intra-oral work on all four internal jaw muscles — as gently as possible.

I can help dental offices help their patients, and I believe we can work well together.

If you think your dentist might be interested in this free training, please connect us. I’ll be offering trainings starting in late February.

Free consultation for TMJ issues

I’m please to announce I’ve added a new service. If you have jaw pain or dysfunction and are wondering if I can do anything for you, please schedule a free 30-minute consultation.

A lot of people, including dentists, are not aware that appropriately trained massage therapists can work on relieving your TMJ issues that are due to muscle tension or trauma. 

Screen Shot 2018-05-30 at 8.44.49 PMI’ll ask about your symptoms and your history. I’ll also evaluate your body, including your neck and jaw.

Then we can talk about treatment options. If you’ve never had manual therapy for jaw pain and dysfunction, or if you’ve received it previously from a different practitioner, I’ll be happy to tell you what a typical session is like and the typical progression if you are curious about buying a series of sessions.

Please note: What I find once I start working and how well your system responds are variable with bodywork.

I’ve been doing TMJ Relief sessions since 2013. My teacher was Ryan Hallford of the Craniosacral Resource Center in Southlake, TX. I’ve taken his cranial base/TMJ class twice and been a teaching assistant for it when Christian Current taught. In addition, I’ve studied craniosacral therapy with the Upledger Institute.

Most recently, I studied TMJ Mastery in London, Ontario, with John Corry, a massage therapist and teacher with 26 years of experience working with TMJ issues.

Please let me know if you have any questions, and don’t hesitate to read the testimonials on my What People Are Saying page.

Treating TMJ issues: releasing trigger points in your jaw muscles

You have four jaw muscles: the two large ones on the outside of your head (the masseter and temporalis) and the four small ones inside your mouth (two medial pterygoids and two lateral pterygoids).

Any of them can get trigger points.

What is a trigger point? Healthy muscle tissue is made of bundles of fibers that run in the same direction. This tissue is pliable. It stretches or contracts when you move.

Screen Shot 2018-07-12 at 8.36.04 AMA trigger point is a spot where the muscle tissue has lost its pliability. A massage therapist may feel that the fibers in a particular spot have become glued together and hard, creating a small nodule. The tissue feels denser and often rolls under the fingers, compared to healthy muscle tissue.

This causes that band of muscle fibers to become shorter and tighter, restricting full range of movement of the entire muscle.

If you can’t open your mouth wide, or move your jaw easily left and right, forward and back, you may very well have trigger points in your jaw muscles.

Trigger points usually feel tender when you apply pressure to them, and they may also refer pain elsewhere. They may also form “constellations.” This makes them the tricksters of the nervous system.

You can work on your own trigger points to release them. It helps if you’ve received trigger point work from an experienced massage therapist, but you can learn to do it yourself. Even then, you may prefer to have someone else work on them, especially if you have a lot of them in multiple jaw muscles.

Screen Shot 2018-07-12 at 8.08.14 AMMy favorite reference book for working with trigger points is The Trigger Point Therapy Workbook, third edition, by Clair Davies and Amber Davies.

It is written for laypeople to release their own trigger points, but I know many massage therapists who use it as a reference book in their offices.

When I am working on TMJ issues, I notice that many people have trigger points in their masseters, the big external jaw muscles on the sides of your face that run from your cheekbone to the bottom of your jawbone.

Here’s how to find trigger points in your own jaw: using a bit pressure, drag your fingers slowly down the masseter muscle on one side of your face. Do this several times, experimenting with adding pressure, and notice if there are tender spots or “roll-y” spots. Repeat on the other masseter.

If you don’t have masseter trigger points, this usually feels pretty good.

Screen Shot 2018-07-12 at 8.41.19 AM
Source: The Trigger Point Therapy Workbook

If you find trigger points in your masseters (and you can still have TMJ issues without them), there are several ways of treating them.

Some therapists apply a huge amount of pressure. I don’t recommend this because if you have TMJ issues, your jaw is probably already out of alignment, and this could make it worse.

A better way, in my opinion, is to use less pressure. Yes, you can gently release trigger points!

I learned to do this from a local (Austin) massage therapist who is very experienced with trigger point release. She’s worked on me and released many trigger points, teaching me how to do this in the process.

If you have a lot of trigger points, I highly recommend seeing her. She works intra-orally, as do I, but her experience is greater than mine, and she’s amazing at discovering patterns if you have “constellations” of trigger points. She’s going to be more efficient than I can possibly be. She is the queen!

If you are interested in having her work on you, her name is Rose of Sharon, and you can reach her by phone or text at 512-282-1672. Please leave a message with your name and number so she can contact you.