We hear a lot from tmd patients who have problems with grinding and clenching.

Bruxism  is a condition in which you grind, gnash or clench your teeth. If you  have bruxism, you may unconsciously clench your teeth together during the day or grind/clench them at night. If you do this at night it’s called sleep bruxism. Right now the medical community doesn’t know what causes grinding and clenching but there are things we can do to help mitigate it or lessen it.

Top tips for daytime clenching/grinding

• Set a timer for every 3 minutes and check to make sure you are not clenching or grinding your teeth together, once you found yourself not doing it you can slowly increase the length of time.
• Wear a guard if you are going to be doing stressful work
• Yoga
• Limit your caffeine intake
• Don’t chew gum!
  
• Consider checking out some great apps to help with your stress level and to try and be conscious of clenching/grinding

                       http://www.tonguechi.com/
                       http://www.withandrewjohnson.com/

Top tips for Grinding/Clenching at night

• Shut off all media 1hr before bedtime, the goal is a calm environment
• Deep breathing exercises or even a simple yoga routine
• Supplements like magnesium, they have a relaxing effect.  If you are taking medications though please check with your doctor. Always check with your doctor before adding supplements or other medications.
  
• Limit your caffeine intake or eliminate it all together
• Biofeedback. There are devices that can be worn during sleep that measure the amount of grinding and clenching that you do, and interrupt it with a sound. Over time you learn not to grind or clench. One such device is SleepGuard. It is a biofeedback headband that also tracks how many times you clench during the night.

Another device is GrindCare. GrindCare works by registering muscle activity and sending a mild electrical impulse that interrupts the teeth grinding. The uncomplicated GrindCare device comes with a lightweight electrode you place on your temple when you go to bed at night. It does its work while you sleep  without you even noticing it. GrindCare measures precisely how much you grind your teeth, and can then reduce the grinding while you sleep.  This system can be rented from a dentist before you buy. 

If conservative methods are not working then consider talking with your doctor about ordering a sleep lab test to check for/rule out other sleep problems.  Sleep apnea may also be related to sleep bruxism, and some doctors suggest that treating sleep apnea can help alleviate sleep bruxism.
If none of  these other options are working then please talk with your doctor about the option of medication, I know it’s not the first choice but sometimes it can be helpful if nothing else has worked. I’ve also heard that sometimes medication can be used to break the night time clenching/grinding cycle and then later you can wean off the meds. Again, discuss this with your doctor.

Let’s get started with this week’s tip!

This week I want to talk about exercise.

I know…..it can be really hard to exercise when you are in pain.

However, there are many studies that demonstrate the positive effects of exercise on chronic pain patients. Exercise also improves memory, productivity, and depression.

I’ve heard this so many times that it went in one ear and out the other, to be honest. I couldn’t imagine how I could exercise considering the amount of pain I was in. One day I thought, what do I have to lose? So, after a particularly difficult week of pain I decided to try some yoga. It was a short (15 minutes) beginner class aimed at lessening the stiffness chronic pain patients often wake up with in the morning.

Getting started was hard. I won’t lie to you.

Afterwards, though, I noticed something. I felt more relaxed. My pain level was lower.

So the next morning I tried it again. And the next, again. Now yoga has been a part of my routine for months, and I have worked up to longer classes. On the days that I just can’t imagine exercising for an hour (or I’m having trouble even imagining myself on the mat at all), I try to do 15 minutes…or even 10. I’ve found over and over again that something is better than nothing.

I’ve also learned to be nice to myself. The hardest part is just showing up. So once I have, I try to let go of any negativity towards myself, my pain, or my body.

When it’s over, I’m proud that I was able to take control of my pain and my life for another day. 

One day, one time – that’s all it takes. Try some exercise and see how it makes you feel. Start with 2 minutes, or 5, or 10 – and don’t beat yourself up. You’re doing it, and that’s all that counts.

• Avoid saturated fats, processed food, sugar and salt in your daily diet
• If your workplace is particularly noisy wear ear plugs or ear muffs
• Keep your diet rich in protein, vitamins A,B,E, zinc and iron
• Stay away from coffee tea and sugary foods
• Keep your blood pressure under control
• Avoid alcohol and smoking they tend to restrict blood flow and worsen tinnitus
• Daily exercise improves your blood circulation
• Coenzyme Q10 is a powerful antioxidant that is crucial in the effectiveness of the immune system and the circulation to the ears
• Drown the noise with less disturbing sounds such as those made by a white noise machine.
• Take part in yoga classes, or try meditating. Stress is thought to be a contributing factor in tinnitus

Tinnitus can be very frustrating and there are many different things that will cause it. What works for one person may not work for another.  As always, be sure to check with your physician for definitive diagnosis.

              Does this sound familiar?

Doctor:     I want to get to the bottom of your complaint, identify it, understand it and
treat it.
Patient:    I don’t want to be seen as hysterical or “stressed out”.

Doctor:     I want patients to present themselves clearly and Confidently.
Patient:     I am afraid of sounding aggressive, or asking stupid questions.

Doctor:    I want patients who understand that I have a hectic schedule and come
prepared.
Patient:    I want a doctor who isn’t distracted and takes time to listen

Doctor:    I want a patient who does not have unrealistic expectations.
Patient:    I want a doctor who is not afraid to admit that they don’t know, and
welcomes the idea of second opinions.

Doctor:    I want a patient to understand and ask questions
Patient:   I want a doctor who does not talk in medical jargon…and gives an
explanation, not just an answer.

Doctor:    I want a patient who follows medical advice
Patient:    I want a doctor who has enough faith in me to let me decide the path that we
will take together.

If any of this sounds familiar, you are not alone!  Patients historically view their doctors from one of two angles, and it should be noted that neither of these angles ends with a satisfying relationship. One patient may view the doctor with the awe of a father or mother figure, while another patient will view the doctor with distrust, and feel that she/he will be judge and jury and leave them in a place that is no better than before the appointment.  One expects too much and the other expects too little.  Never settle for a doctor that you are not comfortable with, one that you are unable to talk to, or one who does not listen. Not all doctors fit all patients, I prefer a warm fuzzy doctor, but my husband prefers one who is all business.

What makes a good doctor patient relationship

The most important thing to remember is that a good doctor patient relationship is a two way street. Here are some tips to help you establish that relationship:

• Communication is one of the main keys to establishing a good relationship. As a patient you may feel scared, you may not understand what is being told to you, it feels like alien territory. On the other side, your doctor may be having trouble understanding your explanation of symptoms etc.

• Type up all of your questions, leaving space between them to make notes. Prioritize your list with the most important questions at the top. (You might consider faxing the list to the doctors office in advance of your appointment). Print two copies — one for yourself, one for the doctor. Don’t be ashamed or shy about asking these questions. Remember, there is no such thing as a “dumb” question. Giving the doctor a copy of the list will prevent him/her from mistakenly thinking you’re finished if there’s a pause in the conversation.
• If you haven’t already, explain to your doctor that you want to be well educated about your health and work with him or her as a treatment partner. As patients, many of us do want to be consulted about our condition, our treatment and how things will progress. On the other hand if you are disturbed by too many details, don’t be afraid to tell your doctor how much or how little information you want.
• Ask for clarification on anything you don’t understand, and ask your doctor if he/she has any questions for you. If your doctor speaks medicalese, let him/her know that you don’t understand.
• Don’t hold back information, something you think is serious may be easily taken care of, conversely something that you think is minor could affect your treatment.
• If you have a problem remembering or understanding what is being said, take notes or ask if you can tape the conversation. You may also want to bring someone with you who can help you remember what the doctor said, or remind you of questions to ask.
• Keep your health records in a file and bring them with you to each appointment. Include any tests, treatments, surgeries, medications etc. It is also helpful to keep a pain diary. The diary should list flare ups, medication taken, triggers, duration and any other pertinent information.
• If you question the strength of your relationship with your doctor, it may help to bring along a friend or family member who hasn’t been at every appointment. That person can be a sort of gauge for you. They can debrief with you after the visit, and they can either reinforce or provide a contrasting view of your impression of the relationship.
• If you are unsatisfied with your relationship and decide to find another doctor, it’s best to find the next doctor before you cut off your relationship with the old one. It can be difficult to change doctors because these are intense, important relationships. Put your personal energy into creating the new relationship. And, at a later time, when you have more space and energy, you can let the old doctor know why you chose to move on, if that’s important to you.

Questions to Ask Yourself

• Does my doctor show respect to me as well as to my family members?
• Is my doctor scientifically up to date?
• Does my doctor have a problem with getting a second opinion?
• Does my doctor return calls in a timely fashion?
• Does my doctor make me feel stupid for asking questions?
• Are waiting times too long for appointments?
• Is the staff courteous?
• Does my doctor listen and respond to questions?
• Am I treated as a partner in my own health care?
• Is my time respected?
• Does the doctor have good eye contact?
• What is the plan for emergencies?
• Does the doctor accept your health insurance?
• Are you more comfortable with a male or a female?
• Do you want to access your doctor online?

An ideal patient is one who knows that getting well is a journey the doctor and patient take together, and trusts the doctor to do his or her best at all times.

An ideal doctor is someone who validates your pain, listens to your problems, treats you with professional courtesy and goes that extra mile.

Tips to get us past “The Winter Blues”

I’ve been through pretty much every treatment, medication, and self-care modality that I discuss here with all of you. Splints, braces, medications, injections, surgeries, physical therapy, etc, etc, etc. In 2006, I had my joints replaced with titanium implants.

I’ve talked with probably thousands of patients since I started doing advocacy. I’ve heard of every possible treatment, procedure, or medicine. Out of everything I’ve learned, some things have stood out, and I’m going to share some of these with you. I’ve noted them not as a rule…but a generalization. While they won’t be true for every single person out there….I do feel like they are true for many of us.

1. Find a patient who is at least one or two steps ahead of you in treatments or surgical procedures.

One of the rules of business (and life) success is having a trusted mentor that you can go to for questions and advice. This is also true for chronic illness. Having someone available to ask questions and to listen to their experiences is invaluable. Plus, when you just need to complain, there is no one better than someone who truly does understand what you’re going through.

2. Put an extremely high priority on pain management.

If I could shout one tip from the mountain top, this would be the one. Even for me, someone who is pretty knowledgeable and feisty when it comes to getting good care , I had NO idea my pain wasn’t managed….until it was. The difference between what I am able to accomplish with my pain managed is night and day. The other important thing is that pain management is not invasive. It won’t change your bite or put you in the position of having more surgeries down the road.

3. Pursue better….but don’t become obsessed with finding something that doesn’t exist.

You certainly have the right to feel better and pursue a better life…and you should! However, know that at the moment, there is no cure for TMJ disorder. There is no “perfect” treatment. When I say the word “know,” I mean, really sit with that statement and consider what it means to you and your treatment goals. There is no cure. How does this change how you feel about the treatments you are pursuing? This also does not mean you should lose hope that someday there WILL be a cure…far from it, actually. This is me telling you….giving you permission, to LET GO. You can have a chronic illness AND a fulfilling life that makes you happy. You don’t always have to be searching and hanging your whole life on treatments that may not help.

4. Realize that others do want to help you.

Let them. A well meaning family member’s advice may go in one ear and out the other, and that’s totally fine if you have already tried what they are suggesting, or you know it won’t help (just be polite, of course). On the other hand, if someone who has been through this gives you advice, consider what they are saying. REALLY consider it. Have you REALLY put in the effort to try everything you can to feel better? Have you REALLY listened? Spend some time thinking about this. I know it sounds ridiculous, but it can change your life. Are you really living your life and doing what is necessary to feel better?! Are you sabotaging yourself? Saying one thing and doing the complete other?

Will you EVER get better if you ignore the advice of those who have been through it before you? Will you EVER get better doing the same old things every single day that GOT you where you are TODAY?

I didn’t start seeing serious changes in my life until I started taking meaningful action on the things I knew I should do, and the things I said I would do.

Are you eating things that cause you pain? WHY?! You are the one that pays for it..start doing things that help, not hinder your progress.

5. No one cares as much as YOU do.

Nobody is going to care as much about your medical issues and general well-being as you will. So, it is your responsibility to learn and search for information that makes you the best patient you can be.

Half the battle is being confident in yourself and your ability to make decisions….so trust your gut instinct. Those around you take their cues from you. Unsure? They will be, too.

You do HAVE to make choices. You can either choose to drive your life and MAKE things happen FOR you….or you can have no control and LET things happen TO you.

Finally, even though I AM positive…It is not from a pollyana, Stepford wife, robot type place.

My goal is to share what has worked for me and the thousands of other patients I have talked to.

The bottom line?  These are the things that have worked. Period.

The common thread that runs through the thriving patients is not one type of treatment, surgery, or medication.

It’s an attitude.

This is YOUR LIFE. Do whatever you can to THRIVE, feel better, and never give up hope.

Here are steps that you can do to help stop the incessant ringing:

• Avoid saturated fats, processed food, sugar and salt in your daily diet
• If your workplace is particularly noisy, wear ear plugs or ear muffs
• Keep your diet rich in protein, vitamins A,B,E, zinc and iron
• Stay away from coffee, tea, and sugary foods
• Keep your blood pressure under control
• Avoid alcohol and smoking since they tend to restrict blood flow and worsen tinnitus
• Daily exercise improves your blood circulation
• Coenzyme Q10 is a powerful antioxidant that is crucial in the effectiveness of the immune system and the circulation to the ears
• Drown the noise with less disturbing sounds such as those made by a white noise machine.
• Take part in yoga classes, or try meditating. Stress is thought to be a contributing factor in tinnitus

Tinnitus can be very frustrating and there are many different things that will cause it. What works for one person may not work for another.

Have you battled with ringing ears? If so, what has helped you? Share with us in the comments below!

Managing medical bills, keeping track of doctor visits, filing insurance claims, and organizing medical records can all leave you feeling overwhelmed. Here are a few tips that can make managing TMJ disorder, or any chronic illness easier – and might stop you from pulling out your hair!

Records that are important to keep:

• Medical Bills
• Records of phone calls, emails and letters from doctors and insurers
• Insurance claims forms including claims filed, reimbursements, and explanations of benefits.
• Records of hospital stays, treatments, procedures, exams, lab tests, drugs prescribed and prescriptions filled.

Doctor Visits & Hospital Stays – What to Keep Track Of

Keep a log that includes:
1. Medical appointments
2. Prescriptions filled
3. Lab work
4. Procedures

Whether you have insurance or not, this is an important thing to do. Keeping logs of appointments, prescriptions, procedures (and their costs) will help you when the bill comes around. Hospitals are notorious for including charges for things you didn’t even use. If you’re in the hospital, don’t rely on your memory to record the medications, tests, and procedures you have. If you can, assign a family member or friend to be your advocate…they can record everything for you so that it’s much easier to ask questions (and to talk with the insurance company if you have a dispute).

Organizing doctor visits

• Obtain a copy of your medical records
• Create a health information journal which includes:

1. Relevant information about surgeries, procedures, allergies, hospitalizations, medications you are on, and family history of diseases or conditions. Be sure to include dates.
2. Basic information including height, weight, blood pressure, any routine blood work results

Keeping a TMJ diary
As you know, the status of your TMJ disorder can change on a daily basis.  It is important to keep a diary that will give you insight into possible triggers that may result in a flare-up. It will also help your doctor in determining your course of treatment.

You will need to track:

• Pain level
• Medications taken
• Any new symptoms, or a change in symptoms
• What you did during the day
• Concerns
• Questions to ask your doctor

Setting up your organizational system

• Keep a basket or file on your desk and put everything medically related into it. Every week or month, file your paperwork in the appropriate place.
• A 3 ring binder can be used for medical records. Use tabs for each category (prescriptions, TMJ diary, notes from prior office visits, insurance, copies of scans and test results). The first information your doctor sees in each category should be the most relevant.
• Consider making multiple copies of any records so that you can hand them to your doctor without him or her having to make copies (and this way, you lessen the likelihood that your doctor will forget – or misplace – your records).
• Create files for any information that you don’t need to carry with you, such as insurance paperwork that pertains to explanation of benefits or records of conversations with your insurer.

Create a System That Works for You – and Stick To It!

Once you have a system that works for you, make sure you are consistently using it. Set a date with yourself on your calendar to spend half an hour organizing your medical records once a week (or month if you are not actively seeking treatment at the moment). After you’re done, reward yourself! Great time for some ice cream

Information can also be backed up on a flash drive and carried with you, but check with your doctor to be sure his office will be able to use information in that format. Some offices haven’t changed to digital records yet.

In the end, staying organized will not only help you better manage your health but will also help your doctor more effectively help you. Since your relationships with your doctor is a partnership, it’s important to show him or her that you are committed to taking care of your health and doing whatever it takes to feel better. In turn, they will be more able to help you.

How do you manage the piles of paperwork that come with having TMJ disorder?  We would be grateful for any tips you could share with us and your fellow patients!

Tips to keep in mind when you have TMJ disorder:

• When making the appointment be sure to give the dentist and hygienist  heads up about your TMJ disorder.
• If you have any concerns, you might want to make the first appointment a consultation to go over your situation and develop a plan.
• Try to schedule your appointments in such a way that you won’t be required to keep your mouth open for extended periods of time….example:  If you are having your teeth cleaned, you may want them to do the bottom teeth in one visit and the top in another. Some patients do their cleanings in quadrants over four visits.
• Bring or fax a copy of your medical records.
• Try to find a dentist who has experience dealing with TMJ patients

Sedation and pain relief options:

• Ask the dentist if you can take a NSAID before your visit.
• It may be possible for the dentist to prescribe medication to take before the visit. The options could be:  Muscle relaxants, anti-anxiety medication, or pain medication
• Nitrous oxide during treatment (don’t underestimate this option)
• Sleeping pills to be taken when arriving at the office.
• IV sedation
• General anesthesia
• A combination of the above

Which pain relief and sedation options you choose will depend on several factors, including:

• The severity of your jaw problem
• The severity of your tooth problem (ie: root canal/cleaning/cavity/extraction)
• Location of the problem
• Your financial situation…. do you have insurance, and if so, does your insurance cover the above options?

Also, I have been through many of these options to receive dental care, and will be writing a post soon detailing exactly how I went about receiving the best care I’ve EVER had in the dentist’s office!

Do you have any tips to share about making your dentist visits easier? Please share them in the comments below!

Is your glass half empty or half full?

How you answered the above question could determine how you view your TMJ disorder. Chronic illness can turn your life into chaos, but a positive attitude can make a huge difference in how you deal with it. Attitude is not just about your outlook on life, it is also about choosing what that outlook will be. If you look for the good in life, you will find it….but if you look for the bad you will find that too!

A new field of study called psychoneuroimmunology has emerged, (combining psychology and immunology), and the medical community has taken a serious interest in the link between attitude and physical illness. Evidence has shown that those who use techniques such as moderate exercise, meditation, yoga, visualization, positive affirmations etc are able to actually enhance their immune systems. Does this prove the theory that those who think sick are most likely to be sick and those who think well are more likely to be well?  Researchers think so!

Did you know that when you laugh your body releases hormones and chemicals that affect your body in amazing ways? Blood pressure goes down, your immune system gets a nice boost, endorphins are released, tight muscles relax, and best of all there is a reduction in pain! There are no known negative effects of laughter…..no wonder it is called the best medicine!

What you can do to keep a positive attitude:

• Laugh…….it is contagious, and best of all helps to relieve pain!
• Stay connected with family and friends.
• Never lose hope. We know much more now than ever before about TMJD, and medical research is being conducted all over the world. Better therapies and treatments are on the horizon.
• Stay involved, learn to be your own advocate. Organizations like TMJ Hope need your help! (click here to learn how to support us).
• Shift your expectations…you may not be able to run the marathon, but you can enjoy a brisk walk. Make a list of the things you want to do, and find ways to do as many of them as possible. Create a new self and merge it with your “old self”.
• Surround yourself with a good support system that includes doctors, friends, family and those who are going through the same thing as you.
• Keep a journal, and make sure to include what you are grateful for each day.

Having a positive attitude is just as important as your physical therapy and proper nutrition. Surrounding yourself with positive people and plenty of laughter is an important piece of the puzzle when you’re learning to thrive withTMJ disorder.

So is your glass half empty or half full?  What can you do to increase the amount of positivity in your life?