As a patient with TMJ disorder and/or chronic facial pain, I have the right to:

• Have my physicians and/or providers listen to and consider my symptoms as serious issues.
• Be an active participant in my healthcare solution.
• A comprehensive examination that addresses my functional problems as well as my pain concerns.
• Appropriate diagnostic testing including MRIs, tomograms, impressions, etc., when my problems are first evaluated and when my condition changes or worsens (including changes from splint therapy).
• A complete, written diagnosis and treatment plan that will guide me on how to properly use any medications and appliances I might be given.
• Be educated by my provider regarding the cause of my problem(s), treatment possibilities, and the pros, cons, and costs of each.
• Contact the physician with any questions or concerns when the treatment plan seems to be inadequate, my appliance is not functioning correctly, or my pain is is not sufficiently controlled.
• Obtain clear, prompt answers to any questions, appropriate time to make educated decisions, and a clear channel of communication between my physician and I regarding any treatment options.
• Refuse treatment options with no repercussions.
• Proper pain management instead of non prescription drugs, including access to opioids (and other prescription medications), alternative therapies, and physical therapy.
• Be referred to a credentialed specialist: dentist, oral surgeon, neurologist, ENT, pain specialist, rheumatologist, etc if my circumstances do not improve, the physicians treatment is not successful, or my condition is out of the scope of that particular professional.
• Courteous and respectful treatment in the emergency room as well as a written plan from my provider to present ER physicians.
• Expect people I come in contact with: family, friends, co-workers, employers, and others to realize that I am doing the best I can to cope with my illness and to assist me in my efforts to improve my quality of life.
• Expect my insurance company to recognize TMJ disorder and other related diseases as legitimate medical problems, similar to problems with knees, shoulders, or other joints in the human body.

In one way, we’ve come so far…. but in others, we have made no progress. Only in continuing to advocate for yourselves, make your voices heard, and talk about your TMJD will this ever change. We can get into the rut of feeling like our voice is too small to make a difference… but that couldn’t be further from the truth. Think about what could be accomplished if even 1% of the 35 million TMJD sufferers stood up and demanded answers.

Evolution of TMJ Disorder

3000BC — Pain and dislocation in the jaw described and treated.

1855 ——   Charles Goodyear provides dentists with a material that  could be molded for many different oral applications.

1859 ——   American Dental Association is established

1862 ——    Thomas Gunning, a practicing surgeon uses vulcanite to  make a custom fitting splint to treat himself for a broken
jaw. His vulcanite splint is very similar to the appliances used today to treat TMD.

1887——     British surgeon Annandale publishes an article describing two cases of discoplasty for the management of disc displacement in the TMJ, and receives credit for
the first surgical repositioning of an articular disc.

1901 ——    Arolyi introduces an occlusal splint for the treatment of bruxism

Early 1900’s —- Pringle recognized as one of the first surgeons to perform a menisectomy.

1909 ——   First published case of a discectomy reported in German  literature by Lanz.

1913 ——    Arthroplasty first used for the treatment of ankylosis.

1920’s —     The connection between what we now refer to as TMD
and ear dysfunction researched by Drs. David
Goodfriend and James Costen.

1926 —— Formation of the Gnathological Society. With the
formation of this society the role of occlusion gain in
popularity and dentists become more interested in
complex occlusal techniques.

1934 —— TMD, known as Costens Syndrome after Dr. James
Costen clarifies many aspects of the syndrome with a
predominant emphasis on dental malocclusion. Costen,
in a publication claims that pain in and around the jaw
and “related ear symptoms” improve with alteration of
the bite.

1937 ——Dr. Louis Schultz publishes a paper in The Journal of the
American Medical Association on the treatment of pain
and subluxation of the TMJ. In his paper he describes
how common TMJ syndrome is and that the traditional
treatments of rest, appliances in the mouth, physical
therapy and surgery were only partially successful.
Schultz disapproved of the traditional method of retracting
the wandering condyle with a steel headband or wiring the
jaw shut for months. His invention was to scar the tmj
tissues by injections of an over the counter bulk laxative.

1950’s — Schwartz questions the association between occlusion
and TMD.
Treatment of TMD shifts to surgical.

1963 —— Charnley warns against the use of teflon in joints because
of the intense foreign-body reactions. He describes
unfavorable results of injecting teflon into his own thigh.

1966 —— Krough-Poulsen create a list to screen the symptoms of
craniomandibular disorders. Because malocclusion is
thought to be the underlying cause, treatment of TMD
shifts from medicine to dentistry.

1967 —— Dupont sends Homsy warning about complications
caused by implanted teflon.

1968 ——- Proplast is developed by Charles Homsy as a surgical
material

1969 —— Laskin describes a subgroup category within TMD called
myofascial pain dysfunction syndrome…or MPD

1970 —— Homsy publishes first article evaluating the
biocompatibility of different materials in their selection for
surgical implantation.

1970’s —-Bernard Jankelson introduces neuromuscular
application in dentistry.

Surgical intervention for the TMJ gains momentum, and
new procedures develop with a focus on the articular
disc of the tmj as a root of the disorder.

Homsy starts Vitek.

1975 —— American Academy of Craniomandibular Disorder
founded.

Onishi adapts and miniaturizes the orthopaedic
arthroscope for use in TMJ.

1976 —— Proplast is patented.
Medical device Amendment creates a scheme linking the
degree of risk inherent in any new medical device and the
amount of control the FDA could exert over its approval
process.

1978 —— Farrar and MccCary challenge the neuromuscular
concepts and focus on internal derangements as the
primary cause TMD signs and symptoms.

Earliest known recipient of vitek proplast-teflon implant.

1982 —— Vitek creates 2 types of proplast: Proplast 1, composed of
teflon and graphite, and Proplast 11, its aluminum-oxide
analogue.

ADA holds conference on the examination, diagnosis and
management of TMD

1983 —— Vitek notifies the FDA of plans to market it’s
interpositional implant (IPI) for disk replacement after
discectomy.

1984 —— Kent, concerned about safety of vitek implants warns
Homsy of “calamity of unbelievable proportions.”

1985 —— First problems with proplast reported.

1986 —— TMJA founded

1987 —— First Lawsuit against vitek.

1988 —— FDA conducts first inspection of viteks plant

1989 —— 9 patients show deterioration’s, foreign-body giant cell
reaction in all joints

FDA cites Vitek for not reporting patient complaints.

1990 ——- Vitek files for bankruptcy.  FDA rescinds 510K approval
for Viteks implants

1991 —— FDA orders Vitek to remove it’s implant from the market
and issues a medical alert to patients.

1992 —— Homsy moves to Switzerland
Congressional hearing on TMJ implants

Wolford developed the philosophy and technique for placing fat grafts around TMJ total joint prostheses to prevent heterotopic bone formation, decrease fibrosis, improve pain levels, and increase jaw function.

1993 —— Class action lawsuit filed on both Vitek and Dow Corning
silastic tmj implants

1994 —— NIH holds workshop on TMD and related pain conditions.

1996 —— NIH health technology assessment conference held to
provide physicians and the general public with
responsible assessment of management approaches to
TMD

2005 —— The Cochrane Oral Health Group reveals common
treatments for TMJ pain have not yet been proven to be
effective despite their popularity. “No strong evidence of
benefit from occlusal adjustment for problems
associated with the TMJ joint.” “Insufficient evidence to
either support or refute the use of occlusal splints for
treating patients  with tooth grinding or clenching during
sleep.” “Insufficient evidence either for or against the use
of stabilization therapy for the treatment of
temporomandibular pain dysfunction syndrome.”

2005 —— NIDCR launches important study of temporomandibular
joint and muscle disorders (OPPERA Study)

2006 —— Researchers at the University of North Carolina at Chapel
Hill discover that commonly occurring variations of a
gene trigger a domino effect in chronic pain disorders.
The finding could potentially lead to more effective
treatments of TMJD.

2007 —— Study published in the Journal of Neurochemistry
identifies a key interaction between head and neck nerve
cell proteins that may help shed light on migraines and
TMD.

2008 —— Emory University begins a study on a comparison of
arthrocentsis, arthroscopy and arthroplasty in the
treatment of TMD

2009 —— National Institute of Dental and Craniofacial Research
(NIDCR) conducts a TMJ awareness campaign “Less is
often best in treating TMJ”

Cochrane Collaboration completes a study of the use of
botulism toxin type A in masseter muscle hypertrophy.
Reviewers conclude that there were not enough quality
studies to properly evaluate the toxin’s effectiveness nor
its potential harms.

2010 —— The American Association for Dental Research revises
their policy statement on TMJD. This policy reflects the
NIH “Less is best”

First results from OPPERA study unveiled.
TMJ Hope founded

2011 ——- FDA orders TMJ implant postmarket surveilance

Lee Weinstein has been inventing since he was 13 years old when he invented a device that could answer the phone before it rings, so he and his friends could call each other in the middle of the night and arrange to sneak out and pretend to be secret agents.

After graduating from and briefly teaching at MIT, Lee invented the electronic battle game now known as Laser Tag, and the electronic dog collar system now known as Radio Fence.

On occasional stints in corporate America between inventions, Lee has designed medical electronics for Hewlett Packard, designed high-voltage electronics that makes measurements miles underground for oil companies, and designed what was for a long time the world’s most sophisticated battery testing system for Duracell.

At another time between inventions, Lee studied for and passed the US Patent bar exam, so he now a registered patent agent, and writes all his own and many of his friends’ patent applications

Interview

Stacy:  Why don’t you start off by introducing yourself.

Lee:  My name is Lee Weinstein. I have a history as a medical equipment designer and an academic, I’ve taught at MIT, I’ve designed medical equipment for Hewlett-Packard and I currently run a small company called Holistic Technologies, that manufactures and sells nighttime biofeedback equipment that helps people change nighttime habits such as teeth grinding.

Stacy: Interesting. Okay. Let’s start it off by actually talking about what teeth grinding and clenching are. So can you tell us a little bit about that?

Lee: All grinding includes clenching, so clenching is the act of using muscles to force your teeth together, to put pressure between the upper and lower teeth and normally the muscles that are used are the masseter muscles, which are at the jaw joints, you can feel it bulge at the jaw joint if you put your fingertip there and then you bite, and the temporalis muscle which  has an anterior and posterior part …you can feel the anterior part if you put your fingertips at your temples and you bite and you’ll feel some muscle fibers bulging under the skin there. Those are normally the muscles that are used to force your teeth together to do clenching. The only exception to that being if you clench only on your front teeth, the muscles that are used to force your teeth together are different muscle sets because that actually keeps your back teeth apart and pushes your front teeth together and that’s a pretty complicated action…

Lee: Some people do clench on their front teeth.

Stacy: That was my next question. Do all people clench the same or is it dependent on their bite or?

Lee: I would say that more that ninety percent of people clench using their masseter and temporalis muscle groups and probably somewhere between.  I’m guessing it’s more like that around one or two percent of people clench specifically on their front teeth and the only thing that that influences or alters that is there are a couple of mouth guards. There are front teeth only mouth guards and if you use one of those and you clench, it kind of forces you to clench only on your front teeth so it forces you to use the different muscle set but without those mouth guards, I would say that something like ninety-eight percent of people clench using their masseter and temporalis muscle groups.

Stacy: Interesting. So what effects does clenching have on your jaw joints?

Lee: Well, that depends on the duration and how hard you clench. So when you’re chewing you may put tenth of a second pulses of a couple of hundred pounds of force on your teeth especially if you’re chewing something that really needs to be chewed through like a piece of meat, but many things require that high force when you’re first really mashing them as you chew them. So brief pulses of force don’t really have much negative effect at all unless you already have some damage. There’s a kind of tissue that bonds the roots of your teeth into your jaw and a similar kind of tissue in your temporomandibular joint that is elastic under brief pulses of force kind of like silly putty. If you form silly putty into a ball you can bounce it for a very brief force, like when it hits the floor it behaves like rubber, but if you hold it between your fingers and you put pressure on it for even a second, it mashes, kind of forms like a toothpaste. So the protective tissues that bond your teeth into your jaw and that protect your temporomandibular joint from damage are similar to silly putty and biological tissue that’s got those characteristics is called thixotropic. T-H-I-X-O-T-R-O-P-I-C. And so like when you go jogging down the street even if you weigh only a hundred and twenty pounds, the pulse forces on your ankles when each foot hits the ground are about 400 pounds. Now if somebody told you, “Here hold this 400-pound weight”, your ankles wouldn’t wouldn’t stand it. They’d crush. Those brief moments they actually can stand it and they don’t even get damaged so similar in your in your teeth and your the roots of your teeth and your jaw joint when you chew. Those brief few tenths of a second pulses of force don’t do damage to the joint but if you clench for even, let’s say longer than 2 seconds you start to build up damage to that tissue. So somebody might say, well let’s say they only clench 15 seconds in a night well if you clench 15 seconds at one time and you clench really hard. You can actually build up quite a bit of damage doing that. You could even crack teeth, you could have your teeth fall out, you could have your teeth get loose and you can get serious pain in your temporomandibular joint or pain gets referred other places from the nerves getting mashed, I could get into lots of different conditions, but maybe you want that listed separately?

Stacy: Well, one thing that I keep thinking about and I don’t even know, I’m not even sure if this is relevant but it’s just something I’m curious about, do people that that clench on their front teeth versus their back teeth, maybe have different symptoms? Is that how you tell that that might be what they’re dealing?

Lee: .Okay I’ll answer two things. You asked me in the beginning and I didn’t finish answering…. what’s the difference between clenching and grinding and I kind of got off track there. In grinding, you’re clenching plus you’re moving around side to side, or forward and backward both. And what that does is while you’ve got pressure on your teeth, you’re moving them around so it actually starts to wear away the enamel…

Lee: ..And likewise if you’re clenching hard and you’re doing those movements that will loosen the teeth even faster,  because you’re putting sideways forces on them as well as the vertical force…

Stacy: Right.

Lee:  also if you’re doing that and you’re clenching because it’s moving the teeth around and they’re getting loose,  it’ll kind of pump bacteria down through the gum line down towards the roots of your teeth and you’ll start to get receding gums or you may need a root canal from an abscess that you get or something like that.

Stacy: okay

Lee: So the clenching is bad. The clenching plus the sideways movement is even worse… so that’s the grinding. Although clenching really hard could be worse than lightly grinding. But you ask because…

Stacy: Well, people also don’t just clench at night so that adds even more because a lot of people do it during the day

Lee: That’s true and most people who clench during the day don’t tend to be grinding because they would notice the sound…

Lee: So daytime clenchers are usually more purely clenching, and people who only clench at night, it’s more likely that they would include grinding because they wouldn’t notice the sounds when they’re asleep.

Stacy: Okay wait.  Let’s actually stop and say that again. So people who clench during the day…

Lee: Are more likely not to be grinders at night because the kind of habit they build up is a pure clenching habit.

Lee: And people  who clench at night may be just as likely to grind during the clenching as not because they are never hearing that sound so they’re never giving themselves any any training to not do that.

Stacy: That’s interesting. That’s something that I’ve never heard before.

Lee: so you know, when I’ve interviewed customers that I have, and and they say, “I clench during the day.” Those are much more likely people to say, “My dentist doesn’t say that I have any sign of grinding. My teeth aren’t worn away but you know, my jaws are sore and my teeth are loose…” or you know, this kind of thing.

Stacy: To take that a step further, is it possible that the people who clench during the day also have an easier time of eliminating the problem because they were actually awake and aware of it. Whereas people who are asleep…

Lee: Well, no. No, because it’s not so easy to be aware of clenching because it doesn’t make a sound.

Lee: You can get quite subconscious with the nerve part of the feedback. I’ve sat in on meetings at companies and watched some people clenching very hard and I’m looking because I’m very aware of it.

Lee: I’ll look and I would say, “Wow! From the way her muscles bulging right now, I’d say, she’s l biting a hundred and fifty pounds of force!”

Lee: But she’s usually writing notes while she’s biting a hundred and fifty pounds of force and she’s not aware of it at all because her concentration is somewhere else.

Stacy: Sure.

Lee: So I think that’s pretty true for most people who clench… that they’re not aware of it very much while they do it. They may occasionally be aware of it but I don’t think at the majority of the time they are.

Stacy: Ha. I’m trying to think of where to go next with that.

Lee: let’s go back to the difference.  I still don’t think I finished the difference between clenching and grinding.

Lee: So grinding… Grinding tends to be noticed by dentists because your tooth enamel is worn away.

Lee: And it may be just the enamel on your front teeth.  Your front teeth could get worn down to be stubs if you’re a front teeth grinder. Grinding is usually included in front teeth clenching and the reason is if you think about when you clench your teeth normally, they kind of mesh together and they interlock…

Lee: And if you’re clenching well there’s not a lot of room for them to move…

Lee: …once you’ve clenched because your front teeth are overlapped and your back teeth mostly kind of interlock at a little points and they’ve been trying to interlock at some extent. So… But if you’re a front tooth clencher, you have to bring your teeth together in a funny way to put that force on your front teeth and you almost have to move them around some… to find how to align them so that you can clench them. So front teeth clencher virtually always I find includes grinding.

Stacy: Interesting.

Lee: Because it’s kind of natural that you have to move around in order to find that clench point and…

Stacy: I’m sure all of our readers are doing this right now. Hahaha.

Lee: Hahahaha. Yeah might be.

Stacy: I know I am.

Lee: And front teeth grinders are the easiest people in the population to spot because when they… when they smile, you notice that their front teeth are shorter, the sharp edge of them has been ground down. And sometimes all the way through to the dentum so that if you look it at an angle you see, “Oh my god! That’s not white that’s this brownish substance.” Well the brownish substance is the interior part of your tooth.

Stacy: Right.

Stacy: It kind of looks like a tree almost… when you cut a tree open. Hahaha.

Lee: Yeah. Well it’s… it’s common to have to see that in people who have been front teeth grinders for awhile. And I always shutter when I see. It’s like, “Oh my god, it’s like having my internal organs exposed or something.” It just feels painful looking at it.

Stacy: definitely.

Lee: So those are the main things that I see as differences between people who are clenching purely and people who are grinders. It’s most obvious on the front teeth grinders, but, if you’re grinding with all of your teeth, if you’re clenching and just moving around a little, eventually you’ll wear down all your enamel.

Stacy: So let’s talk about what types of symptoms somebody that is clenching and/or grinding is feeling when they… possibly when they wake up in the morning or during the day…

Lee: Most of the symptoms come from the clenching part. The part where you’re putting force on. The main symptom that comes from grinding specifically is when you wear away the enamel, your teeth get a lot more temperature sensitive. So you may experience pain from hot and cold. That comes mostly from having ground away some of the enamel, but all the other symptoms I’m going to name come mostly from the clenching.

Stacy: Okay.

Lee: So when you clench, like I said, you do damage to the tissue that holds your teeth into your jaw. Your teeth become a little loose or a lot loose depending on how much you’re clenching and how hard. And as they loosen a secondary problem that I mentioned is you start to get bacteria down inside the gum. the joint between the gums and the teeth and you also start to be able to get bacteria all the way down the sides of the root of the tooth to the bottom and you can get bacteria in there that gives you an infection, which dentists would call an abscess.

Stacy: Right.

Lee: And you know, if that’s inside the tooth, you are going to have it drilled out. You are going to have to have a root canal and so that’s one chain of events. Other things that can happen have to do with the nerves.  When you’re clenching hard, you’re putting force not only on your teeth but on your temporomandibular joint. And there’s a major nerve that runs through that joint called the trigeminal nerve.

Lee: And that nerve contains not only pain and temperature nerves but sympathetic and parasympathetic nerves which are nerves that .feed signals out to things that you don’t really have any conscious control of and back again. So for instance, when you pop a piece of food in your mouth you automatically salivate. When you put that food in your mouth there’s actually nerve signals that are going back from your taste buds to your brain and then your brain sends other signals out through this non-pain, non-sensed set of nerves that says, “Okay, release some saliva.” So there’s a lot of nerve fibers in there that aren’t anything that you can feel. Well, when you start clenching a lot, You start sending spurious signals down these nerve fibers into your brain. And those signals can do all kinds of things. Now, nobody has ever traced out the exact pathways as far as I know, that have this happened but It seems to be true that one thing those signals commonly cause is migraine.

Lee: Or maybe just headaches. but in the case of migraines, you would see those flickering light patterns and there would be spear pain and you might get vertigo, so that’s coming from the clenching a lot of the time especially anybody who wakes up with severe headaches in the morning chances are quite good that is it associated with nighttime clenching. And even if that person’s getting headaches throughout the day after that, it could be from all the damage that they’ve done over the night or previous bunch of nights.

Lee: that those headaches are manifesting. So for instance,  one woman that I interviewed who lives up in Canada, was disabled from her government job… for I think 7 years where she had migraines that were so bad in the morning which she couldn’t typically couldn’t get out of bed until around 2 in the afternoon and function and even then she was in quite a bit of pain. So she’d been disabled for seven years.Through biofeedback, after she got her nighttime clenching reduced by  a factor of 10 or 20 or so… Which she was able to do within about a week. Her migraine started to not occur. So I think like, 3 days after she’d been on the biofeedback, she didn’t have a migraine when she woke up and that was maybe the first time in seven years. So the damage does heal.

Stacy: That’s a key thing and that’s worth repeating that the damage that you can do by clenching does and can heal.

Lee: And I can’t say that all of it does but most of it does. So, let’s say you’ve been clenching really hard for years and  you’ve lost a couple teeth and some of your teeth are loose and you’ve cracked  two.. three… tipped some enamel off and you have to get a crown and you’ve had migraines and you’ve had oh well, okay. So maybe the migraines will go away or maybe they’ll get so that they’re way way way little and they’re just mild headaches and maybe your teeth that are loose will tighten up but  If you’ve had severe bone loss from the clenching which is another thing that can happen, some of that will heal and some of it won’t. If you’ve cracked a tooth, obviously the crack isn’t going heal, and maybe you’re going to have to get that tooth extracted and if you’ve had a severe infection and you’ve had to have a root canal, well, okay, that tooth isn’t going to come back…

Stacy: Right.

Lee: So there’s definitely things that you can do that won’t heal but there’s a lot of things that you can do that do heal.

Stacy:  I think actually I’m about to say what you were going to say… which is this is something that can happen very quickly for people. I mean, as your example, she started using the biofeedback device and then almost immediately she felt better.

Lee: Yeah. Usually the healing takes place in days or weeks. Just like the healing that would take place if you got cut or if you upset a bone or something like that. Pretty much all the healing that the body can do will take place within a month or so.

Stacy: Interesting.

Lee: So you may have some stuff left over that doesn’t go away after that but usually, the majority of things that people experience pain from do heal.

Stacy: if somebody came to you and said, I know that I’m clenching and I want to do something about it. What would you tell them?

Lee: Well, I would tell them that there are several things that they could do.

Stacy: Let’s start with the least amount of effort. Like, what are the things that they could do  tonight without buying anything, without preparing much. What are some immediate things that they could do?

Lee:  So if you want to do an experiment on yourself, and it isn’t really a pleasant experiment but if you want to do an experiment on yourself to find out how much clenching it is influencing the pain that you are experiencing, most of the time this experiment will work, it won’t all the time for people. I’ll explain in a second but the experiment is to somehow plug up your nose. And when you plug up your nose most people will sleep with their mouth open and I will say ahead of time that if it’s a dry time of year and you live in a dry place, you’re going to wake up with your mouth so dry and yucky feeling and this is going to be an awful and unpleasant experiment so…

Lee: If you want to try this experiment in a less unpleasant, less ugly way,  get a humidifier and make sure the humidity in your bedroom is high so that you can, not feel like you’re crunching on sand…

Stacy: And of course,  If you have any issues, please talk to your doctor before you experiment.

Lee: Right. The way that people will often accidentally encounter is let’s say that somebody is normally suffering migraines everyday and then they have a severe cold and they sleep for a few days, put their mouth partly open. Most people who are migraine sufferers where the migraine comes from clenching will find that their migraines either get less or maybe aren’t even there on like the third or fourth day of that. So that’s one way that you can experiment. And in fact, there are people on the internet that sell these ebooks that says “The secret to quitting clenching and grinding” and you know, it charges you $37.95 and what you’re really paying for is that one little idea that’s at the end of the ebook

Stacy: Yeah. So we just saved you $37.95.

Lee: Right. And it’s not a good long term solution but it is a good solution to figuring out whether or not you are ginding without you going out and buying anything or doing anything, and this will figure out whether you’re a likely candidate for being helped… To other means that would help you not clench. So let’s suppose you found, okay, I don’t clench because I’m breathing through my mouth and my mouth is getting all dried out and  yes, some of my symptoms do get less. So now I know I’m clenching. So now we look at what kinds of things might I do to clench less. Well, clenching is a habit.  Well, it isn’t a habit in the very beginning… in the very beginning when you do it. It’s probably due to some altered circumstance in your life, maybe excessive stress because you are getting divorced or some trauma that you had a car accident or there are many number of things that can start you on a path of clenching.

Lee: But, once you’ve been clenching for a little while, your brain actually gets addicted to the nerve sensations that come back from the roots of your teeth. It’s just like how kids are addicted to thumb-sucking.  In some way, that predictable nerve sensation is comforting.

Lee: Even if it’s somewhat painful. In your sleep, there isn’t a much differentiation between pain  and whatever it is so…

Stacy: Sensation. Right.

Lee: So it just sustains itself. So the question is, how do we interrupt this habit?

Lee: Well, dentists will tell how you’ll get a mouth guard and you’ll get it from me and it’s really expensive because I custom make it and it’s just super duper. Well, every mouth guard, you know, every design of mouth guard feels a little different in the mouth and for some people, one or another kind of mouth guard will feel different in a way that seems to interrupt the habit. For other people the mouth…

Stacy: Okay. Let’s talk about that some more.

Lee: Okay.

Stacy: So, for some people, just putting something in their mouth that makes their teeth sit a certain way,  maybe sit differently than it was before…

Lee: Plus you have a feeling there in your lips and in your gums. There’s all kinds of nerve sensations there from having the mouth guard.

Stacy: So what you are saying is that it may not be the mouth guard itself that… that is causing the interruption. It’s actually the sensation of having it in your mouth.

Lee: Well, it’s definitely sensation because you only know that it’s there through sensation.

Stacy: Right.

Lee: Sensation changes in a way that happens to not feed your habit or happens to lessen your habit then it’ll lessen your habit. So different mouth guards it may… like there maybe one particular type of mouth guard… I talked to somebody just the other day and he said, “Well, I tried to have hard mouth guard and I actually clenched more on it. I had more clenching in the morning. But then I tried a spongy soft chewy mouth guard and I guess I didn’t like the feel of that and I didn’t clench at it at all.”

Lee:  You can try hard mouth guard for 40 dollars at CVS or you can try a soft mouth guard for 40 dollars at CVS and so for a small amount of money you can find out whether… either one of those help you and…

Stacy: But let me just insert a “buyer beware” here that this is not something that you would want to do for a long period of time… mouth guards can and do change your bites.we actually recommend that the mouth guards you get at the drug store may not be your best option here.

Lee: Oh. Okay.

Stacy: So… It’s something that you want to use for a short amount of time just to kind of test the theory.

Lee: I think we’re totally agreeing on this because if it doesn’t help you then it doesn’t help you and you don’t want to use it anyway…

Lee: …and if it does help you, the reason it helps you is because it makes you not bite on it and if you happen to be one of the lucky people that it makes you not bite on then it won’t change your bite because you’re not biting on it.

Stacy: That would be true.

Lee: So if you managed to get good results from it. You can keep using it and if you don’t, well then, go on and try something else and…

Stacy: And consult your dentist.

Lee:  And beware while you’re consulting your dentist. Your dentist has a huge profit motive involved in that.

Lee: He won’t necessarily give you unbiased advice like there are some dentists out there who consistently, hundred percent of the time, tell their patients, “Look, the $750 mouth guard I can give you isn’t going to work any better for you than what you can get in CVS so just go out and buy one at CVS.”

Stacy:  And other dentists who will only prescribe a certain expensive mouth… mouth guard because they get a piece of that obviously.

Lee: They get a huge piece of it. Like, if you go to a dental show and you look at the booth of the companies that sell mouth guard making materials, they have big signs above their booth that says like, “2nd most profitable thing in all of dentistry…”

Lee: “…total cost only $13 per mouth guard, average sale price $750 per mouth guard.” Those are real numbers.

Stacy: Wow. Wow.

Lee: So the materials in a thousand dollar mouth guard costs about 12 bucks and the technician time to do the mould and everything costs about 25 bucks. If they were MDs it would be against the law for them to do that because it’s against the canon of ethics for an MD to make profit on something he makes for you. Unfortunately, it’s very legal for dentists.

Stacy: Wait. Say that again.

Lee: So, in the canon of ethics of being a Medical Doctor or an MD, an ali… you know, a doctor of allopathic medicine, you have a code of ethics that says that you will not make things for your patient that you sell to them that you make money off of. So no doctor will make you an appliance of any kind and sell it to you at a profit because its against the ethics code of an MD. And yet it’s one of the most normal ways for dentists to make money because their ethics code hardly has anything in it compared to what MDs’ ethic codes have. Dentistry is really built around money in a lot of ways. It’s unfortunate but true.

Lee: You know if you look at Europe,in pretty much any country in Europe, you can get a cavity filled by a dental technician because…

Lee: …it really doesn’t take a lot of skill. While in the US, it’s illegal for a dental technician to fill your cavities because otherwise the prices would get very cheap.

Lee: And you know, the dentists don’t want the prices to get cheap. Now they’ll say…

Stacy: Wow!

Lee: …they’re doing it because of quality but actually there’s no difference in the quality level in Europe than here.

Stacy: And actually, they are even fighting right now because there’s apparently,  this new thing that some dental hygienist want to do which is almost like what you’re saying. A dental hygienist would be able to fill cavities or do some procedures without…

Lee: We’re talking about the same thing.

Lee: That’s exactly what any dental hygienist could do in Europe.

Stacy: Yeah… and they’re fighting to do that here

Lee: Yeah. You got to have more money to put into that fight… the dentists because they’ve been making that money for a long time and they got it stored up.

Lee:  So yeah! There’s a lot of things in medicine that aren’t good for your wallet.

Lee:  The United States tends to lag in those areas. So, we’re back to the topic of what can you do to get out of the nighttime clench. So you can try a mouth guard.  I don’t have a really good firm number on this but I’m guessing that about 1 in 5 people will succeed. They’ll find a mouth guard that actually reduces their clenching, and that’s cheap and if you’re willing to sleep with something in your mouth, that’s a perfectly good solution. I can’t stand sleeping with something in my mouth…

Stacy: Me, either.

Lee: …that feels yucky to me and I don’t want to do it.  But some people actually are really really fine with it. I don’t think you could really kiss somebody once you have one of those things in your mouth but if you don’t have anybody who wants to kiss you and you don’t mind having a plastic glove in your mouth then it’s an okay solution. Now, One more thing that I should say, and this is something the dentist won’t tell you, and most of them,  to be fair, don’t know, but if you put a mouth guard in somebody’s mouth and they do grind on it, well okay, it is protecting their teeth, the mouth guard is softer than the enamel on your teeth so it’s not going to wear off the enamel. It will wear through the mouth guard, eventually.

Lee: The question is, Is the mouth guard toxic? Well…

Stacy: Ooh! That’s a very good question.

Lee: Well, the injection molded ones that you buy in CVS are not toxic. And the hard plastic ones that you buy in CVS that are injection molded are not toxic. So either the soft or the hard ones are primarily very non-toxic. However…

Stacy: As far as we know.

Lee: Yeah, well, I am saying that from like a chemical standpoint of the molecules that are in them that are capable of bonding to anything.

Lee: So, you know, for something to go into your body, to be able to cause you a problem it has to somehow interact with your biology. It has to bond to something in your cells…

Lee:  A completely balanced out plastic that doesn’t have any polymerizers in it or anything or any loose chemical molecules has no bonds available.

Stacy: Okay.

Lee: So, it shouldn’t interact in a biological system. However, there are a lot of plastics that do have things in them. So for instance, an extension cord that you would use to plug in a lamp or some object in your home is made of vinyl and plastic…the same vinyl that old records were made of. Well, the old records are crisp and they’re brittle and they’d break if you’d bend them. And the extension chord is not brittle. The reason that the extension cord is not brittle is that it has a whole matrix of impurities  fused into it to keep it flexible.

Stacy: Oh-Okay. It would almost be like a alloy, a metal alloy, for example.

Lee: Yeah. So a car dashboard is flexible but it’s often made of vinyl, well what makes it flexible is an oil that’s infused through the vinyl matrix… typically, the oil that’s used comes out slowly over the years on hot days it’ll form this haze inside your windshield.

Lee: Well part of that haze is in the air and is highly biologically interactive,in fact,one tiny amount given into the biology system of a human being will cause many many times its weight in estrogen to be produced. It’s an oil that’s biologically active and it’s called an estrogen precursor.  In our environment, high tech materials that we use in our homes and cars have been credited with being one of the major forces that has reduced the age of onset of puberty of girls.

Stacy: OH

Lee: You know, in the 1950′s, girls typically started having breasts at age 12 or 13. Now, a lot of girls start getting breasts at age 9. And it’s happening because of this estrogen produced in chemicals that we’re breathing in and taking…

Stacy: And this is also the whole controversy behind water bottles and . cans.

Lee: Yes, and to be fair to water bottle manufacturers, the levels of the stuff in the water bottles are billions of times lower than the levels of impurities in the car seat upholstery and stuff like that. SO, yeah you could go into a lab and find a few molecules in the water bottle but you know, you sit in a car for 10 seconds and you will have taken in  5,000 times as much as you’ll get from every water bottle you’ll ever drink in your whole life.

Stacy: Interesting.

Lee: ..So, knowing  the amount is important besides just knowing the substance.

Stacy: Right.

Lee: But let’s go back to the mouth guards for a minute.

Stacy: Ok

Lee: They way the dentists make mouth guards, the dentists. say, “Well, we precisely mold our mouth guard to your teeth.”

Lee: Well, there’s two ways to do that. They either will take a mold of your teeth and then they’ll do a vacuum form… thin very thin mouth guard over that in which case that is actually not a very toxic piece of plastic but they don’t sell it for very much because it looks like a very cheap of piece of junk. Or they’ll do a casting mold and they’ll cast acrylic resin into shape that will . meet between your upper and lower teeth and lock into both of them. Well, that’s the most popular type that dentists sell that is very expensive. And it looks..

Stacy: And that’s also the one that tastes really bad. Right?

Lee: And that is the one so when you make plastic by using a resin what you do is you take a bunch of short molecules of plastic and you add a  polymerizer chemical to them which makes them bond to each other and form long chains and makes the plastic harder…

Stacy: Okay

Lee: Well this is the same as when fiber glass is molded for a boat or bath tub or whatever you might make out of fiber glass. So resins are toxic… doubly toxic because the unpolymerized plastic has tangling bonds at the end that can bond into your biological material in your body. Plus the polymerizing agent is highly poisonous. The agent that makes those bonds click into each other. Now what… What the dentist will tell you because he’s been trained to tell you this by the  company that sold him the resin. They say,  ”Well, if you mix them properly, it all gets used up. And what’s left is fully bonded plastic.” And what any scientist can tell you is that it never mixes perfectly, you know. That’s impossible and then the question is, what percentage of that plastic is those two original poisons?

Stacy: Yes

Lee: And I can tell you that chewing on a dental made mouth guard for one night will put more  unbonded molecule ends into your system than drinking from commercial water bottles for ten lifetimes…..

Lee: … massive numbers. It’s bigger by a factor of tens of billions. And it’s a similar thing for mercury based amalgam filling… when they put a silver and mercury filling into your tooth they’re taking mercury and… enough mercury to kill a hundred bull elephants and  silver, and then silver powder and they put it in a shaker and they mix it up and in about. 45 seconds, it becomes rock hard and it’s an alloy at that point and they say, “Well okay, the mercury is fully bonded to the silver.” Well, that was something that you could say and get away with 40 years ago before there were ultraviolet lasers. But if you go out in the street and you’re under a streetlight, if it’s bluish street light, it’s mercury vapor street light so you know what the color of light that comes out of mercury vapor when electrons pass through it is.

Lee: Well, another way you can get mercury vapor to give off light is you can shine ultraviolet through it, and some of the mercury vapor atoms will give off visible light. Well, these days, you can buy ultraviolet emitting diodes for about 20 bucks. I at one point years ago, maybe 5 years ago, went down to  a lab at MIT where I knew a couple of friends of mine had an even more powerful ultraviolet laser and I said, “Can you tell me, if there’s any mercury vapor coming off of my fillings?”

Stacy: hmmmm

Lee: And they shine it through my mouth. And they say, “Yeah, there’s mercury vapor in all of your fillings but one of them has like 10 times as much mercury vapor coming off as the others.” And, they didn’t really measure it quantitatively. They could just see it, you know. They looked at my mouth, they shine the ultraviolet laser in there and you can’t see ultraviolet. So the way you wind up seeing it is you see this shimmering light suddenly appear out of the air above the tooth and that’s because there’s mercury atoms there and they’re giving off light when they’re hit with the ultraviolet. So I had my mercury levels measured and it turns out I had very high mercury in my tissue and  I did a whole detox using the system that the army developed  to detox troops that  have been exposed to mercury in the field…

Stacy: WOW

Lee: And, a lot of my symptoms that I’d been having that made me curious about all of this to begin with which was I had some shaking in my hands. They all went away because I got the mercury out of my system. So anyway, that’s a complete side story that has nothing to do with what we’re talking about but…

Stacy: Hahahaha.

Lee: …but the relevance is the toxic stuff in the dental made mouth guard so…

Stacy: Right.

Lee: I would never buy and put in my mouth acrylic resin mouth guard or any mouth guard that had been made from a resin. I would never do that!

Lee: Because that’s nasty stuff that you’re chewing on. And even if most of it is polymerized and locked into a plastic matrix, not all of it is.

Stacy: Yeah.

Lee: So, a mouth guard is a good way to try and if you find that having the mouth guard in your mouth has you not bite and if you’re using one of the cheap mouth guards from CVS that was injection molded out of a plastic so it never came from a liquid resin, then I think that’s a decent solution for you if you’re willing to have stuff in your mouth. And then the other possible solution is you use nighttime biofeedback to actually measure when you’re clenching your teeth and that’s measured by picking up the signals… the electronic signals that the brain is actually sending to the muscles to have them clenched. And you give yourself some sort of a biofeedback signal. There are two products available in the market that . that will give you biofeedback from a signal like that. One is mine which uses sound biofeedback. There’s also one made in Europe that uses electric shock.

Lee: I would rather hear sound than feel an electric shock so I like mine better but they both work.

Stacy: Hahahaha.

Lee:  What you do is you train yourself during the day on the unit that I make, the sound comes on slowly so it starts really quiet and then it gets louder. You train yourself during the day  purposely that as soon as you hear that sound the slightest way, you train yourself to  relax your face, your jaw and separate your teeth. And if you really want to be effective, you also train yourself to imagine doing that very cooperatively in your sleep and sleeping really well.

Lee: And if you do that training really well, then you’ll be able to respond in your sleep and you’ll be able to  make use of this thing to have sort of effectively reminding you to relax each time it sees you tensing up. And people who train themselves well, they never wake up. from wha–, from the sound because they relax immediately when they hear it.

Lee:  I think that works extremely well for about 75 percent of people.

Stacy: Okay

Lee:  25 percent of the people tend to respond well at first but then gradually start to learn to sleep through the thing and not respond.

Stacy: Interesting Let me think about what to ask next. . . So we’ve covered what is clenching and grinding, how it affects your teeth and your jaw, the symptoms that is causes, . We’ve covered what the possible things you can do about it

Lee: We actually didn’t cover all the symptoms that it causes so I should go back to that. So… There are a bunch of things that people may find that they wouldn’t have any idea, or well, maybe some people wouldn’t have any idea that a migraine’s related either. But there are others. So for instance, neck pain and… and lower back… pain.

Lee: …are common results of clenching in your sleep. Exactly how that happens? I would be guessing if I told you and I’m not sure that anybody knows the answer as a hard fact of exactly what the path of nerve signals is and stuff. But a lot of people report that they had back pain that they felt was completely unassociated with their clenching. And that the back pain went away when they stopped clenching.

Stacy: If I could have a guess, I would assume that it’s because referred… Well, not just referred pain but also like if you clench your teeth and I’m doing it as I’m talking to you to kind of… figure this out like… your neck hurts then it goes down to your shoulders, to your trapezius muscles and it can go further and further and further I would assume.

Lee: I don’t know whether that’s a muscle tension or whether it’s nerve signals or whether it’s both, but I do know that a lot of people find that something that they thought was unassociated that turns out to be associated… Oh I have this twisted back because i have bad posture or whatever but then they stopped clenching their teeth and they find, “Oh, the pain in my back also went away.” So it is for a lot of people related and then there are conditions like Tinnitus We have ringing in the ear… that can be associated with clenching. Now, I’ve found that for people who have done damage to their nerves such that they get  Tinnitus, sometimes it lessens substantially when they stopped clenching and sometimes it doesn’t.

Stacy: OK

Lee: So that one’s nowhere near as well correlated as the migraines.

Lee: or as heal-able but I have heard cases where it does heal. And then another one is vertigo.
And another thing that I’ve heard some people say is related although again, I haven’t heard a case where it totally went away when somebody stopped clenching is the level of pain in Fibromyalgia can become less when you stop clenching. But I think for most people that have Fibromyalgia, stopping the clenching doesn’t actually make that go away.

Stacy: Well, i think it’s important to kind of look at this as a whole and say that it’s really easy as a patient when you start having jaw pain or headaches or any one of these symptoms to… to panic because you don’t know why…  is this going to be forever? It really affects your life and you don’t want the pain. You do not want it. And I think what we’ve kind of covered here is that, number one and what we cover everyday at TMJ hope too, is that there are small things that you can do to make yourself feel better that add up to big changes and so I think it’s really important that people think about that and think about what are the little things that you can do today that will help you feel better tomorrow? Instead of, “Oh my gosh! What am I going do?  I’m going to be like this forever”

Lee:  And another thing is that when you get into that state of mind, this “Oh my! What am I going to do?” It probably actually makes the clenching worse for most people.

Stacy: Yes. Definitely!

Lee: Because having that level of fright and doom and gloom in your system tends to accentuate  this kind of self-soothing kind of habit. Whether it’s nail-biting or sucking on your thumb or clenching your teeth.

Lee: You did mention at the beginning of the phone call that you want me to address the question of well, can people completely get out of the habit?.. once they’ve started it.

Stacy: Yeah. So since we’ve talked about all of the thing you can do to help make your pain better, is it possible for people to completely stop grinding or clenching?

Lee: Yes it is but not for a very large fraction of the people who have the habit. So if you had the habit only  for instance, for a couple of months… habits actually get built into your neurology. They actually exist as connections between neurons in your brain and the more they… the more those connections are used, the more they strengthen and the longer they last.

Stacy: Right.

Lee: We are built as human beings to benefit from habits so you learn to drive a car pretty much by habit. When you first are driving, you need pay constant attention to lots of different things and… and later on when you’re a skilled driver, you don’t have to pay conscious attention to all those things because they’ve been made into habits.

Lee: Some of those habits would be… Well, okay, I see, I’m moving along and my eyes see red lights come on the back end of a car and I’m only 20 feet away from the car, well, I will have the habit of stepping on the brake.

Stacy: Okay

Lee: And that’s a good habit. That’s very useful.

Lee: And you wouldn’t want to lose that habit.  And that habit is so ingrained in people that if they’re in a passenger seat in a car and the driver doesn’t step on the brake early enough a lot of us will stomp our foot on the floor even though we’re not driving and there’s no brake

Stacy: Right.

Lee: So the habit’s getting grained and once they’re really ingrained, you can count on it that there’s always going to be in there at some level. Even if they’re not dominating, they could come back.

Stacy:  The other question is… does it even matter? Like if what you said is true before that you can… or I think you said this that you can eradicate a large percentage of your clenching and grinding and you can feel better then does it even matter that it is still there?

Lee: Well, it doesn’t matter from point of view of you being in pain but it does matter from the point of view of your convenience, whether you will have to use an appliance at night when you go to sleep, you know. But I don’t think that’s a big matter but you know. If people tend to sometimes search for the ideal solution

Stacy: It’s very true. Yes

Lee: I would say a lot of the time when we are stuck in a condition and we say we’re searching for the ideal solution, part of what’s going on is that part of our identity has become that condition.

Stacy: True.

Lee: And there’s a part of us psychologically that doesn’t really want to change it because we don’t know what our life would be like if we changed it.

Stacy: Definitely.

Lee: I don’t think anyone would consciously say that most of the time, but I think that’s always a component. So people will either for real or somewhat fooling themselves, be searching for the ideal quick and easy fix.

Stacy: Yes

Lee: Well, there isn’t an ideal quick and easy fix for a habit. You know, that’s like saying, “Well I’ve got a habit of overeating and I’m just going to wait and be really sad for 30 years and hope that somebody invents some tiny little pill that I can just take once and suddenly, I’ll be skinny.”

Stacy: Right

Lee: You know, which isn’t going to happen because it’s a habit.

Stacy: And we all know that we should be doing things that we’re not and that’s because of habits. And the only way to really overcome that, at least in my experience is to take action. I mean, you have to look at what you have in front of you, the different options and pick one and try it. Because you know if you’re just going sit there you’re not going to get better and… and so, the only way to get better is by actually trying some of these things and trying to figure out what works best for you.

Lee: Yeah! In reality, each time you get a little bit better, you will be happier and you will be really glad you did it.

Lee: And you will find things that work. It’s not that unlikely that you’ll find things that work. It’s extremely likely that you’ll find stuff that works.

Stacy:  It’s very very likely and I think that when I find people that. That have gotten stucked, it’s that they tend to… to really… they’re not open-minded that… that they will find something. They… They take their previous failures and you use that as a reason not to try something else because they might fail again. And yes, you might but you also might feel better.

Lee: And it’s also that psychological condition plays into where if part of my identity is that my case is hopeless, you know.

Stacy: Yes!

Lee: Or as Eckhart Tolle says…”The power of now.”

Stacy: Right.

Lee: You know, suppose you’re sick now and you start to identify yourself as… well, “I am a sufferer of such and such disease.” and it goes great, now we know who you are. You know?

Stacy: Yeah.

Lee: That’s not who you are, you know. It’s just something that at the moment, your mind has latched on to as part of an identity and unfortunately, it’s a rather unhelpful part of identity.

Stacy: Yeah I think  the other person that talks a lot about that is  Byron Katie… She talks about what is your story and what it is that you repeatedly tell yourself and where would you be without it.

Lee: Exactly!

Lee: …realize that they would still be all of the wonderfulness that they are without it. And then pretty much none of the good stuff in their lives comes from that story. We all do have good stuff in our life.

Stacy: True.

Lee: So you had asked the question, what can you get out of the habit? Well, if the habit hasn’t been established for very long, it doesn’t really exist very noticeably as neural connections in your brain yet. So people who have used biofeedback, and I am one of those people so, I had invented my device to help friends that I have who has  teeth clenching problems and I had not needed to use it myself until about 5 years later when I went through my divorce. And one morning I woke up and my jaw was sore and the next day I wore the thing in silent mode to measure how much . clenching I was doing. And I was doing like 60 seconds of clenching a night which I had it reasonably wanted it to have in silent mode when I first made it to find out what . percentage of… what amount of clenching somebody who’s not a clencher does per night. And I had about 3 seconds…

Stacy: Oh wow!

Lee: …and here I was up at 60 seconds and my jaw was sore. So I wore the thing for a month every night and the habit completely went away and it never came back.  So, yes, you can get rid of it if you haven’t had the habit very long. And I’ve had conversations with people who have had the habit only in a few months and in four, five months of use of biofeedback, they’ve been able to completely get out of the habit and have it never come back. But for people who have had the habit for years, that is not going to be a possibility most likely. I haven’t seen it be a possibility for anybody yet. But what is a possibility is that you can use biofeedback for let’s say a couple of months and get your clenching level down to an extremely low amount and maybe you could go a month without using it before you could notice any soreness coming back. And some people prefer to do that rather than use the device all the time. They prefer to have some time off. You know, whether it’s a week, or a month, or whatever and… And a lot of them have managed to do that. So there’s some sort of continuum spectrum from people who have… only had the habit for a couple of months who are able to completely get out of it to at the other end of the spectrum, people who’ve had the habit for seven years and it’s really severe and they decide, once they get themselves completely out of pain, they just decide, “Hey, if I can use this biofeedback every night, I don’t care, it doesn’t… it makes my sleep better because I don’t wake up from pain from clenching and so, who cares that I’m wearing this band on my head. It doesn’t bother me, I can sleep.” So that… that’s the whole range.

Stacy: So, Why don’t you tell people how they can try your device.

Lee: Ah. Well if you live in the United States I’ve actually made it free for people to be able to try it.

Stacy: Okay.

Lee: And I don’t mean a money back guarantee, I mean you actually don’t get charged anything when you order it. Your credit card doesn’t get charged for 25 days so you order and it gets delivered to you a few days later and you have 3 weeks to see how well it works for you.Usually, within one week you will know whether it’s working well for you or not.

Lee: So, if you find that it’s working great for you, you just keep it and then  you get charged for it at the end of the 25 days and if you find if it’s not for you, either you’re somebody who can’t sleep comfortably with it on your head or you know, it worked for you for the first few days but then you started clenching more again  then you can call me up and get a return authorization number and just send it back and you’ll never even get billed for the shipping of when I sent it to you which… It’s really not costing you anything to try. Well, I guess it does cost you the… the 5 dollars that’ll cost if you send it back… the shipping…

Stacy: Wow!

Lee: …but it’s cheap. And…There was something I was going to add to that. Oh!  If you try it and you had some specific unusual problem like there’s a small percentage of people that are extreme deep sleepers and they find that even at the loudest setting, this thing doesn’t register for them in their sleep and they can’t learn to respond to it. I do make a louder unit that has an earphone on it that I will upgrade some into that for free if  they want to try it and the other one hasn’t work for them. And there’s a few other variations like that. I mean, there are some people, let’s say they’ve had botox injections on their temporalis muscles and so they can’t pick up the signal so they can’t set the thing off. Well, I do make  an external set of sensor pads that you can use to sense your masseter muscles instead  of your temporalis muscles so…

Stacy: Interesting.

Lee: If it works for you great right out of the box, fine. If it doesn’t, you can call me up and I can tell you what the options are to see if one of these various  slightly altered units will work for you and so for about somewhere between 50 and 75 percent of people where the original unit doesn’t… doesn’t do it for them, one of the alterations will do it and if that doesn’t do it, then you just return it and it doesn’t cost you anything.

Stacy: Cool. Sounds great!

Lee: As far as I know, there is no other dental appliance or biofeedback device in the world that offers that, you know. You just have to buy them.

Stacy: Right.

Lee: . But I figured, people have been through so many things that they’ve tried that haven’t worked you know. Let it be free to try.

Stacy: Sure. Yeah yeah Definitely! Well I hope that  those of you who are listening or reading  and maybe think that you clench or even if you don’t know. This would be a great way to find out and…you can try it for free, so… that’s awesome!

Lee: There’s another thing we didn’t go over that maybe  would be of interest to people and I think I put those in a thing I wrote up that you might put up in your website, and that’s how much clenching did people do at night, and the answer is that people who experience pain from their clenching typically do between 15 seconds and 300 seconds of what I called damaging clenching per night. And damaging clenching is the part of any clench that lasts longer than 2 seconds. So if I did four second clenches then each one of those clenches would have lasted 2 seconds beyond the first 2 seconds which is the non-damaging part. So I would’ve done a total of 8 seconds of damaging clenching in that case. So like I was saying at the… at the beginning of this interview, the initial part of the clench… the . thixotropic tissue is acting like a rubber shield…

Lee: …and it’s protecting you. It’s part of the clench that comes after the first 2 seconds that’s really the problem. So the total amount of damaging clenching that somebody who experienced pain typically does is somewhere between 15 seconds in a night and 300 seconds in a night.

Stacy: Wow!

Lee: And the people that are up at 300 seconds, they’ve lost multiple teeth, they are in extreme pain and they’re living with migraines all the time and it’s like this wide spectrum.

Stacy: Ha! Interesting. I think that’s a lot of really good information and will definitely  help people. So, thank you for that.

Lee: You’re welcome.

Stacy: What is your website? So people can visit it.

Lee: Oh! It’s  Stopgrinding.com

Stacy: Well, thank you Lee.

Lee: My pleasure

According to research, there are differences between men and women when it comes to chronic pain. Women experience pain more intensely and more often than men. Females also respond to pain management differently, and their pain is not only often under-treated, it is treated less aggressively than their male counterparts. In a recent study it was revealed that doctors were 22 times more likely to recommend knee surgery for men than they were for women, even though the surgery is considered a definitive way to treat arthritis when other therapies have failed.

• One study indicated that women are more likely to be given sedatives for their pain, while men are more likely to be given pain medication
• Another study shows that women are less likely than men to be referred to a specialty pain clinic, at least upon initial encounters with their physicians
• A study reviewing cancer care at seven outpatient clinics in California found that female cancer patients were prescribed half the pain medication as male patients with the same pain intensity score
• According to an analysis of recent pain research, women are more likely than men to seek treatment for their pain and are less likely to receive it. Physicians may treat women less for pain based on the presumption women can handle more pain or, conversely, that women are in fact imagining pain where none exists.
• An FDA study of 185 drugs approved between 1995 and 1999 found that (despite the fact that 37 of those drugs have known gender-specific differences in interactions) there were no dosage differences based on sex.

Why does this bias occur?

• Our culture often encourages women to express pain, and men to hide it. But this does not mean that friends, relatives — and doctors — react sympathetically to women’s expression of pain.
• Men often communicate their pain in ways that doctors understand. (Perhaps this is because there are more male pain physicians than female pain physicians). Physicians may view women’s statements as emotional, rather than objective.
• Women are more likely to have chronic pain conditions that are more difficult to diagnose and treat. (TMJ Disorder, fibromyalgia), and in many cases these are treated as mental or hormonal rather than as a disease or disorder.
• Physicians are often quick to assume either that women can handle more pain or that they are exaggerating the level of pain they experience

•  Talk to your physician about your pain management. Be assertive, you do not have to accept under-treated pain.
• Maintain a pain record. Note location, time of day, severity, what you were doing at the time and what relieved the pain.
• Make sure that before you leave the doctors office that you understand the medication prescribed. If you have any questions, consult with the pharmacist when filling the prescription.
• Find a new doctor if at any time you feel that your pain is not be treated adequately or you are uncomfortable in your patient-doctor relationship.

Do you have Bruxism???

• Examine your teeth in the mirror, look for any worn lower or upper teeth.
• Run your tongue over the upper and lower teeth to check for sharp edges and rough spots.
• Do you regularly wake up with headaches on the sides, the front, and/ or back of the head?
• Do you have chronic neck stiffness and or pain in the neck when you wake up?
• Do you have tooth pain that comes and goes?
• Has a family member heard you grinding in your sleep?
• Do you have difficulty chewing foods?
• Do your gums bleed?
• Can you wiggle any of your teeth with our fingers or tongue?
• Do you clench during the day?
• Do you have jaw pain?
• Are you under a lot of stress?

Medications For Bruxism
It is believed that bruxism is mainly a stress response, therefore treatment has been focused on relieving the anxiety through the use of stress management and behavior modification. Mouth guards are also commonly used. Current research indicates that some medications are effective in reducing teeth grinding. These medications include:

• BuSpar
• Inderal
• Neurontin
• Amitriptyline

It is important to note that there are some medications that can be directly attributed to bruxism. These medications include:

• Effexor
• Haldol
• Luvox
• Paxil
• Prozac
• Zoloft

Do you have bruxism?  What has helped you?

• 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.

referred pain

Do you have any of the following symptoms?

• Ear pain, a feeling of stuffiness and or ringing in the ears?
• Dizziness
• Shoulder or neck pain?
• Pain behind or above the eyes?
• Headaches, or pain (mild or severe), that may start in the front of the head, along the sides, in the upper part of neck, or pain that radiates to all areas?

Did you know that approximately 20% of the input to the brain comes from the spinal column? The other 80% comes from 12 sets of cranial nerves that control taste, smell, hearing, vision, inner ear function as well as autonomic control of the organs ( not under voluntary control)  and blood vessels of the body. Out of that 80%, more than half of the input to our brain comes as a result of the 3 branches of the trigeminal nerve. The 3 branches are involved with these functions:

• Chewing
• Swallowing
• Eyes
• Ears
• Sinuses
• Teeth
• Talking
• Breathing

It is easy to understand when looking at the two lists above how referred pain or symptoms can occur.

The temporomandibular joint has a close association with the trigeminal nerve, and because symptoms of TMJ disorder frequently are referred to surrounding structures instead of the actual joint they may not be associated with the condition. (such as… feeling like you have an ear infection, but the ENT can’t find anything wrong with your ears, and it never occurs to him/her that it may be TMD)  This is why TMJ Disorder is often called “The great impostor”

There is another source of referred pain from the jaw, and that is a trigger point. A trigger point is an abnormally sensitive spot on a muscle that goes into spasm. In a normal muscle, the fibers contract and relax causing the blood to flow through. In a trigger point the muscle stays contracted leading to a lower blood supply, which in turn causes the tissue to have less oxygen and an accumulation of waste. Trigger points can create referred pain to the muscles of the face and neck as well as surrounding muscles, making it difficult to pinpoint where the pain is originating from.

Do you have referred pain? If so, what helps you?

If you are like most patients, you have been to the end of the internet and back looking for information about TMJ disorder. You’ve searched most of your symptoms, all of the potential treatments you have heard about, any medication your doctor has recommended, etc. You’re looking for helpful information written by patients that have been through it.

Is it possible some of the websites you’re reading about TMJ disorder could be leading you down the wrong path?

How do you tell if a website has ulterior motives? I’ll give you five tips that should separate the sites that have legitimate information from the sites that are just trying to pry you away from your hard earned cash.

1. It’s hard to find any information about the author and his or her reasons for creating the site.

Is there a picture of the author(s)? Are they active on the site, answering questions or at least thanking the readers for commenting? Why did they create the site? What is in it for them?

For example, here on TMJ Hope, it’s quite clear who I am and why I created the site – I’m a patient, and I’ve created the site because so many patients need support and information. I don’t make any money off of the website – in fact, I spend my money to maintain it.

2. The articles seem to address popular topics but don’t actually provide any answers. The website never mentions the latest science or talks about research.

You notice that the articles seem to address all the burning questions that TMJ disorder patients have,  but yet they answer very few (if any) questions. The articles seem like they are being written by someone who either a) doesn’t have TMJ disorder or b) is dumbing down the articles.

3. There are strategically placed links that link to websites attempting to sell you a $37-$67 “system” for “curing” your jaw pain.

4. The articles all interlink to each other in a confusing way that makes it hard to find your way around the website. It’s like a maze that never ends, and you can never find your way home.

5. The site makes claims that seem too good to be true. It promises quick results, and they are unique results – meaning, it’s hard to find other sites making the same claims.

The infromation seems obscure, and the dramatic miraculous results with breakthroughs, secret ingrdients

Does the site make health claims that seem too good to be true? Does the information use deliberately obscure, “scientific” sounding language? Does it promise quick, dramatic, miraculous results? Is this the only site making these claims?

• Beware of claims that one remedy will cure a variety of illnesses, that it is a “breakthrough,” or that it relies on a “secret ingredient.”
• Use caution if the site uses a sensational writing style (lots of exclamation points, for example.)
• A health Web site for consumers should use simple language, not technical jargon.
• Get a second opinion! Check more than one site.

ADA- The American Dental Association

ADHESION- An adhesion is a band of scar tissue that binds together two anatomic surfaces which are normally separated from each other.

ANKYLOSIS-  Ankylosis refers to the partial or complete inability to open the mouth which results in functional and growth deformation of the mandible.

ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION – Dislocation of the disc away from its normal position to a position in front of the condyle.

ANTERIOR DISC DISPLACEMENT WITH REDUCTION – A condition similar to the above, however enough integrity of the ligaments is maintained, that the disc is repositioned normally over the condyle in certain positions of the mandible

ANTI-INFLAMMATORY- Drug that reduces swelling.

ARTICULATE- To join or connect together loosely to allow motion between the parts.
To unite by forming a joint or joints.

ARTHROCENTESIS- TMJ arthrocentesis is a surgical procedure done on the temporomandibular (or jaw) joint.  It is considered a minor procedure, and is generally performed in the oral and maxillofacial surgeon’s office or in an outpatient surgical center.

ARTHROPLASTY- The arthroplasty, or sometimes called arthrotomy, is an open joint surgical procedure performed on the jaw joints under general anesthesia in the hospital. The incision is made similar to a face lift incision (along the ear), and the joint space is exposed for the surgeon to see. This allows for the removal of adhesion‘s, osteophytes (bone spurs), fibrous or bony ankylosis (fusion), tumors, etc. The surgeon can also repair the discs by suturing them into place or implant anything from a temporalis muscle graft to ribs.

ARTHROSCOPY- The arthroscopy is more involved and invasive than TMJ arthrocentesis. This procedure is almost always done in the outpatient facilities (or day surgery) at the hospital. A small scope (camera) is used to take a look inside the temporomandibular joint. Some surgeons will not only look inside, but may perform other procedures like suturing the discs in place, or removing loose scar tissue.

ARTICULAR EMINANCE RE-CONTOURING-Surgical procedure used to reshape the ball in the joint.

BALANCED OCCLUSION- Occlusion in which the teeth are in harmonious working relation.

BIOFEEDBACK- A method of treatment that uses monitors to feed back to patients physiological information that they may not be aware of. By watching the monitor patients can learn by trial and error how to adjust their thinking in order to control “involuntary” bodily processes such as blood pressure, temperature, and brain wave activity.

BRUXISM- Bruxism is the act of clenching and grinding teeth. This may be voluntary or involuntary. (subconsciously).

CARTILAGE- Firm, rubbery tissue that cushions bones at joints. A more flexible kind of cartilage connects muscles with bones.

CAT SCAN- (Computed axial tomography). A type of x-ray which uses computer technology to generate a 3 dimensional model of the area being examined.

CEPHALOMETRIC XRAY- Also known as a ceph, it is a diagnostic radiograph used primarily for orthodontic treatment planning. It provides a view of the patient’s airways, which can help with suspected sleep apnea.

CHRONIC PAIN- Pain lasting 3 months or more, may come on slowly or suddenly.

CLASS I MALOCCLUSION- A malocclusion where you bite is ok (your top teeth line up with your bottom teeth), but your teeth are crooked, crowded or turned.

CLASS II MALOCCLUSION- A malocclusion where your upper teeth stick out past your lower teeth. This is also referred to as an “overbite” or “buck teeth”.

CLASS III MALOCCLUSION- A malocclusion where you lower teeth stick out past your upper teeth. This is also referred to as an “underbite”.

CONDYLE- a “ball” which fits into a socket

CREPITUS- A medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints. With or without associated pain.

DDS- Doctor of dental surgery equivalent to DMD.

DEGENERATIVE CHANGES- Break down and irregularities of bone.

DEGENERATIVE JOINT DISEASE- Also known as osteoarthritis. Also called degenerative arthritis.

DISC- Circular pieces of cushioning tissue situated between two bones. Each disc has a strong outer cover and a soft jelly-like filling.

DISCECTOMY- Surgical removal of a disc that cushions the joint.

DISC RECAPTURING DEVICE- An orthotic which is used to assist in repositioning the disc to its correct position above the condyle.

DISTAL- Away from the middle of the body.

DMD- Doctor of medical dentistry equivalent to DDS.

DYSFUNCTION- Difficult function or abnormal function.

ELECTROMYOGRAM (EMG)- A computerized system for determining electrical activity within specific muscles of the head, face, and neck.

EQUILIBRATION- Grinding down of a tooth surface to correct the bite. May need to be periodically redone or touched up to account for tooth wear and drifting.

FIBROMYALGIA- Chronic condition characterized by extreme fatigue and widespread body ache that affects the body’s soft tissue…the muscles, ligaments, and tendons.

FUNCTIONAL ORTHODONTICS- Functional orthodontics involves the use of custom-fabricated dental appliances and or braces to move the teeth into proper alignment in order to preserve the health of the temporomandibular joints and jaw muscles.

GLENOID FOSSA- The socket within the temporal bone of the skull which forms the roof and side of the temporomandibular joint

INFERIOR- Below

INTERNAL DERANGEMENT- Mechanical fault that interferes with the smooth action of temporomandibular joint. It is associated with a displaced disc, a dislocated jaw or injury to the condyle.

JAW- The bones below the mouth (mandible) and the bone above the mouth (maxilla).

JOINT- A joint is the area where two bones are attached for the purpose of motion of body parts. A joint is usually formed of fibrous connective tissue and cartilage.

JOINT VIBRATION ANALYSIS (JVA)- Records the vibrations made by joint tissues during movement. JVA records vibrations, not sounds.

LEVATOR SCAPULAE MUSCLE- Skeletal muscle that is situated at the back and side of the neck. It’s main function is to lift the scapula or shoulder blade.  

MALOCCLUSION- Misalignment of the upper and lower teeth when the jaw is closed and their surfaces come in contact. The condition may also be referred to as an irregular bite, crossbite, or overbite.

MANDIBLE- Bone of the lower jaw.

MANDIBULAR DYSFUNCTION- another way of saying temporomandibular joint dysfunction

MASTICATORY ELEVATOR MUSCLES- The muscles which close the jaw

MASTICATORY MUSCLES- The muscles involved most directly in the function of chewing.

MAXILLA- Major bone of the upper jaw.

MEDIAL- Towards the middle of the body.

MRI- Short for magnetic resonance imaging. The use of nuclear magnetic resonance to produce images of the molecules that make up a substance, especially the soft tissues of the human body. Magnetic resonance imaging is used in medicine to diagnose disorders of body structures that do not show up well on x-rays.

MUSCLE SPASM- A sudden involuntary muscle contraction.

MYOFASCIAL PAIN- A regional aching pain associated with localized tenderness in firm bands of muscle and tendons (trigger points).

MYOFASCIAL RELEASE- A specialized massage technique employed to treat a variety of chronic disorders in which the muscle tissue is stretched and manipulated to relieve tension in the fascia. (the thin tissue covering the muscle fibers).

NIGHT GUARD- A device similar to a retainer which separates the teeth and often relaxes the muscles which position the jaw.

NSAID- Nonsteriodal anti-inflammatory drugs such as aspirin and ibuprofen which decrease pain and inflammation.

OCCIPITAL- Back of the head.

OCCLUSAL GUARD- Also known as a night guard or bite guard. A removable appliance designed to minimize or eliminate the damaging effects of clenching and or grinding (bruxism)

OCCLUSAL ORTHOTIC DEVICE- A mouth splint used to realign the teeth and reposition the jaw into a more functional position.

OCCLUSAL SURFACE- The chewing surface of the back teeth.

OCCLUSION- The science of the bite. The relation of the teeth of both jaws when in contact during activity of the mandible.

OPEN BITE- A malocclusion in which the teeth do not close or come together in the front of your mouth.

OPIATE- Any narcotic analgesic derived from the opium poppy, such as morphine.

ORAL AND MAXILLOFACIAL SURGEON- A dental specialist who manages the diagnosis and surgical treatment of diseases, injuries and deformities of the mouth and supporting structures. Requires 4 additional years of training after dental school.

ORTHOGNATHIC SURGERY-This is the type of major surgery which deals with the cause and treatment of malpositioning of the jaws. The surgery is usually carried out to alter the position of the dental arches and/ or the supporting structures, and is frequently done in combination with orthodontic treatment.

ORTHOTIC, ORTHOSIS, ORTHODIC, APPLIANCE- Splint used to treat TMJ disorder.

OSTEOARTHRITIS- A type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints.

OSTEOGENESIS- The growth of new bone.

OSTEONECROSIS- Dead or dying bone.

PANORAMIC XRAY- A large, single xray film that shows the entire bony structure of the teeth and face.

SCALENE MUSCLE- Any of the 3 muscles on each side of the neck that serve to bend and rotate the neck and that assist breathing by raising or fixing the first two ribs. 

SPASM- A brief, automatic jerking movement. A muscle spasm can be quite painful with the muscle clenching tightly. Spasms in various types of tissue may be caused by stress, medication, over-exercise, or other factors.

SUBLUXATION- An incorrect movement or a position of bones resulting in abnormal and detrimental nerve pressure.

SUPERIOR- Above

TEMPORAL BONE- A large irregular bone situated at the base and side of the skull. The temporal bone is connected with the mandible via the temporomandibular joint.

TEMPORALIS MUSCLE- A large facial muscle located near the temple.

TEMPORALIS MUSCLE GRAFT-  A surgical procedure where a piece of your  temporalis muscle is slid between the joint to prevent it from being bone on bone.

TEMPOROMANDIBULAR JOINT- The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head.

TEMPOROMANDIBULAR JOINT DISORDER- This is a catch all term for anyone who is having pain in their TMJ. It may be due to a tooth related problem, a muscle spasm, or arthritic or degenerative changes in the joint itself.

TINNITUS- Tinnitus is most commonly referred to as ‘ringing in the ears’ and can be defined as the conscious experience of noise with no apparent external source.  Tinnitus can vary in the way it sounds, its severity, as well as its annoyance. Ringing, chirping, or even clicking sounds may occur a few times a month or many times in one day; for a few moments or hours; or can even be constant.

TOMOGRAPH- A special type of x-ray which shows “slices” of sections of bone, thereby allowing a more detailed evaluation of the structure than could be obtained with plain film x-rays.

TRIGEMINAL NEURALGIA- A painful condition that generally affects the face unilaterally (one side). Characterized by brief shock-like pain that can occur without stimulus. Pain is usually brief and severe and does not cross to the opposite side. However, 3 to 5 percent of patients may be affected bilaterally.

TRIGGER POINT- A trigger point is simply a small contraction knot in muscle. This knot feels like a pea buried deep in the muscle, and can feel as big as a thumb.

TRIGGER POINT INJECTION- The use of local anesthetics and other medications to bring about healing of painful muscles and other structures. The pain from these areas is commonly felt at distant sites. (referred pain).

Orgain is an organic ready-to-drink protein shake that was formulated by a doctor to be the first of its kind on the meal replacement market. Based on what I’ve seen of these types of products, it is unique- it’s organic, nutritious, convenient, and worth a try if you are in search of a protein supplement or meal replacement. I tried Orgain in Creamy Chocolate Fudge and Sweet Vanilla Bean flavors.

The first thing that strikes me about this product is how convenient it is. The Orgain drinks are stable at room temperature, and seemed to have survived what was likely a very warm trip on a delivery truck. I’ve been trying some other protein powders that I mix with water or milk in a blender bottle, but Orgain is much more convenient as it is premixed and portioned out, and can be kept out or chilled in the fridge. It is also nice to just be able to grab one and go in the morning or for lunch (or, bring a few in to keep in the fridge at work!)

My biggest concern with meal replacement shakes in general is that I like to eat! Sometimes the thought of just drinking something in place of eating a meal is enough to keep me away- especially since if I drink one, I might still end up eating anyway. But I had one the other morning in place of breakfast, and I was surprised at how full it kept me. One Orgain drink and a banana kept me full until lunch, which is a rare occasion for me regardless of what I eat for breakfast!

Each Orgain drink box has 255 calories, which is a reasonable amount if you use it as a meal replacement, or even to use in between meals or after a workout. It contains 16g of protein, and has a 2:1 ratio of complex carbs to protein (great for energy and building muscle). The ingredients include several organic vegetables and fruits (this may be the only time I’ve ever had kale!) and tons of vitamins. It’s gluten free, preservative free, and caffeine free, but does contain soy and some lactose for those of you that need to avoid those ingredients. If you aren’t able to eat a healthy meal, or are looking for a protein supplement, this is a great option as it provides tons of nutrients in addition to protein and calories alone.

The price seems to be  about $2.50-$3 per box in stores, but they are sold at limited retailers. Amazon does have a good Subscribe and Save price at about $28 for a box of 12. I just ordered a case of the chocolate on Amazon to use when I start my splint therapy in a few weeks!