Treatment of TMJ, jaw clenching, teeth grinding.
Written by M. Kyu Chung, MD
Jaw clenching, teeth grinding and subsequent TMJ pain is often a difficult clinical condition that is poorly managed. We at the Chung Institute have found an unexpected simple solution to this condition. This treatment often is cleared with only one simple tiny injection of a local anesthetic.
Individuals sometimes complain of chronic tendency to clench their teeth or grind their teeth at night. This chronic behavior results in damage to the teeth either by wearing down the surfaces of the molars or even cracking their teeth or injuring the roots. It can result in chronic spasm and tightness and shortening of the masseter muscle (chewing muscle). This shortening of the muscle impairs the jawbone from gliding forward properly when they open their mouths and puts considerable pressure on the temporomandibular joint (TMJ) causing it to make clicking noises as wells chronic irritation to the joint resulting in arthritis and pain in the joint. It also can prevent full opening of the mouth.
Chronic clenching can also cause the jaw muscle to become too large and give the person a square jaw appearance.
The current standard methods of treatment do not address the cause but try to ameliorate some of the symptoms. Here are some of them.
- Dental splints or night guards. These do nothing to prevent the clenching but may help prevent the wear and tear on the surfaces of the teeth. Some custom night guards can be quite expensive.
- Trigger point injections to the masseter muscles. This can temporarily relax and lengthen the shortened muscle for up to a month or so. This is the method we employed for many years, but it rarely “cured” the problem of grinding and subsequent recurrence of the symptoms.
- Botox injections to the masseter muscles. We have employed this method with what we thought was great success. The recurrence rate occurred less frequently, but patients still required repeat treatment 2 to 3 times a year.
- Pros: it shrunk the size of the masseter muscle and narrowed the appearance of the widened jaw so women who had a square jaw liked the appearance of a narrow appearance of the jaw.
- Cons: it required a fair amount of botox and hence would be costly. (We charged $500; most dermatologists charged much more). It still did not address the cause and therefore required periodic retreatments.
Breakthrough in treatment:
We came across this treatment by accident. We have found that injecting the tongue frenulum with simple novocaine or lidocaine instantly caused a reflexive long lasting relaxation of the masseter muscle. But more surprisingly, the treated patients found that they no longer grinded their teeth. Furthermore, only a third of the patients required a retreatment due to a recurrence.
We have treated over fifty consecutive patients with greater than 95% success. These successful patients no longer needed night guards. More than 50% required only a single treatment.
Additionally, many patients also noticed that their chronic neck tightness disappeared as well.
There is no conventional explanation for why this works. In acupuncture theory the point where the frenulum attaches, is where the stomach point is located on the surface of the tongue. A branch of the stomach channel runs right over the region of the masseter muscle. Hence, a disturbance in the stomach channel could likely disturb the masseter muscle. In neural therapy, irritating nerve foci from abnormal scars can cause severe myofascial dysfunction. The frenulum acts in a similar fashion but without a previous history of scar or injury.
If you are someone who suffers from chronic jaw clenching, and/or restricted range of motion of the jaw, pain in the TMJ (Temporomandibular joint), you may have an abnormal tongue frenulum which may be causing this problem. Many years of suffering from this condition can often be resolved with this surprising nearly painless simple procedure.
Conclusion:
We have found that more than 90% of the patients who complain of jaw clenching, jaw tightness, jaw pain has an abnormal ART testing of their frenulum and a simple tiny injection of a local anesthetic results in either out right cure or long-lasting relief. See video example.
Note to medical practitioners:
For those rare doctors who know how to perform ART (Autonomic Response Testing)
- Palpate the patient masseter muscle and test for “blocked regulation” (almost all patients with problems with TMJ and/or jaw clenching will show abnormal blocked regulation in the masseter muscle)
- Have patient lift her/his tongue up high and test for “blocked regulation”. Most of the time you will find them to have blocked regulation.
- Simultaneously touch the masseter muscle while having patient lift tongue up and the patient will likely reverse back to normal open regulation.
- You have demonstrated the “two pointing phenomena” and injecting the frenulum will very likely result in eliminating the tightness in the masseter muscle and the patient will note disappearance of tenderness of the muscle as well as improved range of motions of the jaw. If the patient also has chronic neck tightness, some, or all of that will also improve.
If you are a dentist:
- Palpate the masseter muscle and confirm that it is tender
- Have patient open the mouth as wide as possible and confirm loss of range of motion
- Empirically treat the frenulum with an anesthetic gel and wait a few minutes
- You should notice improvement of the tenderness of the masseter muscle and improved jaw opening range of motion. You now have confirmed the causal relationship of the frenulum to the jaw muscle, and you can inject the frenulum where it attaches to the tongue with 1% lidocaine without epinephrine for a more lasting result.
- You will likely find that they no longer need their night guard.
If you are a physician who doesn’t know how to perform ART:
- Palpate the masseter muscle and confirm that it is tender
- Have patient open the mouth as wide as possible and confirm loss of range of motion
- Inject 1/3 cc of 1%lidocaine without epinephrine to the attachment site of the tongue frenulum. (This such a low-risk procedure with such a high chance of a positive result, even if you do not know ART, it is worth treating the frenulum empirically)
- Confirm that the masseter muscle is no longer tender and that the patient can open his/her mouth wider and more easily.
For those practitioners who would like to learn this procedure contact our office for a preceptorship.
M. Kyu Chung, MD
Director, Chung Institute of Integrative Medicine,
Clinical Professor, Cooper Medical School
Contact: either Carolann: 856-222-4766
Or email Brigid Bandomer: bbandomer@wonsookchungfoundation.org or 609-760-3793