TMJ pain - dentist or pediatrician or?

[ktgrok]

My 14 yr old says her jaw is hurting off and on and it feels tight when she tries to open her mouth wide sometimes. I'm wondering if I should call a dentist for an appointment or the pediatrician?  Or something else? I swear, humans should come with instruction manuals complete with a troubleshooting section! 

[mommyoffive]

Our dentist refers us to a TMJ specialist. 

Has your dd had Ortho?  A lot of times the dentist says going through Ortho helps with jaw pain.  

[Scarlett]

2 minutes ago, ktgrok said:

My 14 yr old says her jaw is hurting off and on and it feels tight when she tries to open her mouth wide sometimes. I'm wondering if I should call a dentist for an appointment or the pediatrician?  Or something else? I swear, humans should come with instruction manuals complete with a troubleshooting section! 

As a person with a lot of experience with tmj I can tell you dentists and doctors don’t know a lot. I manage my own and I have  for years. I don’t think it round hurt to rule out something rose but don’t expect much in the way of tmj cures. 

[ktgrok]

12 minutes ago, mommyoffive said:

Our dentist refers us to a TMJ specialist. 

Has your dd had Ortho?  A lot of times the dentist says going through Ortho helps with jaw pain.  

No, never been suggested that she needed them. 

[alisoncooks]

Our pediatrician referred us to a specialist (cranio-facial specialist). From there, we went to a physical therapist that treats TMJ (which wasn’t the easiest to find). 

[EKS]

While you're waiting to get into a doctor/dentist, she could try putting heat on it.  I use a hot water bottle with the hottest water I can stand for a few hours each evening until it feels better.  It usually takes a few days.

[prairiewindmomma]

Even a bit of ibuprofen can help. I’d check to see if she is grinding or clenching her teeth at night due to stress (a mouth guard will help prevent tooth damage) and if her jaws are in proper alignment (orthodontist). These two things were tmj triggers here.

[Scarlett]

17 minutes ago, prairiewindmomma said:

Even a bit of ibuprofen can help. I’d check to see if she is grinding or clenching her teeth at night due to stress (a mouth guard will help prevent tooth damage) and if her jaws are in proper alignment (orthodontist). These two things were tmj triggers here.

Yes this does need to be checked. Mine is neither of those. I just carry a lot stress in my jaw. 

[prairiewindmomma]

3 hours ago, ktgrok said:

No, never been suggested that she needed them. 

Heads up that not all dentists will mention jaw alignment issues. You can ask if she has crossbite or overjet, but if she looks ok cosmetically, some wont refer unless you bring up the jaw issue. BTDT with a (previous, no longer see him) dentist.

[Terabith]

I agree with dentist, but I've also had really good help from a chiropractor I trust with this.

[gardenmom5]

dentist.

 

Though my son was helped by our then chiropractor.

[KatieJ]

I vote chiropractor. I had tmj for 20 years. My jaw would get out of alignment, painful and it was hard to chew.

Told my chiropractor …one adjustment and I never had an issue again. That was 25 years ago. 

[Scarlett]

At my worst pain, A massage specializing in TMJ was very helpful. 

[Vasha]

Definitely chiropractor.

[StarSailor]

I have 2 DC with significant TMJ.  In both cases the root cause for them is EDS/hyperflexibility

Pediatrician and rheumatologist (for EDS) could both "feel" the jaw joint "clunk" with open and close.  They had significant pain and reduced ability to "open wide".  PT could feel jaw muscles were very tight and sometimes muscles were firing unevenly.

EDS doc first ordered an MRI to ensure there was not joint damage.  No joint damage but MRI continues to show mild amounts of fluid and inflammation.

Then referred us first to maxo-oral facial surgeon.  I highly do NOT recommend this route.  His answer was simply to take long term muscle relaxer meds.

We double checked with regular dentist to make sure there was no signs of teeth grinding.  Neither dc grinds their teeth, nor had there been concern for jaw alignment or othrodontics issues.

Next step was trying prescription strength naproxen to reduce inflammation.  It helped with pain but caused GI issues.  We now use celebrex or motrin to help when there is significant pain.

Eventually we found a PT who was trained in Racabado 6x6 exercises.  Which we highly recommend.

example of 6x6 exercises  (this was the first link I found to 6x6 exercises, there is also you tube videos)  It looks simple and is.  And it does work.  I recommend finding an experienced PT as they can help make sure exercises are being done correctly, especially at the beginning. Unfortunately, not many PT offices have TMJ PT's or PT's that are experienced with Racabado method.

An experienced TMJ PT will know what Racabado 6x6 method is.  PT will also know how to feel which jaw muscles are tight and then massage jaw muscles to release the knots, etc.  They will also make sure neck and shoulder muscles are not weak.  It is common for TMJ patients to also have weak neck/shoulder muscles.  Heat will also help - so at home we use a heating pad (Target brand shoulder heating pad, fits around jaw easier than square heating pad).  Or sometimes PT will use ultrasound heat in office to release muscles.

Word of warning:  TMJ PT will massage muscles from inside the mouth.  It is extremely painful - especially at the beginning.  But both my DC say it is so much better after the massage and muscles release.  PT has taught both DC how to do this internal massage themselves.  One DC does this and the other thinks it sounds "yuck" and prefers PT to do it.

My understanding is that if TMJ is due to muscle imbalance, or simple alignment, a course of appropriate PT will help strengthen jaw/neck/shoulder muscles and then you can simply restart exercises if it starts to flare from dentist appointment, etc.  This is what works for one of my DC.  (she was to the point of jaw joint getting stuck and needing to pop it back when we finally found good TMJ PT)

For my other DC they actually hyperextend their TMJ joints very easily.  And then it "catches" when they close jaw, so their TMJ flares easily.  Plus they have weak scapular and neck muscles, so they have been working with PT every 2-3 weeks for a year.  This DC has the most joint/muscle complications from EDS.  It took 3 months to get muscles totally released long enough to realize the hyperextension was the root cause (measured by PT).  And now are working on controlled opening (so it doesn't hyperextend) and strengthening shoulder and neck muscles.  Their TMJ flares easily with eating "big" things like a hamburger or chewy candy and also with any illness like strep/flu that causes inflammation in jaw joint.

Both TMJ PT's we use are in "adult" PT offices, not pediatrics.  But they will treat teen patients.

 

[Lecka]

Just since nobody else has mentioned…. It can be associated with PTSD, and treating PTSD can help if that is the reason for it.  

[J-rap]

I had that problem for awhile...  I couldn't even open my mouth wide enough for a thick sandwich!  It was often quite painful.  My dentist started thinking about various treatments, but one thing I noticed:  a couple of my molars (an upper and lower) on one side of my mouth seemed to hit together before the rest of my teeth.  It was a relatively new thing and very subtle.  So I asked my dentist if he could sand them down a bit so they would hit evenly with all of my other teeth.  He did that, and the teeth issues went away!

My dh went through something similar some years later, so I mentioned to the dentist that he should check to see if some molars were biting down on each other before the other teeth.  My dh didn't notice it, but our dentist could see that that's what was happening.  He sanded them down, and voila, it was fixed! 

Edited May 22 by J-rap