After a thoughtful review of the information contained in this web site, I hope that you will agree with me that most TMD patients can be placed in two very broad categories...

        *                 those suffering from an acute injury

                                                 and....

        *      those who are suffering from a painful chronic condition.

Usually, a persons lifestyle does not often contribute to an acute injury (things like sky diving are the exception to this rule). Acute injuries happen when we fall at work, or become involved in an automobile accident or some other type of sudden traumatic event. With appropriate treatment, most of these acute injury patients can quickly be returned to their pre-accident condition. The chronic pain patient presents a more complicated set of conditions.

It often strikes me as surprising how most of the patients with this chronic painful condition seem to feel that TMD is an illness that has come upon them, perhaps caused by a bacteria, a virus, or the environment, much like a sinus infection or seasonal allergy. Frequently, some will comment that they do realize that stress plays a role in the severity of their condition, yet most of them never give any thought to how they can reduce the stress and tension in their daily life and thereby, become an active participant in the successful management of their chronic pain condition.

Often I will say to these patients that, basically, there are two general types of personality... those who yell, break plates and otherwise outwardly express their frustration and anger... and those who turn those feeling inward.  I confess that my personality is the latter. My mother was a proper woman from the old South, as was her mother before her.  She raised me to understand that it is not proper for any person to "show out" in public. Because of her training, I tend to internalize my emotions. For example, you will only know that I am upset about something when I get very quiet. And, because of that trait, I will someday have my heart attack, or ulcers, and I daily clench and brux my teeth together. In other words, my stress can cause me physical harm if I do not learn how to manage it. And, many of my patients are the same way.

Stress is not busyness. All of us are busy now days. A "soccer mom", who has three children, each one due at three different soccer games at exactly the same moment in time, is really busy. But... if that mom enjoys her children and enjoys being an involved mom, she is really busy, but she is not particularly stressed. However, if that mom wishes that dad was helping her manage that busy schedule, and if dad is at home on the sofa watching TV with his favorite beverage in hand... THAT IS STRESS!!!

Life has gotten busy. Leisure time for the family has fallen steadily over the last decade. In most families, it now takes both parents working full time just to make ends meet and to provide the things that most families want and deserve. Often our own personal wants and needs are placed second to the needs of the family.  That is an admirable trait, but... most people can not continue in that fashion for too long without eventually feeling some resentment at always coming in second place.

Everyone needs to take some time out of every day to enjoy something that they want to do. Maybe it is a warm slow bath, maybe it is a few minutes to read, write a letter, or call a friend. Some people take a quick "cat nap" during the mid day break at work. Others like to exercise, walk, ride a bike, or just sit outside, daydream and breathe the fresh air. Whatever it is... if it makes you feel good, it helps.

Following are just a few quick suggestions that I have picked up over the years. There is no way to make a complete list, because your list should be personal to you... the things that you like to do. These ideas are offered just to get you thinking in the right direction...

Practice keeping your lips relaxed, teeth apart and tongue relaxed for one minute six times per day.

This is the rest position for the lower jaw. Do not place your tongue between the teeth... this may cause muscle fatigue.

The teeth should only touch together for about four to five minutes per day. This is total time and includes all chewing and swallowing time. Too much more than that can strain and overwork muscles.

Breathe slowly and regularly from your diaphragm. As you inhale, your stomach should move up and out. When you exhale, your stomach should move in as you slowly let the air out.

Slow your breathing rate by counting to three as you inhale. Then count to six as you exhale and pause before inhaling again. This will increase the levels of carbon dioxide in the blood which has a positive effect on the amount of oxygen that gets to your brain.

You are now learning diaphragmatic breathing, which will help to restore normal blood chemistry and helps to relax muscles. This is the way we are supposed to breathe.

Slow, deep breathing is very relaxing, but it takes some time to re-learn.

Find a comfortable chair. Sit down, shoulders relaxed, place open hands on thighs without crossing your legs. Keep your feet flat on the floor and your head upright. Close your eyes if it is comfortable to you.

While you practice your lips relaxed and teeth apart, exhale and pause while slowly bending your head forward without causing pain.

Then inhale slowly and bring your head upright. Pause 1 second before exhaling and bending your head forward again. Repeat this process six times per minute.

Do not bend head sideways or bend so far forward that you cause pain. Remember that the head is supposed to be upright on even relaxed shoulders. When you move it, you should use both sides of your neck muscles evenly.

This neutral head position prevents neck muscle fatigue and pain.

Raise your hands up as if conducting a choir. Move arms and shoulders forward and back without causing pain.

Repeat six times in 30 seconds.

You are learning neutral, upright shoulder position and increasing circulation to the area.

Start with 5 minute relaxation periods and slowly increase them until each session is 20 minutes long.

Take at least two 20 minute breaks per day.

You are learning to take periods of rest where the mind allows the body to take a break and rest.

Begin your sleep in a relaxed position.

Lay on your back and practice slow rhythmic breathing while keeping your lips relaxed and your teeth apart.

Say out loud "I will not clench or grind my teeth".

Picture yourself asleep with a relaxed jaw and lips.

Start sleeping on your back, but don't worry if you move.

These exercises work best if you follow the following additional rules.

*  Eat healthy and take plenty of liquids. Drink enough water to float a boat.

*  Do not cause pain, but push as far as you can to increase mobility.

*  Reduce or eliminate alcohol intake.

*  Eliminate smoking and the use of tobacco products. Nicotine causes constriction of the blood vessels and prevents optimum muscle health and function.

Be patient. It takes time to reverse unhealthy habits.

Practice number 1, 3, and 4 above six times per day. Practice number 2 and 5 anytime. Practice number 6 before going to sleep.

Let me remind you that stress often plays a real role in a chronic pain condition, but it is rarely the only factor contributing to the problem. Learning and practicing relaxation techniques will help, but for a lasting result, you must also discover and correct the underlying physical causes of the pain. Don’t let anyone suggest to you that "it is all in your head", or "if you would just relax everything would be OK". The person making that suggestion is not knowledgeable enough and/or they have not looked deeply enough to adequately and thoroughly diagnose your condition.

Finally, lets talk briefly about store bought mouth guards, now available in many stores.  Those mouth guards might protect your teeth and dental work from the harmful effects of tooth grinding and/or a clenching habit. But... if you are suffering pain, (and you probably would not be reading this if you weren't hurting) it is too late for a "niteguard" or "mouth guard" to be of any benefit.  Find someone who can really identify the reasons for the pain and get some professional help.