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Dr. K.
Dr. K., Board Certified MD
Category: Medical
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Experience:  Board certified with experience in primary care.
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I clench my jaw at night. Ive been doing it for at least

Resolved Question:

I clench my jaw at night. I've been doing it for at least 10 months, having had a three and a half week constant tension headache and a bout of sinusitis which started about 10 days into the headache. My job was very stressful and had been for a few years and then in January this year I was absolutely exhausted having been sleeping badly, my temples were tight again and my mouth was very sore where I'd chewed the inside of my cheeks whilst sleeping so my GP signed me off for a couple of weeks and prescribed me 10mg to 20mg of Amitriptyline to help me sleep, but said it should also help with the jaw clenching. It's been great in terms of sleeping and since then the firm has taken on someone full time to help me so my workload has been significantly reduced and I no longer feel stressed, but I continue to clench my jaw although probably not as badly.

Since the constant headache 10 months ago, my sinuses have never fully recovered so my nose is partially blocked all the time, so my GP gave me a repeat prescription for Beconase nasal spray, which helps a bit, but I've been taking it daily for about 8 months. My GP (who I don't have that much faith in) says it's fine to take it indefinitely, but I'd like clarification about whether that's actually true? I understand it's a steroid spray so I have my doubts.

My GP told me doctors don't really deal with TMJ dysfunction and that I should see my dentist, which I did, but he told me that there's nothing wrong with my teeth and because my jaw clenching is stress-induced I should go back to my doctor. I've been going to him for 20 years and when my sister went to see him about grinding her teeth he identified that she had a tooth that was too long and filed it down, which fixed the problem so I don't think he's trying to fob me off.

I have a gel mouth guard which was molded by a dental lab, but it seems to encourage me to clench my jaw as I have something to bite into so it puts me off using it. I could get a firmer one, but it seems like mouth guards are primarily to protect the teeth rather than actually to assist with stopping the problem.

To summarise, my usual symptoms now are tenderness in the temples, tight fascia on my head and soreness in my cheeks where I've bitten them. I also have on-going issues with my neck, having been diagnosed with 3 prolapsed discs nearly 4 years ago, which is largely under control thanks to regular pilates, but I always have a lot of tension in my neck and shoulders. I can't categorically say the tmj dysfunction makes my neck worse, but I doubt it's helping.

Are you able to suggest treatment? I've read a short course of a muscle relaxant like diazepam might help, but my GP won't prescribe it.

I have health insurance, but I don't know whether it's premature to get a referral to a consultant and I also don't know what sort of consultant I should get referred to.

I appreciate that others have far more severe cases of TMJ dysfunction, but I feel like it's not something that I'm going to just stop doing without any further assistance, but I don't want to have to put up with it if I don't have to, but neither my GP or my dentist seem able to help.

Many thanks
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. K. replied 2 years ago.

Dr. K. :

wow. Very long question.

Dr. K. :

1. The nasal spray is fine to take on a long term basis

Dr. K. :

2. Amytriptyline will help with jaw clenching and stress, as will many antidepressants. It is key to stay on it to break the cycle.

Dr. K. :

3. A gel mouthguard is absolutely necessary. Its not just to protect your teeth. It greatly decreases the force at which you clamp the jaw together and decreases mouth injury. You should wear it.

Dr. K. :

4. You really need treatment for anxiety, a good recommendation would be Zoloft. Its great for overall anxiety disorder. I think your Gp is wise to stay away from diazepam as its habit forming and won't work long term.

Dr. K. :

5. A muscle relaxant like Flexaril can be very helpful in the short term, and is also very good for neck spasm.

Dr. K. :

I hope this points you in the right direction.

Customer:

Thanks Dr. K.

Customer:

I guess I'll have to see if my GP will prescribe either of those

Dr. K., Board Certified MD
Category: Medical
Satisfied Customers: 4207
Experience: Board certified with experience in primary care.
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