Questions to ask on TMJ Pain

Extracts  from “The Sleepclenching (SC) Syndrome”  
by Louis O. Thomas DDS     Download Book (9.2 MB)

(…) If you dream, you clench. That said, squeezing our teeth together when sleeping is perfectly normal and needed; it is nothing to be ashamed of. It is only pathologic when done too much.

… use these questions to help figure out where the pain is and if it is related to TMJ. 


  •   Female or Male? There is a difference in the way men and women react to SC trauma. Women usually have more muscle pain (headaches, facial pain, etc.), while men seem to damage joints and teeth with less pain; but don’t hold this as gospel.
  • Age? Age makes a big difference in the way we clench and how long we have clenched.
  • How often do you have headaches? This tells me how often you clench. If you do not have headaches it does not mean you are not SC. We have different thresholds to pain. Men usually don’t seem to notice headaches as much. Which side? This tells me which side is the problem joint.
  • How often do you have neck aches? This tells me that you clench in a protrusive di- rection (on front teeth), you may be pushing against something uncomfortable in the front part of your mouth. Which side? This tells me which side of the front part of the mouth you are SC against. Usually, if a left neck muscle hurts, you are SC on the right front, and so on.
  • How often do you have earaches? An earache is often TM joint pain. Which side? If the left side has an earache, the left joint may be hurting. Which ear has less hearing capacity? It is common to have reduced hearing in long term SC next to a problem joint.
  • Do you have ringing in your ear? Which ear? It is common to have ringing next to a problem joint.
  • Do you have vertigo or dizziness? SC could cause this. Which ear collects more earwax? Sometimes patients will accumulate more earwax next to a problem joint. I don’t know why, but it could be due to joint inflammation passing into the ear chamber.
  • How often does your shoulder ache? This usually means that the person is SC in protrusive way that is, the lower jaw is protruding past the upper front teeth or push- ing against the upper anterior teeth, but then again, a shoulder ache may have noth- ing to do with SC. Which side? This can indicate which way one is protruding the jaw that is, if SC is the cause.
  • Does your jaw ever hurt? This is a good sign of SC trauma. Which side? Tells me which side has spastic muscles. Does your jaw ever pop or click? This always indicates that you are a clencher. Which side? Usually, if the left side clicks, the left side is the problem joint. However this can vary. Changing a patient’s bite can shift the SC trauma. It is not a good indi- cator for detecting which joint is the problems joint.
  • How often do you have facial pain? Facial pain means facial muscles are spastic, which is nearly always from SC trauma. Of course, the pain could be from facial nerve damage (neuralgia) but this is rare when compared to SC trauma. Which side? If you have facial pain on the right, the right joint is the problem joint.
  • Do you have receding gums? Receding gums can occur from over brushing or from SC, but recession is usually a combination of the two. Where? Recession usually oc- curs on the side opposite the problems joint but not always.
  • Are any of your teeth sensitive? This usually indicates that the patient is SC on cer- tain teeth, which cause them to be sensitive.
  • Which joint is sore? (Joint-pressure exam.) Usually the problem joint is sorer but not always. Sometime the ‘good’ joint will have a fluid build up when it is trying to com- pensate for the bad joint; it’s a defensive activity but more often this is caused by complex SC trauma because of changing a patients bite.
  • Does your jaw swing to the right or left? This indicates long term SC but does not mean you are presently SC, but it occasionally means that the joint swings away from a problem joint. Does the jaw make an initial jog or movement to the right or left when first open- ing? Which way does it jog? When there is an initial jog, it will be away from a prob- lem joint. This usually indicates that the problem joint has active inflammation in a young adult. In an older person, it may be permanent joint damage and not acute in- flammation. Press on muscles in the jaw area, the forehead area, facial area, and the temporal area, and then answer the following question. Are these tender areas on the right or left side? Tender muscles suggest that SC trauma is causing muscle tenderness but not enough to cause facial or jaw pain. The tender muscle will be on the side of the problem joint. Some people hurt on both sides, that is, they have symptoms on both sides; but one side will be worse. This can occur for several reasons. Orthodontics and dental re- pairs that have changed one’s bite can cause SC trauma on both sides. An unbalanced night guard can case this. All the questions are important. For example, if the questionnaire does not reveal neck pain, it could indicate that the patient does not clench on front teeth; however, negative answers should be checked out with appropriate physical exams. 


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2 Responses to “Questions to ask on TMJ Pain”

  1. Kathy Says:

    Please, where did Dr. Thomas have his practice and where is he today?

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