TMJ Headache

TMJ Headache

Article by J.Miller, S.Armfield

TMJ Headache

(JawHeadache)

TMJ Headache, or as it is known – a Jaw Headache, is a secondary headache disorder. In other words, a jaw (TMJ) problem causes your headache.

What Does a TMJ Headache Feel Like?

tmj headache

TMJ Headaches is a common TMJ disorder. Sometimes TMJ headaches can be a direct result of TMJ dysfunction.

The typical TMJ headache is a tight, dull aching headache over the temple region. It is most commonly on one side, which correlates to your jaw joint issue. But, it can also be bilateral.

TMJ headache aggravates with jaw tension, clenching, stress or jaw movement. Typically, it relaxes your jaw. It also is usually associated with tenderness of the jaw and nearby muscles.

What Causes TMJ Headaches?

TMJ dysfunction may increase muscle tension in the jaw and masticatory muscles. e.g. temporalis, pterygoids.  TMJ headaches are associate with jaw disorders. Abnormal jaw muscle tension can create TMJ disorders such as myotonic or articular disc derangements.

How is TMJ Headache Diagnosed?

tmj physiotherapist brisbane

Your TMJ physiotherapist will assess your jaw function and determine whether you are likely to be experiencing a TMJ headache. Correctly identifying the cause will lead to better treatment.

What About X-rays, CT-scans and MRI?

OPG X-rays, CT-scans and MRI’s are not diagnostic of a TMJ headache. However, they can identify oral and bite conditions, which may be predisposing you to TMJ headache.

How Do You Fix TMJ Headaches?

A TMJ physiotherapist has a particular interest in craniomandibular physiotherapy. They are your practitioner of choice for TMJ headache.

The best fix for your TMJ headache is to normalise your TMJ function. Treatment normalises TMJ joint motion, muscle tensions, muscle timing and co-ordination. Your jaw physio treatment may perform jaw muscle massage, relaxation techniques, joint mobilisation, TMJ movement correction exercises, dry needling or other tools suited to your condition.

For more specific advice, please consult your TMJ physiotherapist.

More info:

TMJ PainJaw Pain

TMJ Dysfunction

Headaches & Migraine FAQ’s

What is the PhysioWorks Difference?

You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff who represent PhysioWorks.

To ensure that we remain highly qualified, PhysioWorks is committed to participating in continuing education to provide optimal care.

If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.

We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quickeffective and long-lasting results by providing high-quality treatment.

We aim to get you better quicker in a friendly and caring environment conducive to successful healing.

With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are Some of the BIG Differences?

Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc.

Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time.

We attempt to treat the cause, not just the symptoms.

PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge.

Our staff care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs.

All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.

What is a Primary and Secondary Headache?

The International Headache Society classifies headaches as Primary or Secondary. Primary headaches are not related to any other problem and include migrainestension-type headaches and cluster headaches. Secondary headaches. Caused by an underlying problem, and can include a post-whiplash headacheneck headache, jaw headache and drug withdrawal headache. “Ice cream headache”, for example, is a secondary headache caused by extreme cold within your mouth. In other words, a secondary headache is a symptom of something else being wrong rather than the cause itself. Treatment for a secondary headache involves treating the source, e.g. loosen some stiff upper neck joints or stop eating ice cream!

Multi-Source Headache

Migraine It is also important to point out that many headache sufferers may suffer multi-source headaches. For example, a migraine sufferer may simultaneously experience a tension-type headache and neck headache. Treatment will vary depending upon your specific symptoms and headache source. Please consult with your healthcare practitioner for an accurate diagnosis and treatment pathway.

When Should You Be Concerned about a Headache?

headache In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.

You MUST thoroughly investigate any Red Flags!

headache red flags Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:
  • History your worst ever headache or a different headache to your usual.
  • Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
  • Age is higher than 50 years.
  • Despite treatment, your headache persists.
  • Acute onset.
  • Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
  • HIV or other immune system compromise
  • fEver or other systemic symptoms, e.g. weight loss, rash.
If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.

Less Urgent & Severe Headache Types

Fortunately, the vast majority of headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis. For specific advice, please consult your doctor or headache physiotherapist.

Suffering a Headache or Migraine?

If you are suffering a headache or migraine, it is appropriate that your first step is to consult your doctor. Your doctor will examine you and then determine if a neurological opinion is required and whether a CT or MRI scan of your head is necessary. Occasionally, scans can identify significant but luckily uncommon headache sources such as an aneurysm or tumour. In the vast majority of cases, your scans will be reasonable.

If Your Scan is Normal?

Firstly, you should feel relieved. Scans will rule out the more sinister causes of headache or migraine.

Discovering Your Headache Source?

headache treatmednt We recommend that you should then commence a process of elimination, starting with the most commonly diagnosed and easily fixed sources. Two familiar sources of headache that can undertake an assessment and elimination are neck headache and jaw headache. A thorough examination of your neck by a skilled headache physiotherapist is your next port of call. Researchers believe that at least one in four headaches are neck origin and less than that are jaw headache. You'll have over a 25% chance that your physiotherapist will confirm and then relieve your headache at your first consultation.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please contact your PhysioWorks team.

Pillows - NexGen Posture Form Memory Foam Pillow 2

Neck Pain, Stiffness or Headaches?

If you’re having a restless sleep or waking with neck pain, stiffness or headaches, your pillow could be the culprit. A good night's sleep is dependent on a healthy sleeping position and a good pillow. A quality pillow will support your head in natural alignment with your spine. Only a pillow offering good support and adjustability can do this.

What's the Classic Signs of an Unsupportive Pillow?

Most quality pillows will only last you three to four years before you need to change. Some of the lesser quality pillows will only remain supportive for a few months. The problem is that pillows internal supportive material breaks down with use and time. Whether your pillow is feather, foam, memory foam, rubber, latex or any other natural or synthetic product, they all eventually disintegrate with time and use. If you are consistently having the following trouble, it's time to change your pillow.
  • Waking during the night or in the morning with a stiff neck, neck pain or headache.
  • Restless or interrupted sleep with difficulty going off to sleep.
Another sure sign is improved sleep when you visit a friend, borrow your partner's pillow or stay in a hotel. If any of these sounds like you, it's time to change your pillow.

Maybe it's NOT Your Pillow!

Sometimes there is simply no pillow in the world that is best for you.

Why?

If you have a neck injury, pain or stiffness, you may not have the available pain-free range of neck motion to have a comfortable, pain-free sleep. The solution on this occasion is to have your neck professionally assessed and treated. Often just one quality treatment of your neck may solve years of sleeping difficulties.

Pillows Online

If you like to see the pillows that most of our therapists sleep on and recommend to our clients, you can view these online here or test them at your nearest PhysioWorks clinic.

More information

Pillows Neck Pain Neck Headache

Why Do Patients Choose PhysioWorks for their Healthcare?

You'll be impressed with the experienced physiotherapists, massage therapists and reception staff who represent PhysioWorks.  To ensure that we remain highly qualified, we are committed to continuing education. If you've been searching for therapists with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at elite and representative levels. We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment. PhysioWorks is an undergraduate clinical placement facility for training the next generation of physiotherapists. Each year we handpick the cream of the crop, add them to our team and fast track their post-graduate education process to ensure that they become experienced physiotherapists well before their peers.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. Our aim is not only to get you better quicker but also to create a friendly and caring environment conducive to successful healing.  With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are some of the BIG differences?

  • Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are constantly updating their knowledge via seminars, conferences, workshops, scientific journals etc.
  • Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that in reality, only last for a short time.
  • We attempt to treat the cause, not just the symptoms.
  • PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge.
  • Our staff actually care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our clients' special needs.
All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.

What are the Advantages of Good Posture?

good-posture-sitting

Good Posture Benefits:

  • It keeps your bones and joints in the correct alignment.
  • It helps to decrease the abnormal wearing of joint surfaces.
  • It decreases the stress on the ligaments holding the joints of the spine together.
  • It prevents the spine from becoming fixed in abnormal positions.
  • It prevents muscle fatigue.
  • It prevents any backache and muscular pain.
  • It contributes to a competent and confident appearance.

To Achieve Good Posture You Will Require the Following:

  • Good muscle flexibility
  • Normal motion in the joints
  • Strong postural muscles
  • A balance of muscle forces on both sides of the spine
  • Awareness of your posture, plus knowledge of proper postural position, leads to conscious correction.
Practise the correct posture for standing, sitting, and lying down (as described below) to gradually replace your old position.

Article by John Miller

What is the Best Way to Sleep?

Your Best Sleeping Position?

best sleeping position
Everybody has their favourite sleeping position. However, some are better for you than others. Try to sleep in a posture that helps you maintain the curve in your lower back. We recommend lying on your back with a pillow under your knees (if more comfortable) or on your side with your knees slightly bent.

It is preferable to not sleep on your side with your knees drawn up to your chest (the foetal position). However, having said that some back conditions will find this preferable. You should seek the advice of your physiotherapist if you are in doubt.

If you are suffering back pain, you could try lying over a lumbar roll or peanut cushion at night to make you more comfortable. A rolled sheet or towel tied around your waist may also be helpful. You may wish to avoid sleeping on your stomach, especially on a saggy mattress. This sag can cause back strain and can be uncomfortable for your neck.

What is Your Best Mattress?

Select a firm mattress or an ensemble that does not sag. If necessary, place a board under your bed's mattress. You can also set the mattress on the floor temporarily if needed. If you've always slept on a soft surface, it may be initially painful to change to a harder surface. Try to do what's most comfortable for you.

How to Rise from Bed

When standing up from the lying position, turn on your side, draw up both knees and swing your legs over the side of the bed. Sit up by pushing yourself up with your hands. Bend forward at your waist with your core muscles activated.

What is Your Best Pillow?

The human neck curves slightly forward (to sustain the weight of the head when upright), and it is crucial to maintain this curve when in a resting position. If the height of the pillow is too high or low when sleeping, your neck is bent abnormally out of alignment, causing muscle and joint strain. You can even wake with headaches.

Poor pillow support can also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep.

The best lying or sleeping position may vary, depending on your symptoms. No matter what posture you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.

To give your body the proper rest it needs, and to ensure the health of your spine, physiotherapists recommend only two sleeping positions: Side sleeping and supine sleeping.

Sleeping Tips

Sleeping on your side, with the spine straight.  Sleeping on your back, maintaining the primary curvature of the cervical spine. Both of these positions prevent poor alignment of the neck and upper back. Proper alignment can help to reduce the number of neck aches, backaches, pinched nerves, shoulder and arm referred pain, insomnia, and mental fatigue from a lack of effective sleep.

More Info

Article by John Miller

When Should You Be Concerned About Neck Pain?

What's Urgent?

There is one situation where there’s no need to wait several weeks before deciding if your neck pain is serious.

If you’ve had an accident with forces that may have been sufficient to fracture your spine or tear nerves, seek a medical assessment as soon as possible. This means to either call an ambulance or head to a hospital emergency department.

Red Flags for Neck Pain

Otherwise, the rule of thumb is that you should start a more thorough medical investigation only when all three of these conditions are met. The three general red flags for neck pain are:

  1. it’s been bothering you for more than about six weeks
  2. it’s severe and/or not improving, or getting worse
  3. there is at least one other “red flag” (see below)

Red flags are reasons to seek a professional opinion rather than to worry. Seek the advice of your physiotherapist or doctor if any of these red flags apply to you.

  • Light tapping on the spine is painful.
  • A torn artery may cause severe, throbbing or constrictive (novel pain), with a high risk of a stroke. Pain is the only symptom of some tears. Most but not all cases are sudden, on one side, and cause both neck and head pain (in the temple or back the skull), but the pain is usually strange. Any hint of other symptoms? Promptly attend a hospital emergency.
  • There are many possible signs of spinal cord trouble in the neck, with or without neck pain, mainly affecting the limbs: e.g. poor hand coordination; weakness, “heavy” feelings, and atrophy; diffuse numbness; shooting pains in the limbs (especially when bending the head forward); gait awkwardness. Sometimes patients present with both neck pain and more remote symptoms and don't realise they are related.
  • Unexplained episodes of dizziness or nausea, and vomiting may indicate a problem with the stability of the upper cervical spine. 
  • Weight loss without dieting (it's a potential sign of cancer).
  • Mystery fevers or chills (especially in people with diabetes).
  • A severe headache that comes on suddenly is a “thunderclap headache”! Most are harmless, but it is always wise to investigate thoroughly.
  • A fierce headache, an inability to bend the head forward, fever, or altered mental state. These are all symptoms of meningitis (inflammation of the membranes covering the brain and spinal cord, caused by infection or drug side effects).
  • The main signs that neck pain might be caused by autoimmune disease specifically include:
    • a family history of autoimmune disease,
    • gradual but progressive increase in symptoms before the age of 40,
    • marked morning stiffness,
    • pain in other joints as well as the low back,
    • rashes,
    • difficult digestion,
    • irritated eyes, and
    • discharge from the urethra (bladder).
  • Steroid use, other drug abuse, and HIV are all risk factors for a serious cause of neck pain.
  • If you feel pretty unwell in any other way, that could indicate that neck pain isn’t the only thing going on.

More info: Neck Pain

What Causes TMJ?

TMJ dysfunction is considered a multifaceted musculoskeletal disorder. The most common causes of TMD include:
  • Masticatory muscle dysfunction,
  • Derangement/displacement of TMJ articular disc
  • Bruxism: nocturnal grinding of teeth leads to increased pressure in TMJ and asymmetrical movement.
  • Occlusal Problems: Poor bite, Asymmetrical or Retrognathic (underbite, overbite) .
Contributory factors include:
    • Mandibular malalignment is secondary to an occlusal appliance or orthodontic treatment.
    • Removal of wisdom teeth,
    • Prolonged mouth opening, e.g. dental procedure,
    • Poor cervical posture,
    • Myofascial pain,
  • Neuropsychological factors,
  • Stress and
  • Whiplash and other less common causes include trauma (e.g., blow to the chin), infection, polyarthritic conditions, tumours, and anatomical abnormalities.

TMJ Dysfunction Classifications

What Causes TMJ The common presentations of TMJ dysfunction classify into three clinical diagnostic groups:
  • Jaw muscle disorder characterised by painful movement.
  • Articular disc displacement.
  • Arthralgia or arthritis.
(Dworkin SF, LeResche L., 1992)

What is the Cause of Jaw Clicking?

Clicking jaw is a sign of articular disc displacement, which is commonly treated by a TMJ physiotherapist. Clicking can occur during jaw opening, closing or both directions. Please seek the clinical assessment of TMJ physiotherapist for a specific diagnosis and treatment plan.

Common Sources of TMJ Dysfunction or Jaw Pain

TMJ or jaw pain can occur as a result of various multi-factorial reasons. Most TMJ dysfunction resulting in jaw pain or clicking jaw results from two leading causes: jaw opening or closing.

TMJ Dysfunction - Abnormal Opening

Most TMJ dysfunction that occurs results in an inability to open your jaw fully or symmetrically. Luckily nearly all opening dysfunctions respond exceptionally quickly and favourably to physiotherapy assessment and intervention since teeth occlusion is not an issue.

TMJ Dysfunction - Abnormal Closing

Closing dysfunction can be due to both a teeth occlusion and an inability of the TMJ to close normally. If the problem is simply a stiff joint or poor muscle timing, then physiotherapy treatment will be very successful. However, if teeth occlusion issues exist, then you will be referred to a dental surgeon for a bite occlusion assessment.

Potential Causes of TMJ or Jaw Pain

What is the Best Treatment for TMJ Dysfunction?

The best treatment for TMJ does vary based upon the clinical diagnosis, the TMJ dysfunction and the chronicity. TMJ opening disorders are more likely to be successfully treated with jaw movement improvement techniques. The techniques may include jaw muscle massage, dry needling/acupuncture, muscle stretch/relaxation/coordination exercises or joint capsule stretching techniques that are provided by your physiotherapist. Your dentist is usually involved in the management of TMJ closing disorders such as bruxism (teeth grinding) due to the addition of teeth occlusion. In some cases, an occlusion splint or bite plate can help. If you are unsure what treatment direction is best for you, we recommend that you seek the advice of your TMJ physiotherapist for pain, clicking or lack of motion when opening your mouth your dentist for problems when you clench your teeth. Either way, seek the advice of your TMJ health professional who will refer you on to the most relevant health professional suitable for your TMJ condition if they feel it is in your best care. After your TMJ assessment, your physiotherapist will commence corrective treatment if appropriate. TMJ physiotherapy usually is very successful for the treatment of TMJ opening disorders due to the problem being a movement disorder that is affected by your muscle and joint control.

How Quickly Does Physiotherapy Relieve TMJ Dysfunction?

The good news is that your TMJ physiotherapist will start treating your TMJ dysfunction, muscle tightness or coordination issue that same day as they assess you. If your TMJ dysfunction is one of the categories that physiotherapy assists, you'll usually leave the clinic with very significant improvement or full resolution after your very first treatment consultation. Alternatively, if we assess you and discover that your TMJ dysfunction will not respond to physiotherapy, we'll happily refer you to the most appropriate health professional to assist you in achieving the quickest result.

TMJ Treatment Prognosis

Prognosis is favourable in the vast majority of patients treated conservatively, and symptoms may improve without treatment. (Michelotti A, 2010). Field 2012, found that with conservative TMJ physiotherapy treatment, 75% of the TMD group resolved their condition within three months, which is certainly consistent with our clinical results. The vast majority improve within a few weeks of commencing TMJ treatment. This result compares to a more sluggish resolution in the non-physiotherapy treatment group studied by Rammelsberg in 2003, who found that spontaneous resolution occurs in a 33% of TMD sufferers over five years.

Locked Jaw Treatment

A locked jaw can be both temporary or permanent. Your TMJ physiotherapist is usually able to unlock your locked jaw via gentle manipulation. Should manipulation fail, you may require an Oral Surgeon to perform a manipulation under anaesthesia or another surgical procedure known as an arthrocentesis (joint washout). In chronic cases, open surgery may identify or remove any physical obstructions, in the permanently locked jaw, but this is relatively rare.

TMJ Physiotherapy Treatment & TMJ Exercises

TMJ exercises and treatment may include:
  • Posture improvement and neck treatment
  • Relaxation exercises
  • Muscle lengthening or jaw muscle massage
  • TMJ joint mobilisation
  • TMJ movement pattern and timing correction
  • Passive, active-assisted, active exercises
  • TMJ stabilisation exercises
  • Dry needling or acupuncture.
Specific TMJ exercises prescribed following a thorough TMJ assessment by your TMJ physiotherapist will be most beneficial.

Summary

Every case of TMJ dysfunction is different. Please check with your Craniofacial or TMJ physiotherapist for their professional opinion.

TMJ Dysfunction - What to Avoid?

Until you seek the advice of your TMJ physiotherapist we recommend the following: AVOID:
  • uncontrolled, wide-opening, e.g. yawning,
  • biting hard foods, e.g. carrots, apples,
  • eating burgers or hard rolls,
  • chewing gum,
  • nail-biting,
  • jaw leaning,
  • stress, and
  • clenching pens, pencils, pipes or cigars.
TMJ Treatment Professionals.
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