tmj - botox for TMj, TMD, bruxism, or jaw clenching is not enough - need to stop the activity

One thing that doesn't make sense to me is your saying that "the headband (grindcare) did not work for me since my temple muscles didn't tighten enough when clenching my front teeth in comparison to say yawning."  I think that there is a company that sells a headband that tries to take EMG readings, but it's not Grindcare.  I remember rejecting this headband product, for 2 reasons.  The first was that I couldn't see how it would be adjustable enough for the huge variation in heads, so how could I get consistently accurate EMG readings?  But the second reason, the clincher for me, was how it emits an audible alarm, when you clench, increasing in volume over time...I cannot imagine how this would restore normal sleeping patterns...does it have to wake you up enough to respond to an audible alarm?  And I did not think it sounded like it would promote marital bed bliss, either.  If you google "Grindcare USA", and click on the menu at left where it describes technically how it works, that might answer some of your questions.  It would be nice if this solves your problem, but I just don't feel expert enough to say anything confidently.

Another question is, I bet that masseter muscles make lots of non bruxing motions, like when you are just opening and closing your airway, when you are not bruxing.  And maybe for other non-bruxing movements (what muscles are involved in sucking in ones cheeks with inhalation?).  So, I wonder how you would winnow down to useful readings, if you limit yourself to reading muscle movements of the masseters only.  Whereas the temporalis gets going only when you are clenching, which is the activity you want to track/stop.  If you have been using another kind of EMG unit, I can imagine that you have had trouble getting good EMG readings off the temporalis, because I have had less success with single electrodes slapped by a tech in the general direction of my temporarlis.  A good EMG connection is critical, since you are reading very tiny electro motions.  btw, I can't imagine Grindcare reacting incorrectly to bruxing that is more toward the front than the back teeth - the muscle clenching of chronic bruxism, is what you you want to read, and is what you want to interrupt, so this should not be a problem for Grindcare (of course you do want your bite to be even, so that you don't put too much load on just a few teeth, but that may be a separate issue from your need to stop chronic night time bruxing, regardless of which teeth touch first).

Anyways, despite lots of nerve damage and Botox to my temporalis, I still get best bruxism readings by reading the temporarlis with Grindcare, so, I have stuck with reading the portion of the temporalis muscle that is in front of the hairline, at the temple, as Grindcare reccommends.  The 5 reasons I went with Grindcare: the capacity to let you infinitely adjust EMG response, that you get 3 EMG leads in such a small, positionable pad (for good EMG readings), that its gel pads give you a good connection so consistently, that CES biofeedback interrupts chronic bruxing without screwing up restorative sleep, and lastly, the great data analysis for not just accurate diagnosis, but to analsyze so you can prove you've trended right away from chronic bruxism.  

I remember a guy who just input his bruxing numbers from the night before, into an EXCEL worksheet.  That way he said he didn't bother with the professional version of Grindcare with the multi-patient software and usb cable - he'd just read the data on the little dock/charger screen, from the night before.  I think he had managed to find someone to sell him a patient unit-with-dock, and he was perfectly happy.  So, people have managed on their own with Grindcare.  But if I could have rented it from a dentist or doctor myself at first, I certainly would have, since that way you don't invest until you have an ironclad diagnosis (a really novel approach that Grindcare is making finally possible).  Also, it's always easier if I have someone with training and experience to ask questions.  I hope you rent or get a Grindcare EMG unit, because it has GOT to be not only easier than what you have been describing, but you are right about the data analysis.  I think many people will probably never buy a Grindcare unit, because they can break a bruxing habit, and do the EMG readings and data capture to prove they broke the pattern, then stop using Grindcare, or just use it occasionally for monitoring.  And I bet you will appreciate having CES biofeedback interrupt bruxing, instead of audible alarms.

I can't tell you how disabled I was, before I finally found someone in England who could buy one for me, since my chronic bruxism was exaberating so many other chronic pain and inflammation issues I deal with.  Sometimes it isn't so great to be on the bleeding edge of technology, huh?  But very soon, you'll be able to rent one from a dentist practically anywhere, which is a lot better than medical tourism.  Good luck.

slv24 said...
Okay... I know what my stress is.. my work!! my bills!! The truth? Im a nurse and I have a very demanding job.. I love my job but it does create a lot of stress. I have tried bite guards but I wake up gagging because they never stay in place. I'm not in a position to quit working because that would leave me homeless and hungry. So what else is there? I started taking antidepressents that I believe exacerbated my jaw clenching at night. They helped me to sleep more soundly which let me to clench my teeth even more to the point I woke up with horrible pain, inflamed, bleeding and blue/bruised gums. My entire face hurt. I couldn't even think about putting a tooth brush on my teeth at that time.. I went to the dentist and he said I have severe TMJ.. I have woke in the middle of the night and caught myself clenching my jaw.. Since I had this experience I have noticed even in the day I clench my jaw often (I never noticed before). I have no idea if this is something new for me or if I have been doing this for years and never realized d/t no pain prior. I have stopped taking the medication but my gums, teeth and jaw still hurt constantly. I think my entire mouth is damaged permanetly. I feel like I need to go to the dentist (Terrified of the pain) but he referred me to a tmj specialist but from what I have studied on this subject there is no cure for it other than relieving the stress that causes it in the first place which is why the physician originally put me on the antidepressents that did make me feel better while awake and helped me to sleep much more soundly ( I havent slept like that in years) The medication helped me to sleep through the rapid, worrying, racing thoughts but it didn't help with stopping them. So although I slept, my mind still continued to worry. I continued to clench my jaw with even more force causing horrible damage to my gums, facial muscles and teeth. What am I to do with all of this?

if you need to be on an anti-depressant, you can always try one that does not have the occasional side effect of increasing brusixm.  Like the older, less expensive tricyclic amitriptyline.  It may be that only the ssri types affect bruxism.

Also, de-stressing may not work to stop chronic subconscious bruxing, like in your sleep. But you CAN stop it, and sop it non-invasively.  You have not gotten the right info from your internet searches, and might want to google "Grindcare USA".  So, you can stop the worrying along with it, since there really are effective, newer non-invasive diagnostics and treatments now.  Use something like Grindcare.  Rent from a dentist first, because you want a yes-or-no diagnosis, before you start treatments.

It really is better now for people who brux subconsciously in their sleep, and many supposedly can stop using machines like Grindcare, after breaking the habit.  Or just occasionally use it for monitoring, to be sure you don't start up withTMD bruxism, in your sleep.

there are only 3 situations in which I ever got CES biofeedback start kicking off constantly thus problematically.  But for me, I always realized eventually that it was my user error:

1. if I slapped on a gel pad, and didn't notice that when I tore off and trashed one the day before, and I had left a gel dot somewhere on the pad, so now 2 leads get a connection to each other when I slap a new sticky pad right over the old gel dot.  This one is easy, because you notice right away during or immediately after nightly calibration, so once you realize what you did, you just rip off the any leftover gel dots and the pad, and now make sure that you lay a single sticky pad on a clean lead pad, right side up.  Definitely user error.

2.  More than once, I've gotten CES biofeedback start kicking off, immediately after I do the nightly calibration, feeling it almost continuously, as soon as sleep mode begins.  Inevitably, I realize that I must have zoned out during nightly calibration, and sat there with my mouth hanging open, staring off into space dumbly, when I was supposed to be clenching to calibrate.  Again, since you notice this right away, it's easy to fix.  So, I've been assuming that the only mistakes I  can make with a repetitive task are dumb ones, like these.  I wonder if the new automatic mode feature is for people who zone out like me sometimes.

3.  Way back with my first lead pad, I yanked it by the wire (before they changed their manufacturing to make this hard to do), until I actually loosened the connection where the wire and the pad connect.  And it was unusual for a bad connection, because it didn't just die completely, after I yanked it one night.  It took a while, acting flakey, reading nothing some nights, and the gaping of the pad separating top from bottom was visibly obvious, where the wire connects.  But I have never experienced this problem with with any of the current leads.  They made that area really strong in manufacturing, long before they rolled out to the USA.

So, I wonder what the heck you are doing to get constant CES biofeedback, that starts later on in the night?  If your model lets you set sensitivity seperately in the configuration menu (with the wrench icon), I would keep the sensitivity low, but I think the newer models don't bother with a seperate, "set sensitivity" in config., since I bet calibration makes this redundant. 

And if you have been careful to clench (not grind and move) during configuration, using at least 60% of your clenching force, I don't see how you could have biofeedback start kicking off continually sometime later in the night.  If you forget to clench without grinding around, you could indeed confuse your calibration, and if you used a move while calibrating, that you don't do again after calibration until later, during deep sleep, it could come back to bite you then, maybe?  A grinder (as opposed to a clencher like me) might not notice that the calibration instructions say clench, don't grind moving your teeth around, during calibration. 

Otherwise, you have me stumped. The only thing that I can think of is to wonder what it means when you say you taped it with the result that you managed to get too many biofeedbacks during sleep.  Is it somehow possible to get some kind of bad connection like my case number one, by taping in such a way that you lose your flat connection to your skin?  Could a long piece of tape starting before the pad on your skin, along the pad, and after the pad onto your skin, done on a curve of your head, or curling the outer leads up and away from your skin by being really  tight...could this make a connection between two of the 3 leads?  I can't quite imagine it, but it is interesting that you say you were able to get constant firing, depending on how you tape over the pad. 

I do remember that when my sleep was very disturbed by bruxing, before Grindcare calmed it down, I would yank or even pull it off sometimes.  But, since the biofeedback level number that I choose is never strong, the CES biofeedback never disturbed my sleep.  But others, who don't have my sensory nerve damage, probably can set the level of CES biofeedback overly high, to interrupt more than just bruxing.  So, finding a biofeedack level during calibration that is only high enough to interrupt your bruxing, and no higher, seems like something worth concentrating on.  But even in this case, it should bother you only if both your level's too high AND your connection is bad (and the connection bad in a way I would have thought difficult to get with any regularity).  Or if your level is too high and your calibration includes movements.  So, I'm really grasping for ideas here, telling you to doublecheck that you use, for example, level 4 versus 9, if 4 is enough to get your bruxing trending down.  And if you use tape, use a short piece on one end, and another on the other, and make sure it is on a flat area of your temple over the temporalis? 

Of course, if you can reproduce this problem at will, you can figure out what you are doing to receive this problem, but that's sometimes easier said than done.  I agree with you that it would be very annoying, when you are seeking restorative sleep. Good luck debugging it, and if you learn anything, please share.

btw, as far as getting a forum supported by the Grindcare developers themselves, I expect that wouldn't be efficient - most people aren't going to debug as patiently as you or I, and will need to have live support, I bet.  Hence the prescription requirement in the USA.  And like I said to FSDUAL, I think that the people in Denmark are engineers, supporting many countries's languages, so if we want a forum, it would have to be supported by users, or maybe when there is a big enough distributor here.  I noticed that some Grindcare distributor in the UK seems all over the net, with a name of a multi-site dentistry group, called something like "Smiles" or somesuch, but even they don't have a forum.  When we have big distributors here, maybe someone will have enough uni-lingual users to support by forum efficiently.  But until and unless, I bet users will start forums like they did for apnea, and one or two with have enough super users, so that they end up being useful, generally.  That's how that user support forum at Mass General grew, called braintalk, grew (it was started by the guy who later started second life).  They have some users that are more knowledgeable than many doctors, but I think it leans toward neurological problems.  Well, enough rambling for today.  Good luck.

Kind regards

Steven.