Eye Pain, Swelling and Twitching

Dr. Shapira Blog 32 Comments

Has eye pain, swelling or twitching just become too much of a strain?

tmj-eye-painDo you sometimes feel a ‘stabbing’ sensation behind your eyes or do they swell up or twitch unexpectedly making it difficult to concentrate on everyday things? Have you tried everything to relieve these painful sensations and haven’t yet come up with a solution?

When you have ruled out organic causes of eye pain with your ophthalmologist it is likely your pain is related to jaw, muscle  and TMJ function.

These sorts of symptoms could be due to a dental problem related to your jaw and neck muscles and your temporomandibular joint (TMJ). These  are  the joints that act like a hinges on both sides of your face. These joints allow you to speak, chew and yawn, amongst other things.

Some problems with the joint can lead to referred pain behind the eyes and the eyebrow area via the Trigeminal Nerve.  The TMJoints  are some of the most complicated joints in your body.  Each TMJ joint is actually two joints in one, a ball and socket joint and a sliding joint.  The entire ball and socket portion can slide forward and back as well as side to side.

The nerve that just might be behind your eye pain

If your bite is not properly lined up, you have what is often called a ‘bad bite’. This can cause friction or uncoordinated motion in one or both of your  (TMJ) TMJoints.

If it stopped right there you would probably never know about it, but unfortunately a nerve runs right past the joints, called the trigeminal nerve.  The Trigeminal Nerve goes to the teeth, the jaw muscles, the jaw joints as well as to the sinuses especially directly behind the eye.  Retro-orbital or behind the eye pain is mediated by the Trigeminal Nerve. This nerve is responsible for passing the message about friction through to the brain and somehow the message is transferred right on through to the eyes as well. The result is that you feel pain behind the eyes and sometimes they cause swelling and twitching because of the pain.

The trigeminal nerve is a cranial nerve, or actually made up directly of brain cells. The impulses of the trigeminal nerve ultimate are more than 50% of all input to the brain after they are amplified in the reticular activating system.  This is similar to music coming out of an amplifier at a concert.  Good input can be amazing but bad input is intolerable noise.  In this example the bad input or noise is what patients percieve as pain. What we call eye pain is nociceptive input perceived as eye pain.  The pain is absolutely real but the cause is often different than expected.  This is called refered eye pain.  Pain that is perceived in the eye but is actually from elsewhere.

These eye pain symptoms are common in the disorder known as temporomandibular disorder or TMD.  Myofacial Pain and Dysfunction (MPD) refers to the pain coming from trigger points in the muscles.  90-95% of all pain is actually muscular in origin.  The muscles work overtime to protect us from problems.  When they are overworked we have myofascial pain and TMD, both repetitive strain disorders.  More commonly known repetive strain disorders include carpal tunnel and tennis elbow.

There are many other symptoms  of TMD and MPD as well so it’s not surprising that it’s hard to work out exactly what is behind all these varied pains and sensations.  Physiologic dentists are experts in understanding patterns of referred pain in the head and neck .

The ‘bad bite’ that causes the problem in the TMJ is actually a poor alignment of the upper and lower teeth. When they don’t match up properly it puts extra pressure on the jaw and the muscles are used incorrectly causing repetitive strain injuries  like a chain reaction.  These problems affect head position posture and the body as a whole. The bad bite affects the muscles and the TMJ (TMJoints) which triggers the trigeminal nerve causing referred pain that eventually makes your eyes hurt.

The swelling around the eyes and dark circles under the eyes are actually secondary results of unhealthy muscles blocking normal drainage creating venous back-ups.  The dark area under the eyes is due to blood that is not receiving enough oxygen.

Dental treatment may be pain resolution

By now you will be wondering if anything can be done to help relieve the symptoms of eye pain, swelling and twitching. Fortunately, we might be able to provide a solution through the use of a diagnostic physiologic orthotic placed in your mouth that realigns your bite and allows your healing.  The orthotic is used to eliminate the impediments to healing. Doctors who allow the body to heal understand the process of health far better than those who promise magic cures.

An ultra low frequency TENS machine (MYOMONITOR) is used to create minute electrical impulses to stimulate your jaw and neck muscles so they  relax and the jaw and TMJ joint takes up a better position. This makes it easier for a dentist who specializes in physiologic treatment of TMJ and other jaw disorders to pinpoint where your bite should be.  Once the bite is idealized postural changes occur in the neck and throughout the entire body.  The diagnostic orthotic is corrected to reflect these postural changes.

When your bite is kept in the correct place then your TMJoints and jaw muscles will not be triggering the trigeminal nerve and resultant  pain will not be referred to  your face and neck. Effective dental treatment may eliminate or improve your eye pain and allow you to reclaim your normal life.

It may be time to seek TMJ relief

tmj-reliefYou shouldn’t miss out on enjoying life because eye pain is distracting you and painkillers have become a way of life. As it is possible that your TMJ is causing your eye pain, then it may be time for you to take the next step.

A diagnosis of TMD will be required, and we will need to make a thorough examination and eliminate any other potential causes of your eye pain. From there, we can determine what the best step would be for you. TMJ relief may be possible if you have bad bite and it can be realigned successfully.

TMJ Orthotics

Dr. Shapira Chicago, Deerfield, Evanston, TMJ Orthotics 16 Comments

How do orthotics help your TMJ?


TMJ is a medical condition that affects your muscular and nervous systems, which explains why many patients experience pain in their shoulders, backs, and necks.

While some think the only symptoms of the condition are a popping in the jaw and jaw pain, it can manifest in various ways, including keeping you from getting a good night’s sleep and preventing you from chewing your food properly.  Chronic headache or migraine is one common symptom that is often misdiagnosed.

There are a number of different causes of TMJ, including trauma to the mouth, clenching your teeth, joint inflammation, arthritis or another degenerative bone disorder. Any type of damage to the joint, including damage caused by a disease or injury, can lead to symptoms of this disorder, but an orthotic can provide some relief.

What are TMJ orthotics?

Orthotics are orthopedic appliances designed to correct underlying orthopedic or occlusal pathology.  A diagnostic physiologic orthotic is an orthopedic appliance utilized to evaluate treatment positions and effect of reversible treatments before long term corrections are made. TMJ orthotics are ideally made to a physiologic position and they are worn 24 hours/ day seven days a week.  The changes that occur are not only in the position of the jaws and jaw joints and jaw muscles but rather changes that occur through the entire postural chain from head to toe with the majority of changes taking place between the head and the sacrum.

All orthotics are not alike.  Depending upon the design and fit orthotics can have little to no effect or even increase symptoms. The orthotic is designed to unload the joint (a mechanical effect) and to relax the muscles and give a physiologically health landing position.  Some patients may require seperate daytime and nighttime orthotics.  During the day the orthotic is used for all aspects of daly living and must be comfortable and attractive.  Orthotics must be worn continuously to allow healing to occur.  Part time orthotic wear may give some relief but full-time wear is ideal when permanent correction is sought.

A TMJ orthotic is distinctly different from a Bruxism Appliance.  A Bruxism appliance is a small device designed to prevent the symptoms of bruxism, which is the medical term for teeth grinding. Also known as mouthguards, mouthpieces and bite plates, these devices fit inside your mouth and provide little to no discomfort. Made from a multitude of strong  materials, your dentist  can chose from a variety of materials whether he or she wants a hard or soft appliance or a combination appliance.  The bruxism guard is fit over your upper teeth or your lower teeth, and it will keep you from causing damage when you are grinding your teeth.  Instead of wearing down your teeth you wear out the plastic which is softer than your teeth.

The motion of moving your jaw back and forth can slowly wear down the enamel and cause cracks and chips to form in your teeth. This motion can also increase your TMJ symptoms and cause additional pain. Bruxism appliance are similar to the some mouthguards that you might use while playing football or another sport, and these products offer a temporary solution to the pain and discomfort that you feel.  The TMJ orthotic can also be used for sports but is designed to improve performance  and idealize physiological function as well as protect the teeth from trauma.

Other phase one treatments

tmj-bite-orthoticIn addition to a TMJ mouth guard, there are other non-surgical TMJ treatments available to you. During the first phase, the doctor will look at remedies that won’t interfere with your life or daily activities.

Physical therapy, which includes using heating pads or cold packs and exercising, is one way to strengthen your teeth and reduce your TMJ symptoms. Your physical therapist will work with you in the office and give you exercises that you can use at home, including exercises that show you how to reduce your bite and increase the strength of your upper or lower jaw.

Spehnopalatine Ganglion blocks are frequently used when there is an autonomic portion to the pain.  This is frequent in chronic daily headaches as well as many types of migraines as well as other issues.  They stimulate a relaxed condition that frequently alleviates pain and prevents it return.

Trigger points in muscles are also looked at during phase 1 treatment.  Ultra low frequency TENS can eliminate much or the muscle spasm and chronic hypertonicity.  Trigger points are sometimes resistant to general treatments but respond well to trigger point injections and spray and stretch techniques utilizing vapor coolants.

A locked TMJoint can cause excruciating pain if you try to force it open.  The body frequently utilizes muscle splinting to protect an injured area.  The muscles tighten up in a patterned response to protect the injury. This is not the same as muscle spasm which is uncontrolled muscle contraction often due to inflammation or injury of the muscle.  The sooner a “lock” is reduced the faster pain will diminish and muscle tightness will dissipate

Myositis is an inflammation of a muscle usually from organic causes.  It is very painful with function and function is severely limited.  There can be different types of muscle pain occurring concurrently.

If you have frozen muscles that do not move or loosen over time, the doctor might suggest steroid injections. A small needle inserted into the jaw or neck forces the steroid deep into the muscle to unfreeze the area. Some forms of medication, including anti-inflammatory medications, can also reduce your symptoms. Steroid are usually not a first choice for treatment but can give relief.

Depending on the severity of your TMJ, your dentist may either recommend over the counter medications or give you a prescription for an anti-inflammatory or pain medication.  The best is treatment is to eliminate the causes of the pain and inflammation and to allow healing to occur.  Use of strides or anti-inflammatory meds will give poor results if the underlying cause is not addressed.

There is no “CURE” for TMJ but treatment can eliminate the pain and dysfunction vastly IMPROVE YOUR QUALITY OF LIFE!


There are permanent changes that occur from long term TMJ disorders and/or pain.  A “TRUE CURE” would give you a do-over on the years you spent in pain which changes you physically and mentally.  Many life choice are altered when we are in pain.  We will make recommendations on multiple treatment options.  The final option always belongs to you, the patient. We strive to find treatment that works perfectly for you, but we rely on you to defining what perfect is.  A TMJ orthotic helps improve your bite, unloads the joints from excessive pressure and allows muscle relaxation while preventing damage from bruxism.   The more advanced physiologic orthotics are designed for 24 hour continual wear.

Other treatments include braces, cast orthotics, DNA Appliances and surgical procedures, but your doctor will work with you before determining that you need one of those more complicated procedures. You shouldn’t feel tied down because of the TMJ symptoms that you experience on an average day. Patients today will find different products that will let them recover and beat their conditions.

If you have questions about whether TMJ orthotics can improve your health, smile, posture, breathing and reduce your symptoms, please read my e-book on TMJ today.

TMJ Treatment

Dr. Shapira Chicago, Deerfield, Evanston, Highland Park, Kenilworth, Lake Bluff, Lake Forest, Libertyville, Lincolnshire, Mettawa, Morton Grove, Northbrook, Northfield, Skokie, Treatment of TMJ, Vernon Hills, Wilmette, Winnetka 4 Comments

How TMJ is treated by a dentist

tmj-treatment3Finding the reason behind the pain that you feel is the best method for a dentist to determine how to treat your condition. Though many patients assume that all type of TMJ treatment are the same, treatments vary significantly from patient to patient.  There are a wide variety of TMJ disorders and frequently there are multiple factors to account for.  Your TMJ problem may be as individual as you are.

The discomfort that you feel typically relates to the way your condition affects your body.

With TMJ, a patient’s nerves, muscles, ligaments and tendons all function in less than ideal ways that causes the patient to feel uncomfortable or in pain. Your dentist will work with you to determine which combination of  remedies and treatments will bring you the most relief.  Dr Shapira is your partner in finding your path to the life you deserve.

TMJ treatment phases

When Dr Shapira determines your diagnosis of TMJ or associated disorders, he will describe the three different phases of treatment. The first phase is the most important phase which is to restore your quality of life as quickly as possible.  It involves non-invasive procedures that do not require surgery. Those treatments can include orthotics, physical therapy and other non surgical TMJ treatment options as well as minimally invasive procedures such as trigger point injections, prolotherapy or SPG (spenopalatine ganglion ) blocks. Orthotics may include a diagnostic physiologic orthotic, nocturnal bite splints, pivotal appliances for TMJ locking or other modalities such as an Aqualizer that uses a basic law of physics to equalize pressure on both joints and relax the musculature.  The second  phase is long -term management after pain relief is accomplished.  It is all about maintaining comfort for life.

Phase 1

Fotolia_35843554_XS2This phase of TMJ treatment is all about restoring your quality of life.  Dr Shapira will dissect your problems to answer each of the problems that make up your specific issues.  The mainstay of Physiologic Dentistry is a diagnostic orthotic, a device that lets you experience the life improving results before committing to extensive treatment.  Patients are told to expect 50-80% improvement within just 2-3  visits.  There is no “ultimate cure” for TMJ but many patients experience almost miraculous cures while other patients have a longer road to reach their goals.  The use of behavior modification, which teaches you how to do simple daily activities without causing additional pain or discomfort is often needed initially but are goal is a complete return to normal function.  Dr Shapira will make you his partner as the guardian of your health and welfare putting you in charge of your future health!

Simple TMJ jaw exercises can  provide relief for some patients but others require guided treatment to relieve the pressure on your nerves can lead to increased pain. Just  strengthening  the muscles in your jaw is not a promise of success.  The creation of an environment where healing occurs is actually the most important aspect of treatment.  We use our jaws twenty-four hours a day for breathing, eating, talking, kissing and to maintain proper postural health.  Dr Shapira builds that healthy bite into your diagnostic orthotic.

Phase 2

Phase two is embarked on when you are feeling good and your body has had a chance to heal.  There is no “Cure” for TMJ because you have changed due to your months or years of pain.  A cure would entail a do over on the part of your life lost to pain.  I want you to have the best life possible moving forward where TMJ and MPD do not adversely affect your life.  Many patients feel as if they are “Cured” but they are not the same as if they never had a problem to begin with.

This phase of TMJ treatment includes the use of occlusal equilibration or coronoplasty for some patients.  This is minute adjustments to the bite to make it function better.  Other patients may require orthodontics or reconstruction to achieve long term stability.  Dental implants can be used to replace missing teeth when necessary.  Phase two can utilize cast onlay orthotics, partials or dentures.

Bruxism which occurs when you grind your teeth at night may require treatment with a night appliance to protect the muscles, joints, teeth as well as the restorations.

The use of other orthodontics can reduce your discomfort and give you a healthier bite.  This can be through standard orthodontic procedures.  The DNA Appliance is an exciting and more comfortable alternative to braces that is worn during sleep and a few additional hours a day.  It allows us to grow your jaws to a more ideal size and shape while permanently correcting your bite.

Crowns, also known as caps, let the dentist repair damaged teeth and reduce the gaps between teeth, while braces are a good option for those with healthy teeth who still suffer some pain.  A full mouth restoration can restore your entire mouth in just a few visits and is an exceptional treatment for many cases.  Due to the cost many patients feel they cannot afford this treatment but financing can make it available in affordable monthly payments.

Phase 3

The majority of patients never need this phase.  The goal of phase 1 and 2 treatment is to avoid temporomandibular joint surgery whenever possible.  Orthognathic surgery is also a phase 3 treatment that can create an ideal situation but carries significant risk.  The DNA appliance can comfortably create orthopedic growth without surgical intervention in may patients.

This phase of TMJ treatment is the most invasive option and typically requires some form of surgery. If the dentist can determine the root cause of your pain, the doctor can do microscopic TMJ surgery, which lets the dentist carefully repair a damaged joint or nerve from an incision made in an out of the way spot.

If you suffer from lock jaw, which is one of the more common symptoms of the condition, your dentist may recommend arthrocentesis. With this procedure, the doctor places needles inside the affected joint and pushes a saline solution through the needles. The liquid slowly works its way through the jaw and loosens the joint and surrounding cartilage. Other forms of surgical intervention can give you some pain relief.

Need to know more?

tmj-questionsA TMJ orthotic is almost alway the starting point for therapy.  Surgery is rarely the first option but in the case of severe degenerative changes it must sometimes be considered.  TemporalMandibular Joint surgery should always be approached cautiously.  Almost all patients can be managed without surgery.  The longer that you live with your condition, the more work you need to do towards repairing your mouth and jaw. While surgery is one option, it’s often the last resort.

Remember Quality of life is your most important outcome.

Your dentist will suggest that you use jaw strengthening exercises, bite plates and other remedies before recommending jaw surgery, braces, tooth grinding or crowns. To learn more about TMJ and the best treatments for the condition, download a copy of my e-book today.