877: TMJ and the Nervous System With Dr. Dickerson

Child: Welcome to my Mommy’s podcast.

Katie: Hello, and welcome to The Wellness Mama podcast. I’m Katie from wellnessmama.com, and I’m back today with Dr. Sharon Dickerson to talk about TMJ and the nervous system, which is a topic I have not covered before. But we go deep on how TMJ, what it is for one, how it impacts the nervous system, how to know if it might be impacting your nervous system, some holistic approaches, how to deal with the neurological effects, and so much more.

And Dr. Dickerson is an absolute wealth of knowledge, and I feel like very unique in the dental world. She’s a biological dentist who also specializes in trauma-informed care, which is an area that often I feel like is not even talked about, much less really provided resources for. So I love her work, and I love that she addresses the root cause of oral health problems and really has made it her mission to help people who feel like they could never receive dental care because of past trauma and triggers to be able to again. Definitely learned a lot in this episode, and I know you will too. So let’s jump in. Dr. Dickerson, welcome back. Thank you for being here again.

Sharon: Thank you for having me.

Katie: Well, I will link to our first episode in the show notes if you guys haven’t heard it. Absolutely fascinating about oral toxins, root cause approach, trauma-informed dentistry. I learned so much. And Sharon, I’m excited to learn from you again today about specifically TMJ and how it relates to the nervous system. I’m guessing there’s a lot to learn on this topic. So to start broad, can you maybe walk us through what TMJ is and how someone might know if they have this or if it could be an issue for them?

Sharon: Absolutely. So the TMJ is the temporomandibular joint, and it is the joint right in front of our ears that hinges our jaw in opening and closing. I think for context, it’s kind of interesting to note that this part of our body, our TMJ, our facial muscles, our teeth are innervated by the largest cranial nerve in our body, the trigeminal nerve.

And there’s just so much sensory and motor innervation and feedback to the brain through the trigeminal nerve that informs our brain about where our jaw is in space, how things are working with the teeth. Are the teeth in good shape? What food is in there? And how is the body going to actually masticate the food?

So when it’s working well, it’s a smooth process. The jaw hinges freely. All the muscles are working in coordination, right to left, front to back. That’s a beautiful thing. When things go awry in the TMJ, because of this high degree of innovation, it can be very disruptive to the patient, to the person, and to their nervous system.

This might be noticed as chronic headaches, chronic migraines, actually pain in the muscles that work your jaw. There are intricate structures within the TMJ that can actually cause people to have trouble opening and closing. Somebody might wake up one morning and they can’t open very far. That’s a signal that there is definitely a problem that needs some attention.

There is also disruption to people’s sleep when the TMJ is not in good biocompatible function. In people who are suffering with clenching and grinding and wearing their teeth down, this is usually a sign of an imbalance between the way the teeth fit and the way the jaw is functioning. So these are all different, I think different symptoms and signs that there could be a problem.

Katie: Okay, so if someone is noticing any of those, like that might be an indication that they would want to get checked and see if this is something that’s going on. What does that look like? Or how do you as a dentist check for to see if there’s an issue going on?

Sharon: Yeah. A lot of it is just the history, taking the history of what’s happened with them. If they have it, there sometimes might be a history of a traumatic injury that can contribute. So just learning what they’re feeling, what are their pain symptoms? We have different charts and graphs that help track that and assess that.

Again, we talked about the three-dimensional cone beam. It’s kind of a CT scan that we have in our office that gives a very close-up view of the temporomandibular joint and can inform us about the condition of the actual structures within the jaw joint. And then the clinical assessment, you know, how is the jaw functioning? Can the person open wide enough to a normal amount? Do they have clicking and popping that disrupts the smooth function of the jaw? Some people open, but their jaw has to take a swing to the right and the left in order to open properly. These all just help us to start formulating a diagnosis about what’s happening within the jaw joint.

Katie: Got it. And you mentioned that this can impact the whole nervous system. I’m curious, is this, if it’s creating enough of a stress response to impact the nervous system, can it, can that alone be enough to keep someone in sort of sympathetic nervous system dominance? As someone who lived in that for over a decade, not from TMJ, but from trauma, I’m just curious because I’ve seen firsthand how that impacts literally every aspect of health and your body’s ability to heal and sleep and so much.

Sharon: So the thing about the TMJ that I think is unique is that it doesn’t seem to even calm down at night. You think about, okay, sometimes people are grinding their teeth all night. They might be clenching all night. So this can be kind of a vicious cycle. When there’s disruption in the, I guess, biomechanical structures within the jaw joint, it causes a pain response. Chronic pain in itself is a nervous system dysregulator. But then when you combine it with nocturnal, nighttime problems that can actually start impacting sleep.

So a lot of times TMJ problems are coordinated with different types of sleep disorder, breathing, different sleep disturbances. So then that’s disrupting the body’s ability to repair and rest this critical part of the body at night. People can get caught really in a spiral of pain and dysfunction and exhaustion that absolutely can cause people to start feeling anxiety, stress, hopelessness. That’s one thing I’ve seen quite a bit. People can feel like there’s no way out. And many of them that I see have already sought solutions. And maybe they’re several years into trying to find solutions. And they just can’t get away from the pain. And they just can get very depressed. And anxiety can be really a problem.

Katie: And I would guess like a lot of people may not even be aware that this could be the root of why they’re experiencing some of those things. Can you talk about the holistic approaches that you take to helping deal with this and also like mitigate some of those neurological effects people have?

Sharon: So on the neurological side, if somebody is in kind of a perpetual parasympathetic state, which could be really expressed as the fight-or-flight mode, their nervous system is constantly on charge because this part of their body is just not functioning well, there’s a lot of things that we do to try to disrupt that cycle.

So a lot of it initially could just be general stress management, meditation practices, yoga, different things that can just calm the nervous system. I love working with other practitioners, physical therapists who can work on different exercises and stretching and things that can help the patients start to establish a sense of control over the situation and start help relieving some of the muscle tension.

Craniosacral specialists, some massage therapists, have really spent a lot of time trying to learn about this part of the body. Even some chiropractors who pay attention to the TMJ can provide at least some temporary relief to some of the muscle spasms and the pain that’s been exacerbated over a period of time. There’s more coming on the forefront with different laser techniques, red light therapy. There’s some different little, almost like a flashlight wands of red light that you can just apply to the muscles and the jaw joint that are hurting.

I have a lot of patients who find these kind of rescue remedies very, very helpful. It’s not treating the root cause, but these can be sort of the holistic adjuncts to corrective therapy.

Katie: So it sounds like there’s some at-home stuff people can do that are helpful as well. So that’s really encouraging. I didn’t know red light was helpful for that potentially. I know a lot of people have red light devices in their home.

Sharon: Yes.

Katie: What other stuff can people do at home, either if they know they have that to help mitigate it and or is there anything we can do preventatively just even to address if we don’t have full blown TMJ, but to address like that tension, that clenching, that grinding or just jaw tension?

Sharon: So, you know, besides the things I mentioned, a lot of people like to use different compounds. Magnesium is kind of a muscle relaxant. Different essential oils. I have lots of patients who are very knowledgeable about what different essential oils can help relieve stress and tension in the body and topically.

Of course, a diet that’s antioxidant, and you know, supports immune function, reduces inflammation, is going to be helpful. Sometimes people just need to rest their jaw and stay away from things that require a lot of chewing if they’re having a kind of a spiral. Those again, are kind of palliative things that I find can be helpful for symptomatic relief short term.

Katie: And is this something that most dentists are aware of and checking for? Or is this something that someone might need to like specifically request to be checked for if they feel like they’re having some of the symptoms you mentioned?

Sharon: I think most dentists have a basic knowledge of what constitutes TMJ dysfunction. That, I think, is something we’re all taught in dental school. It’s not every dentist’s passion to go seek a lot of advanced education about how to actually treat it.

So when you really get into actual therapies and treatment that’s going to correct this chronic spiral and cycle of pain, that’s when it really does take, at least it’s taken for me, years, decades of advanced training about treating actually what I would consider more the root cause of this kind of chronic muscle spasm. It’s not normal. Not everybody has it. So we’ve looked at, okay, what constitutes a healthy chewing system and a healthy TMJ? What constitutes one that’s in a state of chronic disease.

And so my goal ultimately is to help bring somebody with this kind of problem to a state of stability and harmony so that these muscles and nerves can calm down and they can go on with other more fun things in their life.

Katie: And I believe you have a whole handbook dedicated to this. Can you kind of like walk us through what you take someone through on the journey of understanding and then working with and then recovering from TMJ?

Sharon: So the first step is absolutely a proper diagnosis, and that gets to intake assessment, imaging, you know, digital imaging with the CBCT. To me, one of my first goals is to help stabilize the system. So we start talking about beyond teeth, beyond the jaw, how are these teeth and jaw all working together?

And when there’s a discrepancy between how your bite is fitting and how the jaw is fitting, this oftentimes to me is what’s causing the trigger of all this muscle spasm. So somebody had, some people may have felt this just when they had a dental work done and maybe the filling was a little too high. It’s very disruptive. You can’t stand it. It’s like if you get a little raspberry seed, you try to, you can’t ignore it until it’s gone. We’ll picture that on a bigger level. If there’s a problem with the teeth aren’t fitting at the time, the jaws fitting, this is a problem.

So there’s an oral appliance that I utilize and some of my colleagues who’ve trained in oral and ethic bioesthetics that’s called a MAGO, M-A-G-O, Maxillary Anterior Guided Orthotic. And we apply that in a very specific way through full-time wear and perpetual adjustments as the jaw starts to settle and relax. It’s a diagnostic tool and it’s a pain relief tool.

At the end of model therapy, which could take some weeks or even months, depending on how diseased someone’s system is, there usually is something that can be done to the teeth that’s conservative to bring that balance to the teeth and the jaw. So that they’re not in this constant fight and battle between the jaw joint and the teeth. So really actual restoration of the teeth into proper harmony with the jaw joints is something that definitely would be more of a specialist realm. Somebody who’s interested in that as a dentist and taking a lot of time and care to learn about it.

Katie: That makes sense. And like I said, I know you have a whole handbook related to this. So that is of course linked in show notes for anybody listening. What about people who maybe don’t have full-blown TMJ, but like notice they clench at night or grind their teeth a little bit? Are you a fan of like nighttime mouth guards or what do you recommend for those types of people?

Sharon: Yeah, I think most dentists are pretty well-versed in just basic nightguards. It’s been a passion of mine, this whole world of TMJ for the whole of my career. So I’ve worked with a lot of different styles, a lot of different types. I’m very specific about how I would want that to be designed so that it lends all the proper proprioceptive feedback to the brain throughout the nighttime to not only just protect the teeth, but actually hopefully calm down that nervous system reaction of grinding. But yeah, a well-made night guard is a great, kind of a good Band-Aid tool that we’ve used a lot for sure. Cause some people, like you say, aren’t in a real crisis. They just need a little support for that nighttime process to try to alleviate that clenching and grinding.

Katie: Got it. Okay. I would also love your take on mouth breathing, which I feel like has gotten some airtime lately. People are talking about the problem with mouth breathing, especially at night. And, or what do you think about mouth taping? If somebody doesn’t have contraindications like sleep apnea, for instance.

Sharon: Yeah. There’s a lot of things that we’re learning about the development of especially Western humans that has changed in recent years. By recent, I mean the last several hundred years. That’s a fascinating topic in itself, Katie. That could be a whole other podcast.

To me, it always begs the question, why are people having jaws that aren’t really growing to full size? Why can’t people accommodate their wisdom teeth? Whereas several thousand years ago, humans had plenty of room for that. There’s a lot of factors that have affected the development of the human jaw, and a lot of it goes back to nutrition and the airway, the development of the airway.

So in childhood, and as your body’s developing, if there are different allergens and different things that have caused people to habituate breathing through their mouth, it isn’t the best, most efficient way to breathe, and especially all night long. There’s so many benefits of breathing through your nose. It humidifies and filters the air as it comes in, and it actually helps perpetuate a proper size of the airway. If you think of your airway through your nose and to the back of your throat, a lot of people just have that airway is just skinny and atrophied because they’ve been breathing through their mouth for years.

So mouth taping is a great tool. I think it’s so simple and it’s cool that somebody discovered that. And there’s different products and things that I think I’ve, I think I’ve had many different patients experiment with. Some people are sensitive to the adhesive. So there’s not, you know, there’s anti-allergenic different ones on the market. I think it’s a great tool. Like you say, sometimes it’s not enough to really combat some true sleep disordered breathing, but I would say it’s a great starting place for a lot of people.

Katie: Good to note. Okay. And as we get close to the end of our time, I know we’ve gotten to talk a lot about TMJ. I’m curious if there are, so it sounds like you’ve explained so well how if we have toxins in our oral environment or we have stress related to our bite or TMJ, this can very much create sort of like a negative feedback loop that impacts the whole body and the stress response and anxiety and so much more. Are there factors that we can do on our own at home that can help sort of shift into a positive feedback loop or really support our oral health in a way that benefits the whole body? Because anytime I see a negative feedback loop, I think there’s probably a potential for a positive feedback loop to exist in the same place.

Sharon: Absolutely. If we’re talking about toxicity, it stands to reason that if there’s a chronic toxic burden, you have to stop what’s causing that. It’s like if somebody is living in a black mold house, it’s going to be hard for them to detoxify if they’re still living in that house that’s toxic with black mold.

Same thing with certain oral toxins that might be a chronic exposure. So one good thing I think to start with is really do get engaged with a biological dentist that’s going to help sort through whatever there are the oral toxicities. Learning really good, effective, efficient oral hygiene is going to reduce the bio burden from any negative microbiome that might be living in the oral cavity. So we think about that as far as brushing and flossing and tongue scraping and just getting some really good coaching on that. I’m a big fan of water flossing.

But the other thing I think is important is just to realize that having a healthy mouth that supports a good immune function is really more of an inside job. The way our teeth have a blood supply and the nutrition that we take in definitely affects the health of our teeth and our mouth. So that just is always getting back to making sure we get proper the fat soluble vitamins like A, D, E and K, having a proper, you know, an enhanced mineral diet, eating, you know, a diet that supports all the nutrition that is really going to be effective for detoxifying our body and for providing what our teeth need to be strong and healthy.

So I think those are kind of the biggest things that I go to if somebody just really wants to be preventative and maintain a good, healthy oral environment.

Katie: Wonderful. And like I said, I will link to your handbook in the show notes as well as your website.

Sharon: Thank you.

Katie: But you mentioned briefly in the other episode that people can travel and work with you, but also that you do free short consults with them via phone if they’re just curious if it could be a good fit. But can you just remind people the ways that you work with them? And it’s great to know that you’re available as a resource.

Sharon: So yes, we do work to put viable content on our website. If you dig in there, there’s a lot of hopefully good information. We do have some social media presence that we help just keep this on the top of people’s minds. But I think it’s important as a kind of a unique resource to be able to help people walk through, all right, what are we offering? Is this something that’s applicable to where they are with their journey, with their oral health?

So that’s where I do feel like that initial phone call, sometimes we’ve lost the human touch in certain realms of healthcare. You get to speak to a real person who’s an expert on a lot of these factors, who knows our practice and is really good at helping people decide, okay, do I need a biological dentist? Is there something that we can offer here in our practice in Denver that’s unique, that would help you? And so it’s not uncommon that somebody might come in for a course of treatment, but then they can go back to their own community wherever it is, different parts of the country. And just be on their good maintenance program with their local dentist. So, yeah, that’s kind of the main ways that we try to support.

Katie: Amazing. Well, that will all be linked in the show notes. But for now, thank you so much for your time. I feel like these are such important topics. I love your trauma-informed and root cause approach and how much obvious care you have for your patients and passion for the work that you do. And I’m very grateful for your time today. Thank you so much for being here.

Sharon: Thanks for all your great work too, Katie. I’ve learned a lot from you and it’s really a pleasure to talk to you today.

Katie: Oh, thank you. And thank you as always for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of The Wellness Mama podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.