Your jaw has been in pain for some time now.  Your dentist has outfitted you with a new mouth guard to protect your teeth at night.  While you can be assured your teeth are ok, you still wake up with pain and stiffness in your jaw and headaches are becoming more regular than you can stand.  As the stress in your life ratchets up, your ability to put on a happy face dwindles.  You've heard about seeing a massage therapist for stress, know it can help the tension in your shoulders and neck.  A friend of yours has suggest massage therapy and you are keen to give it a try.  Here's a quick list of what you can expect at your first massage for your jaw.

1.        Thorough intake.  Your RMT will want to have a bit of a chat with you to find out about your general health history as well as the specifics about your jaw pain.  Any history of head or neck injuries will be relevant, how long the pain has been troubling you, any dental interventions being used (mouth guard, braces etc) and areas you experience the pain.  They may also want to know if you have found any ways to relieve the discomfort yourself, what makes it worse and any joint noise or “sticking” you have experienced.  Does your mouth feel like it gets stuck with you yawn?  Do you have to clench really hard to get your jaw to close?  These questions will give your therapist an idea of how much trouble your TMJ is in.

2.      Detailed explanation of what will happen.  Because the majority of this work will be done inside the mouth, you will likely have some questions and perhaps some reservations about what will happen.  The gag reflex is usually what concerns people the most, though pain is a very close second.  Your RMT will give you a detailed explanation of what to expect from him or her, what structures they will touch and how they will access them.  A reminder that you are the boss of your body and will be able to stop the treatment, or ask for a break as needed, will likely come up a few times.  While gagging can be a problem for some, most people will discover that it is not an issue at all.  With patience and sensitivity, your RMT will be able to treat inside your mouth without triggering the gag and, should it become an issue, will respect your boundary and retreat from the area.  With time, it is entirely possible to overcome the gag reflex so that it is not an issue at all.  Positioning can make a big difference and your therapist will likely be prepared with pillows or a wedge to allow you to sit upright.

3.  Gloves.  Your therapist will wear a pair of non-latex gloves while working inside the mouth to ensure no one shares their oogies and cooties.  This is to protect both the therapist and the patient from transmitting bacteria or other yuckies between each other.  Some therapists may have a very stringent “glove etiquette” practice, donning and removing gloves each time they enter and exit the mouth.  This ensures that a clean glove is always entering the mouth, and that any contact made outside the mouth is done with a clean, ungloved hand.

4.   Communication.  One of the nice things about intra-oral massage is the patient is not required to keep their mouth open at all times.  Respiration, swallowing and speech are unrestricted through the session.  This allows you and the therapist to always be in communication with each other verbally, ensuring that you can tell the therapist how comfortable or uncomfortable you are, and most importantly, if you need a break from the work.  As stated above, the therapist will spend a fair bit of time explaining to you how the treatment will unfold, and will set up a system for communicating your comfort level.  Generally, a pain scale of 0-10 is used where 0 = no pain and 10 = intolerable pain.  This is a pain scale that you identify for yourself; it is not up to the therapist to tell you where your pain is, and what degree of your pain is acceptable.  In my practice, generally I prefer my client to be below a 7 in discomfort.  When my patient identifies 7/10 on their pain scale, it's time for me to start counting down to my exit, or back off, depending on what I am trying to accomplish in that moment and what my patient has indicated is appropriate.  The moment my patient says stop, I'm out.

5.  Some discomfort.  It is true that some of this work will be uncomfortable, or even painful.  As stated above you are in control of that by communicating with your therapist where you are on the pain scale.  Certain areas will be much more tender and sensitive than others, while some will feel exquisitely painful – that's the 'good pain.'  It's possible that you will experience pain in other places such as the head, neck or throat or the ears.  Be assured that while some of these pain patterns may be unique to you, they are normal.  There's a good chance that you may experience an aha moment as many of these pain patterns will reflect some of what you have been dealing with.  Working in the mouth can trigger some autonomic nervous system activity like drooling, a runny nose or watering of the eyes.  This is all normal and your therapist will provide you opportunity to swallow, blow and mop as you progress through the treatment.

6.   A feeling of spaciousness inside the jaw.  This is one of the goals your RMT will have, to provide you with a sense of freedom, openness or space in the jaw.  This is the opposite of what you may be currently dealing with and is the indication that the muscles of the mandibular sling have relaxed a bit, allowing the mandible to descend in the jaw and taking pressure off the structures inside the TMJ.

7.  Fogginess or sleepiness.  During my training, one of the things that surprised me the most was how sleepy I was getting.  At one point during a lecture, I actually nodded off!  I couldn't figure out why until speaking with the presenter who indicated that yes, working on the TMJ can produce grogginess, fogginess and sleepiness.  For some it may not be as dramatic as my experience was, but for others it may well be.  Communicating with your therapist about this during the treatment can certainly help him or her provide you with some additional work to help clear out some of that fog and wake you up a bit.  Or perhaps if you have a drive home, you can go home and have a nap after treatment.

8.  Post treatment care plan.  Treating the TMJ can sometimes stir up the beehive making you feel a little like you have a nest of angry bees (or even hornets) buzzing in your mouth.  While this may be disappointing and frustrating for you, it will be important for your therapist to know. Generally, post treatment care may involve warm compresses or ice packs, and some simple exercises for your jaw.  If you do find that you're dealing with a lot of pain post treatment, let your therapist know.  It is valuable information as it will help your RMT determine how much is too much; even though it may have felt ok during the treatment, strong kick back responses can show us that the cost is a bit too high.  Together, you and your therapist may decide that, while a 7/10 on the pain scale was ok at the time, perhaps this time it will be better to stick with a 5/10.  Your therapist may also change up which muscles they work with the current treatment, how long the spend working with each muscle, and how long, in general, they spend treating intra-orally.  It's important to note that everyone responds differently to treatment. Some will have strong responses, some will have minimal responses, some will fall in the middle.  None of these are indications of worsening problems nor that your therapist is a bad therapist, just indicators of how your body responds.  It will be important to your therapist to have this follow up so please, don't hold back!

9.  Treatment planning.  You and your therapist will discuss a treatment plan to best address what is going on with your jaw.  Together you will be able to determine what will work best for you, and what kind of outcomes you should be able to anticipate.  Some people will find that a hand full of sessions will be enough and they may not need to continue receiving treatment. Others will find that they will only be able to get so far and will need continued care to maintain the ground they have gained through the work.  Communication will be key here to ensure you get the right care for you.

10.  A healthier happier mouth!  Through the work of your therapist and your dedication to your treatment plan, including the post treatment care, you should see improvement in the comfort and functioning of your jaw which can mean a big difference for many parts of the rest of your life.