Dr. Blank Discusses TMJ Pain, Diagnosis, And Migraine Treatment

How Does Dr. Blank Treat TMJ Situations And Treat Patients With Headaches?

Headaches that start behind the eyes. A jaw that clicks, locks, or feels tight every morning. Teeth that look flatter than last year. If any of that sounds familiar, you might be dealing with more than random stress—you might be meeting your TMJ and your bite in all the wrong ways.

We sit down with Dr. Stephen Blank to map the real connection between jaw mechanics, clenching, and headaches, and why identifying muscle pain versus joint trouble changes everything. Dr. Blank explains how a thoughtful dental exam finds the first tooth that hits in a centered bite, reveals subtle jaw shifts most people never feel, and pinpoints tender muscles that behave like “Olympic” overachievers. From early-click warning signs to trauma-induced cartilage displacement, we explore what your body is telling you and how to measure meaningful limits like reduced opening.

Then we get practical. Forget the boil-and-bite guard that feels like chewing gum—learn why custom, hard-surface appliances calm your system by spreading forces and removing that “satisfying” back-molar squeeze. For stubborn cases, we talk about short, targeted medication to break spasm cycles and Botox to quiet masseter and temporalis overactivity that can trigger migraines. You’ll hear how we stage care based on severity, why reassessment after a week or two matters, and when switching to a lower appliance helps you speak and work without friction.

Most importantly, we share simple daily habits that pay off: lips together, teeth apart at rest; noticing when teeth touch between meals; catching the clench during lifting, driving, or even bowling; and checking how your bite feels the moment you wake up. If you’ve wondered whether your jaw is the hidden driver of your headaches, this clear, step-by-step guide offers relief you can feel and a plan you can follow. Subscribe, share with someone who wakes up sore, and leave a review with your top clenching trigger—we’ll tackle it on a future show.

To learn more about Dr. Stephen Blank visit:
https://www.PSLdentist.com
Dr. Stephen Blank, DDS
184 NW Central Park Plaza 
Port St. Lucie, FL, 34986
772-878-7348  

Transcript

Welcome And Topic Setup

SPEAKER_00 0:03

Welcome to the PSL Dentist Podcast, where healthy smiles meet real talk. Hosted by Fort St. Lucie's very own Dr. Stephen Blank, the one dentist who's been making the treasure coast smile for decades. From one-visted crowns to clear aligners, Botox, and even lifting threads, yep, your dentist does that too. So sit back, open wide, not literally pleased. And get ready to sink your teeth into today's episode.

Headaches And The Jaw Connection

SPEAKER_02 0:43

Welcome back, everyone. Frederick, co-host and producer in the studio with Dr. Stephen Blank, your Port St. Lucie dentist. Dr. Blank, hope your day's been running smoothly. Doing great. Wonderful to see you, Frederick. Wonderful to be here with you. So today's question, uh, if you're open to jumping right in, is how do you, Dr. Blank, treat TMJ situations and help patients who struggle with headaches?

Muscle Vs Joint: Finding The Source

SPEAKER_01 1:08

Wow, this is an important one. Many people come to see us, or actually, some don't come to see us because they don't know dentists have anything to do with headaches. So they'll come to us when their joint is popping here. But headaches up in this area or behind the eyes, they don't always associate that with their mouth at all. So when I get patients in, part of our examination process is just that get a history and ask, do you suffer from migraines? Do you get these more than you know, once every few weeks? Some people are daily and uh they don't know who to turn to. So once we establish that, you know, we have an issue, then we have to separate what kind of an issue? Is this coming from the muscles? Is it coming from inside the TM joint, the temporomandibular joint itself? Um, and are the teeth involved, or is it sinus issues? So we evaluate for all of that. And most of the time we find overlap. So some of the overlap may be that they clench their teeth a bit, their temporalis muscle might throb in this area, and then it starts moving into a full-blown migraine where it's no longer the mouth, but their head goes under a pillow, the room lights go out, and they're out for a couple hours. Um, and then other times we have just the muscles in spasm, and this can be subconscious, like when you're sleeping. Patients will wake up in the morning and their their cheekbone right here, where the muscle goes from the jawbone uh down to the jawbone from the cheekbone, that muscle will get real achy and they'll wake up with it all sore, and they might have tension in the jaw or they can't even open. And that's a muscle-related problem, but unconscious, you can't tell them, oh, just relax. They were busy sleeping. So then we look into ways of protecting themselves from their own muscles. And there's multiple ways of doing that, and we always start with the easiest ones. Uh, often that involves a bite appliance to get their teeth to contact in a more favorable way while they're sleeping subconsciously, and to make the clenching less happy. If your muscles aren't happy squeezing, then they tend to do it less often. But then I get some of my patients that I call the evil clenchers, they'll clench anyway. And they don't always get the headaches, but their jaw might be clicking and popping, or their teeth may be getting cracks or breaking the tooth. Often a broken tooth is the first thing that gets them to me. Uh, and then we look in and see all the other teeth are kind of flat, also. So if a bike guard doesn't do it alone, then we look at uh making the muscles more relaxed. That's when we get involved with Botox therapy to relax the muscles in this area and up in this area. So sometimes it's to relax the muscles so they don't cause trouble, and other times it's to relax the muscles so they don't stimulate the beginning of a headache or the migraine itself and be a triggering effect.

SPEAKER_02 4:13

Wow. That that is really great info. I didn't know a lot of that stuff. Uh thanks for sharing that. Uh you mentioned that TMJ issues can come from several different causes. Uh, what are the most common causes you see in your practice?

Early Signs, Trauma, And Measurement

SPEAKER_01 4:27

Well, when we talk about TMJ, TMJ is just a short for temporomandibular joint. Everybody has one. You have a left one and a right one. But not everybody has dysfunction in it. So we call it TMJ dysfunction. Uh, and then the we have to narrow it down to is this a muscular problem or is it a joint problem? A joint problem is when the cartilage is moved out of place. You have a ball here, and then the your skull has the socket in it, and it moves around, and that lets us open and close and stick our jaw forward and then chew left and chew right. When the cartilage gets out of position, patients can't open well, or they'll hear a big click click when they open and close, or the cartilage can get in a real bad place where they can't open. And we measure that by measuring the distance between the front teeth, and we can see if they're below a certain amount that they're having uh the cartilage displaced, and that's usually a result of the muscles being in spasm for a long time. Early signs we can treat when the it clicks sometimes, but not all the time. Those are the wonderful patients because they're easy to get back to normal. Uh, and then the other issues are trauma. They hit the steering wheel, uh, they fall down, uh fighting, punching, those kind of things, um, can also lead to direct damage in the jaw. So they can uh have a uh an area that needs healing time. Uh most often with TMJ cases that are beyond the simple early clicks, uh, we're trying to get the patients to a stable position where their cartilage can grow, which is real slow because we can't put a splint on your head and tell you don't use your mouth for a month. Uh you have to eat, you have to open, breathe, swallow. Um, so we have to just help them adapt to a more healthy position that they can function in again. So that's when the bite appliances come in. Sometimes muscle relaxant medication for a short period of time to get everything to settle down. Um, each case is different. And sometimes it's just on one side, not the other side. So every patient is different, also, even within the cells.

Bite Harmony And Hands-On Exam

SPEAKER_02 6:41

Wow. So you talked about uh distinguishing between uh joint and muscle-caused headaches and those things. How do you uh evaluate whether a patient's headaches are connected to their bite or their jaw alignment?

First-Line Treatments And Stress Cycles

SPEAKER_01 6:54

That's a great question. And we do that with a dental exam. Uh, we check the jaw by holding it with the joint centered, and we find out which tooth is hitting first. If I tell you to just bite, you bite and you feel all your teeth touching. But that's not necessarily a jaw-centered position. Your jaw might be a little cocky where you shift a little one way or the other way to get there, and you don't even know you're doing that. So my job is to find out are they your muscles in harmony with your teeth? Or your teeth causing your jaw to be offset, and then a muscle has to work to hold it there when it should be relaxed. So we see that often. And then the rest of it is with the fingers. We feel the muscles, we feel the different areas, and we feel up here, uh, and we can find tender muscles. Uh, a patient at the end of today came in and very, very tender. When I touched her master muscles, it was like a hot dog here. It bulbs so much. So she's an Olympic athlete for jaw, but that doesn't get you any points. No gold medals this week in that one. But um, that's something that we can reduce in size with medication. That's a Botox kind of case. And then possibly a bite appliance. So during the interim, she doesn't crack her teeth into.

SPEAKER_02 8:08

Wow, that's really uh Olympic level jaw clencher. That's amazing. Um so speaking of when it comes to TMJ discomfort, what types of treatments do you typically start with for TMJ discomfort?

SPEAKER_01 8:22

Very often it's with a removable bite appliance, something to help protect the people, the pay the patient's teeth from harm from their own muscles pressing against them, to change the muscle pattern so that they can't get the pleasure from clenching, the subconscious pleasure. They don't think of it that way. Uh, and to to break the cycle. So we want to break the cycle where they clench. And people do that in waves anyway. People have times where they clench for a couple days, then they're quiet. Or for a month, and then they're quiet for a month. Um, students are common in college. Anytime a final's coming up, their jaw starts to hurt. They clench more, they're they got stress going on, and we subconsciously take it out on our jaws. They've even tested football players. When they're pushing the line guys, linemen, are pressing against those big heavy sleds, they clench their teeth. And if they have a bite appliance in, they can push harder on the sled. And it's not connected, their mouth's not connected to their legs, but it is through the brain. So they can get more force out of it. Just like you're weightlifting. You don't do it with your mouth relaxed, you're you're bearing down. So we don't want patients bearing down during their sleep and during between meal time. We don't want teeth touching. We want them when you're at rest. Normally your lips touch, but if you sneak a peek inside, the teeth are just a little bit apart. And if they're touching during between meals, then your muscles are busy when they should be relaxed.

Why Custom Guards Beat Store-Bought

SPEAKER_02 9:53

That's amazing. Uh, so you did talk about how, say, wearing bite guards, if you're a football player, can help you exert more force and everything. But how can wearing a bite guard or a custom appliance help relieve tension and reduce headaches? As apart from pushing heavy uh lines.

SPEAKER_01 10:11

Yeah. Well, and that's a good question because patients come in and they get a sports guard to protect their teeth, which is a wonderful home remedy to start with. But the soft ones that you can buy at the store where you put them in hot water and then squish into them, those will protect your teeth from cracking, but they do nothing to reduce the biting activity. It's almost like having chewing gum in your mouth. You bite more. So they might not crack a tooth, but their muscles are not getting the break that they need. The appliances that I design and most dentists do are the more hard appliances. They might have a softer inside to hold against the teeth, but the the biting surfaces are slippery plastic, and we adjust that for a more even bite. And many of the appliances I make, we don't cover the back molars or we adjust the bite very lightly there. So you can't get that satisfying satisfying clench in the back. And that that helps reduce the activity a bit.

SPEAKER_02 11:09

Amazing, amazing. Thanks for clarifying that. And so for yeah, so for with patients who have chronic symptoms, how do you decide when to explore more advanced treatments or more advanced options?

Escalating Care: Meds And Botox

SPEAKER_01 11:21

Well, and it depends on the degree, the severity of the case. If they're having a lot of difficulty, I try to do everything at the same time. The day we deliver the bike guard, we may give them some medication to help them sleep better at night or relax for just two or three nights. We don't want to have somebody on medication for life. We want to break a cycle. And we may also do Botox that same day. Those would be the severe cases. On the mild cases, we start with the bike guard, reevaluate in one or two weeks and see how they're doing. And then we can always take it a step further or sometimes just adjust the appliance a little bit and tweak it. So if a patient's been clenching a lot, their bite might not be their own bite anymore. It might be an acquired uh clenching kind of bite. And then when we check them later, we see a different uh patient. You know, they they're biting together, but different teeth hit first versus when they first came to see me. So it helps us learn what's really going on. We don't like to make a critical decision based on the person that comes in with all their muscles and a knot. Just can't check how they're doing that way.

Daily Habits And At-Home Strategies

SPEAKER_02 12:27

That is incredible. Wow. So in closing, Dr. Blank, can you tell us, you know, what lifestyle or at-home strategies you would recommend to support the treatment plan and reduce flare-ups?

SPEAKER_01 12:40

Well, being conscious of it is a huge thing. When I tell my patients you have a homework assignment, and that's to pay attention to when do your teeth touch with no food in between. So that's what we call it parafunctional activity, activity other than your normal eating function. And when they start to pay attention to it, they start noticing things. I've got bowling later tonight. And when I go and it's my turn, sometimes I'm and I I and I catch myself, stop that. Um, so you can become conscious and then just not do it. Um, the nighttime clenchers, they have a different situation. They'll wake up in the morning and it's like a dream. If you don't think of it right away, you don't know that you've been clenching unless you're really sore. So I tell them, pay attention to when you first wake up, are your teeth together. The ones that have pain, they're easy. They tell me about it. I don't have to be a detective. Um, but the other ones, uh, you know, have the cracked flat teeth and say, oh, I don't grind my teeth. Well, somebody's grinding them. So it's always uh about pain and being a detective and finding when these things need to be treated, and then we can fine-tune uh the situation. Some of my patients clench during the daytime. And instead of an upper bite appliance where it's hard to speak, uh, we make them a lower one. So a little bit more tolerable during a workday. Um, so those things we don't treat everybody the same.

SPEAKER_02 14:05

Gotcha, gotcha. Amazing. Thank you so much for the insights today, Dr. Blank. Uh, and thank you, everyone at home who's tuning in. Thanks for joining the journey, and we'll see you all next time.

SPEAKER_01 14:16

Thank you, Frederick. Nice to be with you.

Closing And Appointment Info

SPEAKER_00 14:21

That's a wrap for the PSL Dentist Podcast, where smiles are brighter and laughter always cavity-free. To keep your smile in shape, call 772-878-7348 or visit psldentist.com to schedule your appointment with Dr. Stephen Blank, the one stop doc for smiles, beauty, and everything in between. Until next time, keep lost, keep smiling, and keep listening.