My first diagnosed issues with temporomandibular dysfunction (TMD, sometimes called TMJ) occurred in 2007. Anyone who has experienced this knows that determining the cause of this pain and tightness is difficult, as is treating it. For whatever reason, TMJ issues do not constitute a recognized specialty within dentistry, so finding a practitioner with more than minimal study and understanding of these problems can be difficult. If you are looking for someone with such qualifications, organizations like the American Equilibration Society, the American Academy of Orofacial Pain, and the International Academy of Gnathology are good places to start.

Happily, I have had few jaw symptoms for several years. I sleep with a nighttime appliance to prevent clenching and grinding but otherwise do nothing to manage the condition besides occasional stretching. When the symptoms first began, though, I went through a whirlwind of tests, exams, suggestions, and providers. Treatment suggestions ranged from orthodontic treatment (probably career ending for me) to dental reconstruction (also risky and expensive) to conservative treatment with a nighttime appliance. I am thankful to have chosen the third option, and as I have observed developments within the dental community over the past decade regarding TMD treatment the trend seems to be away from aggressive and invasive treatments toward conservative ones. As it turns out, correcting the occlusion or “bite” issues which are often blamed for TMD does not always resolve pain and muscle symptoms. Indeed, despite modern Americans’ reticence to attribute physical symptoms to emotional or psychological issues, stress seems to be the primary trigger of TMD symptoms, regardless of the disposition of one’s dentition or other physical factors. That certainly seems to be the case for me, though I have also observed that sinus pressure from head colds and related illnesses will also cause some TMD pain.

I do not mean to suggest that when I encounter students with TMD symptoms that I suggest only that they “chill out,” though when a student first complains about pain or noise in the jaw I do begin with a suggestion of stress relief. Most of the time this resolves the issue. When symptoms persist I refer him or her to a dentist belonging to one of the three associations listed above. One student in particular who took this advice used an appliance to slightly reposition his jaw for a while and has now been symptom-free for several years. Another suggestion I make has to do with the disposition of the corners of the mouth in the student’s embouchure.

If I had to name as singular fault in my embouchure setup it is that the corners of my mouth are often too loose. How I am able to play well with overly loose corners is not entirely clear to me; I suppose it probably has something to do with the relationship between my teeth and mouth. A couple of years ago, though, I began to notice a correlation between upticks in jaw pain and playing with the corners excessively loose, especially when playing tuba. Purposefully playing with firmer corners resolved the symptoms in short order, so it appears that when the corners of the mouth are too loose the jaw has to bear the extra stress in order to maintain a cohesive embouchure. Not only is this inefficient—it hurts!

If you or one of your brass students experiences jaw pain while playing encourage stress relief first, and refer him or her to a qualified dental provider if symptoms persist. But check the corners of the embouchure, as well. If they are too loose, correcting that problem might both improve playing and relieve pain.