Muscular TMD and TMJ Dysfunction: Why the Right Assessment Matters

Jaw pain is often dismissed as stress, teeth grinding or something that will eventually settle by itself.

For many people, it does.

For others, it gradually begins to affect far more than the jaw. They may wake with facial tension, experience headaches around the temples, struggle to eat comfortably, notice that their teeth are wearing or breaking, or find that their jaw feels constantly tired. Sleep can become disrupted. Concentration becomes more difficult. Opening the mouth widely may feel uncomfortable or restricted.

These symptoms are frequently described as TMJ dysfunction, but the more accurate term is temporomandibular disorder, or TMD.

TMD is not one single condition. It is an umbrella term for a group of disorders affecting the temporomandibular joints, the muscles responsible for chewing, or both. Muscular TMD is specifically associated with the muscles controlling jaw movement and may also be referred to as myogenous TMD, masticatory muscle pain, myofascial jaw pain, myofascial pain dysfunction syndrome, MPDS, craniomandibular dysfunction, jaw muscle dysfunction or simply TMJ pain. 

Understanding which structures are actually responsible for your symptoms is fundamental. A treatment designed for overactive jaw muscles will not necessarily help pain arising from the joint, a displaced articular disc, a dental condition or another form of facial pain.

Is it TMJ or TMD?

The temporomandibular joint, or TMJ, is the joint situated immediately in front of each ear. It connects the lower jaw to the skull and allows the jaw to open, close and move from side to side.

TMD refers to the disorder. TMJ refers to the joint itself.

Although patients commonly search for “TMJ treatment” or describe themselves as having “TMJ”, their symptoms may be muscular, joint-related or a combination of both. TMD encompasses more than 30 different conditions, including disorders of the jaw joints, disorders of the chewing muscles and headaches associated with jaw dysfunction. 

This distinction is not merely technical. It directly affects what treatment is likely to help.

What are the symptoms of muscular TMD?

Muscular TMD may present differently from one person to another. Common symptoms include:

• Aching or tightness through the jaw
• Pain around the cheeks, ears or temples
• Headaches, particularly around the temples
• Facial pain that spreads into the head or neck
• Jaw fatigue while eating or speaking
• Tenderness in the masseter or temporalis muscles
• Difficulty opening the mouth fully
• Pain when chewing
• A feeling that the jaw is constantly tense
• Symptoms that are worse on waking
• Sleep disturbance
• Teeth clenching or grinding
• Wear, fractures or damage affecting the teeth and restorations

Clicking, popping or grinding can also occur, although a painless click is common and does not necessarily require treatment. Painful clicking, locking or restricted movement warrants further assessment because it may indicate an intra-articular problem rather than a purely muscular one. 

Is muscular TMD the same as bruxism?

No. Bruxism describes repetitive jaw activity such as clenching, grinding or bracing the jaw. It can occur during sleep, while awake or both.

Bruxism and TMD are related, but they are not interchangeable diagnoses. A person may grind their teeth without experiencing TMD, while another person may have significant muscular TMD without obvious tooth grinding. Bruxism may, however, aggravate existing muscular pain and contribute to wear or damage affecting the teeth, fillings, crowns and other dental restorations. 

This is another reason why simply injecting the masseter muscles or providing a generic nightguard without a comprehensive assessment can be inadequate.=

Why early, accurate assessment matters

Many TMD symptoms improve with conservative care. Treatment should therefore begin with the least invasive appropriate measures, rather than permanent changes to the teeth, bite or jaw. 

However, waiting indefinitely while symptoms repeatedly return is not the same as conservative management.

An early assessment can help to:

• Determine whether the pain is predominantly muscular or joint-related
• Identify clenching, grinding and other aggravating behaviours
• Assess jaw movement and muscle tenderness
• Examine dental wear, fractures and existing restorations
• Identify whether a splint may be helpful
• Recognise symptoms requiring medical, dental or maxillofacial referral
• Establish a supported self-management plan
• Avoid unsuitable, unnecessarily invasive or irreversible treatment

There is no single test that diagnoses every form of TMD. A careful history and clinical examination are therefore particularly important. Other dental, neurological, medical and musculoskeletal causes of facial pain may also need to be considered. 

What can go wrong with a generic approach?

The problem is not that every less expensive treatment is poor, nor that every patient requires complex intervention.

The problem is the assumption that all jaw pain is the same.

Treating the muscle when the problem is elsewhere

Injecting the masseter muscles will not correct every form of TMD. Pain may arise from the jaw joint, a displaced disc, inflammatory joint disease, a dental problem, headache disorder, nerve-related pain or another condition entirely.

Treating without first establishing a working diagnosis may delay more appropriate care.

Using a standard dose for every patient

Jaw muscles vary considerably in size, strength, pattern of activity and contribution to symptoms.

An appropriate treatment plan must consider the patient’s anatomy, muscle function, facial movement, symptoms, dental history and previous response to treatment. The aim is not simply to weaken the largest muscle or administer the highest possible dose.

Insufficient treatment may offer little meaningful benefit. Excessive or poorly placed treatment may produce unwanted weakness or affect nearby muscles. Botulinum toxin products can also cause localised muscle weakness, and rare but serious effects involving swallowing, speech or breathing are recognised. 

Providing injections without a wider management plan

Muscle-relaxing treatment does not address every factor that may be perpetuating TMD.

Sleep, stress, awake clenching, parafunctional habits, pain sensitisation, neck dysfunction and dental damage may all require consideration. Current guidance supports a broader approach that may include education, self-management, exercises, physiotherapy, behavioural interventions and, where appropriate, dental splint therapy. 

Providing the wrong splint without appropriate review

A splint is not simply a piece of plastic placed over the teeth.

Its design, coverage, fit, bite contacts and intended purpose matter. Poorly selected or inadequately monitored appliances can increase discomfort or produce unwanted changes in the way the teeth meet. The Royal College of Surgeons advises that soft and particularly partial-coverage splints can alter the bite or aggravate joint pain in some circumstances. Splints should therefore be provided and reviewed by an appropriately trained dental professional. 

The role of splint therapy

A dental splint may also be called a:

• Biteguard
• Nightguard
• Occlusal splint
• Stabilisation splint
• Bruxism splint
• Intraoral appliance

For appropriately selected patients, a splint may help manage muscular symptoms, reduce loading during clenching or grinding and protect vulnerable teeth and restorations.

It should not, however, be presented as a universal cure.

The evidence regarding splints is mixed. Current UK guidance regards splint therapy as an adjunctive treatment, particularly for myogenous or muscular TMD and some TMD-associated headaches. It should form part of a wider management strategy rather than being used in isolation. 

A splint also requires ongoing review. Its fit, condition, bite contacts and effect on symptoms should be assessed periodically. It should be adjusted or discontinued if it aggravates pain.

How muscle-relaxing treatment may help

In selected patients with muscular TMD, botulinum toxin type A can be administered to specific jaw muscles to reduce excessive muscular contraction temporarily.

This may help some patients experience:

• Reduced muscular tension
• Less jaw fatigue
• Reduced pain
• Less forceful clenching
• Improved comfort during everyday jaw movement

The objective is not to completely immobilise the jaw or remove normal chewing function. It is to reduce excessive activity in carefully selected muscles while preserving appropriate function.

Botulinum toxin may reduce pain for a limited period in some patients, but it is not suitable for everyone and should not be positioned as routine first-line treatment. Evidence remains uncertain, and UK guidance recommends a detailed consent process addressing the potential benefits, limitations, need for repeat treatment and known uncertainties. 

Documented considerations include muscle atrophy and possible changes affecting mandibular bone following repeated treatment. The clinical significance of these bone changes is not yet fully understood, which makes appropriate patient selection, dosing, review intervals and stopping rules particularly important. 

The treatment of muscular TMD with botulinum toxin is also outside the licensed indications of commonly used botulinum toxin products in the UK. This does not automatically make treatment inappropriate, but it does mean that the rationale, evidence, alternatives and uncertainties should be discussed transparently before consent. 

Why combine muscular relaxation with splint therapy?

For the right patient, muscle-relaxing treatment and splint therapy may address different parts of the clinical presentation.

The muscle-relaxing treatment may reduce excessive muscular contraction and associated discomfort. A properly designed splint may support the dental component of care, distribute forces and help protect the teeth and restorations.

Neither should automatically be regarded as a complete treatment by itself.

The most appropriate plan may also include:

• Education about TMD and pain
• Awareness of daytime clenching
• Jaw relaxation and movement exercises
• Heat, massage or short-term dietary modification
• Sleep and stress management
• TMD-focused physiotherapy
• Dental monitoring
• Review of the splint and bite
• Medical or specialist referral where indicated

This is why a coordinated approach is often more valuable than purchasing an isolated procedure. 

Dr Sheila’s approach to muscular TMD

Dr Sheila is a dentist and advanced facial aesthetics clinician with a special interest in muscular TMD, facial anatomy and muscle-relaxing treatment.

Her dental background is central to the way she approaches jaw pain.

A consultation does not begin with the assumption that every patient needs injections. It begins with understanding:

• Where the symptoms are coming from
• How they affect the patient’s life
• Whether the problem appears muscular, joint-related or mixed
• Whether clenching or grinding may be contributing
• What dental treatment, splint therapy or investigations have already been completed
• Whether muscle-relaxing treatment is appropriate
• What other care may be required alongside it

Dr Sheila will continue to work with the patient’s own dentist wherever possible. The patient’s dentist remains essential for ongoing dental assessment, the provision and maintenance of splint therapy, monitoring tooth wear and exploring other appropriate dental options.

This collaborative model avoids fragmenting the patient’s care. Muscle-relaxing treatment is not used as a substitute for dentistry. It is considered as one potential component within a broader treatment plan.

Why experience matters

The question is not simply whether a clinician can inject a masseter muscle.

The more important questions are:

•     Can they distinguish muscular TMD from joint-related or other facial pain?
•     Can they assess how the muscles function rather than simply how prominent they appear?
•     Do they understand the relationship between the jaw muscles, facial movement, the patient’s bite and their dental history?
•     Can they develop an individualised dosing strategy?
•     Can they recognise when treatment is unlikely to help?
•     Can they manage an inadequate outcome or complication?
•     And can they work constructively with the patient’s dentist rather than treating the injection as an isolated procedure?

The value of experience lies not only in delivering treatment. It lies in making better clinical decisions before treatment is delivered.

When should you seek help?

Consider arranging an assessment if jaw pain, facial tension, headaches, clenching or restricted movement are persistent, recurrent or affecting sleep, eating or quality of life.

Seek urgent medical or dental advice if you are unable to eat or drink, your jaw becomes locked, you develop severe or unusual headaches, or you experience visual or other neurological symptoms. 

Why has my previous TMD treatment not worked?

Many patients come to Dr Sheila having already received treatment for jaw clenching, bruxism or muscular TMD, but without achieving the improvement they expected.

They may have been told that they are “resistant” to treatment, that the medicine does not work for them, or that nothing further can be done.

That is not always the case.

A disappointing result may occur because:

• The pain was not predominantly muscular
• Only the most obvious muscles were treated
• The dose was insufficient to reduce the excessive muscular activity
• The dose was distributed incorrectly
• Active trigger points were not identified
• The temporalis muscles or other contributing muscles were overlooked
• The patient received a standard protocol rather than an individualised treatment plan
• The treatment was not supported by splint therapy, dental care or wider TMD management
• There was no structured review to assess response and refine subsequent treatment

Muscular trigger points are hyper-responsive areas within a muscle that may reproduce local pain or refer pain into another area, including the temples, face, teeth or head. Identifying where palpation recreates the patient’s familiar symptoms can provide important information about which muscles are contributing to the pain pattern. 

Simply injecting the most prominent part of the masseter muscle may therefore be inadequate.

The assessment must establish where the symptoms originate, which muscles are involved, how strongly they are functioning, and whether the patient’s pain is muscular, joint-related or a combination of both.

Dose is not simply a number

The dose used in muscular TMD treatment is not determined by a generic menu or a single standard protocol.

It is a clinical decision based on factors including:

• Muscle size and strength
• The severity and duration of symptoms
• Functional examination
• The location of tenderness and trigger points
• Whether symptoms are unilateral or bilateral
• Which muscles reproduce the patient’s pain
• Dental wear and bruxism patterns
• Previous treatment and response
• The need to preserve comfortable chewing, speech and facial movement

In some carefully selected patients, Dr Sheila uses higher therapeutic doses than those commonly offered during routine jaw-clenching or lower-face slimming appointments.

This is not because more treatment is always better.

It is because a dose must be sufficient to create a meaningful therapeutic change. A small cosmetic dose may alter the appearance of a muscle without adequately reducing the force, pain or persistent activity responsible for the patient’s symptoms.

Equally, higher doses require greater expertise.

Potential adverse effects can include excessive chewing weakness, an altered smile, facial imbalance, difficulty managing certain foods and unwanted weakness in adjacent muscles. Botulinum toxin products also carry recognised risks of muscle atrophy and, rarely, more significant weakness involving swallowing or breathing. Repeated treatment of the masticatory muscles has additionally been associated with changes in mandibular bone, although the long-term clinical significance remains uncertain. 

The aim is therefore not to use the highest possible dose.

It is to use the right dose, in the right muscles, for the right patient, with an appropriate review and stopping plan.

Why Dr Sheila’s experience matters

Dr Sheila has been assessing and treating muscular TMD for more than 12 years.

She is both a dentist and an advanced aesthetic clinician, giving her a detailed understanding of the relationship between:

• The jaw muscles
• The temporomandibular joints
• The teeth and restorations
• The patient’s bite
• Bruxism and clenching
• Facial anatomy
• Headache and referred pain
• Splint therapy
• Prescription muscle-relaxing treatment

Her expertise extends beyond her own clinical practice. Dr Sheila teaches and trains other clinicians in facial anatomy, TMD assessment, treatment planning and advanced muscle-relaxing techniques, and lectures professionally on the subject.

This matters because successful treatment is not defined by the ability to place an injection into a jaw muscle.

It requires the judgement to determine:

• Whether muscular treatment is appropriate
• Whether another diagnosis should be considered
• Which muscles are genuinely contributing
• Whether previous treatment failed because the dose or distribution was inadequate
• Whether a higher therapeutic dose can be used safely
• How treatment should work alongside splint therapy
• When another dentist, doctor, neurologist, physiotherapist, audiologist or specialist should be involved
• When not to treat

Dr Sheila frequently assesses patients whose previous treatment has provided limited or no benefit, as well as managing the complications of patient’s who are referred following treatment. Her approach is not simply to repeat the same treatment with more product. She reassesses the diagnosis, maps the muscular pain pattern, reviews the previous dose and injection strategy, and considers the patient’s dental and wider clinical needs before recommending the next step.

That depth of assessment is reflected in both the treatment plan and the fee.

The patient is not paying merely for a quantity of medicine. They are paying for twelve years of experience, advanced anatomical knowledge, individualised dosing and the clinical judgement required to balance meaningful symptom improvement against the risks of more intensive treatment.

For patients who have already tried treatment without success, the next step should not automatically be another generic appointment. It should be a more comprehensive assessment.

Dr Sheila has spent more than 12 years treating muscular TMD and teaches and lectures other clinicians in the anatomy, assessment and advanced treatment of these conditions. Her approach combines dental knowledge, detailed muscular examination, individualised dosing, trigger-point assessment and collaboration with the patient’s own dentist.

The objective is not simply to weaken a jaw muscle. It is to understand what is driving the patient’s symptoms and give them the best possible opportunity for a safe, meaningful and lasting improvement.

What can go wrong with muscular TMD treatment?

Prescription muscular-relaxing treatment works by temporarily reducing muscle activity. That is what may provide therapeutic benefit, but it is also why accurate dosing and precise injection placement matter.

When treatment is inadequately planned or delivered, patients may experience:

• Little or no improvement because the dose was insufficient
• Partial improvement because not all contributing muscles were identified
• Uneven results because the dose was distributed inconsistently
• Excessive weakness or fatigue when chewing
• Difficulty eating particularly firm or chewy foods
• An altered, limited or asymmetrical smile
• Unwanted facial asymmetry
• Excessive hollowing through the cheeks
• Changes in lower-face shape or support
• Paradoxical bulging, where part of the masseter remains active and becomes visibly prominent when the patient clenches
• Bruising, swelling, tenderness or discomfort at the injection sites

Studies of masseter treatment have documented temporary reductions in chewing strength, smile limitation, asymmetry, paradoxical muscle bulging, cheek hollowing and changes in lower-face appearance. These complications may result from dose, technique, anatomical variation or unintended effects on adjacent muscles. 

More rarely, the effects of botulinum toxin may spread beyond the intended area and cause more significant muscle weakness. Patients should seek urgent medical advice if they develop difficulty swallowing, speaking or breathing following treatment. The official prescribing information also emphasises that relevant anatomy must be understood and vulnerable structures avoided. 

These risks do not mean that treatment is inherently unsafe. They mean that therapeutic treatment of powerful chewing muscles should not be approached as a simple or generic injection appointment.

Why do complications happen?

Complications may occur for several reasons.

The wrong patient has been treated

Not every patient with jaw pain, headache or clenching has predominantly muscular TMD.

If the symptoms arise from the jaw joint, an internal disc problem, a dental condition, neurological pain or another cause, muscle-relaxing treatment may provide little benefit and may delay more appropriate care.

The dose is inappropriate

A dose that is too low may not meaningfully reduce excessive muscular activity. This is a common reason patients report that previous treatment “did nothing”.

However, an unnecessarily high or poorly distributed dose can produce excessive weakness, chewing difficulty or unwanted facial changes.

The objective is not to use the lowest dose or the highest dose. It is to identify the effective therapeutic dose for that particular patient, while preserving appropriate function.

The correct muscles have not been identified

Some patients are treated with a standard masseter-only protocol despite significant involvement of the temporalis muscles or other parts of the masticatory system.

Trigger points may also reproduce pain into the temples, teeth, face, ears or head. If these patterns are not identified during examination, treatment may be directed at the most visible muscle rather than the muscle actually driving the patient’s symptoms.

The placement is inaccurate

The masseter sits close to muscles involved in smiling and lower-face expression. Treatment placed too far forwards, too superficially or outside the intended anatomical area may affect adjacent muscles and alter the patient’s smile.

Clinical evidence indicates that respecting an appropriate anatomical treatment zone and keeping injections within the intended muscle reduces local complications. 

The internal architecture of the muscle is overlooked

The masseter is not a single, uniform block of muscle.

Different compartments and layers may respond differently. If only one part of the muscle is adequately treated, another portion may remain active and produce paradoxical or compensatory bulging during clenching. Anatomical variation is one recognised explanation for this complication. 

Different products are treated as though their units are identical

The units used for different botulinum toxin products are not directly interchangeable. Product selection, dilution, dose calculation and previous treatment history must therefore be accurately understood rather than compared through unit numbers alone. 

There is no structured review

Some effects develop gradually over several days or weeks.

Without appropriate review, a clinician may fail to distinguish between an expected temporary change, an inadequate result, an evolving complication and a symptom requiring medical assessment.

Higher therapeutic doses require greater experience

In selected patients, Dr Sheila uses higher therapeutic doses than those frequently offered in routine clenching or cosmetic masseter appointments.

This is because large, powerful and persistently overactive muscles may require a sufficient dose to produce a meaningful functional effect. A small dose may change the appearance of the lower face without adequately addressing pain, muscular force or associated symptoms.

However, higher doses also carry greater clinical responsibility.

They require:

• Accurate diagnosis
• Detailed knowledge of functional facial anatomy
• Careful examination of muscle size, strength and activity
• Identification of trigger points and referred pain
• Recognition of pre-existing asymmetry
• Precise distribution across the appropriate muscles
• Consideration of chewing and facial function
• A clear review and longer-term treatment plan

Current Royal College of Surgeons guidance advises that muscular treatment should not be regarded as routine first-line care. It recommends careful patient selection, informed consent and explicit discussion of dosing schedules, stopping rules and uncertainties regarding repeated treatment. Documented muscle atrophy and possible changes affecting the mandibular bone also require appropriate consideration, although the long-term clinical significance of the bone findings remains uncertain. 

Dr Sheila’s approach is therefore not that higher doses are always better.

It is that a therapeutic dose must be sufficient, individualised and delivered by someone with the experience to understand both its potential and its risks.

Why Dr Sheila’s experience reduces avoidable risk

Dr Sheila has been assessing and treating muscular TMD for more than 12 years.

Her background as a dentist gives her an understanding of the relationship between the chewing muscles, jaw joints, teeth, bite, dental restorations, bruxism and splint therapy. Her advanced facial aesthetics experience adds detailed knowledge of facial expression, muscular balance and the consequences of unwanted treatment spread.

Before recommending treatment, Dr Sheila considers:

• Whether the diagnosis is predominantly muscular
• Which muscles reproduce the patient’s symptoms
• Existing chewing strength and jaw function
• Baseline smile and facial movement
• Natural muscular and facial asymmetry
• Trigger points and referred pain patterns
• Previous products, doses and injection sites
• The patient’s dental history and splint use
• Relevant medical conditions and contraindications
• Whether another clinician or specialist should be involved

Her approach is designed to reduce avoidable complications by treating the patient’s anatomy and function, rather than applying a standard protocol.

No clinician can remove every risk. Experience matters because it improves the quality of the decisions made before, during and after treatment.

When treatment has caused a complication

Dr Sheila is frequently referred patients who have experienced an unexpected result following muscular or lower-face treatment elsewhere.

These patients may present with:

• An altered or asymmetrical smile
• Excessive chewing weakness
• Difficulty managing certain foods
• Facial imbalance
• Unexpected cheek hollowing
• Paradoxical masseter bulging
• An uneven treatment response
• Persistent pain despite treatment
• Anxiety about whether the change will be permanent

Many treatment-related muscular effects are temporary, but they may persist for several months and can have a considerable functional and emotional impact while they resolve. Official prescribing information acknowledges that adverse effects are generally transient but may last for months or, rarely, longer. 

A complication cannot always be reversed immediately. The first priority is therefore to understand exactly what has happened and ensure that the patient is safe.

Dr Sheila’s assessment may include reviewing:

• The original diagnosis and treatment objective
• The product used
• The dose and dilution
• The muscles and injection sites treated
• The timing and progression of symptoms
• Baseline and post-treatment photographs or videos
• Smile, speech, chewing and jaw function
• Whether the presentation reflects treatment spread, excessive weakness, undertreatment, anatomical variation or another diagnosis
• Whether urgent medical assessment is required

She can then provide an appropriate plan for monitoring, supportive care, further investigation or staged management, depending on the nature of the problem.

Supporting clinicians with complications

Dr Sheila also supports clinicians who encounter complications within their own practice.

Her role is not to criticise the treating clinician. It is to help them understand what may have happened, protect the patient and make a proportionate plan.

This may involve:

• Reviewing the treatment history and clinical photographs
• Examining the dose, product, dilution and injection pattern
• Identifying the likely anatomical explanation
• Distinguishing expected treatment effects from a complication
• Assessing whether the patient requires face-to-face examination
• Advising on appropriate monitoring and communication
• Helping the clinician recognise red-flag symptoms
• Supporting longer-term prevention and learning

As an educator and lecturer, Dr Sheila teaches clinicians about muscular TMD, functional anatomy, advanced dosing, patient selection and complication management.

This is an important part of her expertise.

She does not only know how to achieve a therapeutic effect. She understands how complications arise, how to reduce their likelihood and how to support both the patient and clinician when an outcome is not as expected.

Frequently asked questions

Is TMJ dysfunction the same as muscular TMD?

Not exactly. TMJ refers to the jaw joint. TMD is the broader term for disorders affecting the joint, chewing muscles or both. Muscular TMD specifically involves the muscles responsible for jaw movement.

Can teeth grinding cause jaw pain?

Clenching and grinding may aggravate muscular pain and can contribute to dental wear or damage. However, bruxism and TMD are not the same condition, and not everyone who grinds their teeth develops TMD. 

Will a nightguard cure TMD?

Not necessarily. A properly selected splint may be helpful for some patients, particularly when muscular TMD or bruxism is present. It should normally be used as part of a wider management plan and reviewed regularly by a dentist. 

Can botulinum toxin treat TMJ pain?

It may help selected patients whose symptoms are predominantly muscular. It is not expected to help every form of joint-related TMD and should not be provided without a proper diagnosis. Current UK guidance does not recommend it as routine first-line treatment. 

Why is a comprehensive consultation necessary?

Jaw and facial pain can arise from several different structures and conditions. A comprehensive consultation helps determine the likely source of symptoms, exclude unsuitable treatment and establish whether dental, muscular, medical or multidisciplinary care is required.

Will Dr Sheila replace my dentist?

No. Dr Sheila will work alongside your dentist. Your dentist remains important for your routine dental care, assessment of the teeth and bite, provision and maintenance of any splint and consideration of other dental treatment options.

Book a muscular TMD consultation in London

Living with persistent jaw tension, facial pain or headaches can gradually begin to affect eating, sleep, concentration and everyday quality of life.

A consultation with Dr Sheila is designed to establish what may be driving your symptoms, whether muscular relaxation is likely to help and how treatment could fit alongside splint therapy, dental care and other appropriate management.

The purpose is not to provide the same treatment to every patient.

It is to understand the problem properly, treat selectively and give each patient the best opportunity for a safe, meaningful improvement.