My dentist sent me to physical therapy

If your dentist brought up physical therapy, you probably left the appointment with a few words you did not expect: clenching, grinding, maybe an appliance and a referral. Here is the short version. Your dentist is the expert in taking care of your teeth, your bite and the joint itself. What they just don't have time for in the dental chair is the clenching habit along with poor breathing patterns that likely keep setting off the grinding pattern. We work alongside your dentist to help you find lasting results.

Line drawing of the jaw, teeth and skull with roses. PhysioVictory, Conroe.

Why did my dentist send me to physical therapy?

Usually for one of a few overlapping reasons: the night guard is protecting your teeth but the muscles are still working overtime, the pain is behaving like muscle rather than tooth, there is a procedure coming up that will go better with less tension in the system, or your dentist wants the strength side covered.

That last one surprises people. Dentists are rarely asking us for jaw exercises. They want us to build the core, diaphragm and shoulder strength that lets the neck and jaw stop doing all the holding.

Why can't I just stop clenching?

Because clenching is not a decision. It is an automatic response to stress, to airway resistance during sleep, or to a neck that is working too hard, and conscious exercising alone does not switch it off. Your night guard still matters, because it protects your teeth from wear, but you can clench full force into it all night. That is why so many people wear their appliance faithfully and still wake up with temple pressure, a tired jaw, or headaches at the base of the skull.

What does change clenching is changing the load on the system that keeps setting it off. The muscles on the side of your neck are meant to be backup breathing muscles, saved for sprinting and hard days. When they end up lifting your ribs with every breath, thousands of times a day and all night long, the neck never gets to rest, and a jaw anchored to a neck like that does not get to rest either.

Feel it for yourself

Sit the way you sit at the end of a long day, slouched, head drifting forward, and swallow. Notice how hard your jaw grips just to get that done. Now bring your ears back over your shoulders and swallow again. Most people feel the jaw let go on the second try. The test does not diagnose anything. It shows you that your jaw is responding to something beyond your jaw.

What happens at the first visit?

The first visit is an hour and it is a hands-on evaluation. We use it to understand how you got here: how you sleep, whether you snore, how much stress you are carrying, what your dentist has already done and what they are planning. We look at the jaw itself, how far it opens and how the muscles around it feel, and we spend just as much time on your neck, your upper back and your breathing, because that is usually where the clenching is coming from. You will not be rushed, dismissed, or sent home with a printout. We don't do guesswork.

We rarely work inside the mouth. Most people with jaw pain have had plenty of hands in their mouth already, and we get good results through the neck, the shoulders and the muscles on the outside of the face. If we ever need to, it is gentle, it is never painful, and we ask first.

You will leave with two or three things to work on at home to start setting you up for success. Hands-on treatment and dry needling usually start at your follow-up visits after we have created a plan together to address your specific symptoms and muscle imbalances.

Every follow-up starts in the recovery room. Your therapist has planned a calm, welcoming recovery experience for your transition into the clinic, where you decompress, settle your nervous system, and relax your muscles. That prepares you to get the most out of the hands-on and movement-based portions of your session.

What will treatment involve?

Every plan is built around what we find, so this is the shape of it rather than a recipe. Gentle hands-on work to the jaw muscles, the temples, the base of the skull and the top of the shoulders. Dry needling when you want it, and if needles are not for you, we have other ways to get the same release. Breathing retraining, so the air goes into your ribs instead of up into your neck, which is usually where the biggest change in all-day tension comes from. Strength for the mid-back, the shoulder blades and the deep core, so your neck can stop holding your head up by itself. And a resting position for your jaw, with a short way to settle a flare when one shows up.

Your home habits are part of the Victory Method. Five minutes a day, as non-negotiable as brushing your teeth.

How long will this take?

If the jaw tension showed up recently, it usually takes four to six visits. If it has been going on for years, we usually start at twice a week for four weeks, and then we sit down together and look at your progress before planning the next stretch.

Will you work with my dentist?

Yes, and please keep wearing whatever they prescribed. The bite, the teeth and the joint itself stay with your dentist; we add the muscle and movement side. Tongue resting position and airway work belong to the airway dentist and the myofunctional therapist, and we work closely with them rather than duplicating what they do. With your permission, we send your provider a short progress note, and when there is a question about what you are cleared to do after a procedure, we ask them rather than guess. We take referrals from general dentists, orofacial pain and airway dentists, and myofunctional therapists across Conroe and The Woodlands.

If you have dental work coming, a tongue-tie release, a new appliance, orthodontics or jaw surgery, the weeks beforehand are a good time to get the tension down and learn what you will need afterward. And if you are on the other side of it, a long appointment that left your jaw sore, or a new appliance changing your bite, we treat the headaches and muscle tension that follow by settling the face, jaw and neck and restoring the mid-back and shoulder blade mechanics that take the load off your neck.

There are a few situations where we want a dentist or physician to see you first: a jaw that locked suddenly and will not open, new numbness in your face, or pain that started with a blow to the jaw or head. If that is you, we will say so at the first visit and help you get to the right person.

Common questions

Do I need a referral from my dentist to come in? No. In Texas you can see a physical therapist directly for the first thirty days. If your dentist gave you paperwork, bring it; a referral on file also lets us give you a superbill.

Should I stop wearing my night guard? No. Keep wearing whatever your dentist prescribed. We work on the bigger picture to support what your dental care is addressing.

My dentist said my jaw problem is really a neck problem. Is that true? Often, at least in part. The jaw and the neck share muscles and nerve wiring, and the muscle that hurts is not always the muscle that is actually the problem.

Can you just teach me to stop clenching? I wish it worked that way. Clenching is automatic, not a decision. No one wakes up in the morning and decides to grind their teeth or have a lot of neck tension! What we can change is the load on the system that keeps setting it off.

Do you take my insurance? No, we are out of network. A New Client Assessment is $225 and follow-ups are $199. With a physician referral on file we can give you a superbill to submit yourself, and we accept HSA, FSA and CareCredit.

What does it cost?

A New Client Assessment is $225 and follow-up visits are $199. We are a cash-based practice, which means we are out of network with insurance. Payment is taken at the time of the visit, and we keep a card on file for follow-ups. We also take HSA, FSA and CareCredit. Most people pick a standing time and keep it, booking four to six weeks ahead.

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If your dentist sent you

Bring whatever they gave you, and send us their info so we can keep them in the loop. You really don't need to be in crisis to find lasting relief. Schedule your first visit below or fill out our contact form if you would like more information.

More on how we treat jaw and TMJ pain, what to expect at your first visit, and how cost and insurance work here.

Dr. Lindsay Kennedy, PT, DPT, COMT · PhysioVictory, Conroe, Texas

Anatomy line art by Khanali Anatomy, used with permission.