Tag Archives: splint therapy

Bruxism? Sounds Uncomfortable – and Is

We’ve talked about bruxing before – habitual tooth grinding and clenching. It’s an unconscious act that can happen day or night, during sleep or waking hours. It sounds uncomfortable – and is, often leading to pain in the jaw, neck and shoulders. But even while awake, bruxers are usually oblivious to the noise that can sometimes put others on edge (and even keep bed partners from getting a good night’s sleep).

But why would someone brux anyway? Until fairly recently, there was a popular school of thought that poor bite alignment, known as malocclusion, was to blame. Yet while that idea has fallen into disfavor, there’s still no consensus on what makes people brux. Several triggers – including stress and medication side effects – have been identified.

tmj_painA study published last year in the Journal of Oral Rehabilitation verified what many dentists have long suspected: bruxism is related to temporomandibular disorders (TMD) and, by extension, depression. Although non-bruxers with painful TMD proved at higher risk for “moderate/severe depression and non-specific physical symptoms,” bruxers with TMJ problems were even more at risk. The authors couldn’t say that any one condition caused the others, only that they tend to occur together.

A slightly later study, published in Pain, likewise found an association between TMD and depression and anxiety, which the authors said should thus be considered risk factors for TMD pain.

Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination.

TMJ pain and its related problems aren’t the only trouble to come from bruxing. The constant grinding can cause physical damage to your teeth, too. It can wear them down and even fracture them. (Take a look at this gallery of suffering teeth.) Obviously, this has potential for financial pain, as well – but it needn’t come to that, not if we identify and address the issue early on.

A quick visit to the dentist could be the first step to relief. We have many options for pinpointing problems and assisting in treatment. If you’re experiencing pain associated with bruxing, controlling or stopping the behavior usually alleviates the symptoms, but the associated pain can be treated independently, as well.

For most people, a combination of behavior modification and splint therapy with a night guard or other appliance does the trick. Dr. E can steer you to the one that is most comfortable and best suited for your specific needs.

Most people get used to their night guards very quickly. But don’t get too attached. Many patients find that, in time, the need for their mouthpiece disappears.

As with devices for sleep apnea, there are over-the-counter night guards available. And just as with the apnea devices, they’re rarely effective. Most who use them experience no improvement and end up going to a dentist to get a custom splint, properly fitted and suited to their problem.

A helpful hint: Just skip that extra step and talk with your dentist first. It’s your quickest way to a solution.

Image by reallyboring, via Flickr

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What’s Bite Got to Do with It?

“Bruxism” is the dental term for the habitual, involuntary clenching and grinding of teeth, often during sleep. It’s also pretty common.

Physical and psychological stress are often the main culprits, but a variety of other factors have been suggested, too, including sleep disorders, SSRIs and other drugs, even parasitic infection. Many have thought bruxism can result when a person’s teeth don’t come together (occlude) properly – an attempt to self-correct the problem, even if it means wearing down the teeth for a more comfortable bite.

But according to a meta-analysis published earlier this year in the Journal of Oral Rehabilitation, the bite may actually have little to do with it. Having reviewed 46 relevant published papers, the authors say they found “no evidence whatsoever for a causal relationship between bruxism and the bite.”

Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism.

What’s more, malocclusion (“bad bite”) may not even play a “mediating” role between the grinding and the damage it does.

Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date.

Of course, malocclusion and bruxing can and do occur together. It’s just that there may not be a causal relationship between them.

For the individual who grinds, though, that may make little difference. What they know is how it affects them – the headaches; the face, neck and shoulder pain; the damaged teeth; the receding gums and tooth sensitivity; and so on. Usually, it’s the pain that leads people to seek help.

One of the most common and conservative measures for bringing relief is splint therapy, in which a special appliance is used to cushion the forces of bruxing. Since most grinding occurs during sleep, they’re often called “night guards.” Unfortunately, the mass market ones you can buy in a store are often of little help to serious bruxers. They grind right through them pretty quickly. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint provided by your dentist will fit your mouth precisely and normally last much longer.

Here’s what one of our patients had to say after just his first week of using a specific type of night guard called an NTI device:

Previously

Learn about other causes of jaw, face, head and neck pain

 

Image by Dr Parveen Chopra, via Flickr

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