Tag Archives: TMD

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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Dealing with TMJ Pain/TMD

There are a lot of reasons why you might have jaw, face, head or neck pain. One of the most common involves the temporomandibular joint or TMJ. This is the hinge that lets your mouth open and close, and you have one on each side of your head. Here’s what a healthy, functioning TM joint looks like:

Suffice it to say, it doesn’t move so smoothly when it’s damaged:

(You can see more videos of the TMJ in action in this post at Know Thy Health.)

There are three main ways in which the TMJ may become damaged or dysfunctional, leading to a condition known as TMD (temporomandibular joint disorder):

  • Clenching, grinding and bruxing, often brought on by stress and maintained through sheer habit

  • Malocclusion, or the state of the teeth not coming together properly, which may be due to tooth removal, ill-fitting restorations or the rupture of wisdom teeth

  • Trauma, such as a blow to the jaw or whiplash, that has thrown the jaw out of alignment.

Additionally, some inflammatory and autoimmune disorders can put stress on the TMJ and adjacent muscle groups, generating pain.

While TMJ pain begins in the jaw and face, it can come to affect the neck and back, too, and can be quite debilitating. For this reason, pain relief is often the first thing people seek. While painkilling drugs may be convenient, they’re not a great long-term solution for many reasons – from potential abuse and addiction to their adding to the body’s toxic burden.

The best long-term solution involves correcting the problems putting stress on the joint – reducing grinding and clenching, for instance, or realigning the teeth or pursuing physical therapy – as well as reducing pain. Fortunately, there are gentle, nontoxic remedies available.

One of the most promising is acupuncture. Just recently, a study was published in the Journal of Orofacial Pain that found “moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMD.”

Nineteen reports were systematically reviewed. There was moderate evidence that classical acupuncture had a positive influence beyond those of placebo (three trials, 65 participants); had positive effects similar to those of occlusal splint therapy (three trials, 160 participants); and was more effective for TMD symptoms than physical therapy (four trials, 397 participants), indomethacin plus vitamin B1 (two trials, 85 participants), and a wait-list control (three trials, 138 participants). Only two RCTs [randomized controlled trials] addressed adverse events and reported no serious adverse events.

The authors did note, however, that more studies are needed to see how well acupuncture works over the long haul.

To learn more about jaw, face, neck and back pain and dental conditions – including how dental diagnosis can be made and what types of therapies may be helpful – see my article “Why Your Jaw, Face, Head and Neck Might Hurt – and What We Can Do to Help.”

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Filed under Dental Health, TMJ/TMD, Video