Tag Archives: TMJ

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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Not Sleeping Well? Could Be You’re Bruxing

Today, we usually think of clenching and grinding teeth as a sign of stress or anger. And it often is. Consequently, we’ve seen quite a rise in this behavior since the onset of economic turmoil in 2008. But the phenomenon itself isn’t new at all. Our ancient ancestors did it, too, with the earliest records of it – via clay tablets found in the Mesopotamian Basin – dating back to about 3000 BC. Our modern word for the habit – bruxism – comes from the other side of the Mediterranean, though: from the Greek word ebruxya, which literally means “to gnash the teeth.”

Though statistics remain a little sketchy, estimates say about 5 to 20% of us are bruxers, with the higher number likely being closer to right. The habit is especially common during sleep. In fact, it’s the third most common sleep disorder after insomnia and snoring.

What’s more, those with another sleep disorder are more apt to be bruxers, too. Other risk factors include smoking, high caffeine intake, high alcohol intake, medication use and, of course, stress. But because bruxism is a habit, it can – and usually does – continue even after its cause has been dealt with. Among the problems it can lead to:

  • Poor quality sleep
  • Worn down teeth and fillings or other restorations
  • Fractured teeth
  • Inflammation and receding gums
  • Loose teeth and premature tooth loss
  • Persistent headaches and chronic jaw, face, neck and head pain
  • TMJ disorder

TMJ stands for temporomandibular joint, and you have one on each side of your head. Together, they’re the hinge that lets you open and close your mouth – something than can be hard or painful to do if the joints are damaged or dysfunctional. (To see why this may be so, check out these videos showing what both healthy and dysfunctional TM joints look like in action.) You may experience clicking, grinding or pain in your jaw joints, or ringing or buzzing in your ears. “When the joint puts pressure on the nerves, muscles and blood vessels that pass near the head,” says Dr. Nigel Carter of the British Dental Health Foundation, “it can often result in headaches and migraines.”

Even so, adds Dr. Carter,

The cause of your headaches could actually be the way your teeth meet when your jaws bite together, otherwise known as dental occlusion. If you do suffer from continual headaches or migraines, especially first thing in the morning, pain behind your eyes, sinus pains and pains in the neck or shoulders, you should consider visiting your dentist, as well as a doctor, as soon as possible.

To check my patients’ occlusion, I use an imaging system called Tek-Scan, which shows how the teeth come together. It lets us see places where your bite may be “off” or where there’s an imbalance of force when you close your jaw. Once we’ve found these imbalances, we can determine the best solutions for correcting them.

For TMJ issues, we have another diagnostic tool: BioJVA (joint vibrational analysis). BioJVA lets us take fast, non-invasive and repeatable measurements of your TMJ function by determining the amount and kind of vibration at the joints. With it, we can diagnose dysfunction more specifically, and, because it’s repeatable, we can easily measure your progress through treatment.

Splint therapy is one of the most common and conservative measures taken to bring relief and readjust the jaw and related musculature. You may have seen or heard of over-the-counter “night guards” meant to cushion the forces of clenching and grinding, the main virtue of which is their low cost. Unfortunately, they’re often of little help to serious bruxers, who pretty quickly grind right through them. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint, on the other hand, will fit your mouth precisely and will normally last much, much longer than an over-the-counter device. Here’s what one of my patients had to say after just the first week of wearing a night guard we provided him:

But wait, you say. If I’m sleeping, how can I know if I’m grinding my teeth? Here are a few questions to ask yourself:

  • Are your jaw muscles or neck achy when you wake up?
  • Is it hard to open your mouth first thing in the morning?
  • Do the biting surfaces of your teeth look worn down?
  • Do you have frequent headaches?
  • Has your bed partner ever complained about you making grinding noises while you sleep or told you about any mouth movements he or she has seen you make while sleeping?

As is the way with such questionnaires, the more “yesses,” the more likely it is that bruxing is an issue for you, in which case you should consult your dentist for help with remedies and relief…and a better night’s sleep.

Image by justin, via Flickr

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What’s Ozone Therapy & How Is It Used in Dentistry?

If you’ve read much about “alternative medicine,” you may have run across discussion of something called “ozone therapy.” But what’s that?

The word “ozone” might make you think of pollution. We’ve all heard of the “hole” in the ozone layer caused by CFCs and other toxins. Maybe you’ve read that ozone is found in smog or know a little about its industrial uses, many of which tap into ozone’s disinfecting properties (including use as a pesticide, bacteriacide and fungicide).

Ozone also has a significant history in medical treatment, as well. According to Dr. K.W. Donsback,

Ozone therapy was used medically by Nikola Tesla in 1900. It has been in continual use for over 50 years in Europe and the USA, but due to our legal pressures, ozone is presently only widely used [as an orthodox treatment in Germany, Russia and Cuba]. When the proper protocols are followed, ozone has been proven effective in the treatment and possibly the elimination of over 40 common diseases.

Ozone therapies are among the safest therapies ever used. One European study of over 5.5 million treatments showed a side effect rate of .0007%, probably among the lowest of any therapy known. Side effects (like fever and weakness) are minor and temporary.

Ozone therapy also has a place in dental practice, although its use remains uncommon here in the US, owing to opposition from the dental/medical establishment. Among those dentists who do use it for oral healing and health, there are five main applications :

  1. Ozonated water may be used as a gargle or rinse to treat oral abscesses, gum problems, sore throats and ulcerations. It may also be used for irrigation.
  2. Ozone gas may be used as a preventive measure against tooth decay and periodontal disease.This is done by fitting a custom tray over the patient’s teeth and gums, and letting ozone into the tray for a short while.
  3. Teeth that might otherwise be subject to a root canal or extraction may be treated by washing an exposed nerve first with ozonated water, then with ozone gas.
  4. Ozone may be used as a disinfectant before a root canal or restorative dentistry is done. Ozonated water and gas can get through the walls of the tiny dentinal tubules, killing harmful bacteria that have taken up residence in these hard-to-reach, hard-to-clean places.
  5. Temporomandibular joint pain may be treated with ozone, where gas injected right into the TMJ can kill harmful microbes, as well as reduce inflammation and spur the growth of new cartilage.

Learn more about dental uses of ozone:

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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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