Teeth Grinding & TMD

Temporomandibular Joint Disorder is a collective term covering acute or chronic pain and other related symptoms possibly linked to the way the jaw functions and the way the teeth move over each other. The flexibility in the joint allows you to chew from side to side as well as open and close your mouth. Neck, back and shoulder muscles also contribute as bracing muscles which allow our jaws to move smoothly and efficiently.

If your teeth don’t fit together properly, you can have problems in your teeth, gums, the temporomandibular joint (jaw joint) or the muscles that control movement of your jaw as they begin to suffer from fatigue. These problems are called ‘occlusal’ problems.

Occlusal problems can be indicated by teeth that are aching, worn, chipped or broken, fractured fillings and loose crowns. If the jaw is in the wrong position, the jaw muscles can become overworked and start to ache or contribute to other symptoms which are associated with TMJ disorders including:

• Biting or chewing difficulty or discomfort
• Clicking, popping, or grating sound when opening or closing the mouth
• Dull, aching pain in the face
• Earache (particularly in the morning)
• Headache (particularly in the morning)
• Hearing loss
• Migraine
• Jaw pain or tenderness of the jaw
• Reduced ability to open or close the mouth
• Ringing in the ears (Tinnitus)
• Neck and shoulder pain
• Dizziness

It is important to note that many different factors can contribute to these symptoms. Conditions other than occlusal problems can cause similar symptoms such as fibromyalgia, arthritis, back problems and even poor posture, but if an examination by your GP has been unable to identify the cause of the symptoms and relieve the pain,  a trip to the dentist is another way of potentially addressing the problem. As dentists we will now focus on the bite.

It is important that you mention any neck, facial pain or headaches as part of your medical history update during your routine dental examination, especially if they occur in the morning.

Stress can also be a factor. When some people are not responding well to stress they can change the behaviour of their jaws consciously (e.g. during the day) or unconsciously (e.g. at night). For example they might tense up their chewing muscles, clench their teeth and even grind their teeth at night. This can cause short or long term problems to the teeth and joint.

In the same way that not all facial pain will be caused by occlusal problems, not all occlusal problems will lead to pain. Some people will go through life with the most awful of bites and yet experience no problems or pain whatsoever. Yet another individual with just the smallest of discrepancies could display many of the symptoms listed above and be living with constant pain. It is a complex subject and each case is unique.

When it comes to treating occlusal problems, there is no text book solution. Every person and every case is different and we will treat them as such. As yet there are no impressive gadgets to replace the years of experience we have in this field that enable us to work out what is happening within the bite and how that may be contributing to the pain being experienced.

Initially we will undertake a thorough clinical assessment that will begin by looking at how the teeth bite together and move over each over. We will examine the muscles and look for soreness. We will assess the function of the temporomandibular joint i.e. its range of movement and listen for any joint noises.

The next stage is to make an appliance that will sit over the teeth,  allowing the teeth to come back together in the correct position i.e. to promote a perfect bite. The appliance will be adjusted over time in order to bring the teeth together in such a way that the pain, and symptoms, disappear. This solution could be the end of the treatment, but there are permanent options available that remove the need for continued use of the guard.

BSOS (The British Society of Occlusal Studies) ‘headache and facial pain’ web site contains very useful information and contact points across the UK for patients. The BSOS web site aims to educate patients so that they better understand their pain problem as well as explain how their problems can be treated

Dr Laura Rudge is a member of the BSOS. Please click the following link for more information on BSOS