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Clenching/Grinding of Teeth

What is TMJ / TMD?


Normal Condyle


Temporomandibular joint and muscle disorders (TMJDs) refer to a complex set of conditions that can cause pain in the area of the jaw joint and associated muscles and/or problems using the jaw. Both or just one of the TM joints may be affected.

Displaced Condyle

TMDs can affect a person's ability to speak, eat, chew swallow, make facial expressions and even breathe. When untreated, it can cause other parts of the face, head and neck to hurt, even though the tissues are intact and do not have a problem in and of themselves.

 

Who Suffers From TMJ

The National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH) indicates that over 10 Million people in the United States suffer from TMJ problems at any given time. Both men and women experience TMJ problems, however, 90% of those seeking treatment are women in their childbearing years.

Recent research indicates that more women seek medical care for a TMJ problem than men, and women are more likely than men to report ongoing pain. Physiological differences in pain signal processing may explain why more women suffer from TMJ conditions than men.

What is TMJ

"TMJ" stands for TemporoMandibular Joint, or the jaw joint. There are two TMJs, one in the front of each ear, connecting the lower jaw bone (the mandible) to the skull. The joints allow movement up and down, side to side, and forward and back-all the mobility necessary for biting, chewing and swallowing food, for speaking and making facial expressions.

Because of the vast issues associated that are co-related with TMJ, some of which are directly caused by a TMJ disorder, physicians for decades have called TMJ disorders "The Great Imposter" because so many of the symptoms they were chasing originated from TMJ disorders  
TMJ - The Great Imposter  

 

What Causes TMJ

Not all causes are known for TMD. The most common cause is bruxism, or clenching of the teeth in our sleep. There is new evidence showing a relationship with bruxism as a 'protective mechanism' against sleep apnea; other contributing factors are injuries in the jaw area, various forms of Arthritis, dental procedures, genetics, hormones, low-level infections, auto-immune diseases, and even stretching of the jaw that occurs with inserting a breathing tube before surgery.

How Can TMJ Disorders Be Treated

Once the TMJ Disorder is diagnosed, the doctors and staff of the TMJ and Sleep Therapy Centre of Conejo Valley will prescribe a custom designed program for each individual patient. This may include day and/or night appliances, Acupuncture, Chiropractic referral, Naturopathic Doctor referral, Oriental Medicine procedures, Nutritional guidance or Orthodontics; or very simply, evaluating dental/orthodontic work, and running lasers or medications to correct acute pain.  The most important component in success is the diagnosis. This is why your initial appointment takes between 1-2 hours so that all parameters are evaluated and a diagnosis is achieved.

Symptoms

TMJ/TMDPain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw point and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:

  • Being unable to open the mouth comfortably
  • Clinking to popping or grating sounds in the jaw joint
  • Locking of the jaw when attempting to open the mouth
  • Headaches
  • A Bite that feels uncomfortable or "off"
  • Neck, Shoulder and back pain
  • Swelling on the side of the face

Additional symptoms may include ringing of the ears, ear pain, decreased hearing, dizziness and vision problems.

Facial Pain

 With a TMJ Disorder, a number of related symptoms can arise. One of these symptoms is facial pain, often called atypical facial pain, or even trigeminal neuralgia.  The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the nerves that supply the face, which can be experienced as anything from a dull ache in the muscles to sharp stabbing pains, usually just from touching the face or chewing.

Clicking or Popping in Jaw Joints

TMJ/TMDClicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak.

Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle.

If your bite is not right or trauma tears the tissues the jaw joint is pulled out of alignment, and the disc is typically pulled forward or torn. Now that the cartilage disc is not serving as a cushion between the ball and socket these bones are rubbing against each other and pressing on nerves, causing pain in the jaw and clicking or popping sounds in the jaw joint. The muscles holding the disc in place are now strained as well, causing additional pain in the jaw and face as well as in the head, neck, back and shoulders.

Anxiety and Depression

 


While not a physical symptom, the majority of people suffering from TMJ also suffer from depression, usually as a result of their condition being so commonly misdiagnosed or dismissed as having no physical cause.

There is also scientific evidence that shows that patients with chronic pain, a condition that nearly all TMJ patients can claim, have chemical changes in the brain as a result of the pain. These chemicals can cause depression. Because TMJ is a multifaceted disorder, many patients need to work with more than one specialist to return to optimal health.

 

Jaw Pain

Because TMJ is a dysfunction of the jaw joint, jaw pain is a very common symptom. There are very important nerves that supply the jaw joint, and when they are enflamed, they can cause anything that those nerves supply to ALSO hurt, even though there is nothing wrong with that area! This is called Central Sensitization, and is the leading cause of chronic pain being so challenging to correct and eliminate.  These nerves that were enflamed, in essence, weren't addressed when the symptom was acute. And when the transition of pain went to chronic (which is different every individual, ranging from 6 days to 6 months), now ANY nerve that is related to the Trigeminal System can now hurt.  This is why TMJ is called the Great Impostor.

Limited Jaw Movement or Locking Jaw

Limited jaw movement or locking jaw may feel like the lower jaw is "catching" when the jaw is opened. In some cases a person with a locked jaw must move the jaw to one side or the other in order to open the mouth wide. A person might also have to open the mouth until a popping sound is heard and felt, at which point the jaw unlocks. This is most commonly felt in the mornings, but is not mandatory.  A subluxated TMJ can result in locking jaw, clicking or popping in the jaw, and eventually, headaches, ear pain, tinnitus, tooth pain and etc.

Numbness or Tingling in Hands / Arms

TMJ/TMDThe nerves and muscles in the jaw area of the face are very complex, so when there is a TMJ disorder, these nerves and muscles are also affected. The jaw is more of an orthopedic entity than it is a dental one, something that is often called C0, as in the cervical vertebrae above C1.  It is extremely common to have subluxations in the cervical spine when there is a TMJ subluxation, and determining which one came first happens on the initial appointment,  When the cervical spine is subluxated, it 'pinches' the nerves the supply the muscles of the neck and arms.  These can pinch the nerves (brachial plexis) leading down the arms and into the hands, which in turn results in feelings of numbness or tingling.

Unexplainable Tooth Pain

Tooth pain or sensitivity are common symptoms of TMJD (temporomandibular joint disorder). Often, an enflamed jaw and muscles can 'refer' pain to the teeth, and treating the cause can relieve the tooth pain, avoiding root canal. Unfortunately, when seeking relief from this tooth pain many patients are misdiagnosed and may even go as far as having the nerve from the tooth removed with root canals or even having the tooth extracted. The worst part is that these measures may not relieve the pain, and can actually make it worse! The teeth may also become sensitive because of clenching or grinding the teeth, a common action in many people.

Tinnitus (Ringing in the Ears)

Ringing in the ears, or tinnitus, is another symptom of TMJ that is commonly misdiagnosed and often goes untreated or is ineffectively treated. In many cases ringing in the ears is the result of a slightly dislocated or 'clicking' or 'locking' jaw joint. There are ligaments that connect the jaw joint with the malleus of the ear, and when the jaw joint has moved it pulls on this ligament causing tinnitus, as well as 'whooshing' sounds in the ear, all of which is not detectable via an audiologist evaluation. Over 300 studies have shown the relationship between the malleus of the ear and TMJ disorders, and countless case studies have confirmed efficacy in treating (properly) the jaw alleviating the tinnitus.

 

 

Clenching/Grinding of Teeth

Clenching or Grinding, often called Bruxism, is a neurologic, sleep movement disorder characterized by grinding or clenching of the teeth in our sleep.  This disorder is very damaging to the teeth and the Jaw Joints, and also causes fatigue and pain to the facial muscles.  The damage done to the teeth when compared to teeth not subject to bruxism are seen in figures 1, 2 and 3.

http://www.medindia.net/patients/patientinfo/sleep/images/Bruxism.gif
Figure 1
   
http://www.opdentist.com/Dental_Reference/bruxism.jpg
   
Figure 2
   
   
http://www.identalhub.com/images/files/9(1).jpg
   
Figure 3
   
     

Bruxism and Sleep Apnea

Though often correlated to stress, new research has shown a direct correlation between clenching our teeth and sleep apnea.  Specifically, sleep studies have shown extremely strong EMG activity to the bruxing muscles either right before or during sleep apnea events.  It is postulated that this is a 'protective' mechanism in order to reduce or eliminate sleep apnea by one of the research studies.

Children and Bruxism

http://kidshealth.org/parent/general/teeth/headers_91152/P_bruxism1.jpg

Children on average clench and grind their teeth 50% more than adults. This wear of children's teeth is especially damaging as the baby teeth have much thinner enamel on them then adult teeth. This can cause the baby teeth to exfoliate, or fall out, much faster than what is planned.  

This is extremely problematic for the childs' facial, airway and TMJ formation as another purpose to the baby teeth is in 'holding the position' of the jaw.  When teeth are lost, the lower face profile is reduced (vertically), which then negatively impacts the airway, the aesthetics and even can retrude (pull back) the jaw closer to the ears.  


Bruxism, Sleep Apnea and ADD/ADHD symptoms

There is extremely strong research that shows that children with ADD, ADHD, and behavioral issues have sleep breathing issues, and that correction of the sleep breathing disorder eliminates or greatly reduces the symptoms of ADD, ADHD and behavioral issues.  Click HERE to see roughly 200 research studies on the subject.

Treatment of pediatric sleep apnea is most commonly successful with palatal expansion, tonsil and adenoid removal and CPAP therapy.  Research has shown however that pediatric and adolescent CPAP use can flatten the faces of these children that will necessitate facial surgery when they are adults.  Palatal Expansion and Tonsil/Adenoid removal both have minimal side effects.  

Scalloping of the Tongue

http://www.identalhub.com/userfiles/image/Bruxism%20pic2(1).jpgThis image is of a large tongue with scalloped sides.  This scalloping of the sides of the tongue is when the tongue is too large for the mouth, and research has shown that it is 70% predictive of sleep apnea.