Diaries of a Dentist

How To Stop Grinding Your Teeth At Night

  On   the morning of the big presentation my jaw ached as if I’d just chewed through my pillow top mattress and maybe my nightstand too.  I’d been clenching my teeth all night long, like I always do when I’m stressed.” 

  Sound familiar?  Most dentists agree, nighttime clenching, grinding and bruxing is one of the most common conditions we see. The symptoms are wide ranged, from sore muscles in the face, neck, shoulders and back, to headaches, cold sensitive teeth, cracked teeth, ear pain and joint damage.  

In most cases a custom made prescription night time appliance called a night guard or occlusal guard is the answer.  The function of the night guard is multi faceted.  It protects the teeth and enamel from wear and fractures caused by the trauma of grinding.  It also breaks the “muscle memory” of the facial muscles that control the movement of the lower jaw.  

Because of the custom fit, it also serves as a type of retainer so your teeth don’t move with age.  These guards are made of a hard high quality acrylic that will last for years.

TREATMENT OF TMD BY SEVERITY

CONTINUED FROM LAST WEEK’S BLOG:

 TREATMENT OF TMD BY SEVERITY

MILD TMD

 Diet and Exercise: Eat a healthy, balanced diet. Strongly reduce or stop the use of caffeine, tobacco, and chewing gum. Don’t open the mouth widely, especially during flare-ups. Cut food into small bites and chew them well. Eat slowly. During flare-ups do not eat tough, chewy foods, like heavy meats or vegetables. Get regular exercise and stretching, especially neck and back muscles. After the flair-up, three times daily do the face and jaw exercises we will show you. Get 30 minutes or more of fast walking four or more times per week.

Heat, Anti-Stress Treatment, and Medications: During flair-ups, use hot, moist heat to the sore muscles of the head, neck, or face. Use ice cubes on trigger spots in these muscles. Use Ibuprofen 400mg, or other anti-inflammatory-pain pills that you can take, 2 or 3 times per day, not to exceed two weeks at a time. Use medications to relax the muscles, if prescribed by Dr. Bridger. Reduce stress through physical therapy, chiropractic treatment, and/or psychological, stress, or biofeedback counseling. Try to not clench the teeth or press the tongue against the teeth. For those over twenty-one years old and who partake of alcohol, one alcoholic drink in the evening during flare-ups is recommended.

 Night Guard: A night guard will usually be made by Dr. Bridger to be worn during the hours of sleep and while exercising. It is a usually upper hard plastic appliance with a flat biting surface that protects the teeth from clenching and braces the teeth that are loose from clenching. The surface of the appliance is softer than tooth enamel and absorbs the pressure of clenching and grinding, thereby helping the muscles to relax and the jaw joints to be repositioned into proper alignment with the skeleton and the bite, thereby usually reducing jaw pain. After placing the appliance, one free adjustment within the next two months is included.

 Occlusal Equilibration (Bite adjustment) (Limited is one adjustment at a time, Complete is three or four adjustments): This procedure of slightly smoothing and reshaping of the teeth so that they fit together and function properly in harmony with the jaw joints is often prescribed by Dr. Bridger. The teeth are shaped so that when the mouth is closed and the jaw joints are seated in the middle of the sockets, most of the back teeth touch at the same time, and the front teeth almost touch. They are also shaped so that when one talks or chews, the front teeth touch or slide against each other, separating the back teeth.  The teeth may also be shaped to make them more even and of more similar shape and length, and to smooth the edges.

 Additional Treatment: If after the above TMD treatments, the patient is not mostly comfortable most of the time, they may elect to go to the moderate TMD treatment below.

 MODERATE TMD

 All of the above treatments for mild TMD above, except, often no equilibration is done until later when the jaws have realigned, and appliance therapy is substituted for a night guard.

 Appliance Therapy: Similar to a night guard with a bumpier bite surface, but for more longer standing TMD with more pain and other symptoms, the usually upper appliance is worn from 3-6 months 24 hours per day and night, except to eat, to help the muscles to relax and the jaw joints to be repositioned into proper alignment with the skeleton and the bite, thereby acquiring Orthopedic Stabilization and usually a reduction in jaw pain. The appliance is adjusted at first weekly, then less often, as the bite and jaws adjust themselves to a more comfortable position. After six months, there will be additional fees for adjustments. Usually CT jaw joint X-rays are taken before and after appliance therapy to verify the jaw joints positions.

Possible Need Of Further Treatment: After Active Appliance Therapy has ended and Orthopedic Stabilization and a reduction in jaw pain has been experienced, if when the jaw joints are in their new comfortable position, there is no solid centric bite position of the teeth, Orthographic Surgery to reposition the segments of the teeth, Orthodontics (braces), Crowns, and/or Equilibration (re-shaping of the bite of the teeth) may be needed to make the upper and lower teeth fit together when the jaw joints are in their comfortable, healthy positions, each at additional fees.

SEVERE TMD

If after treatment of Moderate TMD above without enough success or if in addition to Structural-Functional Problems, there are Behavior Disturbances (like sleep, family, social, psychological, and/or job problems) or Impaired General Health (like Fibromyalgia, Chronic Fatigue Syndrome, Chronic Bowel Syndrome, CT Disorder, Multi-Chemical Syndrome, Restless Leg Syndrome, and others), the patient may be referred to a TMD Specialist and/or to an MD with special training in Impaired General Health.

TEMPORO-MANDIBULAR DISORDER (TMD)

TEMPORO-MANDIBULAR DISORDER (TMD)

Our bite (how our upper and lower teeth fit and mesh) is very important. Our bite is controlled by several factors. First our genetics passed down through generations affect the size and shape of our upper and lower jaws, the age at which they grow, and how they come together. Our jaw muscles play an important roll. If certain of these muscles are tight from overuse, the shape of the jaws and the movement of the lower jaw are manipulated, sometimes negatively.

 CAUSES OF TMD

The size and the way our teeth erupt into our jaws have a big affect on our bite. If our teeth are too large for our jaw, they do not have enough room to come in fully and, therefore, come in crowded and crooked. If our teeth are too small for our jaw, there are spaces, which let the teeth drift around changing our bite. Impacted teeth can, also, influence the position of the teeth and the bite. Missing teeth allow the opposing and adjacent teeth to move toward the missing tooth area, causing bite shift. Lastly, habits of pushing one’s tongue out toward the teeth, clenching, gnashing, and hard bracing of the lower teeth to the uppers move teeth, crack and wear down the enamel, thereby changing the bite.

 Severe Enamel Wear from Clenching

   

If our bite is slightly off and we have few or no habits as listed above, then our teeth, jaws, jaw joints, and muscles stay mostly healthy, and we experience few, if any, symptoms. But if our bite is way off and/or we have stronger habits, we often experience symptoms of Temporo-Mandibular Disorder (TMD).

SYMPTOMS OF TMD

Any or all of the following symptoms and/or others not listed here may result from TMD:  headaches, neck and shoulder pain; loose, sore or sensitive teeth; gum recession and periodontal (gum) disease; sore jaw joints with/or without restricted opening; popping, clicking, or grating noise in jaw joints or inner ear; dizziness, ringing in the ears; clenching and/or grinding of teeth either daytime or nighttime; fractured and/or worn teeth or restorations; either over-tight (can’t floss), or open contacts between teeth (food traps).

 

TREATMENT OF TMD

 TMD is NOT curable, but is treatable. Milder cases with fewer, less extensive symptoms and of shorter duration usually require less extensive treatment. More severe cases with many, more serious symptoms and of long standing duration usually require more extensive treatment. The goal of TMD treatment is to be mostly comfortable most of the time. Most people, according to the ups and downs of their stress, do experience some flair-ups, even after their TMD has been helped by treatment.

IN NEXT WEEK’S BLOG WE WILL GO OVER TREATMENT OF TMD IN DETAIL. FOR MORE INFO NOW:  http://en.wikipedia.org/wiki/Temporomandibular_joint