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What is TMD and Bruxism?
Millions of people suffer from jaw pain. It can be a twinge of pain that comes and goes for some people, and for others, the pain is crippling.
Quality of life can be severely impacted, affecting the ability to talk, sleep and even eat.
There are many reasons for jaw pain. However, two of the most common jaw-related issues are temporomandibular joint disorder (TMD) and Bruxism. These two conditions have different causes but very similar symptoms.
Determining what is causing the joint pain is critical in proper treatment.
Characteristics of TMD
The temporomandibular joint, often referred to as TMJ, is the hinge that connects the jawbone to the skull. It is located where the lower jaw and skull meet right in front of the ear.
It is responsible for lower jaw movement allowing for actions such as chewing, yawning, and talking.
When the TMJ shows signs of dysfunction, it is referred to as a temporomandibular disorder or TMD.
Temporomandibular disorder is a condition where the improper functioning of the joints and muscles that connect the lower jaw to the skull can lead to pain and extreme discomfort in some people.
TMD occurs when both of the temporomandibular joints are functioning poorly. The result is pain and discomfort when moving the jaw through opening and closing motions. In addition, there can be a pain in the joint and even issues moving the jaw in a usual way.
The symptoms of TMD include:
- Jaw soreness and discomfort.
- Fatigue in the joint
- The jaw pops or makes clicking noises
- Repetitive jaw movements cause pain (talking, chewing, etc.)
- Ear issues such as ringing or earaches
- Headaches that can occur daily
- Changes in the way the upper and lower teeth come together.
- Pain in the neck, back, and shoulders
- Jaw locking
- Teeth grinding and clenching
Exhibiting some or all of these symptoms can mean you have issues with your temporomandibular joint and need to schedule an appointment with a dentist.
What causes TMD?
Determining the exact cause of TMD is often difficult. The discomfort can be due to an injury, arthritis, or just plain genetics. There are also cases where patients with TMD show signs of teeth clenching and grinding.
Other factors that may lead to TMD are as follows:
- Excessive strain on the muscles that control chewing and talking.
- Trauma directly to the jaw.
- Trauma to the neck or head.
- Jaw joint displacement
- Nervous system issues
- Misaligned teeth (crooked teeth)
- Excessive stress
It is important to note whether or not any of these issues have occurred when describing joint pain to a dental professional.
Treatments for TMD
For most people, the pain and discomfort experienced with TMJ disorders are temporary and will subside self-care. In addition, most TMD sufferers have mild or occasional symptoms, which you can manage with at-home treatments.
Some of these treatments may include the following:
- Avoid hard foods and eat things that are soft to chew.
- Heat or ice packs
- Refrain from excessive jaw movements like chewing gum or yawning.
- Manage Stress
- Massage the jaw joint
- Gentle jaw stretching
- Pain relievers
- Orthopedic appliances
The key is to work with a dentist to plan the correct course of action to combat TMD issues. The focus should be to use the most conservative approach possible to try and alleviate the problem.
In addition, for those people with bite issues or missing teeth, you may need a tooth reconstruction. This treatment would involve replacing missing teeth or bringing the teeth back to the correct shape and size to improve how the teeth come together. Orthodontics may also be used to move misaligned teeth or correct tooth crowding. Each of these can alleviate the burden being placed on the jaw joints.
Surgery to correct TMD
However, surgery may be the solution for patients who suffer from more severe and persistent TMD symptoms. While typically a last resort, some people may benefit from surgical treatments.
Below are the possible surgical options:
- Arthroscopy – A micro-incision is used to repair the TMJ disk.
- Arthrocentesis – The joints are cleaned with a sterile fluid.
- Modified condylotomy – Increases the joint space.
- Open joint surgery to fix the joint
- Joint replacement – The joint is replaced with a prosthetic
Surgery is often the last resort and only offered in extreme cases. The best course of action is to use conservative treatment options and manage at-home TMD remedies.
What is Bruxism?
Bruxism is a condition that shares similar symptoms as TMJ disorder. In some cases, Bruxism is thought to be caused by TMD, and it can also worsen TMD symptoms. These two conditions often coincide with one another. For example, misaligned TMJs can cause both nerves and muscles to be over-stimulated. This can cause teeth to grind. This, in turn, can cause bite issues and significant tooth wear, making TMD symptoms worse.
Bruxism is identified in people who unconsciously grind their teeth. While some people grind their teeth during the day, it primarily occurs at night. As with TMD, finding the cause of a person’s Bruxism is also challenging. One of the critical factors, however, is stress and anxiety.
The symptoms of bruxism include:
- Tooth grinding complaints from a sleep partner.
- Teeth are worn and chipped
- Signs of enamel wear
- Tooth Sensitivity
- Pain in the jaw
- You wake up with teeth clenched
- Pain in the TMJ
- Gum sensitivity
Bruxism can cause significant damage to teeth as well as pain and discomfort.
What causes Bruxism?
Bruxism that occurs when you are awake may be caused by anxiety, stress, and even depression. People who chew on pencils, bite their nails or bite their cheek or tongue are also considered awake bruxers. In addition, some medications can cause bruxism.
Sleep bruxism, the most common form, is thought to be caused by issues disrupting the sleep cycle. Regular sleep cycles have micro-arousal periods that allow the body to adjust our temperature, breathing rates, etc.
People who show signs of sleep bruxism have more frequent sleep arousal periods. During these periods, contractions of the jaw muscles occur, and bruxism occurs.
Treatments for Bruxism
Managing bruxism is extremely important. If left untreated, it can lead to severe damage to your teeth and jaw joints as well as cause pain. Also, bruxism can lead to temporomandibular joint disorders.
To avoid further damage to the teeth and joints, the following methods may help:
- A night guard can help protect teeth at night
- A bite splint can prevent unwanted movement of the teeth and jaw and help alleviate both pain and damage.
- Reducing stress and anxiety can improve the occurrence of grinding. This can be accomplished for many through their faith or deep meditation.
- Be aware of jaw clenching and make an effort to keep the jaw relaxed throughout the day.
- Quality of sleep is important to manage symptoms. Practice good sleep habits such as avoiding large meals and alcohol before bed. Make sure the sleep environment promotes deep sleep.
If teeth have been damaged due to bruxism, it is important to work with your dentist or periodontist to not only manage the grinding but to also repair any damage that has been caused by it.
What is an Occlusal Guard?
The forces of clenching and grinding, also known as bruxism, put pressure on the teeth that can cause severe damage. In addition, the jaw can put an extreme amount of force per square inch on the teeth causing them to crack, break and wear down.
If the teeth become worn down, they are more susceptible to decay.
This pressure can cause the following:
- Muscle and joint pain
- Facial Pain
- Broken, cracked teeth
People who experience the symptoms of bruxism must seek out a solution to help minimize the damage.
An occlusal guard, also known as a night guard or bite guard, helps prevent damage and bring relief for the symptoms of jaw pain.
An occlusal guard is made to fit over the teeth. The word occlusion refers to the coming together of the upper jaw and lower jaw teeth. Therefore, an occlusal guard functions as a barrier that prevents this contact of the upper and lower teeth.
It acts as a barrier to protect teeth from the forces of clenching and grinding.
Occlusal guards are custom-made specific to each patient. This will ensure a secure and comfortable fit.
The guard is either worn on the bottom or top teeth. They are usually made with a smooth thin material that helps to ensure the patient is comfortable when wearing it and can still receive a good night’s sleep while using the device.
Occlusal Guards for Sleep Bruxism
While some people may grind their teeth during the day, most people suffering from bruxism tend to grind their teeth at night while asleep; this is known as sleep bruxism or nocturnal bruxism. In addition, people suffering from bruxism reveal destructive wear to their teeth during the night.
4 Reasons that a Person may be Grinding Their Teeth at Night
- Anxiety and Stress – Going to bed feeling anxious and stressed has been linked to sleep bruxism. In addition, negative feelings at bedtime can lead to overstimulation of the brain, which plays a role in clenching and grinding.
- Aggression – Often, people with aggressive personalities, such as those who get angry fast, experience bruxism at night. They can experience tenseness in the body that leads to teeth grinding.
- Youth – Young children and teens tend to grind their teeth at night but can grow out of this when they get older.
- Genetics – For some, genetics plays a role in teeth grinding. Sleep bruxism is an inherited trait that causes involuntary clenching and grinding and ultimately harms teeth.
While an occlusal guard does not prevent you from grinding, it does act as a barrier absorbing the pressures keeping your teeth from hitting and grinding on the enamel surfaces of your natural teeth. This protects the teeth from breaking, fracturing, and wearing down.
Occlusal Guards for Awake Bruxism
Awake bruxism is a less common form of bruxism. It also involves the grinding and clenching of teeth that can lead to worn-down teeth, headaches, facial pain, broken and chipped teeth.
5 Reasons That Cause Awake Bruxism
- Anxiety and Stress – Similarly to sleep bruxism, awake bruxism can be caused by high stress. People with awake bruxism are often also involved in demanding and challenging careers.
- Prescription Medications – People who have been prescribed antidepressants can experience awake bruxism as a side effect.
- Drugs/substances – Recreational drugs, tobacco, alcohol, and caffeine can also cause people to grind their teeth during the day.
- Coping mechanism – People may tend to grind and clench either as a formed habit when involved in deep thought or concentration.
- Health Issues -Issues such as Parkinson’s disease, epilepsy, dementia, and other mental and medical issues can lead to awake bruxism.
People who suffer from awake bruxism are usually subconsciously clenching while awake when they are focused on other things.
A custom-made occlusal guard for a person with awake bruxism can be designed to be less noticeable since it does need to be worn during waking hours. Often, these occlusal guards help break the habit of clenching by making the subconscious habit conscious. In addition, it acts as a reminder for the patient to stop grinding and clenching.
What To Expect When Getting An Occlusal Guard
After a thorough dental exam and the dentist has determined that an occlusal guard is necessary, impressions are taken of your teeth.
These impressions can either be made with impression material placed in an impression tray and put in your mouth, or they are made using an intraoral scanner that digitally captures the teeth and bite.
After impressions have been taken, a custom occlusal guard is manufactured with specific properties that treat your symptoms.
When you come back in to be fitted with the newly created occlusal guard, adjustments may be necessary to ensure the device is comfortable and functions as needed. The fit of the guard is critical as a poorly fitted occlusal guard can create an even more severe problem.
While there are over-the-counter occlusal guards that can be done at home and are less expensive, these can cause more damage to your overall oral health. In addition, these devices must fit properly and be designed to address each person’s individual needs. An ill-fitting one-size-fits-all occlusal guard can cause discomfort and make the issue worse.
It is important to note that your custom-made occlusal guard should make your mouth and jaw feel more comfortable. However, if you wear it and feel any discomfort, you may have an issue with fit. Let your dentist know so that they can adjust it.
Cleaning Your Occlusal Guard
It would be best to clean your occlusal guard before and after each time it is used. These devices can collect bacteria, mold, and yeast that can create other issues for your teeth, including the spread of other diseases.
Some occlusal guards have been found to have staph microbes which can cause the following diseases:
- Periodontal disease
- Heart disease
- Urinary tract infection
Cleaning your occlusal guard is extremely important.
How to clean you occlusal guard
There are several ways you can clean an occlusal guard. The idea is to sanitize the guard and rid it of accumulated bacteria. It would be best to clean your occlusal guard before use and after use. You should only put it in your mouth after brushing and flossing your teeth.
A standard cleaning method is to use a non-abrasive toothpaste and do the following steps:
- First, rinse the occlusal guard with water.
- Next, use a soft-bristled toothbrush and add the non-abrasive toothpaste.
- Brush the occlusal guard with the toothpaste, ensuring that all surfaces are cleaned.
- Thoroughly rinse the toothpaste off of the guard.
- Let the occlusal guard dry before storing.
For deep cleaning, at least once a month, you should soak the occlusal guard for 30 minutes in a disinfecting solution like mouthwash.
Please make sure the container you store your occlusal guard in is also cleaned every few days with dish soap to keep it free of contamination.
Once you have removed and cleaned your guard after use, make sure you brush and floss your teeth.
Types of Occlusal Guards
According to the American Sleep Association, approximately 10% of adults clench and grind their teeth, a condition also known as bruxism.
While this can occur during the day, it mainly occurs during sleep.
This condition is usually diagnosed by a dentist or periodontist who may notice damage to teeth such as worn, broken, or cracked teeth during a dental exam. Other side effects include jaw pain, neck pain, headaches, and earaches.
Occlusal guards help prevent the teeth from contacting, preventing further damage and alleviating pain.
Occlusal guards are removable and made to fit over the teeth. They are an effective way to protect teeth. After a thorough exam from your dentist and it has been determined that an occlusal guard is needed, there are a few different types available:
Soft Guards are flexible and an excellent option for people considered light grinders. Because soft guards are soft, they often are noted as being comfortable. However, their soft nature makes them less effective for people who suffer from more severe grinding.
Hard Guards are made from a more rigid material. They are not flexible and thus are best suited for someone with a more severe grinding issue. These guards are durable under pressure.
Hybrid Guards have a flexible interior with a more rigid outer layer. These guards are a good option for people considered moderate to heavy grinders.
Which Occlusal Guard Should I Choose?
The key to choosing an occlusal guard is to ensure the guard is designed with your specific needs in mind. To work correctly, they need to fit over your teeth with accuracy. An ill-fitting guard that does not meet your individual needs can do more harm than good.
There are several places to obtain an occlusal guard.
These mouthguards are made by boiling an acrylic-like material and making it soft. Let it cool, and then place it in your mouth, biting into it as it molds into the shape of your teeth.
The fit on this type of guard is poor. They are often used to protect teeth while playing contact sports.
These guides are not designed to protect against grinding and must be replaced often.
These are one-size-fits-all products or sometimes referred to as a stock guard.
While they may offer a quick and inexpensive solution, they do not provide the fit necessary to provide a comfortable and effective solution.
They are not designed to protect against bruxism and must be replaced often.
3. Custom Occlusal Guard
A custom occlusal guard is directly made from an impression of your teeth. This impression is used to create a mold that represents your teeth exactly. Skilled technicians then create a unique customized guard at the direction of your periodontist.
The periodontist will have determined whether you need a hard, soft, or hybrid guard depending on the level of your bruxing issues.
This guard is made with professional-grade materials and processing. As a result, they are a superior solution to protecting teeth from bruxism.