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Bruxism | AKA: TMJ

Teeth Grinding / Pain

* Jaw joint pain splints
* Use of bite planes and how to treat bite problems
* Treating bruxism (stopping tooth wear)

WHAT IS IT

The jaw joint is called the Temperomandibular joint [TMJ]. It is right in front of the opening of the ears or auricles and can be felt on opening and closing the mouth.

A range of problems may cause TMJ disorders, including trauma to the face or head, missing teeth, arthritis, tooth grinding, and emotional stress. The most commonly know reason is people grinding their teeth (for whatever reason) while they are awake and often asleep.

A TMJ disorder is one where the person experiences pain while chewing food, opening and closing their mouth that may be associated with headaches, chronic muscle and facial pain with tension headaches caused by muscles in spasm.

It may be characterized by ear ache or pain in the jaw joint.

Disorders of the TMJ are caused by the following:

* Grinding or clenching teeth which may be stress related.
* Emotional and physical stress leading to tension in the jaw muscles
* Injuries such as jaw fractures, dislocations of the TMJ, whiplash, car accidents
* Degenerative diseases such as osteoarthritis and rheumatoid arthritis
* Lack of harmony in the person's natural and restored dentition or teeth.
* Missing teeth at the back on one or more sides leaving front teeth unsupported

Symptoms of TMJ

The symptoms of TMJ pain vary from person to person. This varies from mild discomfort to severe pain. This pain can be sharp, searing and intermittent, or dull and constant.

They may include limited opening of the jaws making it impossible to function properly, a locked jaw, or one that catches at one point on opening, pain when opening widely or gives pain on yawning,

Popping, clicking noisy painful joints are all symptoms.

Others include pain around the ears and cheeks, headaches that may even mimic migraines - with associated nausea, ear aches, loss of hearing, ringing in the ears [tinnitis], face neck and shoulder pain, muscle spasm, toothache, and clenching and grinding of teeth.

Overall a lack of comfort of the bite when the teeth touch is experienced with TMJ problems.

Diagnosis and treatment of TMJ Disorders

Diagnosis of TMJ is by careful clinical examination and medicodental history. There may be actual palpation of the muscles and joints to pinpoint the exact location of the pain by the dentist.

Other clinical signs of tooth wear and tooth movement may be noted, along with a set of study models of your teeth to see if the bite is balanced, radiographs and in extreme cases specially if a recent trauma has occurred an MRI of the jaws may be taken to confirm damaged joints.

Treatment is mostly by making what is known as an occlusal appliance known as an occlusal splint or bite plane. These are usually worn at night and help to take the pressure off the jaws.

Other ways to lessen the symptoms are to modify diet to cut food up into smaller pieces and eat soft foods to enable healing to take place.

Limiting the range of opening when yawning and chewing helps to lessen strain on TM joints.

Physical therapy massaging the upper shoulders and neck musculature and gentle stretching of the neck with particular emphasis on the top two cervical vertebrae which are the axis of rotation of the mandible will help to relieve symptoms.

Warm or cold packs may be indicated, short-term medication using anti-inflammatory drugs as well as muscle relaxants will be of use during the acute phase.

Sleeping on the back, moist heat, behaviour modification to identify stress and learn how to deal with it, looking at any destructive habits such as phone holding under the chin, and poor posture sedentary poor work position all can be looked at to relieve the TMJ pain.

Surgery is viewed as a last resort and is rarely successful as a treatment for TMJ.

TMJ disorder is common in that seven in ten people are affected by it during some stage of their lives. Only five out of every two hundred seek treatment.

On average only about three in every 2,000 people will require surgery for their injured joint. Conservative management of the TMJ problems is a good starting point which is making an occlusal splint.

How the splint works

The splint ensures that all the teeth are separated from each other so that when the teeth touch, they hit the plastic evenly in such a way as to de-program the jaw muscles and create what is called neuromuscular release.

This happens in the ideal bite with canine disclusion leading to muscle relaxation as the canines take the load off the back teeth as they come together. Wearing the splint allows the muscles to relax, and may enable the TMJ to heal.

Some of the injuries to the joint include dislocation of the disc around the coronoid process, perforation of the meniscus of the TMJ, stretching out and loss of integrity of the attachments of the disc assembly, internal derangement of the disc, damage to the muscle attachments around the TMJ and whiplash injury to the TMJ.


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