TMJ
Dysfunction is a popular term to describe
a disorder of the jaw joints or the muscles
that control the joints. Dentists use various
terms to describe the same disorder. TMJ stands
for Temporomandibular Joints, which are the
two joints that connect your jaw to your skull.
When the joints are out of place serious problems
can arise. "Craniomandibular Dysfunction"
is the dental term which describes a collection
of symptoms that result when the chewing muscles
and jaw joints aren't working correctly. Because
the nerves and muscles in this area are so
complex, when these muscles are in spasm,
the problems can be far-reaching. Symptoms
masquerade as a multiple of other problems,
such as:
- Sinus
headaches
- Migraines
- Neck,
shoulder, and back pain
- Earaches
or ringing of the ears
- Dizziness
- Pain
behind the eyes
- Clenching
or grinding of teeth
- Numbness,
or tingling of the fingers
The
primary problem can be in the joints themselves,
the muscles of the face and jaw, or a combination
of these. Because the symptoms masquerade
as so many other conditions, many people travel
from doctor to doctor in search of a cure.
It is estimated that as many as 44 milliom
Americans suffer from one or more of these
symptoms. Many never think to seek a dentist
for help.
What
Causes Craniomandibular Dysfunction?
The
structures that make it possible to open and
close your mouth include the bones, joints,
and muscles. These are very specialized and
must work together whenever you chew, speak,
or swallow.
Your
teeth are inserted in your jaw bone. At the
other end of your jaw bone are the temporomandibular
joints. These joints attach your jaw to your
skull. Muscles attach both the bones and joints
and allow them to move. Any problem which
prevents the complex system of muscles, bones,
and joints from working together in harmony
may result in Craniomandibular Dysfunction.
A
"Bad Bite"
There
are various ways this system can be disrupted,
such as accidents involving a blow to the
face or a whiplash. Yet the most common cause
of Craniomandibular Dysfunction relates to
your teeth and your bite. If your bite isn't
right, it can affect both the muscles and
the joints. What do we mean by a "bad
bite"? We mean that your upper and lower
teeth do not come together in a way that provides
the proper bracing support for your jaw against
your skull. This might result from a missing
tooth, misaligned teeth, or back teeth which
are too "short."
Muscle
Spasm
Your
upper and lower teeth must come together firmly
each time you swallow. This is happens over
2000 times each day and night! When your bite
is unstable your muscles work extra hard.
This extra work makes them shortened and stiff.
Eventually this strain makes them feel painful.
There is vicious tissue damage, muscle tenderness,
and pain. This makes you feel tense and uptight.
This worsens the muscle spasm, which in turn
increases the pain.
Jaw
Joint Displacement
The
position of your teeth can also affect the
position of your jaw joints. Each jaw joint
is a ball and socket joint. When functioning
properly, the ball and socket do not actually
touch because a thin disc of cartilage rides
between them. The disc acts as a cushion and
allows the joint to move smoothly. Each disc
is held in place and guided by muscle. If
your bite is not right, the joint is pulled
out of alignment. Typically, the disc is pulled
forward. Since it no longer serves as a cushion,
the joint itself now rubs against the bony
socket and presses on pain fibers. Mild displacements
cause a clicking or popping sound in the jaw
joint; more severe displacements can be very
painful and eventually can cause permanent
damage to the joint.
An
unstable bite can cause both jaw joint displacement
and muscle strain and pain. Many seemingly
unrelated symptoms result which are collectively
known as Craniomandibular Dysfunction. When
this condition is prolonged, the body begins
to compensate and adapt by involving the muscles
in the neck, back, and even sometimes those
of the arms, fingers, pelvis, legs, and feet.
Treatment
Since
the teeth, jaw joints, and muscles can all
be involved, treatment for this condition
varies. Typically, treatment will involve
several phases. The first goal is to relieve
the muscle spasm and pain. Then, your dentist
must correct the way the teeth fit together.
Often a temporary device (known as orthotic,
or "splint") is worn over the teeth
until the bite is stabilized. Permanent correction
may involve selective re-shaping of the teeth,
building crowns on the teeth, orthodontics,
or a permanent appliance to lay over the teeth.
If the jaw joint itself is damaged, it must
be specifically treated. Though infrequent,
surgery is sometimes required to correct a
damaged joint. Ultimately, your dentist will
stabilize your bite so that the teeth, muscles,
and joints all work together without strain.
The important aim of correcting your bite
is to insure optimal long-term health. If
you have any of the signs or symptoms mentioned,
discuss them with your dentist. Your health
is your most priceless possession. It is worth
the investment.
Headaches...
Headaches
are our number one pain problem in the Untied
States. Approximately 40% of all "healthy"
individuals suffer from chronic headaches.
Head pain is not new. Early civilizations
relied on magical potions and spells to cure
headaches. In several cases, holes were drilled
in the skulls of headache sufferees so that
the evil spirits which were believed to be
the cause of the pain could escape. Over the
years we have learned much about what causes
headaches and how to treat them. Today, there
is a growing realization that a common cause
of tension headaches is a bad bite.
Headaches
from Dental Stress
How
can your bite cause a headache? Tension headaches
result from muscle strain, or contraction.
When muscles are held tight for long periods
of time they begin to ache. Headaches from
dental stress are a type of muscle tension
headache. A tension headache may be on one
or both sides of your head. Or, it may surround
your head as if a steel band were wrapped
around it. The pain feels like a dull, non-throbbing
ache. Tension headaches are usually relieved
by aspirin. Specific signs which indicate
that the headache may have a dental origin
include:
- Pain
behind the eyes
- Sore
jaw muscles or "tired" muscles
upon awakening
- Teeth
grinding
- Clicking
or popping jaw joints
- Head
and/or scalp painful to the touch
Tired
Bite
The
muscles which control your jaw and hold your
head upright are very complex. Many people
do not realize that every time they swallow,
their upper and lower teeth must come together
in a firm way to brace the jaw against the
skull. We swallow over 2000 times each day
and night! If your bite is unstable, as from
poorly aligned teeth or even a missing tooth,
the muscles must work harder to bring teeth
together. Most people take a vacation from
work when they tire out, but your jaw muscles
never get a break! The overworked muscles
become strained. When the muscles are under
constant strain, they eventually become painful.
Referred
Pain
The
pain may be felt in the cheeks or the jaw
joints. Many times, however, the pain is "referred"
to other areas of the head. Referred pain
is when a pain originated in a part of the
body that differes from the area where it
is felt. Even a single tooth can refer pain
to the head.
Muscle
Imbalance
Other
muscles may also become involved. Your head
is delicately balanced on top of your spinal
column by muscles in your jaw, neck, shoulders,
and back. Your head weighs approximately 15
pounds. Imagine your head as a baseball balanced
on top of a pencil by a number of rubber bands.
When the muscles are tense, they shorten.
Now imagine shortening just one of those rubber
bands. Some rubber bands would stretch, some
would shorten, and the baseball would be thrown
off kilter. Similarly, when even a single
jaw, neck, or shoulder muscle become shortened,
all of the other muscles are forced to overwork
to keep the head balanced on the top of the
spinal column. We see then that dental headaches
originate from an unstable bite which cause
the muscle of the jaw, head, and neck to overwork
and become painful. Once the muscles become
painful, a vicious cycle begins. The pain
makes you feel tense and uptight. This worsens
the muscle spasm, which in turn increases
the pain.
Dental
Treatment
If
you suspect that your headache might be caused
by your bite, contact your dentist. Your dentist
will examine your teeth, your muscles, and
your jaw joints to determine if dental stress
is the source of your headaches. If so, treatment
will involve correcting your bite so that
the muscles can function without extra strain
and tension. In some cases, it is helpful
to receive other types of treatment, such
as physical therapy, along with dental treatment
to correct the postural relationship of your
head, neck, and shoulders. Counseling or relaxation
training might also be helpful to teach you
ways to relax the muscles and to identify
sources of emotional stress. However, if the
true source of the headache is an unstable
bite, this must ultimately be corrected to
relieve the headaches. The importance of correcting
your bite is to insure optimal long-term health.
If you have any of the symptoms mentioned,
discuss them with your dentist.
Bruxing...
Bruxing,
or grinding your teeth, is one of those quiet
health disorders which doesn't hurt, is completely
invisible, and doesn't require hospital care.
Initially, the condition may be more disturbing
to your partner. Often, afflicted individuals
do not even realize that they do it. Most
bruxers are night time teeth grinders. The
grinding noises can keep lightly sleeping
roommates awake. Eventually, however, it is
the bruxer who is left with the long term
effects of night grinding. Bruxing can cause
bone loss and loosening of teeth. Typically,
people who brux also have a greater incidence
of gum disease.
Signs
of Bruxing
In
addtion to the sounds of grinding, other signals
of bruxing include:
- Tired
jaw muscles upon awakening
- Locking
of the jaw and a tendency to bite the cheeks,
lips or tongue
- Tenderness
of the jaw muscles of the jaw joints
- Cheek
muscles which are larger, or more developed
on one side than the other.
- Broken
or chipped teeth or fillings
- Teeth
which have notches or indentations at the
gum line
- Teeth
which seem shortened or worn down
Why
do People Brux?
Bruxing
has been around for a long time. Many skulls
of cavemen exhibit short, flat teeth. Some
ground their teeth altogether! This was do
to a combination of diet, poor hygiene, and
bruxing. Over the years, our diet and hygiene
have improved. Bruxing, however, has not.
It is estimated that over 50% of the population
are night time grinders. Men, women, and children
are all equally affected.
Bruxing
is thought to result in a combination of emotional
tension and a bad bite. Clenching the teeth
is associated with anger in both humans and
animals. People learn to suppress their emotions
by keeping their teeth together. This can
become an unconscious habit. You may learn
to keep your teeth together all the time as
a response to tension without realizing you
are doing so.
"Lips
Together, Teeth Apart"
Many
people do not know that most of the time,
the upper and lower teeth should not touch.
Except for when chewing, swallowing, or talking,
the teeth and jaws should be in a rest position.
By rest position we mean "lips together,
teeth apart."
A
Bad Bite
A
bad bite is another contributing factor to
bruxing. If the teeth do not meet properly,
or if one tooth hits before the others, the
chewing muscles will become protective. Rather
than bumping into that spot each time they
close the teeth, the chewing muscles will
maneuver around the interference. The chewing
muscles will learn to bring the jaw around
the high spot each time the teeth close. This
places extra strain on the muscles and eventually
they become tired and painful.
To
reduce pain, we clench harder! Technically,
this is called pressure anesthesia. Babies
do this by biting against a teething ring
to decrease the pain of erupting teeth. Or,
as adults we may press our temples to decrease
the pain of a headache. When our teeth stay
constanlty clenched, however, it worsens the
condition. The teeth and jaws become misaligned,
which increases clenching.
Treatment
To
treat bruxing, the dentist must eliminate
bite interferences and correct the bite so
that the chewing muscles function without
undo strain and tension. Often, a removable
device (known as an orthotic, or "splint")
is fit over the lower teeth to protect them
from further damage and to temporarily correct
the bite.
Relaxation
therapy can also be an important aspect of
treatment to explore new ways of coping with
stress. Biofeedback is a particular technique
which teaches you to break your clenching
habit and relax the muscles of your face.
In some cases, more in depth counseling may
be in order to discover the sources of stress
or discuss lifestyle changes. Your health
is your most priceless possession. It is worth
the investment.
