Bruxism, tooth-grinding and TMD

Jaw and facial pain? Non-specific facial pain? Excessive teeth grinding or jaw clenching – also called bruxism – is a common problem. It can damage the teeth and cause a number of different painful symptoms associated with the jaw and affect the overall day to day quality of life. Collectively, these symptoms are often referred to as Temporomandibular Disorders (TMD). Symptoms include:

  • Teeth grinding or jaw clenching
  • Pain in the chewing muscles and/or jaw joint soreness
  • Radiating pain in the face, jaw or neck
  • Jaw muscle pain or stiffness
  • Aching pain in and around ears
  • Limited movement or locking jaw
  • Painful jaw clicking, popping when opening or closing the mouth
  • Headaches or migraines
  • A change in the way the upper and lower teeth fit together

At The Stafford Dental Practice, we offer different solutions for this depending on what your particular symptoms are.

Cerezen:

The traditional treatment for TMD and associated symptoms is a bite splint. But this is not always a long term solution at relieving symptoms. Patients do not like wearing them because they are cumbersome and can really only be worn at night. As a new innovation, Cerezen’s main advantage is that it permanently prevents the problems through it’s unique in-ear placement. It is non-invasive, comfortable and discreet enabling it to be worn day and night with no impact on lifestyle. So why put up with traditional methods that don’t solve the problem when you can have new technology that will?

jaw pain face TMD joint

  • Can be worn day and night apart from when swimming, bathing or during contact sports
  • No adverse effects on speech, hearing or eating
  • Conservative, non-invasive treatment so no negative long-term effects

The Somnowell:

This is an extremely effective treatment for bruxism. It is made from a medical super alloy that is impervious to wear from teeth grinding. The smooth surfaces of the Somnowell allow the individual to rhythmically move their jaw during sleep without damaging the tooth enamel. The discreet design and super alloy construction make it highly stable and easy to wear. Click here for more information. Furthermore if you happen to snore or suffer from sleep apnoea the Somnowell can be fitted with the discreet adjustable connector to effectively treat both these conditions at the same time.

Whilst it is an excellent solution if you also suffer with snoring or sleep apnoea, Somnowell cannot be used if you:

  • have central sleep apnoea
  • have severe respiratory disorders
  • have loose teeth or advanced periodontal disease
  • are under 18 years of age

 

Michigan/Tanner splint:

These acrylic splints are used if you have a problem with your bite or you are a heavy tooth grinder or clencher. They provide balanced forces and remove any interferences to smooth jaw movement. When fitted, all teeth will touch the splint at the same time with the same of force, reducing the force that the muscles can generate.  It is usually only worn at night.

dental michigan splint, jaw pain, TMD
Here is an example of a stabilisation appliance.
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Due to the material used, plastic devices tend to be bulky and regularly need to be replaced due to the wear and tear caused by the grinding teeth. With unchecked wear, plastic devices can encourage unwanted tooth movements that end up worsening the problem. Whilst they are excellent for diagnosis, there are a couple of drawbacks:

  • Potential adverse effect on speech and appearance
  • Cannot be worn when eating

If you have a problem with clicking from your jaw and the click disappears when you posture your lower jaw forwards and open and close your mouth, then the splint of choice is an Anterior Repositioning Splint. The splint of choice at our practice is the Somnowell due to the published, high success rate as well as the durability and improved levels of acceptance and toleration. This guides your jaw downwards and forwards into a position from which you can open and close without causing the click and this allows the joint disc to reposition because of its natural elasticity.

natural bite, dental splint, TMD

The bite without an anterior repositioning splint in place.


natural bite, splint, dental

Here is an example of someone using an anterior repositioning splint.

 

The most frequently made splint is a soft poly vinyl appliance similar to a gum shield. What does happen is that these allow an increase in the bite force and tooth grinding habit in a significant number of people as they are aware of having a soft compressible material between their teeth. This can often increase the rate of tooth grinding or tooth clenching. These can wear very rapidly and they are not made to any particular prescription with the suggestion that they will “absorb” some of the bite force.

One design of splint which must be avoided at all costs is a partial coverage appliance. These are sometimes made to cover the back teeth only because patients do not like the appearance of the splint covering their front teeth where it is visible. It permits unwanted, uncontrolled and unplanned tooth movement (Dahl movement) severely disrupting the bite. In these instances we prescribe such an appliance to intentionally encourage such controlled and planned tooth movement.