Tuesday, April 27, 2010

What's the Story on Tooth Grinding/TMJ?

Do You Grind Your Teeth?     

You may notice some gradual shortening or flattening of your teeth over time. It's possible that your dentist noticed some wear on your teeth at your last cleaning but you weren't aware of it. Maybe you had an idea that you were grinding at night because you wake up with a stiff jaw in the morning. Or, it might be that you've had some broken teeth or broken fillings lately even though this hasn't ever been an issue for you before. Whether your jaw clicks, pops, hurts or doesn't seem to do anything at all, it's possible that you grind your teeth. Tooth grinding(also known as bruxism) is incredibly common in the United States. While it's commonly linked to stress there can be a number of different causes, most of which are out of a patient's control since it commonly occurs while sleeping. The causes, however, are vastly outnumbered by the different ways in which grinding can affect a person's teeth and jaw joints/muscles. The effects can be as mild as some minimal wear or flattening of a person's teeth (which may not even be noticed by the person doing the grinding) to a debilitating and painful complex condition that severely affects a person's quality of life.Fortunately most people's experience with grinding, if any, falls short of this type of situation. Once a person's grinding habit is identified problems can often be avoided or managed with dentist supervision and treatment, if needed.

     Why does grinding cause problems? For one, although our tooth enamel is the hardest substance in our body it was not designed to come into contact with other teeth covered with enamel for more than a split second each time you chew. Add it all up and your teeth should only come together for about 9 seconds over the average day. Someone who grinds, however, often does so for three hours or more every night. Add to this the fact that some people also grind some more during the day (maybe while driving or at work) and you can see why it's a recipe for wearing away that protective enamel. Once you get through to the dentin layer underneath it, the tooth wears away about seven times faster.

So What Do I Need to Do?

     For some people, only the teeth are affected. When that's the situation the goal for most dentists and their patients is to restore those teeth that have been chipped or broken back to health with fillings and/or crowns while setting up a game plan for protecting and reducing any further damage to the teeth. In other people, problems arise in the muscles (often sort of like a Charley horse). This can occur either just occasionally for some people or more regularly for others. Often a soft diet and over-the counter pain medication can get a person through the occasional episode. For others who have pain more often some type of mouthguard is usually used. Most dentists make one or several styles of occlusal (bite) guards; fortunately, most of them work well when they are designed and fitted by a licensed dentist. Although mouthguards can be obtained for less outside of a dentist's office, there can be a big advantage to having your dentist supervise your care and provide the ongoing repairs and maintenance that are usually needed. 
     In rarer cases the problem is within the jaw joint (TMJ) itself. Sometimes this is clear right from the start, but other times it is only discovered by the process of elimination when other attempts to treat the pain are unsuccessful. In these cases, a referral to a doctor with extensive training in TMJ disorders and treatment is usually a person's best bet. While there is no specialty limited specifically to bite problems, there are many qualified oral surgeons, prosthodontists, orthodontists, periodontists and general dentists that have a strong interest in helping those with more severe problems and who have received additional training in this area. Surgery is reserved as a last resort, and there are several options available for those suffering in these situations.

     While both the problems related to tooth grinding and the options available to treat them range from simple to complex, fortunately most people can benefit from a discussion with their doctor. I often recommend keeping a journal about when and how the problems or discomfort you're having affect you. It's always tough to sum up an ongoing ailment while you're in your doctor's office--we all forget some detail until later that might be the key to selecting the right treatment. The more details you doctor has available the better he or she can serve you.