TMJD & Bruxism

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TMJD (Temporomandibular Joint Dysfunction)

Temporomandibular Joint Dysfunction Syndrome (TMJD) is a common condition affecting a wide variety of people. TMJD is characterized by severe headaches, jaw pain of varying degrees, limited opening, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJD sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

The symptoms of TMJD are sometimes debilitating and can greatly interfere with everyday life. The comfort and general well being of the patient are at the heart of the dental practice, so pain relief is the first consideration of the dentist. The dentist is often able to test, diagnose, and devise an immediate plan to treat the underlying causes of the TMJD disorder.

Reasons for treating TMJD

TMJD sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress and that intense outbreaks of the condition can lead to neck pain and dizziness.

A common cause of TMJD is the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to realign or adjust the teeth without the need for painful or expensive surgeries. The realignment/adjustment will alleviate the headaches, jaw pain, and the dizziness.

The grinding teeth symptom is particularly common and usually occurs at night. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Untreated TMJD is a significant underlying factor in worn and loose teeth.

It is important for anyone experiencing the symptoms of TMJD to visit their dentist for a diagnosis, and discussion of treatment options.

What does treating TMJD involve?

TMJD could be a result of several different problems. A bad bite is the most common, but an injury resulting from a blow to the meniscus cartilage is also a possibility. Osteoarthritis may also be a factor in older individuals. Initially, the dentist will thoroughly examine the jaw area, the patient’s bite, take X-rays, and review the patient’s history in order to make a diagnosis and recommend necessary treatment. More advanced imaging such as an MRI or CT scan may be necessary as well.

Once a reliable diagnosis is attained, there are several ways in which relief can be provided. A specially molded bite guard can be created to reduce muscle activity and to protect the teeth during grinding at night. A bite relationship analysis may also be recommended. The dentist can also provide advice on relaxation techniques which will lessen the effects of stress. As a last alternative, the dentist is also able to prescribe muscle relaxants on a short-term basis.

A better option is to change the shape of the teeth and get rid of the bad bite completely, often called “occlusal equilibration.” This is especially useful because it alleviates TMJD symptoms and may improve the aesthetic appearance of the teeth as well. Occlusal equilibration involves adjusting the relationship between how the upper teeth come together with the lower teeth. This may require new restorations and/or adjusting the natural teeth as well. It is not a painful or time consuming procedure. As with any procedure, the dentist will be happy to answer questions and discuss symptoms, options, and treatments.


Bruxism refers to an oral parafunctional activity that occurs in most people at some point in their lives. Grinding of the teeth and clenching of the jaw are the two main characteristics of this condition, which can occur during the day or at night.

Bruxism is one of the most commonly known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism are symptomatic of an over-active chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps cause the reflex nerve control center in the brain to turn off and the reflex pathways to become active.

Typically, the teeth of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders, and anxiety are among the most common symptoms of bruxism; these symptoms also accompany health issues such as chronic stress, Alzheimer’s disease, and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks, abrasive foods, and eating disorders such as bulimia nervosa.

Reasons for the treatment of Bruxism

Here are some of the main reasons why bruxism should be promptly treated:

Gum recession and tooth loss

Bruxism is one of the leading causes of gum recession and tooth loss. It damages the soft tissue directly and leads to loose teeth and deep pockets, where bacteria can colonize and destroy the supporting bone.

Occlusal trauma

The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.


In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).

Myofascial pain

The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to debilitating headaches and muscle pain in the myofascial region.

Treatment options for Bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:


An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help to stabilize the occlusion as well as prevent damage to teeth and to the temporomandibular joint.

NTI-tss device

This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.


Botox® can be injected into the muscles to relax and weaken them. Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent grinding but not enough to interfere with everyday functions like chewing and speaking.

Other methods of treatment include relaxation exercises, stress management education, and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts, and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

*Please note that we do not provide Botox treatments in our office but are happy to refer you to a physician specially trained in this treatment if it is something that we feel will be best for you.



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