Clenching, Grinding, & Bite Guards
– Facts & Solutions –

Dr. Al Danenberg ● Nutritional Periodontist

August 21, 2022 [printfriendly]

We all clench or grind our teeth at times. We may do it when we’re sleeping, or we may do it when we are awake. The medical term is bruxism. Most times, bruxism is not a problem. If you do grind your teeth at night, you might develop a dull, constant headache or sore jaw when you wake up. Many times, people learn that they grind their teeth after their loved one hears them grinding at night.

The problem of bruxism is not limited to adults. Children may grind their teeth when their baby teeth emerge and when their permanent teeth come in. However, most children lose this habit after these two sets of teeth have come in more fully.

There may be many causes of, and methods to treat, bruxism. Continuous bruxism should not go unchecked. It could cause serious damage to the teeth, the jawbone, and the jaw joint.

 

Facts

Damage Done

The tooth root is anchored in the jawbone just like a pole is anchored in the dirt. If you continuously wiggled a solid pole in the ground, it probably would become loose. The reason it would loosen is because the side-to-side rocking of the pole would push the dirt aside.

Assume the pole was your tooth and the dirt was your jawbone. If you wiggled that tooth in the bone by grinding or clenching your teeth, you could weaken the surrounding bone. Since the bone around the tooth root on the cheek sides of the teeth is extremely thin, it is very vulnerable. Any wiggling of the tooth in the bone could cause that very thin bone to melt away. Once the bone is gone, it is gone for good.

With the bone gone, the gum tissue covering that area of the tooth would no longer have a scaffolding to attach to. The gum would become unstable. The gum could then recede exposing the root because the bone would no longer be there to hold the gum in place.

In some cases, there can be an opposite effect on the jawbone. Bruxism could cause excess growths of bone called “tori”. This result is basically a protective mechanism of the bone to build itself up to repel the pressures from bruxism.

Bruxism also may cause tooth pain and cause the tooth to feel loose. Bruxism can exacerbate existing periodontal disease by furthering the breakdown of the bone surrounding the tooth root.

The heavy forces of bruxism could cause severe wear on the chewing surfaces, cracks in teeth, muscle pain, and damage to the jaw joint.

 

Causes

Sometimes, a poorly fitted crown on a tooth or a filling on the chewing surface of a tooth may have “high spots”, which may create an interference with the tooth on the opposite arch when they bite together. If that is the case, you may unconsciously grind your teeth to make them “fit together better”. That process of grinding your teeth (i.e., bruxism) can create serious problems for the teeth, the jawbone, or the jaw joint.

Sometimes, bite treatment (orthodontic treatment) may cause teeth to be moved into positions in the jaw that do not fit well together with the opposing teeth in the opposing arch. This could cause interferences in the chewing surfaces of the teeth that cause a person to grind or clench.

Often, when a person is under emotional stress or performing strenuous physical activity, they may clench their teeth.

In addition, if the jaw is not shaped correctly, and the tongue does not have adequate room to function, there may be a problem with breathing called obstructive sleep apnea. When that occurs, frequently bruxism could result while asleep.

 

Solutions

First, the most obvious potential causes must be addressed.

If the chewing surface of a tooth is interfering with the chewing surface of a tooth in the opposite arch, then the bite pressure must be adjusted. To correct these heavy “pressure spots”, the chewing surfaces of the teeth are selectively smoothed and polished to remove the interferences. This may be all that is necessary to stop the grinding.

If a patient grinds his or her teeth habitually, sometimes a bite guard could be worn during sleep to reduce the pressures. If people go to the gym and perform strenuous workouts, they often clench. This also would be a good time to wear a bite guard to protect the teeth and jaw joint.

Generally, the best bite guard is made in a dental office that fits the upper teeth and is hard rather than soft. This type of bite guard can guide the teeth in the lower jaw to slide gently on the bite guard during bruxism and prevent damage to the tooth, the jawbone, and the jaw joint. A dentist can do a “compatibility blood test”[1],[2] to determine the best material to use to construct the bite guard in the dental lab for that patient.

A more inexpensive and immediate type of bite guard that could be used would be a store-bought bite guard that is soft and just reduces the pressure from bruxism.

At other times, orthodontic treatment might be necessary to correct the bite. In more complicated cases, the upper and lower arch may be too narrow to allow the tongue to fit comfortably between the lower teeth. In this case, the upper and lower jaw arches could be widened, the teeth properly positioned, and the tongue given more comfortable space. These efforts will open a compromised airway space regaining normal function for the tongue, improved oxygenation, and reduced bruxism.

 

Concluding Thoughts

Almost everyone clenches or grinds their teeth at times. Most of the time, it is not a problem. When it becomes habitual and continuous, there can be serious damage caused to the tooth, the jawbone, and the jaw joint.

So, how can you tell if your teeth grinding is cause for concern?

Well, any pain in a tooth, the jaw muscles, or jaw joint area would be indicative of damage from bruxism. Also, headaches especially upon wakening could mean that you have been grinding your teeth at night. The only way to determine the true extent of the damage would be for a dentist to evaluate the bruxism habit and the actual areas of the tooth and the jaw joint.

It is incumbent upon an individual who wants to be proactive to seek a proper diagnosis and pursue necessary treatment from a qualified dentist to prevent damage from bruxism.

 

[1] Clifford Consulting Laboratory, www.ccrlab.com

[2] Biocomp Laboratories, www.biocomplabs.com

 

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“My Jaw Pain is Killing Me”
– 10 Causes … Treatment Options –

Dr. Al Danenberg ● Nutritional Periodontist

February 13, 2022 [printfriendly]

Have you ever experienced jaw pain? It is estimated that up to 80% of people have experienced some type of jaw or tooth pain at some point in their lives. So, if you haven’t experienced it firsthand, there’s a good chance you will.

Today, we’re going to look at some of the causes, treatment options, and how you can be proactive to avoid this unpleasant experience all together!

On July 3, 2016, I published a Blog about Monique. She was a patient I saw in 2015. She was one of many patients I treated for similar symptoms. She entered my office saying, “My jaw pain is killing me.”

Another patient I treated in 2018 had similar symptoms but they were much more serious. Jonathan had a root canal procedure performed on his upper right molar about 3 months before I saw him. His general dentist performed the root canal and also placed a crown on that tooth. Then, Jonathan began to have severe pain in that tooth, in his jaw muscles, and in his jaw joint.

At first, Jonathan thought that the root canal was failing and was the cause of his pain. That was part of his problem. The other immediate cause was related to his biting pressure on that newly crowned tooth, which Jonathan didn’t consider.

When I saw him on an emergency visit, I needed to get him out of pain. I also had to determine a definitive treatment plant to resolve his issue for good. I treated the emergency problem that day; the other was definitively treated later in the week.

 

What Is Jaw Pain?

As a periodontist, I frequently treated jaw pain.[1] Most pain comes from the jaw joint and the muscles that help chew food. This jaw pain may be called TMJ (temporomandibular joint) pain or TMD (temporomandibular disorders). Many of the causes of this type of jaw pain also can damage the jawbone around the roots of teeth. Here’s the inside skinny about jaw pain (TMD).

More than 40% of adults experience pain in their mouth annually, according to the Centers for Disease Control and Prevention (CDC).[2] But only 50 to 60% of people with jaw joint pain will seek treatment. Those who don’t get treatment continue to live with painful side effects.

The most frequent complaint I have seen is pain either in the jaw joint or in the jaw muscles. Another common symptom is discomfort when opening the jaw, most obvious when eating or speaking. Popping and cracking sounds in the jaw joints when opening and closing may be present. Also, buzzing or ringing sounds in the ears are possible. Sometimes there is swelling; most of the time swelling is not obvious.[3],[4] Pain also can be isolated to the areas around the roots of the teeth.

 

10 Causes of Jaw Pain

TMD is multifactorial, and there may be sources that are difficult to identify.[5],[6]

Below are 10 related causes for TMD:

  1. Trauma (like a car accident) involving the jaw joint could create damage in the structures of the joint resulting in pain.
  2. Habits of clenching and grinding the teeth can damage the jaw joint and cause muscle pain. These habits also wiggle the roots of the teeth in the jawbone, which will damage the bone around the teeth and may cause tooth pain and cause the tooth to feel loose. Grinding also may crack teeth.
  3. Improperly designed chewing surfaces because of a poorly shaped crown or a poorly placed filling material could cause forces that rock a tooth from side to side. The rocking motion can cause spasms in the jaw muscles as well as cause a hairline crack to develop in the root of the tooth. This also can cause the involved teeth to feel loose in the jawbone.
  4. Poor nutrition and unhealthy digestion could cause chronic systemic inflammation that could affect all joints (example: rheumatoid arthritis).
  5. Emotional stress has been shown to create biochemical changes in the blood system that could increase chronic inflammation throughout the body and joints.
  6. Lack of sleep increases chronic systemic inflammation and can affect joints in the body.
  7. Excessive estrogen may increase inflammation and damage in the jaw joint.
  8. Infection beginning in the joint will cause swelling and pain.
  9. Infection in the jawbone from a failing root canal filling, from residual infection in an extraction site, from an abscessed tooth or a decayed tooth, and from other areas of infection in the mouth and head can affect the TMJ.
  10. Complications with airway space because of a narrow jaw, improper position of the tongue, and misalignment of teeth can create obstructive breathing and poor oxygenation which can result in clenching, teeth grinding, and jaw pain.

 

Treatment Options for Jaw Pain

First, the most obvious potential causes must be addressed.[7]

If the bite is causing muscle and jaw soreness, then the bite must be adjusted. Correcting heavy pressures on the chewing surfaces of the teeth by selectively smoothing out these heavy pressure areas may be all that is necessary to make the bite healthy and stop the pain.

If a patient grinds his or her teeth habitually, sometimes a bite guard could be worn during sleep to reduce the pressures in the jaw joint. If people go to the gym and perform strenuous workouts, they often clench. This also would be a good time to wear a bite guard to protect the teeth and jaw joint.

At other times, orthodontic treatment might be necessary to correct the bite. In more complicated cases, the upper and lower arch may be too narrow to allow the tongue to fit comfortably between the lower teeth. In this case, the upper and lower jaw arches could be widened, the teeth properly positioned, and the tongue given more comfortable space. These efforts will open a compromised airway space regaining normal function for the tongue, improved oxygenation, and reduced bruxism.

I published a paper called, Shoddy Dentistry & Mouth Splinters, where I describe many dental issues that could cause dental pain and inflammation. It’s Free to download if you would like.

Clinical studies show other factors affecting TMD. Examples are emotional stress and lack of sleep, which have been reported to aggravate the symptoms of TMD.[8],[9]

Based on published research papers, these other therapeutic steps should be considered:

  • Treat any obvious or not-so-obvious infections or inflammation in the mouth
  • Reduce stress
  • Get restorative sleep
  • Eat a nutrient-dense, anti-inflammatory diet
  • Avoid eating foods that contain chemicals that can affect the gut and create chronic systemic inflammation
  • Seek the advice of a myofunctional therapist and an orthodontist who are trained in proper jaw structure and function
  • Only as last resorts, investigate medications or surgery for TMD

 

How I Eliminated Jonathan’s Jaw Pain

Jonathan’s pain was related to (1) his bite after his crown was made and (2) a hairline crack in the root of his upper molar root canal tooth. The crown was improperly designed and shaped poorly. The chewing surfaces between that tooth and his lower molar were bumping too hard. Since these pressures were too heavy, his jaw muscles went into spasm, which in turn caused his jaw pain initially. Jonathan couldn’t make this pain go away and didn’t know what was causing it. He also could not tell if the upper crowned tooth was hurting more than the lower molar tooth which was also being pounded with heavy biting forces.

In addition, the heavy pounding pressures on the crowned tooth which had the root canal procedure eventually caused a hairline crack in the roots of that molar. A root canal tooth tends to be more brittle and prone to root fracture. The hairline fracture went through the roots of the upper molar into the jawbone.

At first, I needed to get Jonathan out of pain. The first thing I did was to determine the spots on the crown that were hitting his lower molar too hard. I used a very thin “carbon paper” to visualize the responsible heavy pressure points. I then evened out these heavy contacts by smoothing and polishing the chewing surfaces so that his teeth came together properly. Immediately, he noticed his jaw was more comfortable.

Next, I rescheduled Jonathan to extract the upper molar. Once there is a crack in the root that travels up the root into the jawbone, it is not treatable. After I extracted the tooth and prepared the bone socket to receive an implant, Jonathan scheduled to have me place a zirconia-type implant into the socket about a month after the extraction. At times, a bone graft and other bone rebuilding procedures are required to restore the bone socket to receive an implant.

 

Putting It All Together

Many factors affect jaw pain. The more obvious causes should be explored first. If grinding habits or bite problems exist, these must be corrected. If those pressures on the tooth have cracked the root, then the tooth must be extracted since a cracked root cannot heal.

Any irritant in the mouth that may cause infection or inflammation must be diagnosed and treated appropriately.

If the jaw is out of alignment or if the jaw needs to be widened, proper orthodontic treatment is crucial to regain function, to provide room for the tongue to become comfortable, to normalize the airway space, and to resolve TMD issues.

Also, stress reduction, restorative sleep, and good nutrition must be implemented to reduce TMD symptoms.

If symptoms persist, other treatment options must be investigated and implemented to resolve the issues and make the patient comfortable.

 

[1] https://www.ncbi.nlm.nih.gov/books/NBK551612/

[2] https://www.forbes.com/health/body/common-causes-of-tooth-pain/#footnote_1

[3] https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/temporomandibular-disorders-tmd.html

[4] http://www.ncbi.nlm.nih.gov/pubmed/21835653

[5] http://www.rjme.ro/RJME/resources/files/570116185189.pdf

[6] http://www.ncbi.nlm.nih.gov/pubmed/?term=Association+between+estrogen+levels+and+temporomandibular+disorders%3A+a+systematic+literature+review

[7] http://www.ncbi.nlm.nih.gov/pubmed/?term=Different+association+between+specific+manifestations+of+bruxism+and+temporomandibular+disorder+pain

[8] https://pubmed.ncbi.nlm.nih.gov/33829540/s

[9] https://pubmed.ncbi.nlm.nih.gov/27687043/

 

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