Facial Pain, Teeth Grinding and Clenching

The first way to know if you have TMD is to look for specific symptoms. These symptoms include:

• Pain in your joints (or the joints connecting your jawbone to your skull)
• Jaw pain
• Difficulty or painful chewing
• Pain around your ear
• Jaw joint locking, so you’re unable to open and close your mouth
• Facial pain

This isn’t the most noticeable symptom, but some TMD sufferers experience a clicking noise when they open their mouth. It’s also common to experience a grating sensation while chewing.

If you experience any of these symptoms, it’s best to see a dentist for TMD treatment.

Your mandible can move and your joints work with a myriad of muscles in your jaw.

Bones interact with the joint. They’re separated by a small, shock-absorbing disk and are covered by cartilage. These bones ensure jaw movements are smooth and healthy.

When TMD sufferers first experience symptoms, the parts connected to the joint are first damaged.

This can be caused by a number of different factors. For example, the disk can erode or get out of alignment. Many people develop TMD if their joints are damaged due to injury.

Other ailments, such as arthritis, leave you at risk for developing TMD.

Medical attention isn’t always necessary. You can develop symptoms because your joints are overworked and stressed out. Pain and discomfort will go away on their own.

However, there’s a time you need to see a dentist. For example, do you have constant issues opening and closing your mouth? This means your TMJ is causing your joints and jaw muscles to function incorrectly.

Another reason to see a dentist for TMD is if the pain is severe and persistent.

There are many treatments for TMD. Pain medication can help your pain and swelling. If you develop TMD because you clench your jaw, anti-anxiety medication can help relieve your stress so you don’t clench your jaw.

Your dentist may also recommend you eat primarily soft foods to take the chewing stress off of your joints and muscles.

Severe cases may require specialised treatment and devices such as the occlusal splint.

The Temporomandibular Joint (TMJ) is the joint connecting the lower jaw and skull, which enables you to open and close the mouth, and chew from side to side. Temporomandibular Joint Dysfunction (TMD) is the name given to problems with the jaw, and the muscles in the face that control it.

The most immediate signs occur first thing in the morning; a stiff jaw, or tenderness when you bite together. You may also be suffering from severe headaches or neck and shoulder pain; from pain and discomfort on the sides of the face around the ears or jaw joints; or difficulty moving the jaw. You may also notice loosened teeth and receding gums, and occasional prone to tiredness or spasm in the muscles that move the jaw.

‘Occlusion’ is the dental term used to describe the way the teeth meet when the jaws bite together. If the teeth do not fit together properly, this can create problems not only for the teeth but also the gums, the temporomandibular joint and the muscles that control it.

Conor and Cormac Shields have undertaken extensive postgraduate training with the British Society of Occlusal Studies and are experienced in the assessment and treatment of TMD.

Various muscles may be sore when testing, or broken and worn areas of the teeth can provide tell-tale evidence of clenching or grinding, a common sign of an incorrect bite.

The dentist may treat the problem by prescribing an Occlusal Splint, a hard plastic appliance that fits over the upper or lower teeth. This will be measured and fitted accurately so that when you bite on it, when your muscles are relaxed, all your teeth meet at exactly the same time.

The Occlusal Splint may have to be worn all the time, or at night only. If the appliance relieves the symptoms, it is possible that your bite will need permanent correction.

Up to 1 in 4 people, men and women equally, may have some symptoms. The symptoms can often start with the menopause or other hormonal changes. Many people have imperfect occlusion and missing teeth, yet never have symptoms because they adjust to their problems. Occasionally, in times of increased stress and tension, the symptoms may appear and then go away immediately.

In some cases, the teeth and gums can be affected straight away and, instead of headaches, you may suffer:

• Flattened, worn teeth
• Broken teeth, fillings and crowns
• Loose teeth
• Continual sensitivity of your teeth to temperature change
• Toothache with no apparent cause

• Occlusal splint: In many cases, an occlusal splint (or Michigan splint) can help.
• Tooth adjustment: the direction and positioning of the slopes that guide your teeth together can often help to reposition the jaw.
• Teeth replacement: missing teeth may need to be replaced using bridges, dentures or implants to ensure the TMJ has equal support from both sides of the both jaws.
• Medication: some drugs may assist, but this is usually only a temporary measure.
• Diet & exercise: a soft diet may help, so that there is less stress on the TMJ, as can corrective exercises, external heat, and, in some cases, physiotherapy. Caffeine may make you more likely to clench your teeth. It can also cause anxiety and that anxiety makes it harder to rest. Also avoid alcohol. Alcohol can give you a hangover, but it can also make you wake up with pain of a different kind.
• Relaxation: counselling and relaxation therapy can help in some cases, assisting the patient to become more aware of how to manage stressful situations and control tension. Meditating before you go to sleep at night can help you relax. If you’re relaxed, you’re less likely to grind or clench your teeth. Think about training your mouth to relax while you’re awake. If you’re experiencing stress and feel your mouth clenching up, stop yourself. You can do that by first taking a deep breath. Then place the tip of your tongue between your teeth. That position keeps you from grinding. At night, wet a washcloth with warm water. Then place it against your cheek.

Tooth adjustment (equilibration)

Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.

Teeth replacement

The temporomandibular joint needs equal support from both sides of both jaws. Missing teeth may need to be replaced by tooth replacement therapy using bridges, dentures, or implants. Replacement is not usually done until a diagnosis is confirmed using an Occlusal Splint that has relieved the symptoms. Relief for some patients is instant, for others it can take a long time.

Medication

Some drugs can help in certain cases, but this is usually only temporary. Hormone replacement therapy may also help some women.

Diet & exercise

As with any joint pain, it can help to put less stress on the joint. A soft diet can be helpful, as can corrective exercises and external heat. Physiotherapy exercises can often help.

Relaxation

Counseling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.