TMJ Disorder and Bruxism (Grinding and Clenching)

TMJ Disorder and Bruxism (Grinding and Clenching)

Bruxism has been defined as the complex, unconscious grinding or clenching of teeth, especially during sleep, or as a mechanism for releasing tension during periods of extreme stress in waking hours.

It has also been called “the most prevalent, complex and destructive of all oral disorders”. The amount of destruction of tooth material can be severe, even resulting in nerve exposure, which leads to root canal treatment.

There is extensive literature on bruxism, offering a wide spectrum of opinions. Psychological factors have long been recognized as contributing to the build-up of stress, which is then released by bruxing. Another reason is the bodys attempt to remove interferences in the bite.

Although there is a strong association between bruxism and temporomandibular joint (TMJ) dysfunction, one can be found without the other. When initial treatment is done to control the symptoms of TMJ dysfunction, bruxing may stop since the joints and the facial muscles are balanced. This does not necessarily mean that a permanent solution for the bruxing has been achieved.

A typical treatment plan might involve initial management of any pain or sensitivity arising from the bruxing, which is usually a full coverage splint, also called a “bite guard” or a “night guard”. It is anticipated that the splint will probably continue to be used at night, for an unspecified period. This particular treatment is only a temporary solution for a chronic problem, and bruxing still continues.

An example of severe bruxism is now presented. This illustrates how a physiologic explanation of this phenomenon can be developed.

This patient presented a long history of nocturnal bruxing and TMJ disorder. Other symptoms the patient mentioned were neck and shoulder pain, low back pain, headaches, ringing of the ears and loss of balance.

The next photograph shows the upper and lower dental midlines are not coincident. This patient has a side-bend malocclusion, where in the upper jaw is deviated to the left and the lower jaw is deviated to the right.

The treatment for this patient is the Advanced Lightwire Functional (ALF) appliances, which are shown below.