Night guard for TMJ pain

Diagnosing TMJ pain

A night guard for TMJ disorders is a commonly recommended first line of treatment for certain types of pain around the TMJ area. Pain around the jaw joint area can be one of the most difficult diagnoses to make as a dentist since your teeth, TMJ, and muscles around the TMJ all act as part of a complex system. In addition, pain in this area can radiate and refer to other areas making it challenging to isolate the source of the pain. A night guard for TMJ pain can be effective in some patients where the cause is muscle hyperactivity such as grinding at night. In this article I will go over the TMJ system and what can happen to it over time and some of the common symptoms patients have and what patient’s options are.

YOUR TEETH, JAW MUSCLES, AND TMJ ACT AS A SYSTEM

Your teeth and the Temporomandibular joint (TMJ) on each side of your jaw form a tripod with jaw muscles acting on the sides to stabilize the tripod. As time passes, our teeth wear down and change, and this system adapts by having the muscles gradually move the jaw around to get the best overall contact between all the teeth. The jaw can be moved about since the TMJ acts like a ball and socket joint such as a knee joint, plus more imporatantly, the TMJ can allow the jaw to come out of the socket and translate or move away from the socket.

At the same time, the TMJ undergoes changes also. The disc that interfaces with the jaws can move erratically, the jaw bone can degenerate or both. The important take away here is that for most patients, their jaws adapt to the changes and even though the jaw may be slightly out of alignment, their day to day function is not affected and there is no pain. However, some patients can have a lot of symptoms even with what seems to be a slight change to this system.

MUSCLE PAIN FROM CLENCHING/GRINDING

A night guard can help patients who have jaw pain if the pain is from clenching or grinding. Typically, these patients will present with sore masseter muscles which are the biggest muscles on the side of the jaw. Sometimes, patients will say that their teeth feel loose or sore also.

The night guard acts like a shock absorber for some of these patients and the night guard can be adjusted so that the bite is relieved more on the back teeth which can make patients put less pressure on the back teeth automatically. To demonstrate this, try putting your finger in between your back molars and bite as hard as you can. Next, put your finger between your front teeth and try to bite as hard as you can. You will notice that you can generate a lot more force with your back teeth than your front teeth. This is because the brain is programmed to put less pressure if the front teeth are touching since the front teeth are not designed in a way to accept so much pressure. Compare that to the back molars which are double the size of the front teeth.

TMJ PAIN WHEN THE JAW SEEMS TO BE PUSHED BACK ON CLENCHING

If you have a deep bite where your jaw seems to be pushed back as you bite your back teeth together, this may be a sign that your lower jaw is not allowed the freedom of movement that it needs. This typically happens when patients who have front teeth that are sticking out and those teeth are pulled back for a more esthetic smile.

A night guard for this type of TMJ pain can help by covering the upper teeth and allowing the lower jaw to move around without being constrained by the upper teeth. It is very important that the patient’s bite be carefully analyzed before a night guard is prescribed in this case.

TMJ PAIN FROM ABNORMAL TOOTH WEAR

This type of pain is common to varying degrees. The teeth naturally wear down and the muscles have to constantly move the lower jaw to get them to close properly. Over time, this can lead to pain since the muscles that are used to slightly position the jaw a certain way never get a chance to relax. These muscles are much smaller than the masseter muscle discussed earlier. In this case, a night guard can help if the bite can be adjusted on the night guard so that the jaw can be positioned in a even and aligned position where the muscles aren’t working all the time. However, this is more of a diagnostic tool for some patients who have severe symptoms. If the adjusted bite with the night guard makes things much better , this is a sign that the problem is in the way the teeth are coming together or your bite. If this is the case, this may require major changes to your bite.

WHAT TO EXPECT WITH NIGHT GUARD WEAR

A night guard will not stop someone from clenching or grinding since this is a brain mediated activity. The night guard is just meant to lessen the damaging effects of clenching and grinding on teeth and dental restorations.

I have to say that even though patients understand the benefits of night guards, I still have some patients who just can’t seem to get used to wearing one on a nightly basis. At the same time, I have patients who say they cannot get a good night’s sleep without one. So the only way to find out may be to try it.

PRECAUTIONS TO TAKE WITH NIGHT GUARD FOR TMJ PAIN

Just like any dental appliance, long term night guard wear can have unintended consequences if used improperly or the night guard is not fitting well with your teeth. For some patients, a night guard that does not cover all the teeth may allow the teeth to shift and alter the bite long term. Because of this, it is very important that the night guard wear be monitored closely.