TMJ Q&A, Dentist Charlotte NC


What is TMJ?
TMJ = temporomandibular joint. This is your jaw joint which is located in front of your ears. Often times when patients say they have "TMJ" they are referring to either pain in one or both of the joints (there is a right and left joint), pain in their facial muscles, headaches, sounds that they hear in the joint such as clicking, popping or cracking and finally unsmooth movement or locking of the jaw so they cannot close it or open it normally of the lower jaw. All these are symptoms of temporomandibular disorder or TMD.

What causes TMD?
TMD is caused by many things. One cause is occluso-muscle disorder. This is the only type of TMD a dentist can treat. Occluso-muscle disorder is an unbalanced bite that causes the symptoms of TMD.

What is bruxing?
Bruxing is excessive grinding or gnashing of the teeth. This happens at night when they are asleep. The signs of bruxism are seen on the teeth. The teeth of a bruxer will have signs of wear and fracture. If someone is a "heavy" bruxer the wear and fractures on the teeth will be more severe.

Can someone be a bruxer but not have TMD (TMJ)?
Yes. Not all bruxers have any signs of pain, muscle tenderness, sounds in the joints or problems with jaw movement.

Does everyone grind their teeth at night?
Absolutely yes. The question is whether it is damaging for a particular person. Everyone is a tooth grinder at night. But for many people the grinding (bruxing) is very minimal. Either the time of bruxing (teeth grinding) is minimal or the force of the bruxing is minimal or both. So there is no major stress on the teeth and the rest of the masticatory system. If someone grinds their teeth with a lot of force for a long enough time there will be more obvious signs of tooth wear and damage. Remember, even with this heaving grinding, many bruxers do not have TMD pain or dysfunction.

What cause someone to grind teeth or brux at night?
There are several contributing factors that cause people to grind their teeth at night. If bruxing is caused by an unbalanced bite then it is an occluso-muscle disorder and needs to be treated by a properly trained neuromuscular dentist.

Does emotional stress cause you to grind your teeth at night?
People will grind their teeth at night regardless of how stressed they are. However, emotional stress will absolutely increase the time and intensity of the grinding or bruxing. The stress may not be the intial reason to grind but it will make it a lot more intense.

Do you grind your teeth the same amount every night?
No. Some nights, days or weeks you may grind a lot and other times you will grind minimally. Also, when you do grind at night it is at different levels during your sleep and most of the time you are not grinding your teeth at all.

What is the difference between grinding/bruxing with a balanced and unbalanced bite?
When grinding with a balanced bite, you are minimizing the stress on the teeth and other oral structures. Therefore the damage will be less. Grinding with an unbalanced bite will result in much more damage to the teeth and other oral structures. Grinding with an unbalanced bite can cause TMD pain and dysfunction. Also remember, that the cause of excessive bruxing or grinding could be the unbalanced bite itself.

Do you have to see excessive wear on the teeth to have TMD (TMJ)?
No. Every person is different and often times a person can have mild to extreme TMJ symptoms with little signs of wear from bruxing.

Do bruxers make noise when they grind their teeth at night?
Most of the time no. Bruxism or grinding is usually quiet.

Who should be treating TMD (TMJ)?
Many different types of health care practitioners treat TMD. If TMD is caused by the bite or occlusion (occluso-muscle disorder) then a dentist well trained and experienced in neuromuscular dentistry should be treating you. In my office I have a simple inexpensive way to determine if I will be able to help you before getting into more expensive treatment.

What about other non-dental ways of treating TMD (TMJ)?
There are many other non-dental therapies that will relieve TMD (TMJ). They include cold laser therapy, bio-feedback, massage and chiropractic adjustment just to name a few. I promote all these modalities to my patients as adjuncts to my therapy because they can help my patient. However, if the cause of the TMD is completely or partially do to an unbalanced bite, then none of these therapies will be a permanent solution to the problem.

Should someone who grinds their teeth at night (bruxism), but has no TMJ symptoms, get therapy?
Yes. Usually bruxers or teeth grinders have various amounts of wear and tear on their teeth. This wear or attrition will make the teeth more prone to dental disease. People who grind their teeth, wear away the enamel of the teeth and expose the softer dentine under it. The dentine is much softer than the enamel and is more prone to wear and cavities. Also, a bruxer often times will have excessive wear of the front teeth that will make their smile less attractive and older looking. Bruxing also will break and fracture teeth and make the teeth more prone to root canals and periodontal (gum) disease.

What is the difference between the treatment for TMD (TMJ) and the treatment for buxism with no TMJ symptoms?
Ultimately the treatment can be the same. Ideally, the patient would have a bite analysis or occlusal analysis to determine what is wrong with the bite. Then the bite is balanced or equilibrated. The bite balancing can be relatively simple or very involved. The main difference between treating TMD (TMJ) and treating for bruxism is the initial therapy. Unlike a bruxer with no TMD symptoms, the person with TMD has to go through initial therapy to get pain-free and to get the jaw functioning properly. Once this occurs the remaining therapy is the same for both patients.

2009 Paul Plascyk, DDS • Site designed and maintained by TNT Dental