Circumstances that Cause TMD #3

Circumstances that Cause TMD

My prior article defined TMD. It also described the common denominator responsible for all of TMD symptoms. INFLAMMATION!

Next we will cover the circumstances that create the inflammation of the Temporomandibular Joint (TMJ)

The first is the most common.  Clenching and grinding of the teeth, voluntary or involuntary, day or night, causes inflammation of the TMJ.  The technical term for clenching and grinding is bruxism.  Bruxism is very common in both adults and children.  Roughly half the population bruxes and most are not aware they do so.  Other than extreme and obvious ware of the enamel surface of the teeth, the best way to confirm you are a bruxer is to look for bony knobs on the inside of your lower jaw towards the front underneath your tongue, or a bony knob in the roof of your mouth.  These bony knobs, if present, are a sure sign you are a bruxer. These bony knobs are called Tori and are caused by the extreme back and forth forces placed on the teeth and transferred into the surrounding bone which causes additional bone to be created by the body.  Of course, the gold standard that proves you are a bruxer is your sleeping partner saying, “My god you make a lot of noise with your teeth at night”.  If you have ever heard that, you are a bruxer. Once a bruxer, always a bruxer, although at times people do brux more than other times.  This is usually modulated by the amount of stress they experience.

But many people brux during the day also.  Clenching the teeth does just as much damage to the TMJ’s as grinding the teeth.  Clenching and grinding of the teeth, night or day, knowing or unknowing, eventually causes inflammation within the TMJ and it is the inflammation that causes each and every symptom of TMD.

There is no on and off switch for bruxism.  People who brux have no control of it.  Doctors who have studied bruxism have no full understanding of the mechanism for bruxism within the central nervous system.  There are lots of theories, but no one really knows. The only thing we know for sure about bruxism is that it is related to stress.  The more stress, the more likely people will brux.  And we do not have a god definition and understanding of stress.

Not all people that brux develop symptoms of TMD. But if you brux, you are more likely to develop TMD symptoms sooner or later.

Mouth guards and night guards, whether they are custom made by a dentist or purchased off the shelf at the pharmacy, will not stop anyone from bruxing.  These devices only serve to protect the surfaces of the teeth from wear and frequently make the symptoms of TMD worse because they do not address the common denominator of TMD, Inflammation.  Patients continue to brux and the inflammation gets worse.  The night guard just gives the person something in their mouth to chew on as they continue to brux.

Years of bruxism can eventually destroy the internal hard and soft surfaces and structures within the TMJ.  TMD is a gradual and progressive problem.  And bruxism is the most common circumstance that creates the inflammation within the TMJ, which in turn creates the symptoms.  This one fact and relationship is what is most often misunderstood and unacknowledged about treating patients with TMD.

The next article in this series will cover the second most common circumstance causing inflammation within the TMJ, “Functional malocclusion.”  Functional malocclusion is a little more complicated to define and describe.  So I will take my time and give appropriate effort to fully educating the reader regarding TMD.

Till next time.