Clenching, Grinding and TMD Pain
The most destructive forces on teeth today are not cavities but the effects of clinching and grinding. Periodontal (gum) disease and clinching and grinding generate more tooth loose than any other cause today. Most people are not aware they clinch and/or grind their teeth unless it is extreme and it wakes them up at night. The average person does approximately 80% of their grinding at night and 20% during the day, but for some people it is as much as 50/50 between night and day. All people clench and/or grind their teeth, it the duration and intensity that vary. People are not aware of night time clenching and/or grinding as it makes no noise unless extreme and is do during the deepest stages of the sleep cycle, between REM and Delta sleep stages. During the day people clench and/or grind their teeth while in deep thought, worry or concentration so they are not aware of it. The only way for people to know the intensity and duration of their grinding and/or clenching is to wear a monitor taped to the side of their face at night to measure the electrical activity of their jaw (massater) muscle as they sleep. It does not cause pain usually, especially in men. TMD (temporal mandibular disease) symptoms occur in women 9 times more frequently than men. Men normally destroy their teeth over time (wear them down or break them), but women more often than men have joint and/or muscle pain as well. Since it does not cause pain and people are not aware of it, they usually find out about it when they go to a dentist who does comprehensive examination for his patients. This may not occur in high volume insurance driven practices. Insurance usually does not pay for treatment of teeth caused by clinching or grinding of the teeth. The dentist discovers this after the damage has been done, by observing the wear patterns, amount of lost tooth structure, fractures and disfiguring of the teeth during the examination. Patients may notice in old pictures their front teeth used to be longer once they become aware of it. Thus many people are not aware of it until the damage is extreme and the longevity of their teeth has already been compromised.
Grinders tend to bring their lower jaw forward till their upper and lower front teeth line up and grind them side to side or front to back causing their front teeth to shorten over time. Overtime this shortens the front teeth which makes us look old beyond out years. Old people have short front teeth and longer back teeth. Additionally this puts stress fractures in out teeth and weakens our teeth over time. Clinchers put their back teeth together and contract their biting muscles generating up to 300 pounds of force per square inch. This weakens all our teeth that touch, especially the ones that hit first. Fractures develop, especially teeth that have fillings in them, notches also develop in the teeth near the gum line called abfractions. The result is severally weakened teeth that often break and split. The good news is a bite splint, a custom built acrylic covering of the upper or lower teeth can be made to protect the teeth from the stress of clenching and grinding, making the teeth last much longer. In theory a sports guard would do this, both appliance research has found primitive appliances like a mouth guard is effective for sporting events while you are awake, but when worn at night, they increase the incidence of jaw muscle and TMJ pain. For this reason we make our patients an appliance designed to balance the forces of our bite to within 50 micros which decreases muscle activity causing clenching and grinding forces on our teeth by 40%. An analogy would be patients with plantar fascitis or foot support problems. You can get a prefabricated insert for your shoe or you can get a custom made orthopedic insert made by a podiatrist. Both are for the same purpose but have dramatic differences in results. The differences in effectiveness between a sports guard and a custom made night guard like a Tanner appliance is similar in it’s effectiveness protecting the teeth , muscles and joints from the effects of clinching and grinding is similar the the difference between a prefabricated shoe insert and a custom made insert from a foot specialist. The Tanner appliance protects the teeth at night when clenching and grinding are usually most extreme as well decreases the effects on the Tempormandibular joint and the muscles of mastication (clinching and grinding).. People with TMD pain often have to wear this appliance at night to manage their pain. Much like a chiropractor helps someone with back pain, it helps prevent pain. Severe TMD patients have to wear this appliance as close to 24/7 as possible.
Some patients who do not like having something in their mouth at night and do not have Temporalmandibular joint pain but possible muscle pain can wear a smaller appliance covering only the front teeth. This appliance is called an S appliance (Sowell) in our office is like an anterior deprogrammer and has all the benefits of a Tanner appliance as long as you do not have joint problems causing pain. The S appliance protects the teeth effectively from clenching and grinding and muscle pain, it is much smaller and more comfortable for patients. This smaller appliance is effective for clenchers, grinders and patients having muscle pain, but not effective for patients who have pain coming from their temporalmandibular joint itself.
Another Appliance called an NTI is even smaller than the S Appliance as it fits over the front 2-4 teeth where the S appliance fits over the front 6-8 teeth. It was originally developed to treat headaches caused by tension in the temporalis ( a jaw muscle over the temporal area of the head) muscle. This pain is described as a migraine headache in the literature, but is really a muscle tension headache. The NTI is an excellent appliance for this type of muscle pain, but for extreme clinchers and grinders it can sometimes put to much stress on the teeth. Since it covers so few teeth, these teeth are subjected to more force than they can tolerate in some extreme clinchers and grinders. For the reasons it is best to work with your dentist who is knowledgeable and experienced in appliance therapy to help you choose the appliance that will best suite your needs.
