"Do you clench or grind your teeth? "
This is a question we ask each patient during their comprehensive exam. The medical/dental term for clenching or grinding of teeth is bruxism. Less than half of my patients state an awareness of a bruxism habit, yet I see evidence, in nearly
everyone of habitual clenching or grinding. In other words most people are not aware they clench or grind their teeth yet nearly everyone does!
Most people brux while asleep, our term for this is nocturnal bruxism. Some researchers have placed devices which measure muscle activity on the faces of participants and asked them to clench their teeth together as hard as they can. Try it yourself, clench your teeth together as hard as you can. Scary, huh? The researchers then measured the activity of the same participants while asleep. They discovered some of them were bruxing with forces 4 X as much as while awake. Can you imagine?!
4 times harder! No wonder many of us are not sleeping well!
The physical signs of bruxism include wear on the edges of the front teeth, flattening of the cusp tips of the molars, jaw joint pain, noise or locking, headaches, and sore jaw muscles. Most of these signs are obviously a result of bruxism. Headaches are another matter. The origin of a headache can be multi factorial and in some cases they are impossible to explain medically.
In many cases though headaches are a direct result of bruxism. These are what we call muscle contracture or tension type headaches. The temporalis muscle, the large muscle on each side of the head just above an imaginary line between the ear and the eye, is a major elevator of the jaw. Oftentimes, in the morning especially, this may be sore and the pain alleviated by massage. Another muscle, the masseter, located along the side of the face lower than the temporalis and attaches to the lower jaw is another muscle that may be sore and lead to headaches.
It has been determined that tension type headaches can precipitate, or snowball into migraines in many people.
Since so many people are unaware of their bruxism habit they rarely make a connection of that being the primary cause of their headaches. By treating the bruxism habit in these patients the headache pain can be better controlled or eliminated all together.
How do we treat bruxism? Back in the early '80's when I was in dental school we were sending patients to psychologists to learn a visualization technique called biofeedback. Biofeedback works by moderating stressful thoughts. If the stress triggers were controlled it was thought the bruxism habit would cease. Unfortunately bruxism is usually not a response to stress but a learned habit, which can start at a young age. Parents will often complain to me of their toddler grinding his or her teeth while asleep in the crib. That toddler will eventually need a nightguard! So, as you may imagine we do not use biofeedback anymore in treating bruxism.
The only definitive treatment for bruxism is a nightguard. Putting a piece of plastic between the teeth is the only way to prevent further wear of the teeth while asleep. Also, the nightguard will lessen the forces the jaw muscles can create thus allowing for better rest , less muscle soreness and less stress on the temperomandibular joints (TMJ's).
Physical therapy and various exercises are helpful but usually need to be augmented with the nightguard due to compliance problems and the reality that when we sleep we have no control over our jaw muscle activity.
There are several types of nightguards. Two of them I frequently use. One is called a flat planed splint. It is made out of a hard clear acrylic and fits over the entire upper or lower arch. It looks like a sleek version of a hockey players mouthguard. This works well for patients who have wear issues and/or an unstable joint.
Another effective splint is called an
NTI. I've been fabricating these for over 10 years and prefer to use them for my patients who have facial pain, including headaches, and/or cannot tolerate the flat planed splint due to its size. It is very small and typically fits over the 4 lower front teeth. The
NTI has been approved for use by the FDA for use for migraine cessation.
I have found the
NTI to be very satisfying professionally due to the oftentimes profound diminishment or cessation of facial pain and headaches. When a patient is able to stop taking their prescription migraine medication because of a treatment I have rendered is one example of true healing.
So, the reasons to consider whether or not you are a candidate for a nightguard are threefold: 1. do you have frequent ( 1 or more/week) headaches? 2. do you have wear of your front teeth? (Chipped edges, flattened edges - especially the canines). 3. do you have TMJ pathology (clicking, locking, pain, limited opening) which is worsening &/or increasing in frequency? A yes to any of these means you should stop in for a visit with me or your general dentist.
One final comment. Many patients ask about the store bought or nightguards which can be purchased online. I always tell this story: I have practiced dentistry for 25 years, all of those years fabricating nightguards. In order to fabricate a nightguard it is imperative to take excellent impressions of the teeth. Working with assistants with years of experience, and the best impression materials made in the world, we still have occasional problems. To have a lay person attempt to take an impression of their own mouth and then fit a store/internet bought appliance and have it fit well and occlude correctly against the opposing arch is impossible! Don't waste your money! It doesn't work! Have one fabricated professionally.
