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They told me I’ve got TMJ

They’re right because all of us have two TMJ’s (Temporomandibular Joints) and like with most things we can take these joints for granted when they are not bothering us. But what most of us don’t realize is it’s the delicate balance between our TMJ’s our jaw muscles and our teeth that keeps this whole system healthy. When any one of these areas is altered in some way it can wreak havoc on the others and lead to what we now call collectively Occlusal Disease.

What is Occlusal Disease?

Occlusal Disease is a collection of disorders involving the jaws, jaw joints (TMJ’s), jaw muscles, and biting or other surfaces of the teeth, which may include any or many of the following:

Temporomandibular Joint Disorder (TMD) – Like with any joint in your body your TMJ’s can be injured, overworked, go through arthritic type changes, have pathology, and show effects of age. Any of these might create pain/discomfort, joint noises, and changes to the bite. TMD can effect up to 10 percent of the population.

Muscular Pains – the muscles that operate your jaws are used to doing the job during times of eating, talking and normal function. When they are asked to perform extra duty (para-function) such as clenching or grinding (bruxing) they may react with symptoms of soreness. Stress can be a typical trigger for increase muscle activity.

Attrition – this is functional wear of teeth from the mere act of rubbing two surfaces together over and over again, and is typically seen on the biting surfaces. Attrition can be accelerated through clenching and grinding.

Abrasion – this type of wear is usually mechanical in nature. Aggressive tooth bushing, rubbing from loose fitting dental appliances, improper use of stiff toothpicks, abrasive gritty foods all can play a role in loss of enamel. Abrasion can present itself on a variety of different tooth surfaces.

Erosion – more correctly corrosion is breakdown of the teeth through chemical action. In your mouth this is most often from acid softening and dissolving your teeth. Your own stomach acid can be very destructive to enamel and in conditions such as anorexia, bulimia and GERD show specific patterns of erosive wear. Dietary acids can be almost as corrosive, especially in frequent doses, such as sipping a soda throughout the day. Enamel softened by acid wears at a much faster rate.

Abfraction – heavy compressive loading (clenching) coupled with grinding can produce loss of tooth enamel in the form of notches at or near the gum line of your teeth and accelerate gum disease.

Occlusal disease can be just as long term threatening to your oral health as decay and gum disease. Loss of enamel is usually slow and progressive, and often discounted unless symptoms arise. As the bite changes it can place additional stress on the jaw joints and muscles creating more symptoms and breakdown.

This video visually demonstrates some of the types of tooth wear described above.

Signs, Symptoms and Factors that suggest TMJ/Bite issues

Many people are more familiar with the signs and symptoms of bite and jaw joint disease than the process behind it. Do you have any of the following?

• Pain or tenderness near the jaw joint, just in front of the ear.
• Jaw joint clicking, popping or grating.
• Tenderness to the muscles around the jaws, face, head, or neck.
• Change in the way the teeth come together.
• Difficulty with jaw opening, closing, or moving side to side.
• Noticed shortening or wear on any parts of your teeth.
• Noticed notches developing along the gum line.
• Increase in tooth sensitivity to temperatures, sweets, air.

What are my treatment options?

Occlusal disease has many components and symptoms that can be similar or mimic other sources of dental disease. Therefore a thorough evaluation of the jaw joints, jaw muscles, and tooth surfaces is needed to determine your individual condition. Corrective, interceptive, and preventive strategies may include:

Jaw Joints and Muscles – Day to day stresses usually play a role in this system and account for a majority of the symptoms exhibited.

• Relaxation techniques, removing the source of stress
• Use of bite “splints” to help position the jaws and muscles in more relaxed positions
• Use of pharmacological agents: anti-inflammatories and muscle relaxants
• Physical therapy techniques to calm muscles
• Use of injectables, such as Botox to relax muscle groups is gaining popularity
• When a poor bite is involved- orthodontics or a bite make-over may be needed
• When joint pathology exists proper measures are taken.

Loss of Enamel/ Bite Issues – Loss of tooth structure is never desirable and can collapse the bite which places more stress on the joints and muscles.

• Identify causes of breakdown and eliminate through modifying behavior, diet, and use of protective agents, such as fluoride
• Biting stresses and enamel wear can be prevented with the use of a night guard
• Minimal loss of enamel may be repaired with tooth colored filling materials
• More moderate to severe enamel loss may involve multiple teeth and require a bite make-over

TMD Home Therapy (pdf)

Jaw Exercises (pdf)

Benefits of Treatment

Benefits of occlusal treatment include:

• Muscles that are relaxed
• Jaw joints that are comfortable and functional
• Teeth that show minimal or age appropriate wear.
• Teeth that are solid and healthy, for your lifetime.

Occlusal disease is a complex issue. Turn to the experience of the dentists at Generations Dental to help evaluate your problems and find solutions that work with your oral health goals, lifestyle, and budget.