Temporomandibular Joint Disorders -commonly referred to as “TMJ” but clinically termed as “TMD” can be related to problems with jaw muscles, the jaw joints and often may involve a postural component. Patients presenting with TMD may have symptoms that range from sore or tight muscles in the face, scalp and neck, pain in the TMJoints at rest and/or to function, headaches, inability to open wide and/or move the jaw laterally,ear stuffiness and tinnitus (ear ringing). Usually the disorder is a result of microtrauma (history of clenching or grinding the teeth) or macrotrauma (accident or event that caused trauma to the jaw).
Recent literature indicates that the source of 50% of TMDisorders is a sleep-related breathing problem. As a reflex to open the airway when it is blocked during sleep the lower jaw moves forward moving the tongue with it and the lower teeth clench against the upper teeth to hold it there as a protective mechanism. In addition it is thought that the arousals during sleep that occur with an airway obstruction also cause an episode of teeth grinding .
As these events happen repeatedly night after night the cumulative effect over time can cause signs and symptoms of TMD. A complete and thorough assessment of the patient is imperative in attempt to identify the source of the patient’s complaints and contributing factors. Oral orthotic appliances, various surgeries, exercises, physical therapy and other related modalities ie ultrasound, phonphoresis,etc, lifestyle and habit modifications can all play a part in resolving the patient’s symptoms once the primary source is determined.
When an oral orthotic appliance is the treatment of choice the dentist must decide why it is being used, when the patient should wear it, what is to be accomplished in using it and how should it be designed. The orthotic appliance can be used to relax fatigued jaw muscles or those in spasm, realign the upper and lower jaws, reposition TMJoint discs that are dislocated or more favorably posture the head with the neck and shoulders.
The important take home point is:
“ALL DENTAL MOUTHGUARDS ARE ABSOLUTELY NOT THE SAME”
One last myth to dispel:
“DENTAL MOUTHGUARDS CANNOT STOP A PATIENT FROM GRINDING THEIR TEETH”.