Dr. Tanenbaum | New York TMJ & Orofacial Pain

Several weeks ago a 38-year-old gentleman came to my office complaining that shortly after having three crowns (caps) put in his mouth, he began to grind his teeth at night for the first time in his life. On arising in the morning he was experiencing jaw muscle soreness and on some occasions more sharp pain which limited his breakfast selections, which are common symptoms of Bruxism (the clinical terms for teeth grinding).

The first comment out of his mouth was, “I want to rip these teeth out of my mouth!” Was poor dental work the cause of this patient’s Bruxism? More questioning revealed that my patient’s new teeth were in great shape; not sensitive to hot, cold, or chewing, and his bite did not feel off balance.

Is it possible that these three new crowns were responsible for the reported night grind and if so how is this possible?

Point number 1:
Night tooth grinding (Bruxism) has been shown to have little, if anything, to do with the type of bite a person has. People with good and bad bites grind and clench their teeth at night.

Point number 2:
Night tooth grinding (Bruxism) seems to be related to arousals that occur in the brain during sleep. These brain arousals can be due to a number of factors such as drinking alcohol or caffeine close to bedtime, poor sleep environments, crying babies, chronic pain problems (back and neck), asthma, sleep apnea and or chronic tension and stress to name just a few possibilities.

Point number 3:
In clinical studies that have been conducted in patients with known histories of night grinding, the placement of dental restorations made intentionally high and out of balance with the rest of the teeth, have actually led to a diminished amount of night grinding for several weeks. This suggests that throwing the bite out of balance can actually reduce the amount of teeth grinding at night!

Conclusion

Based upon what we know, it is unlikely that Bruxism can be caused by poor dental work (unless pain developed as a result of the work and disrupted a patient’s sleep). When similar scenarios occur, other factors are likely playing a role and it is very important to see your dentist for a full evaluation.

This is a common question asked by patients in my practice. The answer to this question is based mainly on the reason it was recommended in the first place! So, if you are wondering if you will have to wear your nightguard forever, here are some common scenarios. There’s a good chance that one of them fits your situation exactly:

Scenario 1: You have no teeth grinding symptoms, but your dentist notices that your teeth are worn or chipped or that fillings and caps previously placed look worn.

The dentist then informs you that you have been grinding your teeth at night. You’re shocked! You have no pain in your teeth, no jaw muscle soreness in the morning, and you haven’t noticed any other signs to indicate that you are grinding your teeth. Your dentist recommends that you wear a nightguard while you’re sleeping, warning of the problems that will develop if you don’t wear it.

Now here’s the important thing: If you move ahead and get the nightguard, bring it with you and show it to the dentist when you go in for your twice-a-year dental cleaning. If the nightguard exhibits grooves and notches cut into the acrylic, then you have been grinding and you should continue to use it. If, however, there is no evidence of wear and tear, it’s probably in your best interest to bring this to the attention of the dentist and discontinue using it.

Scenario 2: You make an appointment with your dentist because “out of nowhere” your jaw muscles and teeth are aching in the morning.

You mention to your dentist that stress levels have been high in your life and will likely stay that way for an undetermined period of time. A TMJ nightguard is advised and you wear it for a while and notice that the achiness in the morning has decreased.

What next? This all depends on what is going on in your life: stress, fragile emotions, disrupted sleep, etc. As these factors may drive the night grinding it is probably advisable to stay with the nightguard until things calm down. Once life is calm and if your morning symptoms have gone away, you can begin to reduce the number of days the nightguard is worn during the week.

Over time you will likely find that you no longer need the nightguard. Keep in mind, if life issues arise again, the grinding will likely return and you may need the nightguard again, so don’t throw it away!

Scenario 3: You not only have morning jaw muscle soreness, but your teeth ache and you have persistent facial pain during the day. In addition, you feel that you can’t open your mouth wide and chewing has become a chore because your jaw joints click and/or lock.

This scenario suggests that you may have a more significant jaw problem often called ‘TMJ’. Unlike the first two scenarios, the level of muscle and joint compromise is more significant with TMJ. And beyond the night grind there are likely other factors that have led to and are perpetuating the symptoms. In this situation the use of a nightguard at night will likely be for an extended period of time (maybe forever).

I have many patients who return to my office 3-6 years after they were last seen looking to get their nightguard repaired or replaced. Many of these patients tried to stop wearing it when they felt better, but the symptoms began again. In this situation I ask my patient to visit me at least once a year to help maintain the integrity of the device and make sure it is doing the right thing and not causing harm.

Note: There are many different names for dental nightguards:

Nightguard
Mouthguard
Oral Appliance
Splint

There are many different types as well. The decision to pick one type over another is usually made by your dentist based on your diagnosis.

If you have more questions about TMJ, and you live or work in New York City or on Long Island, schedule a consultation with me here or call 212-265-0110

Thank You!

Dr. Donald Tanenbaum has been practicing in New York City and Long Island for over 20 years. He is uniquely qualified to diagnose and treat bruxism, TMJ and TMD problems, Sleep Apnea, facial pain, muscle pain disorders, nerve pain disorders, tension headaches, and snoring. Learn more about Dr. Tanenbaum here.