Health Essentials from Cleveland Clinic

Plenty of dental problems develop silently. People may not realize how conditions can eventually result when their dental and pain issues go undiagnosed.

This can include conditions affecting the joint between your lower jaw and your skull (known as the temporomandibular joint or TMJ), those that affect the muscles that move your lower jaw, and/or those that affect your teeth (bite).

Disorders of these three structures, referred to as temporomandibular joint disorder (TMD), can cause noises like popping or clicking of the TMJ, as well as facial pain, headache and or damaging wear on the teeth.

“Each of the three parts of the system involved in TMD — the joints, the teeth/bite and the muscles require a practitioner to evaluate and confirm a diagnosis of TMD,” says dentist Karyn Kahn, DDS.

What you need to know

The condition can be temporary and may go away with little or no treatment, and there are many at-home treatments for TMD you can try before seeking a dentist’s help.

Here’s what you need to know about this disorder:

• You’re probably grinding your teeth. You can learn to recognize and control daytime habits like clenching teeth, chewing gum and biting your nails. Unfortunately, you can’t stop grinding and clenching during sleep because these are controlled in the brain and happen during deep sleep. In these cases, night guard therapy can reduce muscle overload and save tooth structure, but night guards do not stop the grinding. Some patients with TMD present with morning headaches from grinding or clenching their teeth during the night,” says Dr. Kahn.
• It may run in families. There’s some evidence that grinding is common among family members. Studies have shown a familial tendency.
• Drugs might play a role. Grinding can also be influenced by certain drugs like selective serotonin reuptake inhibitors (SSRIs) used to treat depression, as well as alcohol use, smoking and stress.

What you can do

It’s important to be conscious of your daytime habits.

“Your teeth should only come into contact when you swallow, which is only about 17 to 20 minutes a day,” Dr. Kahn says. “We teach patients to practice having their lips together, teeth apart and tongue resting lightly behind the front teeth.” Try saying “N” — this is where your tongue should rest.

To address TMD, you should also:

• Avoid chewing gum and other chewy foods.
• Use moist heat to ease facial pain.
• Maintain good posture when using a computer.
• Try to sleep on your back to help ease TMD pain. Avoid stomach sleeping.
• Take steps to reduce stress and tension.

What a doctor may do

If self-help strategies don’t give you relief, talk to your dentist or TMD specialist. They may prescribe splint therapy, physical therapy for jaw and neck muscles, short-term muscle relaxers or analgesics, or Botox® (botulinum toxin) injections to help ease muscle contractions. TMJ imaging may be necessary in some cases to confirm the diagnosis.

Dr. Kahn advises patients to give conservative management therapies a try before having invasive surgery for TMJ. This helps patients learn how to manage their habits, and allows the joints to adapt by allowing inflammatory processes to resolve.

“We allow a period of adaptation to allow the body to resolve inflammation, usually six to nine months,” she says. “Through self-help therapies and orthotics (night guards), we can allow for adaptation to possibly avoid surgical intervention.”