TMJ Pain & Night Guards Explained
In my practice, Night Guards (or “occlusal guards”) have become an extremely popular and powerful tool in treating the following: bruxism (tooth grinding & wear), night-time clenching, TMJ pain, chronic tension headaches, and overall protection of expensive crown and bridge work.
I can honestly say that I have changed people’s lives (in a dramatic and positive way) by making a simple Night Guard. It’s amazing that this little piece of acrylic, if fabricated correctly, can eliminate years of TMJ chronic pain and even stop the source of the clenching and grinding habit.
The way I describe most TMJ problems is the following: The human brain, when relaxed, wants the teeth to come together in a balanced and even way. However, if a new crown or filling is placed OR the teeth drift into an odd angle & position OR stress/anxiety affects the patient… then this could create an abnormal bite relationship. As a result, the brain becomes unhappy, annoyed… The dental term for this is an “occlusal interference” or a premature tooth contact.
If the brain can’t get the teeth together in a balanced way, then the brain (sometimes subconsciously) will try to force the teeth together. This often happens while sleeping. This puts undue force on the TMJ joint and the muscles surrounding the joint. The patient, then, feels pain in front, above, and below the ear. This is what people refer to as “TMJ”!!!
In the case of anxiety/stress, there may not always be a bite interference. The stress in one’s life, by itself, may lead to the clenching and grinding action. It’s like the brain is trying to release stress through grinding, but the TMJ and muscles surrounding get the brunt of abuse, and the patient again ends up in pain.
This clenching/grinding can involve one tooth or several teeth. It’s interesting. I can’t tell you how many times I’ve seen other dentists confuse this type of pain with “Root Canal” type pain. It’s sad. But I, personally, have seen hundreds to thousands of root canals done UNNECESSARILY when all the person actually needed was an acrylic night guard!!!
What’s more… is that this is a “self propagating” problem. This means: pain leads to more pain, which causes more pain, which leads to more pain, etc…
I think of the TMJ pain response like a game of ping pong. Imagine the tooth is the ping-pong ball. The socket is a paddle. And, the opposing tooth is the opposing paddle.
When a patient clenches down on a “premature contacting” tooth, this is similar to a paddle hitting a ping-pong ball into the tooth socket. The compression of the tooth into the socket causes a reactive, inflammatory response. This inflammatory response (socket swelling) pushes the tooth back out of the socket in the opposite direction (ie. hitting the ping-pong ball back over the net!!)
This inflammatory extrusion, then, puts the tooth into even more of an interfering contact position against the opposing tooth. So, the opposing tooth again compresses the offending tooth even harder causing even more of an inflammatory response. The ping-pong ball (the TOOTH!) gets hit harder and harder each time back and forth, self-propagating, with less and less room to move. This causes more and more pain until it is agonizing and unbearable to the patient. In fact, I’ve seen patients visibly swollen, even black & blue from this process!!!
SO, short of a physical bite adjustment to the teeth, a hard acrylic Night Guard is a simple non-invasive, prosthetic way to even out the bite. And, combined with an anti-inflammatory medication (like Ibuprofen or Advil), the guard will settle down the inflammatory response, eliminate the premature contact and permanently stop the self propagating nature of the ping-pong match!!
In the case of a “stress/anxiety” caused TMJ problem, the Night Guard, if properly fabricated, acts to open the jaw slightly (particularly at night) putting the TMJ into a more relaxed position. Again, this stops the “clenching” reflex arc.
Making a Night Guard
The way I make a Night Guard is a very exact and custom process. First, I’ll take a detailed impression of the arch receiving the guard. It can be done on the upper and lower, but typically the upper arch is easier ergonomically for the patient to take in and out.
From that impression, a cast is poured and mounted on a “mechanical mouth”, in dentistry called an “articulator”. This simulates the movements of the patient’s jaw. The guard can then be fabricated and customized to specifically balance the jaw movements of that patient.
Then, upon delivery, the guard can further be contoured and adjusted chair-side (and directly in the patient’s mouth) until a comfortable fit and appropriate bite is achieved.
The Over-the-Counter Night Guard
Most dentists dislike the soft thermoplastic “night guards” sold over the counter at pharmacies. Typically, they are heated in boiling water and arbitrarily pushed/molded over the teeth.
These guards are good at physically protecting the teeth. But, the soft, squishy nature of these “over-the-counter” guards can actually make the clenching and grinding habit worse. While sleeping, the brain, in squeezing the soft guard, can actually trigger the clench reflex. This will again initiate and worsen that self-propagating problem.
I will admit, I have seen some of the “over the counter” guards help patients… or, at least, this is what is reported by the patient. But, in general, this is not the opinion of most dentists and the greater dental community.
The Athletic Guard
In our practice, we DO make athletic guards.
Where the traditional night guard is a full arch, horseshoe shaped, piece of hard acrylic, athletic guards are made of a slightly softer material. Their primary purpose should be to protect the teeth from physical trauma in sports or the like.
Again, athletic guards should not be used as night guards.
Like the hard night guard, athletic guards are also made with an impression and detailed cast pour up. It fits the patient custom and provides excellent protection from sports injuries. They come in many colors and designs and can be made custom to the patient’s request.
