Unpacking TMJ Pain

In the era of COVID, is everyone developing TMJ pain? Bruxism appears to be more common than ever, and it does not discriminate between class or socioeconomic status. It is important to understand that bruxism and temporomandibular disorder (TMD) often go hand-in-hand. Let’s delve into how to alleviate jaw pain.

Clinical Signs of Bruxism

The clinical intraoral signs of bruxism include incisal wear of teeth and a flattened occlusal plane with wear facets, especially on mandibular molars; bilateral linea alba; scalloping of the tongue; exposed dentin; generalized abfraction lesions; and, often, lingual tori. Extraorally, bruxism often manifests in myofascial pain located to the masseter muscle and simultaneously may refer to the temporalis muscle. Patients who say they have TMJ pain may also report stiffness of the neck, specifically in the sternocleidomastoid muscles.

The temporomandibular joint is part of a greater complex of muscles termed the “muscles of mastication.” These muscles are the masseter muscle, temporalis muscle, medial pterygoid, and lateral pterygoid. Of these muscles, only the lateral pterygoid is involved in depression and protrusion of the mandible, while the rest are involved in elevation and retrusion. The main muscle involved in chewing, bruxism, and TMJ pain is the masseter muscle. A temporomandibular disorder (TMD) can cause pain in the jaw joint as well as the muscles responsible for moving the jaw.

TMJ pain has been historically misunderstood and undertreated in the dental setting.

There is no one agreed-upon theory behind TMJ pain. Often, TMD develops through teenage years when orthodontic intervention moves teeth faster than muscles that do not appropriately follow suit. Thus, one theory titled the neuromuscular theory points to occlusion as a possible cause of TMD. It proposes that all parafunctional habits are due to an imbalance with the muscles; individuals brux in an attempt at achieving occlusal equilibration. Anecdotal evidence has also found that orthodontic treatment that establishes Class I occlusion has treated temporomandibular joint clicking, popping, pain, and locking.

Dentists often suggest an occlusal guard along with myofascial massage to protect teeth and alleviate jaw pain, respectively. Trigger point injections and neurotoxin injections into masticatory muscles are also therapeutic modalities for patients experiencing myalgia.

While a night guard prevents destruction to oral hard and soft tissues, it does not improve the condition of bruxism.

This is because a night guard does not relax the intensity of one’s bruxing force. It simply prevents tooth destruction from parafunctional wear and prevents fractures of natural dentition and restorative materials alike.

The practitioner must further consider the psychological characteristics of bruxism. For those with clenching habits, occlusal guard alone will not solve daytime clenching. The practitioner must also educate the patient. For instance, that daytime clenching can accompany stress and that neutral position consists of placing the tongue to the roof of the mouth. At rest, one should keep their lips together but teeth apart. When considering facial musculature, relaxing overused muscles through muscle deprogramming is the key to alleviating the habit.