Orofacial Myology Adelaide Blog
Who has a dental splint?
At a dental appointment a patient may hear that it looks like you’re grinding your teeth and you need a splint. An over simplified answer to a complex problem! I want to stress that splints are absolutely necessary in many instances and these recommendations should be taken seriously. Tooth wear from grinding can be serious and extremely expensive to treat. Joint problems like lock jaw can be painful and it’s worth wearing a splint to keep the joint happy. Splint types can also vary and depending on your dentist’s training and experience there can be different splints for different problems. Most dentists don’t specialize or have additional training in jaw joint problems. In dental school, students learn a wide variety of skills and then continue to develop and hone those skills over their professional career. Unless they choose to specialize or focus on jaw problems, complex issues tend to be referred to someone who does. If you don’t feel like your splint satisfies your needs, ask your dentist for a referral.
Tooth enamel is precious and must be cared for. Tooth wear is a serious issue and should be addressed as early as possible. Splints may act as band aids and are not always a solution. Yes, let’s use a band aid to stop the bleeding but shouldn’t we prevent further injury too? Historically, most of the research has linked grinding with stress and psychological factors. However, science is still exploring more about this issue and we are looking at the following factors; acidity, airway, breathing, facial growth, head and body posture, trauma and the tongue. This blog will briefly discuss some of the additional factors that you could explore further. Each of these factors can be incredibly complex so this is an overview, or a starting point, and not a comprehensive list.
How Do You Know, You’re Asleep?
My approach is always airway and breathing first. If your airway is closing during sleep then clenching will increase muscle tone in the airway so you can breathe. Again, oversimplifying a complex problem. However, we will prioritize breathing above all. Muscle contraction of the jaw is actually measured during a sleep study because we know there is a link. I would suggest you take a moment to examine your own sleep quality. Do you wake refreshed? Are you tired during the day? How often do you wake during the night? Do you wake with a dry mouth? Do you have unexplained reflux? Do you snore? If you answered yes to some of these, consider speaking to your GP about having a sleep study. Sleep studies can be done at home and they are a useful tool to know what is happening when you fall asleep. It can measure your muscle activity during sleep and measure if clenching and grinding happens more in relation to your breathing. It’s not a treatment, more of a diagnostic tool to understand what is happening. After all, you don’t know, you’re asleep. If you have the correct diagnosis, you can get the right treatment.
There are known risk factors for obstructive sleep apnea and we often stereotype heavy-set men with large necks. Yes, this is true but did you know that slim women with small jaws are also at risk? So are young children with poor facial growth or nasal obstruction. We need to be aware of the signs of poor sleep when it comes to our health. Poor breathing during sleep affects energy, cognition, mood, productivity and happiness. Poor sleep is linked with nearly every chronic disease and research is now seriously looking into the link between sleep and Alzheimer’s disease.
Pain and Bite
The first step for all tooth and jaw pain is to see your dentist. Pain that is related to a dental infection or a cracked tooth must be dealt with as a priority. Infections can be found using x-rays to pin-point the problem tooth and dentists are excellent at providing treatment for this type of pain. Cracked teeth can be a little more challenging as times. Sometimes we can look at a tooth and see a crack in the surface and immediately notice the problem. Other times, cracks in the surface can be miniscule and require more investigation. Cracked teeth can be excruciatingly painful. Often times they can happen to teeth restored with dental amalgam. However, it can happen to any tooth given the right pressures. Sometimes the tooth can be saved and other times it ends up in the bucket as the only way to relieve the pain.
Dentists are excellent at looking at mechanical factors, bite relationships and x-rays or CBCT imaging. There are some incredibly smart specialists and researchers working throughout the world in this area. We have specialists who work with complex issues and design complex splints, orthodontic techniques and surgical interventions to help people in need. However, I truly believe there are also a significant number of people who can address their pain with a non-invasive, inexpensive and a functional approach.
It’s All in Your Head, Literally
If someone has told you that your pain is all in your head, then maybe it’s time to seek answers elsewhere. The fact that you have ruled out pathology with a traditional approach is a good thing. Health professionals do their best to help but if they don’t know, then they don’t know. The dental industry in general doesn’t have standardized training around muscle-related face and jaw pain. This is not a criticism but rather an observation. Dentists and dental specialists conduct complex and intricate procedures on a daily basis and many are technical geniuses in their chosen fields. I just mean that non-tooth related facial pain has been poorly understood and pain science in general is evolving. Muscular pain exists in the head, face and jaws just like anywhere else in the body. It can be extremely painful and intense. If someone has doubted your pain, maybe its time to think muscular. Start looking at all the factors around your pain like when it started, when it’s at its least and most intense and try and map out more information so you can find those triggers that contribute. Long term and chronic pain can have multiple factors and often cases like these do require a number of professionals to address each factor.
When it comes to this type of pain, I have two basic approaches. Is there ‘sharp’ pain directly in the jaw joint? This pain can get more intense with movement. This could be an acute response and may improve with a splint and anti-inflammatories prescribed by your dentist and a period of rest. An example of when this might happen is after surgical extraction of wisdom teeth. The jaw may have been hyper-extended during the process and the muscles have been strained. More examples could be a knock to the face, or biting hard into something awkwardly. This kind pain can improve with rest over about 10 days.
Another type of pain is a deep, dragging pain and may or may not be felt directly in the jaw joint. It can be anywhere around the face including the jawline, the temples, the eyes, the sinuses or even one or several teeth. Deep, dragging pain can be intensely painful but can also be treated with brief and targeted muscle manipulation followed by therapeutic exercise of the affected muscle. This type of persistent pain can often occur after a period of acute pain like we discussed above. Headaches fall into this category too and can be effectively relieved with the same approach. Anti-inflammatories may not do much to relieve this type of pain because it is not inflammatory in nature. More a referred pain pattern that will improve with heat and gentle movement. This is a similar concept as doing Pilates or Yoga for back pain.
Bring attention to your oral rest posture too. If your lips are closed, your tongue is lightly suctioned to the roof of your mouth and you are nasal breathing then your muscles can rest in a harmonious position. Do you swallow saliva, food and drink correctly so your oral and facial muscles are working just the way they are designed? Dysfunctional movement can lead to pain anywhere in the body and the mouth and face is no different.