Teeth Grinding, Jaw Clenching and Jaw Muscle Pain

What happens

1. History and examination. When it happens, what you notice on waking, headaches, and how you sleep. Wear is mapped tooth by tooth, the chewing muscles and both jaw joints are palpated, and jaw opening is measured.

2. A scan, so it can be measured. A 3D scan records the biting surfaces as they are today. Overlay a scan taken a year later and the wear is a number rather than an impression — which is how we tell an old problem from an active one.

3. The cause, before the repair. Disturbed sleep and snoring, reflux, caffeine and alcohol, some prescribed medicines, and daytime clenching all drive it. Where sleep-disordered breathing is suspected we refer for a proper sleep assessment rather than treat around it.

4. Protection. A nightguard, made from the scan, to take the wear and spread the load across all the teeth instead of a few. Which appliance suits you depends on how you grind and what we are protecting; we decide that after the examination rather than in advance.

5. The muscles. Heat, stretches and self-massage first. Where muscle pain persists, a jaw muscle injection may be discussed — see below.

6. Repair last. Worn, cracked or shortened teeth are restored once the cause is under control, so the new work is not put into the same environment that destroyed the old.

The signs, including one you can feel yourself

Most people who grind do not know they do. It usually shows up on examination rather than in a complaint: flattened biting surfaces, enamel chipping at the edges of the front teeth, fillings and crowns that keep failing, teeth that are sensitive to cold, a scalloped edge along the tongue, a ridge of cheek lining along the biting line, or jaw muscles that ache on waking.

Bony lumps in the mouth — tori — are one of the signs. A hard, smooth swelling on the inside of the lower jaw beside the tongue, or a ridge running down the middle of the palate, is a torus: normal bone, not a growth or anything sinister. They are common in people who clench and grind, and the usual explanation is bone thickening in response to years of heavy loading, on top of an inherited tendency to form them. They are not proof on their own — plenty of people have tori without grinding, and plenty grind without ever forming one — but finding them is a reason to look properly at your bite and your muscles.

Tori themselves need no treatment. They are only removed when they genuinely get in the way, usually of a denture, and occasionally when they are so large that the overlying lining is repeatedly traumatised.

What a splint does, and what it does not

A splint takes the wear instead of your enamel, and distributes clenching force across every tooth rather than concentrating it on two or three. That is genuinely worth having: grinding is the commonest reason a restoration fails.

What it does not do is stop you grinding. The habit is generated centrally, not in the mouth, and a piece of acrylic cannot switch it off. Some people clench harder against a new splint for the first few weeks. It protects the teeth while the cause is dealt with, which is a real and worthwhile job.

Jaw muscle injections

Botulinum toxin injected in small doses into the masseter or temporalis reduces how hard that muscle can contract. In people whose main problem is muscle overactivity and muscle pain, that can reduce clenching force and the ache that comes with it. It is one part of a plan, not a treatment on its own.

It is worth being clear about the limits. It does not stop the brain initiating the grinding, so the habit continues with less force behind it. It does not treat a problem inside the joint itself, which is a different diagnosis with different management. And it is not permanent — muscle activity returns gradually over roughly three to four months.

Botulinum toxin is a prescription-only medicine. Whether it is appropriate for you is a clinical decision taken at consultation after examination, and it is not where we would start: cause management and splint therapy come first. Possible effects include temporary weakness when chewing firm food, bruising at the injection site, and, where the medicine spreads beyond the intended muscle, temporary changes to the smile. Repeated injections over a period of years reduce the bulk of the treated muscle.

Jaw joint pain is not one condition

“TMD” is an umbrella covering several different problems: pain coming from the chewing muscles, pain coming from the joint itself, and mechanical problems with the disc inside the joint. They feel similar to the person who has them and are managed quite differently, which is why the examination separates them before anything is treated. A jaw that clicks painlessly and opens fully is usually in the group that needs nothing done.

Who does this at Calm Dental

The consultation fee is on our fees page, including GST. A nightguard is S$872. Any further treatment is quoted in writing after examination.

Questions

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