HJAR Sep/Oct 2023

58 SEP / OCT 2023 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH HAVE you ever noticed that you grind your teeth, or do you know someone who suffers from this issue? Teeth grinding can be very damaging to teeth and can cause pain and discomfort to the facial muscles and jaws. The temporomandibular joint (TMJ) is one of the most intricate joints in the body and one of the most complex in terms of provid- ing multiple essential functions. 1 Not only is it the most frequently used joint in the body, its action allows a wide range of movements necessary for chewing, swallowing, opening, and communicating. 2 It is unique in that it navigates with the maxillary jaw via muscles, tendons, and ligaments while operating on two different sides, since the mandible is fused in the midline. The joint’s position is wholly dependent and dictated by the teeth and occlusion. 3 Temporomandibular disorders (TMD) are grouped into three different categories. These include disorders of the chewing muscles, disorders of the jaw joints, and headaches that result fromTMD. 4 There is no one cause, but these disorders can arise from joint dys- function. Dysfunctional habits include teeth grinding (bruxism), clenching, using teeth as tools like tearing clothing tags, chewing on pens or pencils, or chewing ice. Jaw anatomy, arthritis in the joint, trauma to the jaws, ge- netics, and overworking your jaws with such activities as excessive gum chewing or taking huge bites of food can precipitate TMD and are all considered risk factors. 5 Stress gets a bad rap, as we blame it for so many conditions. However, in September DIALOGUE COLUMN ORAL HEALTH can have similar symptoms. 12 After ruling out other sources of pain, the dentist will perform a TMJ assessment. An important component in establishing a TMD diagnosis is taking a careful history and ex- ecuting a thorough clinical examination. For example, noting wear on teeth is not enough information, without a history of the patient stating they have been told by their spouse they grind their teeth at night. Muscle palpi- tations, range of motion of the jaws, survey questions about sleep patterns and positions, and medication use are all essential pieces of information required in order to diagnose this complex disorder. Patient education and awareness is key in treating TMD. In fact, education induces patient engagement, which is paramount in the varied treatment approaches. 13 In some cases, there is a trigger, which is the stimulus for TMJ dysfunction. When the dysfunction is permitted to go uninterrupted, the dysfunc- tion becomes a habit, which then leads to destruction, as in the case of bruxism leading to severely worn teeth. 14 When the trigger is identified, removing or altering it is the goal. In the past several years, it was discovered that a group of medications can cause bruxism. An anti-depressant group of medications, selective serotonin reup- take inhibitors (SSRIs) have been identified in causing bruxism in patients taking these types of drugs. 15 Symptoms of bruxism, jaw pain, or jaw spasm can develop within three to four weeks or with long-term use of SSRIs. The longer the habit of bruxing continues, the 2020, anAmerican Dental Association survey revealed that more than half the dentists who responded were seeing an increase in stress- related conditions among patients. 6 Cracked and fractured teeth, worn teeth from bruxing, sore muscles, headaches, and jaw pain are all associated with TMD. There is evidence in the literature that an association of anxiety and bruxism begins in childhood and can persist into adulthood. 7 Some patients grow out of this habit, while others brux for their lifetime. TMD is the second most common cause of orofacial pain, with dental disease being the first. 8 Pain and discomfort often drive pa- tients to seek care due to symptoms of TMD. Symptoms are varied, and pain can be ei- ther acute or chronic. These symptoms can include muscle pain, which travels through the face, jaw, or neck; stiffening of jaw and neck muscles; limited movement or locking of the jaw; painful clicking or popping in the jaw; changes in the way the teeth occlude; headaches; and/or pain in the ears or TMJ. 9 Generally, females have a higher prevalence of TMD thanmales, however the exact reason is unknown. 10 The fact that women visit the dentist and seek care more often than men could be a reason. 11 It is of utmost importance to diagnose the origin of pain. While odontogenic pain is the most common type of orofacial pain, there are non-odontogenic causes other than TMD that could be the source of pain. These in- clude neuralgias, myofascial pain syndromes, ENT diseases, benign tumors, cancers, neu- rovascular pain, or psychiatric diseases that Temporomandibular Disorders: What Makes People Grind Their Teeth?