You hear so much about stress causing teeth grinding and grinding causing TMJ disorders (TMDs), no one could blame you for thinking that it’s their primary cause. In reality, TMDs have many potential causes – traumatic injuries, for instance, or misaligned bites; developmental joint anomalies or parafunctional habits such as chronic nail biting, pen chewing, cheek biting, and so on.
Because there are so many possible causes, successful treatment depends on identifying the root cause for any given person. That includes one that’s often overlooked: clenching.
Where grinding involves horizontal movement, clenching’s movement is vertical, and this exerts different kinds of forces on the teeth and jaws. In fact, as a recent commentary in Clinical Insights put it, “clenching, now known as ‘dental compression syndrome” (DCS),…poses a far greater threat to joint health.
The intense pressure from vertical forces, which are twice as powerful and last twice as long, not only surpasses the damage potential of grinding but stems from a broader range of etiological factors far beyond central nervous system triggers.
The Anatomy of Clenching
To understand this, it helps to know a little bit about TMJ anatomy, starting with the temporomandibular joints themselves. These are the “hinges” that connect your lower jaw to your skull and allow you to move your jaws up and down, forward, backward, and side-to-side. There’s one on each side of your head.
The rounded ends of your jawbone are called condyles, which fit into sockets in your skull. Between each condyle and the skull is a small disc of cartilage which acts as a cushion and allows for smooth jaw movement. That disc is key to your comfort.
While grinding causes the condyle to glide past the disc, the vertical forces of clenching smash down the disc, compressing it. This can lead to microtrauma, inflammation, and even displacement of the disc itself.
There are many reasons why you might clench your teeth. It’s common during exercise, for instance, or doing heavy physical labor. It can be caused by certain medications, such as SSRIs and stimulants like those used to treat ADHD. Clenching can be a symptom of sleep apnea. It can also be a product of anger, fear, or stress.
Because the physical forces of clenching are different, signs of clenching aren’t as obvious as signs of grinding. Still, there are some things that can be identified during a dental exam that suggest dental compression syndrome:
- Wedge-shaped notches near the gumline.
- Shiny, polished areas on certain tooth surfaces.
- Bony growths around teeth.
- Cracks in dental restorations.
- Unexplained tooth sensitivity.
Common TMD symptoms are also signs, of course, particularly headaches – often in the temple areas – and jaw fatigue or soreness, especially in the morning.
A Holistic Approach to TMD Treatment
As mentioned, the key to successful treatment of any TMD is to identify the root cause so the cause can guide the path to the solution. While a nightguard may help with grinding during sleep, it does nothing to address clenching during the day. Bite adjustments might help with alignment issues, but they won’t necessarily resolve the compression problems that arise from clenching.
Any treatment needs to address actual causes in order to achieve long-term success.
That’s why Dr. Abdulla takes the time to thoroughly evaluate all aspects of your TMJ health, along with your dental and medical histories. She’ll evaluate your joint function, muscle patterns, bite alignment, and other factors, including lifestyle, that may be affecting your jaw. With all this information at hand, she can then develop a custom treatment plan for you that meets your specific needs. That plan may involve any number of therapies, including
- Stress reduction techniques – including therapy, exercises, and meditation – to relax face and jaw muscles.
- A custom-designed orthotic or other oral appliance.
- Ultrasound therapy to relieve face and neck pain.
- Myofascial trigger point release (manual) therapy.
- Botox injections in the chewing muscles.
As we noted last time, most patients benefit from a combination of therapies. The great news is that most of our patients notice improvement after just the first visit, with complete pain relief usually achieved within a matter of weeks.
Bottom line? Your jaw joints are part of a complex system influenced by many factors – from your anatomy and sleeping position to stress levels and daily habits. By recognizing and addressing the true causes behind your symptoms – including the often overlooked impact of clenching – we can develop more effective strategies that lead to lasting relief.