TMJ/Teeth Grinding


Not sleeping …… waking with jaw , tooth pain and TMD


What is Bruxism?

Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.

Alternative Names: Teeth grinding and clenching

Causes of TMJ & Migraine Headache

People can clench and grind without being aware of it. It can happen during both the day and night, although sleep-related bruxism is often a bigger problem because it is harder to control.

Bruxism and clenching muscles

Headaches, Jaw ache in morning, constant noise, hissing, ringing

There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms.

Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:

  • How much stress you are under
  • How long and tightly you clench and grind
  • Whether your teeth are misaligned or a new filling or crown is ‘high’
  • Your posture
  • Your ability to relax
  • Your diet
  • Your sleeping habits
  • Tinitis…. ringing , hissing, buzzing in ears

TMJ Symptoms

Clenching the teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ). Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners. Dr. Walk has seen patients with broken veneers, fractured teeth an damaged porcelain crowns all caused by clenching and grinding.

Symptoms of bruxism include:

  • Anxiety, stress, and tension
  • Enlarged facial muscles ( Masseters and Temporalis especially)
  • Earache (due in part because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
  • Eating disorders
  • Headache
  • Muscle tenderness, especially in the morning  ( Masseters, cheek muscles)
  • Hot, cold, or sweet sensitivity in the teeth
  • Insomnia and sleep interruption epidodes
  • Sore or painful jaw
  • Tinitis…. ringing , hissing, buzzing in ears
  • Tinitis… ringing in ears, hissing, noise…

    Pills are not the answer, ask Dr.Walk for treatment options

How we test for TMJ

An exam can rule out other disorders that may cause similar jaw pain or ear pain, including:

  • Dental disorders
  • Ear disorders, such as ear infections
  • Problems with the temporomandibular joint (TMJ)

You may have a history of a high stress level and tension.

TMJ Treatment

The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.

The following self-care steps may help relieve pain:

  • Avoid eating hard foods like nuts, candies, and steak.
  • Avoid chewing gum.
  • Drink plenty of water every day.
  • Get plenty of sleep.
  • Massage the muscles of the neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout the head and face
  • Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
  • Try to reduce your daily stress and learn relaxation techniques.
  • Dr. Walk usually takes a frontline approach for muscle relaxation utilizing Botox. This is very helpful and usually reverses symptoms in as little as one week. Neuromuscular toxins (Botox) in combination with mouth guards do wonders for these issues.
  • Allure magazine patient story ( click here)

How Do Mouth Guards Help With TMD?

To prevent damage to the teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.

A well-fitting splint should help reduce clenching. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.

There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn’t work, another may.

A splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.

Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.

In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.

Contact sports as well as cycling, skiing, skating and other fast action sports should protect the TMD complex by having your dentist fabricate a good fitting  flexible mouthguard.


Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth, veneers, crowns and yield uncomfortable jaw pain, headaches, or ear pain.

Possible Complications with Bruxism

  • Depression
  • Insomnia
  • Increased dental or TMD problems
  • Fractured teeth
  • Receding gums

Nightly grinding can awaken roommates or sleeping partners.

When to Contact a Medical Professional

See a dentist immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions, from arthritis to whiplash injuries, can cause TMJ symptoms. Therefore, see your dentist for a full evaluation if self-care measures do not help within several weeks.

Grinding and clenching does not fall clearly into one medical discipline. There is no recognized TMJ specialty in dentistry.

Dentists who have more experience with TMJ disorders will typically take x-rays and prescribe a mouth guard. Botox and neurotoxins are the new frontline treatment for orofacial muscular tension and pain. Surgery is now considered a last resort for TMJ.


Stress reduction and anxiety management may reduce bruxism in people prone to the condition.

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Newton, MA 02461