Grinding teeth, jaw tension and facial pain
WHAT IS TEMPOROMANDIBULAR DISORDER (TMD)/BRUXISM AND WHAT ARE THE CAUSES?
Temporomandibular disorders (TM D) are a complex and poorly understood set of conditions characterised by pain and dysfunction as a result of problems with the jaw, temporomandibular joint (TMJ), and/or surrounding facial muscles that control chewing and jaw movement. TM D’s result in a large range of symptoms that vary for each individual and can include significant face and neck pain; headaches; damaged teeth and tooth pain; stiff jaw muscles; limited mouth opening; ear pain and ringing in the ears (tinnitus); as well as painful clicking, popping or grating in the jaw joint when opening or closing the mouth Bruxism is the term used to describe teeth grinding, which is a type of TMD. TMD/Bruxism can be caused by several things and often an individual’s condition has multiple contributing factors. It is vital that you consult your Dentist, who may need to perform various tests, take x-rays, and seek referrals to determine the nature of your condition before undergoing any treatment.
In many cases, the exact cause of TMD is not clear, but Dentists believe symptoms often arise from problems with the muscles of the jaw or with parts of the joint itself.
Other contributing factors can include:
- Injury to the jaw, TMJ, nerves or muscles of the head and neck. eg. a heavy blow, whiplash
- Grinding or clenching the teeth which results in a lot of pressure on the TMJ
- Dislocation of the soft cushion or disc between the ball and socket joint of the TMJ
- Presence of osteo or rheumatoid arthritis in the TMJ
- Emotional/Psychological Stress Sleep disorders and breathing difficulties
HOW CAN TMD/BRUXISM BE TREATED?
There are several options to consider for the treatment of your TMD/Bruxismand these should be discussed in consultation with your Dentist as they are the only people qualified to assess all aspects of the condition and help you determine the most appropriate choice for your individual circumstances. Available treatment options address different aspects of the condition depending on the cause and they vary in cost, complexity and the expected results, including how long results last and potential complications. While no single treatment has proved universally effective for all patients, many patients need to try several treatment methods before finding relief of their symptoms and sometimes treatment is ineffective in providing relief.
Current treatment options include:
- Pain/Relaxation/ Anti-inflammatory medication
- Oral appliances called splints or bite guards
- Massage/Manipulation/Exercise of the TMJ and associated muscles
- Orthodontics (braces) and dental work/adjustment
- Botox injections into the muscles of mastication TMJ Surgery
WHAT IS A Muscle RElaxER INjection?
There are various brands of muscle relaxer injections, they all contain the active ingredient, Botulinum Toxin A. These medications are sterile, pharmaceutical-grade proteins that target part of the mechanism involved in muscle contraction. When these medications are administered to a target muscle, the ability of that muscle to contract with the same strength is reduced. The higher the dose of medication, the greater the reduction in the ability of the muscle to contract and the more relaxed it becomes. While the medication is eliminated from your body rapidly, the effect will last from several weeks to several months depending on the circumstances. After this time, the effects will completely wear off and the muscle will regain the ability to function as normal.
HOW DO muscle relaxers WORK FOR TMD/BRUXISM?
After diagnosing that your Bruxism/TMD/Facial Pain has a component that is related to the activity of muscles of the face, your dentist will determine the dose of medication required depending on the severity of the condition. The medication is administered by an injection into the target muscles from the outside of the face, using very fine, sterile, disposable needles. The injection sites are specifically chosen to target the muscles that are contributing to your individual condition. By reducing the ability of these muscles to contract as forcefully, there is thought to be a reduction in the tension placed on the TMJ and surrounding tissues, leading to relief of symptoms, including a reduction in teeth grinding. Muscle relaxer injections offer a reversible, not permanent and minimally invasive treatment option and can also be used as a diagnostic tool by dentists when trying to determine the exact nature and origin of your pain.
WHAT CAN I EXPECT AFTER THE TREATMENT?
Many patients report that the injections do “sting” while the medication is being administered, however this only lasts a few seconds. Immediately after treatment, the area may be red, bleed briefly and you may experience a slight tingle or itch for a few minutes before feeling completely normal. It is very important that you do not rub or manipulate the area of injection for at least 4 hours. The effects will begin to work after a few days and full results may not be felt for up to two weeks. For this reason you should schedule a review appointment with your dentist two weeks after receiving treatment, at which time a further dose maybe required depending on results achieved. You will notice a softening of facial pain and tension, but you will still be able to perform normal jaw and facial movements, with no effect on your ability to eat, talk or smile. Results will last from several weeks to several months depending on individual circumstances. As the effects of the medication wears off, symptoms may return and re-treatment may be required. In some situations, treatment with muscle relaxing injections does not provide total relief of symptoms. This is usually an indication that there are other contributing factors to the condition and additional therapies may be required.
ARE THERE ANY POTENTIAL PROBLEMS?
Thankfully these medications have been shown to be very reliable and safe, yet all medications do have the potential to cause unwanted side effects/complications and you should discuss these with your dentist. Rest assured that your dentist will conduct a thorough review of your health and medical history prior to delivering treatment to ensure that you are safe to receive this medication and unlikely to encounter problems. While problems are rare, the most common issues come from the injection process rather than the medication and can include redness, swelling, itching, bruising, bleeding and skin infection. The medication may affect a muscle that it was not intended to, or it may cause excessive relaxation of the target muscles. If this occurs then it is possible that the appearance of your smile, function/movement of your mouth and how you eat/speak may be affected. While exceptionally rare, life-threatening allergic reactions and problems with other parts of the body are possible. Some people have also reported a general feeling of tiredness or “flu-like symptoms”, including a headache, after receiving treatment.
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