Chapters
Introduction to Bruxism and TMJ Disorders
[0:05 – 3:53]
Eon Engelbrecht introduces the episode as the year’s finale.
Dr. Yudelman explains bruxism and TMJ disorders, symptoms, risks, and the importance of professional diagnosis.
Details on mouthguards: – Custom-fitted bruxism splints offer superior protection. – Over-the-counter guards are less effective and can worsen problems.
Cost considerations: Proper orthotics cost approximately R6,000, while cheaper options may exacerbate issues.
Effective Treatments for TMJ Disorders
[3:54 – 6:57]
OptiSmile’s approach includes physiotherapy referrals to Trish Lang, a specialist in TMJ treatment.
Treatment options: – Physical therapy for jaw alignment. – Anti-inflammatories like Arcoxia for short-term relief. – Botox for severe cases to reduce grinding. – Invisalign for bite realignment in severe cases.
Botox – More Than Just a Cosmetic Tool
[6:57 – 8:39]
Botox relaxes overactive jaw muscles and reduces tension headaches.
It is a second-line treatment, recommended only after other interventions.
The Critical Role of Sleep in Bruxism Management
[8:39 – 10:25]
Bruxism often stems from poor sleep quality.
Recommendations include bedtime routines, avoiding caffeine, and using tools like SnoreLab.
Dr. Yudelman shares personal success with a CPAP machine.
Jaw Exercises and Stress Reduction Techniques
[10:26 – 13:49]
Basic exercises: Jaw relaxation, massages, and warm compresses.
Stress management techniques like mindfulness and progressive muscle relaxation help reduce triggers.
Dietary Adjustments for Jaw Health
[13:50 – 15:19]
Avoid hard, chewy foods like biltong and toffees during flare-ups.
Stick to a softer diet, stay hydrated, and maintain balanced electrolytes.
Bruxism in Children vs Adults
[15:19 – 16:21]
Childhood grinding often resolves naturally.
Persistent grinding may indicate underlying conditions like enlarged adenoids or sleep apnoea.
Long-term Effects and Seeking Help
[16:22 – 19:04]
Chronic grinding can alter facial structure and damage teeth.
Importance of seeking professional help for diagnosis and treatment.
Conclusion and Final Thoughts
[19:05 – 22:43]
Dr. Yudelman emphasizes mindful celebrations and dental health awareness.
Eon encourages listeners to subscribe and visit OptiSmile.co.za for expert care.
Transcript
Eon Engelbrecht – E-Radio-SA
(0:05 – 0:48)
Welcome again to Save Your Money, Save Your Teeth, the go-to podcast where curiosity meets dentistry right here on eRadio. It’s straight from the experts, Dr Clifford Yudelman joining me. Every single week he is from OptiSmile and we take a nice deep dive into the world of dental care from a consumer’s perspective.
If you’re looking to brighten your smile or just protect your wallet, you’re in the right place because we’ve got you covered with practical advice and also the latest insights with Dr Yudelman. So stick around. This is our final podcast for 2024 and Dr Yudelman on that festive note, what are we talking about today?
Dr Clifford Yudelman – OptiSmile
(0:49 – 1:27)
Hi Eon, thanks for having me back and I’m looking forward to our last one, number 42 for the year. Today is the second one on managing bruxism and TMJ disorders or TMD and I called it relief and recovery. Sorry if we kept you hanging after last week’s episode, hopefully you listened to that.
If this is a problem that you have or one of your family members has, go back and listen to last week’s and we’ve got some good advice today for saving your money and saving your teeth.
Eon Engelbrecht – E-Radio-SA
(1:28 – 1:37)
Excellent. So let’s start with this one. How effective are mouth guards, Dr Yudelman, for managing bruxism?
Dr Clifford Yudelman – OptiSmile
(1:37 – 3:53)
So yeah, thanks for that. So a mouth guard is really something that you wear to protect your teeth when you’re playing sport or when you’re boxing, something like that. And we sometimes call them a night guard because you only wear them at night.
The correct term is maybe a bruxism splint or an orthotic. There’s a number of different fancy names for it, but for purposes here, we’ll just call them mouth guards. But just so you know that they are highly effective for preventing further damage.
They create a physical barrier between the teeth and they reduce the force of grinding. Custom fitted bruxism splint or bite guard, night guard, orthotic fitted from a dentist is the most comfortable and long lasting. It can be expensive.
When we scan a patient, our laboratory uses special software to design it and it’s 3D printed and they fit beautifully. We don’t have to adjust them on the fitting surface. And then we always make sure that the bite is in the correct position.
It’s a lot of work. It takes several visits. The laboratory alone, that fee is around about, I think around about 2,800 grand for a proper custom fitted orthotic or mouth guard.
A sports one is way, way less. It’s just a soft rubber thingy that you make over a model. So you mustn’t get the two confused.
And then our fee is about the same. So you can pay for a proper EMJ or bruxism splint, you can pay almost 6,000 grand. If you’re getting one for 900 grand or 1,200 grand, it’s probably not the same thing.
There are these over the counter ones, but they don’t fit as well and they definitely don’t do the same job. You can chew on them if they’re soft and they can actually make your muscles stronger and they can move your teeth and cause problems. And while these don’t stop the grinding itself, they do alleviate the pain and they protect your teeth.
Eon Engelbrecht – E-Radio-SA
(3:54 – 3:59)
And what are the treatment options for TMJ disorders or TMD?
Dr Clifford Yudelman – OptiSmile
(3:59 – 6:57)
So like I mentioned last week, our first port of call at OptiSmile for most patients is before we even make them a bite guard or a bruxism splint, we refer them to Trish Lang in Bree Street. Trish is a special physio that has specialised in TMD and TMJ problems and head and neck. And after two or three visits, she’s able to send the patients back to us in many cases much, much better shape.
She gives them exercises to do and she does physical therapy for them. It works really well. There are cases where we will prescribe anti-inflammatories or painkillers, things like Ocloxia or some kind of very strong anti-inflammatories.
In severe cases, we give Botox. One of my doctors here, Dr. Cara Loubser, is very experienced. She does Botox in the masseters where it’s called for, but only after patients have seen Trish.
The Botox will help to relax any overactive muscles. We, of course, we re-advise patients some of the stuff we spoke about last week, which is reducing or cutting down caffeine or cutting it out, alcohol, sleep study, proper diagnosis, make sure they don’t have undiagnosed sleep apnea. Very rarely will we actually send someone to an oral surgeon to consider surgery to correct a structural issue.
It’s very rare. In 41 years of practise, I don’t think I’ve ever personally referred a patient to get their joint operated on, although you do hear of people getting it done. That’s where they’ve maybe gone straight to with some kind of surgeon and they haven’t tried all of this more conservative treatments.
So, yeah, just a little word of warning there. Bite realignment treatments like Invisalign often will help patients where their jaw is locked in, where they’ve got a deep bite and they smash in on their lower front teeth and they’ve got what’s called entrapment. And then definitely the bruxism splint, that’s the most common thing.
But the dentist needs to really know what they’re doing. One of the most common is what’s called a Michigan splint named after University of Michigan. And if there’s 50 dentists in a room, there’s probably about 30 types of splints.
Every dentist has got his own or just leaves it up to the lab. So, Michigan splint is generally the go-to for most dentists that know what they’re doing.
Eon Engelbrecht – E-Radio-SA
(6:57 – 7:16)
That’s very interesting. Now, you mentioned Botox, doctor. And when we think of Botox, we think of the celebrities with the frozen foreheads.
But Botox is also used for many other things. I know that it’s also used for migraines and so on. But how can Botox help with bruxism or TMJ pain?
Dr Clifford Yudelman – OptiSmile
(7:17 – 8:39)
A lot of patients feel relief from both tension, jaw tension and headaches after Botox. It is a good option for severe cases after all the other stuff has been done. It’s not a first resort.
And the effects can last three to six months and then you need repeated treatments as with the frozen forehead. Eventually, the muscles do get a bit weaker and you don’t need as much. But it’s not a first port of call, like I said.
And I’d watch out for getting too much or someone that doesn’t really know what they’re doing. Generally, myself personally, before I consider any kind of extensive treatment or I’ve got problems, I like to get a few opinions because there are different ways of treating things. And Botox is injected into these overactive jaw muscles and it relaxes them, paralyses them partially and that reduces the intensity of the grinding and the clenching.
So yeah, it’s not, if we see every 10 patients we see with signs of clenching and grinding or problems with their jaw and so on, I would say maybe one out of 10 is suitable or gets Botox.
Eon Engelbrecht – E-Radio-SA
(8:39 – 8:45)
All right. And what role do sleep habits play in managing bruxism?
Dr Clifford Yudelman – OptiSmile
(8:46 – 10:25)
So sleep is very important because that’s the time that most people are clenching and grinding on their teeth. So definitely want to listen to our podcast about sleep apnea. Sleep apnea is very closely linked to bruxism.
So improving your sleep quality can significantly reduce grinding. In between the snoring, you then push your jaw forward and then you grind and clench your teeth. So when it comes to sleep habits, maintaining consistent bedtime routine is important.
Avoiding caffeine like we mentioned last week and good sleep hygiene. You can Google that. I mean, we could maybe do something about sleep hygiene, but I think we’ve done quite a bit about sleep already.
And then a lot of time I see patients who come to me for clenching or grinding and I send them for a home sleep study and their sleep apnea is severe. The AHI is over 30 times an hour, which is considered severe and they end up with a CPAP machine. Personally, when I sleep with my CPAP machine, I don’t grind my teeth.
And when I don’t use a CPAP or a mandibular advancement splint and if I have a good night where I’m not snoring or don’t have any apneas, I don’t clench and grind. And if I wake up and I’ve recorded myself with SnoreLab and there was a lot of snoring and apnea, maybe I was on my back, maybe I had some red wine, then my jaw and my teeth will generally be sore as well. It’s very much related.
Eon Engelbrecht – E-Radio-SA
(10:26 – 10:35)
Any exercises you can recommend doctor to relieve jaw tension and also at the same time improve TMJ health?
Dr Clifford Yudelman – OptiSmile
(10:36 – 12:00)
So they are, they’re very, very specific. I can just give a few basic ones, but I would say don’t go and try these. In certain cases, some exercises can make your jaw worse.
It depends on your specific situation. We’ve got a handout that we give patients and we’ve got a little checklist where we’ll tick off the ones they should do and the ones they shouldn’t do. In general, we leave that up to Trish.
She or prescribed very specific exercises and like with all exercise, they need to be done the correct way and the correct number of times and you do need a coach or a person that shows you. Some of them are very simple like opening and closing your mouth while keeping your tongue against the roof of your mouth. That’s the most simple and common and it generally can’t do any harm.
It does feel a bit strange, but it gets your jaw in a better position. You can massage your jaw muscles and apply warm compresses, which can help to relax tight areas and making sure you do the exercises that the physio gives you. Those are very good for flushing out all the lactic acid and the buildup, the toxins and so on, especially lactic acid that builds up in the muscles and causes spasms and tightness.
Eon Engelbrecht – E-Radio-SA
(12:01 – 12:08)
I would imagine that stress reduction techniques can also help with both bruxism and TMJ.
Dr Clifford Yudelman – OptiSmile
(12:09 – 13:49)
Yes, so if it’s not being caused by medication or whether it’s illegal medication like or cocaine or sometimes legal medications like SSRIs or I mentioned as well, something like Ritalin and it’s not caused by these types of things, sleep apnea medications, then one of the best things one can do is stress management techniques. I mentioned breathing before, but there’s mindfulness, yoga, guided relaxation exercises that will help your blood pressure as well. A lot of people who clench and grind and get headaches, they also have high blood pressure and all other types of problems can go on from that.
I mentioned CBT, cognitive behavioural therapy. I’ve never done CBT. I’ve done some DBT, which is something similar.
There’s a lot of therapists around that can help with that, which helps you to identify and address the things that stress you out and help to prevent emotional triggers of bruxism. Not just deep breathing, but there’s very specific breathing exercises you can do and progressive muscle relaxation before bed. Listen to one of those relaxation CDs or now they would be I guess on YouTube and calming music, making sure you wind down at the end of the day.
If you go to bed relaxed, there’s less chance of grinding at night.
Eon Engelbrecht – E-Radio-SA
(13:50 – 13:57)
Exactly. Dietary changes, can they also help reduce grinding and TMJ pain?
Dr Clifford Yudelman – OptiSmile
(13:58 – 15:12)
Oh, yes. Avoiding hard, very hard foods like eating a lot of pretzels, which is not that common here, but in America, a lot of my patients would eat a lot of corn chips. The things here, people chew ice, that’s very bad for your jaw and your teeth or very chewy food.
Some people eat a lot of junk food and toffees and things that can really put a lot of strain. In South Africa, the most common thing I would say that sets off someone’s jaw is they buy themselves a big bad biltong or even worse, like some drew horse or something that’s very tough or those stockies or stickies, not just cut moist biltong, but the dry stuff that can get your jaw out of whack. It’s a bit different to the clenching and the grinding.
This is someone who’s maybe strained their jaw. We already mentioned caffeine and alcohol. You’re making sure you stay hydrated.
If you’re dehydrated, not getting enough electrolytes, that can cause problems and irritate your jaw. Then just sticking on a softer diet for a while so your jaw feels better.
Eon Engelbrecht – E-Radio-SA
(15:13 – 15:19)
How does childhood bruxism or TMJ pain differ from adult cases?
Dr Clifford Yudelman – OptiSmile
(15:19 – 16:21)
It’s quite different. Sometimes kids will grind in their sleep. From growing, teething, stress usually resolves as they age.
I wouldn’t be too concerned about clenching and grinding in kids unless they’ve got underlying sleep apnea. Sometimes kids can have very inflamed adenoids and tonsils. You want to listen for signs of snoring and choking, coughing.
If there’s a lot of allergies, if there’s a history of tonsil problems, ear infections, I would definitely get an ENT or a doctor to check it out, an ENT, ear, nose, and throat specialist. The adult cases tend to be more chronic and cause more significant damage and require active intervention. Parents should consult a dentist if the grinding continues for a long time.
If the kid goes through stages on and off grinding, it’s not a big deal generally. We don’t make bite plates or grinding plates with kids.
Eon Engelbrecht – E-Radio-SA
(16:22 – 16:30)
I was wondering now, bruxism or TMJ disorders, can they actually permanently alter your facial structure?
Dr Clifford Yudelman – OptiSmile
(16:31 – 17:01)
Yes. We see people where their jaw starts going all crooked or they can’t open their mouth straight because one side of the jaw is locked up. Chronic grinding will cause those muscles to get really large and makes the bottom part of your face look much wider, a bit like your cheeks are swollen.
Early intervention, consistent treatment can help to prevent these from becoming permanent.
Eon Engelbrecht – E-Radio-SA
(17:02 – 17:10)
All right. Then, finally, Dr Yudelman, what should people do if symptoms of bruxism or TMJ persist?
Dr Clifford Yudelman – OptiSmile
(17:10 – 19:04)
Like we always say, you should get help from your own professional. You definitely want to get a comprehensive evaluation from a dentist or even a TMJ specialist. In South Africa, there’s very few TMJ specialists, but some dentists have done extensive additional training in TMJ.
In our practise, I’m definitely not the expert. Dr Cara Loubser and Dr. Harris Smeyatsky have a lot of experience with this and I’ll usually make sure that they see the patients as well. Of course, we send them to Trish who knows a lot about it.
Just getting regular checkups and adjusting your mouth guard or splint, making sure that it’s comfortable and it’s not causing any problems, and then combining dental solutions along with what we mentioned, which is the stress management and physical therapy and reducing things like the caffeine, the alcohol, any medications that could be contributing, whether they’re legal or illegal, or should I say recreational, but the law, not so much about the law, but whether they’re prescribed by a doctor or they’re being used under one’s own steam for the effect. So yeah, I have seen some of the worst effect from patients that have used recreational drugs and after they stop, their jaw just keeps going from side to side, they flatten their teeth and they end up spending a fortune on building all the teeth back up. These are patients that have had rehab.
They generally can’t stop grinding.
Eon Engelbrecht – E-Radio-SA
(19:05 – 19:18)
Sure, that’s hectic. And on that note, that’s a wrap for Save Your Money, Save Your Teeth, not just for this week, but for this year, Dr Yudelman, can you believe it? Our time flies when you’re having fun.
Dr Clifford Yudelman – OptiSmile
(19:19 – 20:18)
Yeah, amazing. Thank you. And yeah, I know I ended off on a bit of a downer there with talking about people damaging themselves with drugs and so on.
I think we should rather just say, have a safe Christmas and a happy new year, and it’s a good time to enjoy, don’t drink and drive, get an Uber. It’s so easy these days with Uber. Yeah, no excuse.
You arrive alive and arrive back on our podcast next year, ready for more information to save your money and save your teeth. And I just want to thank you, Ian and your team for helping me with this podcast for the whole year. I’ve really enjoyed doing it and hopefully we’ve helped just a few people save their money and save their teeth and then perhaps have a better quality of life because of that.
Eon Engelbrecht – E-Radio-SA
(20:19 – 20:39)
Absolutely. And I want to say thank you to you, Dr Yudelman, for your time and sharing your expertise with us. You know that the good fundamentals in radio is to inform, entertain and educate, and you’ve really been helping us with the education part.
That was superb this year. Thank you so much for that.
Dr Clifford Yudelman – OptiSmile
(20:40 – 20:54)
Thank you and I wish you and your family and everyone a happy new year and a good Christmas and just some relaxation and family time and I’ll see you in the new year.
Eon Engelbrecht – E-Radio-SA
(20:54 – 21:47)
Thank you so much. Same to you and your family and also your colleagues, Dr Yudelman. Much appreciated.
And with that, remember while we strive to provide valuable insights, always consult with your own dental professional for advice tailored to your personal health. Don’t forget to subscribe for more enlightening discussions. You now have a lot of time to catch up with the podcast’s 42 episodes for you to listen to, whether it’s on a road trip or whatever.
We all have more time during December, so now’s the time to catch up on those podcasts. So do subscribe and join us again next year as we continue to explore the fascinating intersection of dental health and financial savvy with Dr. Clifford Udelman from OptiSmile. Until then, keep smiling and taking great care of your teeth this festive season.
Announcer
(21:58 – 22:43)
Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Dr. Clifford Udelman, a seasoned expert with 40 years of dental experience across four continents. Gain unique insights and expert dental advice by visiting OptiSmile.co.za for articles that illuminate the path to optimal oral health. If you’re seeking unparalleled dental care in Cape Town, get in touch with OptiSmile or book directly online on OptiSmile.co.za. OptiSmile, where global expertise meets local care.
Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations.Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns.The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.
