Understanding Bruxism and TMJ Disorders

OPTISMILE Podcast 41 Grinding Through It – Understanding Bruxism and TMJ Disorders

Eon Engelbrecht – E-Radio-SA (0:08 – 1:03)

Welcome to Save Your Money, Save Your Teeth, the go-to podcast where curiosity meets dentistry straight from the experts. The expert is with us in the room. I’m chatting with Dr Clifford Yudelman.

He is, of course, from OptiSmile, and on this podcast we take a nice deep dive into the world of dental care from a consumer’s perspective. So if you want to brighten your smile or just protect your wallet we’ve got you covered with practical advice and the latest insights. So do stick around as we uncover the secrets to maintaining both your dental health and also your finances.

And today we’re starting with a brand new topic. It’s the penultimate edition before the end of the year and I’m going to allow Dr Yudelman to introduce us to the new topic. Dr Yudelman, welcome back.

Dr Clifford Yudelman – OptiSmile (1:03 – 2:02)

Thanks Eon, great to speak to you. Hope you had a good week and looking forward to today’s episode. We get a lot of patients asking us about this and there’s a lot of misinformation.

So today’s episode is called Grinding Through It. It’s part one of two parts on this which is Understanding Bruxism and TMJ Disorders. And then next week we have our last podcast for the year.

We have been going since just before Valentine’s Day. So this will be number 41 and then next week is number 42 which is Relief and Recovery Managing Bruxism and TMJ Disorders. So if this is something that you have a problem with, night time grinding, bruxism, then stay tuned and be sure to tune in again next week.

So I know you’ve got some good questions for me Eon, so why don’t you go ahead with your first one.

Eon Engelbrecht – E-Radio-SA (2:03 – 2:09)

Dr Yudelman, first of all I want to know what is bruxism and how does it differ from casual teeth grinding?

Dr Clifford Yudelman – OptiSmile (2:10 – 3:12)

So bruxism is a condition where you habitually grind or gnash or clench your teeth often subconsciously, generally when asleep but there are a lot of people who do it when they’re awake, when they’re working or working out. Casual grinding might occur occasionally in response to stress or frustration but bruxism is a chronic problem which over time it causes significant damage like wearing down your teeth. It can cause jaw pain, can even lead to other health issues.

It can be one of the biggest causes of headaches and then of course there’s this TMJ problem. TMJ is your temporomandibular joint which is that joint there just by your ears and it can feel like an ear ache. People call it TMD or temporomandibular joint disorders, TMJ, TMD, same thing and so this should help people today.

Eon Engelbrecht – E-Radio-SA (3:13 – 3:17)

Okay and what are the primary triggers for this bruxism doctor?

Dr Clifford Yudelman – OptiSmile (3:18 – 5:35)

So of course stress and anxiety are the most common triggers during and after COVID with people dying and with financial problems. We saw a lot of people smashing their teeth up from all that added stress and anxiety and you know people that are stressed out can be clenching and grinding their teeth during the day. At night, there’s sleep disorders like sleep apnea which we had a few podcasts on just recently.

Sleep apnea can lead to grinding as your body reacts to disruptions in breathing and then dental issues like an uneven bite or crooked teeth can also contribute. So we often see patients who come in because their teeth are getting worn down and the upper front teeth are not angulated properly and there’s something called entrapment where the lower front teeth are catching in behind the upper front teeth and we find that gets alleviated when people have Invisalign and their teeth are in a better position and then there’s lifestyle habits like too many coffees during the day or very heavy caffeine use especially now with these energy drinks and then alcohol at night before bed that doesn’t help you. You don’t have a very restful sleep and then there’s also something I should add and that’s a lot of medications especially common they’re called SSRIs for depression, generally depression and anxiety, they can have a side effect.

If you weren’t grinding your teeth before and then you were getting some stress or anxiety or depression and you went and you got on these meds and now you’re really clenching and grinding and smashing your teeth, if you Google or look up that medication and put the word bruxism or clenching grinding, you’ll find out if that medication is one of them. Perhaps your psychologist, psychiatrist or doctor can aim you out for a different med that is not as bad or otherwise keep listening because you maybe have to stay on that medication and there’s other things you can do to help from damaging your teeth. So let’s carry on.

Eon Engelbrecht – E-Radio-SA (5:36 – 5:41)

Okay and what is that connection between bruxism and headaches Dr Yudelman?

Dr Clifford Yudelman – OptiSmile (5:42 – 6:58)

So the bruxism which is as we said this clenching and grinding which places excessive pressure on the muscles and the joints around your jaw and these can radiate upwards and cause tension headaches. So one of the muscles to your jaw, there’s those ones when you clench they feel and some people they’re very developed like a little golf ball on the side of your corner of your jaw but if you put your fingers up sort of on your temples above your temples and you clench down, there are these very big fan shaped muscles called the temporalis muscles and they attach to your jaw and some people have got very well developed temporal muscles and those ones can get caused headaches and these headaches are often described as dull throbbing pain around the temples and it’s particularly common when you wake up in the morning after a night of grinding and especially if you’re grinding and you have sleep apnea and then chronic grinding can also trigger migraines or migraines or however you pronounce it and exacerbate existing headache problems. So especially when you’ve got stress and TMJ, all of these things go together.

They’re all part of the same sort of syndrome.

Eon Engelbrecht – E-Radio-SA (6:59 – 7:06)

Okay and then what physical symptoms suggest someone might be grinding their teeth? Can you see it? Can you hear it?

Dr Clifford Yudelman – OptiSmile (7:06 – 7:48)

Yes, so exactly. So partners often hear grinding noises at night which can confirm sleep bruxism. Sometimes it can be very, very loud.

I’ve had patients record their partners and it sounds like a cricket or something like rubbing two pieces of wood or two pieces of metal together and it kind of gets amplified. Some people complain about their partners grinding a lot more than they do about the snoring and then you also would notice visible damage like flattened or chipped teeth and you can feel clicking or popping in your jaw. The most common sign is waking up with a sore jaw or headaches in the morning or very sensitive teeth.

Eon Engelbrecht – E-Radio-SA (7:49 – 8:06)

Okay, so it definitely does not go unnoticed. You can definitely hear when somebody’s doing it. Okay, so how does bruxism impact the TMJ, the temporomandibular joint?

I don’t know if I said that correctly.

Dr Clifford Yudelman – OptiSmile (8:06 – 9:29)

It’s a massive word. Yes, it just rolls off the tongue, doesn’t it? The bruxism can place a lot of strain on the TMJ.

So if I get you to bite down say on an old-fashioned HP pencil like we used to have at school, you will bite with a certain amount of pressure that can be measured. But if you’re clenching down in your sleep, they say you can clench almost 10 times harder because you don’t have that feedback like something’s going to break. So some people can clench and grind much, much harder when they’re asleep.

That puts immense strain on your TMJ. It leads to dysfunction, which we said was TMD, which may cause – TMJ is your actual joint and TMD is the temporomandibular dysfunction. Then this will cause pain, stiffness, maybe difficulty opening or closing your mouth.

Over time, the repeated pressure can cause joint inflammation and lead to even more clicking and popping sounds and something that sounds like crinkle paper in your ear. It’s called crepitus. In severe cases, people can get a dislocation or their jaw can lock, misalignment.

The TMJ issues or TMD often creates a vicious cycle where the discomfort from grinding causes further tension and makes symptoms worse.

Eon Engelbrecht – E-Radio-SA (9:29 – 9:35)

All right. What are the long-term risks, doctor, of untreated bruxism?

Dr Clifford Yudelman – OptiSmile (9:36 – 10:15)

That’s a great question because it’s not something to be ignored. It can erode your enamel on your teeth and leave them more susceptible to fractures and decay and sensitivity. The excessive pressure can lead to the gum recession.

We’ve spoken a little bit before about these gumline abfractions and in certain cases can even cause teeth to get loose. Chronic grinding may also permanently change your facial structure, enlarging your jaw muscles and misaligning your jaw. It can create functional and aesthetic concerns as well.

Eon Engelbrecht – E-Radio-SA (10:16 – 10:24)

How do you as a dentist diagnose bruxism or TMJ disorders? How do you go about?

Dr Clifford Yudelman – OptiSmile (10:25 – 11:42)

When we see wear on the teeth, enamel loss, visible cracks, we can feel the patient’s jaws, feel tenderness around the jaw muscles. Oftentimes, the patients are aware of it. They’ll tell us before we tell them.

There are x-rays you can take to check the jaw joints. There’s MRIs and special x-rays. If imaging is needed, we would tend, even though we have a machine that can do it.

In a lot of cases, we work with other specialists like an axillofacial surgeon if we suspect arthritis or actual physical joint problems. Sometimes and quite often, I recommend a sleep study for patients to rule out or rule in sleep apnea. If there are other issues, they might even have a hospital sleep study, which is a lot more involved.

Then they can put sensors on your different muscles and see which muscles are clenching and grinding. That’s kind of overkill. For our purposes in general, we just want to find out if the patient has got the snoring and sleep apnea, which we spoke about extensively in our previous episodes.

Eon Engelbrecht – E-Radio-SA (11:43 – 11:50)

Am I correct in saying that stress really has a massive impact on bruxism and TMJ disorders?

Dr Clifford Yudelman – OptiSmile (11:51 – 12:27)

Oh, yes. Stress triggers muscle tension. For a lot of people, that manifests as clenching and grinding.

Chronic stress not only exacerbates the grinding, but it also increases the inflammation and the pain. Exacerbates means makes it worse, but also increases inflammation and pain in the TMJ and potentially worsens any dysfunction. Managing stress can significantly reduce symptoms and making stress reduction an important part of the treatment, which some of that stuff we’ll talk about next week.

Eon Engelbrecht – E-Radio-SA (12:28 – 12:34)

Then lifestyle factors like caffeine or alcohol, can they make it all worse?

Dr Clifford Yudelman – OptiSmile (12:35 – 13:41)

Yeah, definitely. Caffeine simulates the nervous system. Especially now with some of these very high caffeine drinks or other stimulants, they heighten the muscle activity and make grinding more likely.

Then certain other illegal medications like speed or tic or cocaine. Personally, I was on Ritalin for a while. I found that made me grind my teeth a lot.

Any of these sort of stimulants and then alcohol disrupts the sleep patterns, which leads to much worse grinding in your sleep. It also can really just mess you up and touching back on these things, especially in the evening. I drink quite a bit of coffee.

I have one or two cups in the morning and then one at lunchtime. I consider that quite a bit of coffee. I like my coffee strong.

I have a strong Americano, but I’m very careful not to drink coffee after three or four in the afternoon because then I definitely know I’m going to be clenching and grinding my teeth that night.

Eon Engelbrecht – E-Radio-SA (13:42 – 14:02)

Wow. Okay. That’s very disciplined.

I wish I could stop drinking coffee. But around that time, I’ve got the afternoon slump, so I need the coffee, you see. Yeah.

So finally, Doctor, what would you say are the first steps to address what we spoke about today, bruxism and TMJ disorders?

Dr Clifford Yudelman – OptiSmile (14:02 – 17:14)

So as always, anybody listening to my podcast, this is general advice. It’s always best to visit your dentist or a dentist that has a good knowledge about these to assess the extent of the damage and to determine the best treatment approach for you, like a custom-fitted mouth guard or night guard, which you wear at night to protect your teeth. We’ll talk more about that.

If you don’t listen to the next episode, I should say that a rubber mouth guard that you buy in the store, keep away from those. It just makes you clench and chew even more. It’s like a chewy toy.

The type that we’re talking about is a specialised one fitted by the dentist, either up or lower, and they generally will be hard or almost hard, where there’s a little bit of flex in them. And then stress management is equally important. Relaxation, like going for long walks, meditation, yoga, or even therapy, DBT is something I’ve tried personally.

It’s called dialectical behavioural therapy. There’s cognitive behavioural therapy. You don’t always need to take medications.

And then personally, I’ve just had four sessions with a breathing coach. And I found that that really has helped me. Nasal breathing, where you breathe in for six and out for eight, there’s a lot of different breathing techniques.

And there’s some very good books on this. The book that I listened to that got me interested was a second book. There’s one called Oxygen Advantage.

And then the one that I listened to on Audible was called The Breathing Cure. And then I had some one-on-one coaching. And I find that that’s really, really helped me for any kind of stress.

So that’s just a little tip for people. And also for severe cases, you can combine dental care with medical interventions such as Botox. At OptiSmile, one of the dentists specialises in Botox for the TM, for the masseters and the temporal.

Usually, it’s the masseters. We don’t normally inject your temporalis muscles. And then physical therapy or physio, I want to do a shout out in case you don’t listen to our next episode.

We do refer all of our or 90% of our TMJ patients or bruxism patients as a first step. We send them to Trish Lang, who’s a physio in Bree Street in Cape Town. Trish has got her master’s in this particular subject.

Not all physios have got a master’s in neck and face and TMJ treatment. And after two to three visits, she generally sorts people out. She gives them exercises to do at home.

And then they come back and they get a bite plate from us. But more about that next week. Today was a nice, tight podcast, not a lot of chit chat.

I know it’s getting closer to Christmas. People don’t have time for one necessary chit chat. So I hope this was very helpful for people that were listening.

And make sure you do tune in for next week.

Eon Engelbrecht – E-Radio-SA (17:14 – 17:27)

Dr. Utterman, thank you so much. That wraps up another episode of Save Your Money, Save Your Teeth. And looking forward to next week’s one.

Just by the way, congratulations on podcast number 40 last week.

Dr Clifford Yudelman – OptiSmile (17:28 – 17:36)

I couldn’t believe it. Since February, we have not missed a single week.

Eon Engelbrecht – E-Radio-SA (17:36 – 17:36)

Exactly.

Dr Clifford Yudelman – OptiSmile (17:37 – 19:10)

Consistency. Yes. That’s it.

And next week will be our last one. We’re going to give the listeners a break over the Christmas, New Year. And we’ll announce next week when we’ll be starting up again.

And we’ve got a lot more episodes. I was writing the book, Save Your Money, Save Your Teeth. And that’s when we met and we started doing these podcasts.

And the book is on hold. But we will be coming out with a book, especially for consumers, with all of these subjects and more in-depth and definitely with some images and some references. And we’d love to get feedback from listeners on any particular subjects that they are interested in that they maybe haven’t listened or that we haven’t covered yet.

I’m not short of things to say, but we want to make sure that we’re hitting all the right spots for the listeners. And I have heard from around that there’s a lot of dentists now listening to the podcast, maybe trying to find out what we do at OptiSmile. And hopefully, imitation is the best form of flattery.

And I’ve had a lot of dental reps that sell a lot of the materials and the equipment when they’re driving around visiting from one dentist to another. They listen to my podcast. I’m very flattered.

Just when I said not a lot of chit-chat, today’s episode, there’s a bit of chit-chat for you. So I’ll speak to you next week. Thank you very much.

Thank you, Dr Yudelman

Eon Engelbrecht – E-Radio-SA (19:10 – 19:19)

And I’m pleased to hear that the other dentists are listening in. I think they’re probably jealous of you having your own podcast. They’re thinking, oh, damn, I should do that as well.

Dr Clifford Yudelman – OptiSmile (19:20 – 19:28)

Yeah, well, good luck to them. And I look forward to listening to your podcast when you start it.

Eon Engelbrecht – E-Radio-SA (19:31 – 20:00)

As always, as we say, remember, we strive to provide valuable insights, but it’s always good to consult with your own professional for advice tailored to your personal health. Don’t forget to subscribe to the podcast for more enlightening discussions and join us again next week for our final one for 2024 as we continue to explore the fascinating intersection of dental health and financial savvy. Until then, keep smiling and taking great care of your teeth.

Announcer (20:07 – 20:51)

Discover the world of dental excellence with OptiSmile. Join us for a weekly podcast featuring Dr. Clifford Yudelman, 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.