Headaches: The Dental Connection

You probably remember the old song “…the knee bone’s connected to the leg bone; the leg bone’s connected to the hip bone…etc.” Your (lower) jaw bone actually is connected to your “head bone”—and it is connected by muscles, ligaments, and tendons. This area is known as the temporomandibular joint or the TMJ. When the lower jaw lines up perfectly with the upper jaw and everything functions normally, everything is fine. If the lower jaw does not line up properly or, perhaps more importantly, if there is abnormal stress present when the lower jaw contacts the upper jaw, problems can occur. The abnormal stress is usually clenching or grinding of the teeth and it can occur any time, day or night, awake or asleep. When this happens, a person can develop regular, chronic, or migraine headaches; muscle pain or tenderness in the jaw joint muscles; or the temporomandibular joint dysfunction (TMD). Forty-four million Americans suffer from chronic clenching and grinding, resulting in tooth damage and 23 million suffer from migraine headache pain.

While mouthguards have been used with some success to treat TMD patients, an FDA-approved device seems to offer a higher success rate in eliminating TMJ problems. This device has an additional advantage in that it was designed to reduce the clenching habits that often lead to chronic and migraine headaches. This device prevents the upper and lower teeth from coming into contact. By preventing high-intensity clenching (and the muscular irritation that leads to migraine pain, TMD, and chronic headaches), studies have shown that 82% of migraine and headache sufferers has a 77% reduction in the migraine incidents. In short, the frequency and intensity of headache episodes and muscle tenderness can be reduced with the use of a mouthguard.

A tension suppression system is another effective form of mouthguard that can treat TMD. This small removable device, made in the office, can be worn day and/or night and has been shown to reduce clenching intensity by 66%. It takes advantage of a naturally protective reflex that suppresses the powerful chewing muscles active in clenching. For those concerned about insurance coverage, the cost of this device is submitted first to medical insurance for evaluation of benefit coverage. Most insurance carriers do consider this device a payable benefit.

How important is the reduction of clenching stress? Try this simple demonstration. Put a pencil between the last top and bottom molars on one side and bite hard. Remember how hard you were biting. Then take the pencil and place it between the top and bottom front teeth and bite down hard again. You will not be able to bite down as hard when just biting on the front teeth. You should be able to detect a great difference between biting (clenching) on back teeth only and front teeth only. Try another test: lightly place your fingertips on either side of your head in the temporal area (above and in front of the ears). Clench your teeth and feel the muscles on either side of the head bulge out. Then take a pencil, place it between the top and bottom front teeth, and bite down again. You will easily feel that the temporal muscles do not (cannot) bulge out as much, meaning that not as much clenching compression is possible.

Source: Elsevier Mosby, Dental Practice Tool Kit: Patient Handouts, Forms, and Letters

Am I Grinding My Teeth At Night?

How do you find out if you are grinding your teeth at night? Many patients are often unaware that they have this problem. Some people do grind or clench their teeth during the day, but it oftentimes occurs at night when the person is asleep. Because of this, it can be difficult to self-diagnose.

Ways to find out

• When you wake up, are you in pain?
• Such pressure applied can cause a tooth to hurt or cause soreness in the jaw muscles.
• Does someone observe you grinding your teeth while you are sleeping?
• Many people who grind their teeth at night will make repetitive clicking or grinding noises while sleeping. They will not make these noises all night long, but instead exhibit repeated short periods of grinding/clenching activity.
• Does your front teeth look worn when you look in the mirror?
• Do you experience these symptoms when you wake up?

• A dull, constant headache
• A sore jaw
• Audible teeth grinding sounds as you are falling asleep
• Tooth sensitivity to heat, cold, or brushing
• Inflammation of the gums (gingivitis)
• Wounds on the inside of the cheeks (from biting)

Ask your dentist because chronic teeth grinding can result in fracturing, loosening, or the loss of teeth.Your dentist can observe the wear patterns on your teeth and examine your mouth and jaw for signs of grinding, such as jaw tenderness, worn-down teeth, and other abnormalities. They will also check to make sure that you are not suffering from some other ailment that cause similar pain, such as: dental disorders, ear disorders, or TMD.

How to fix

•  Ask your dentist

• Dentists often recommend that patients wear a night guard in order to protect teeth and jaws from further damage. Many patients who do wear a night guard report that they feel better in the mornings. A previous blog post goes over the process of getting a bite guard.
• Muscle relaxants can be prescribed
• Crowns or onlays can be put onto your teeth to fix any damage caused to the teeth and repair your bite
• Understand bruxism: it is a condition where a person grinds, gnashes, or clenches his teeth unconsciously. 
• Reduce your stress. The degree of severity can be influenced by the amount of stress that someone is experiencing. Many patients who are aware of their nocturnal bruxing report that it can be worse during stressful periods of their lives.

• Stress counseling, exercising, meditating
• Eliminate major sources of stress in your life
• Go to bed and wake up at the same time every day
• Have fun with family and friends
• Eat well: three well-balanced and healthy meals each day
• Relax before bed
• Reduce stress on your mouth
• Stop chewing non-foods (chewing on pencils)
• Train yourself not to clench your jaw during the day
• If your muscles feel sore, you can apply ice to your jaw to alleviate the pain
• If your jaw hurts, you can take a pain reliever like ibuprofen for temporary relief