(previously published in the Lawrence Journal-World news – 01.10.11)

Think teeth grinding can be a real pain?

Just ask Kate Whitsel, a junior at Kansas State University, who drives 90 minutes twice a month to Lawrence to visit dentist Jim Otten for severe TMJ issues.

But the road time, Whitsel says, has been worth it.

“I was told I would need surgery by one (dentist), and then another dentist said to see a TMJ specialist, Dr. Otten. After the first couple of weeks, I was a new person,” Whitsel says.

Photo by Richard Gwin

Jim Otten, a Lawrence dentist, uses two plastic sheets that leave marks on a mouthpiece that Kate Whitsel, 20, of Manhattan, wears to correct her teeth.

For others who suspect teeth grinding is behind restless nights and head and jaw aches and pains, Otten will give a program titled “Headache: It’s Enough to Make You Grind Your Teeth! The Role of Bite Problems” on Thursday as part of Lawrence Memorial Hospital’s ConnectCare series.

What causes TMJD?

The temporomandibular joints allow your jaw to open and close effectively, chew and speak. If the joints are defective, dislocated, or degenerated, facial or joint pain, jaw “clicking” or limitation of movement can occur.

Otten says, “There is a lot of confusion in the medical and dental community about what causes TMJD to occur and why. For example, why do some patients with degenerative changes in the joint have facial pain, and others don’t hurt at all?”

Patients need to be individually evaluated and treated. No one case is the same with TM problems.

“This disorder is generally progressive over time,” Otten says. “So for increased success, proper therapy has to begin early and be patient specific.”

Who is affected?

The National Institute of Dental and Craniofacial Research reports, “TMJ (disorders) are the second most commonly occurring musculoskeletal condition, resulting in pain and disability (after chronic low back pain), affecting approximately 5 to 12 percent of the population. About half to two-thirds of those with TMJ disorders will seek treatment. Among these, approximately 15 percent will develop chronic TMJD.”

Otten says, “In our internal practice studies we have noted that approximately 65 percent of adults have verifiable degenerative changes in one or both TM joints. These numbers are also increasing in young women.”

He says that women seek treatment at a rate of nine to one over men, and women also have a significantly higher frequency of joint breakdown and more severe effects.

Otten also reports that in his practice, 15- to 45 year-old females are the “highest demographic group with profound problems of muscle hyper-contraction and/or breakdown in the TM joint.”

Diagnosis

According to the American Dental Association, a dentist can help identify the source of the pain with a thorough exam and appropriate X-rays. But some types of pain, the cause is not easily diagnosed.

Arthritis may be a culprit of TM problems, as well as dislocation or injury. If the physiology of the joint and surrounding muscles don’t fit together correctly (a poor bite) a TMJD diagnosis is probable.

Stress and teeth grinding (bruxism) are also considered as possible factors, according to the ADA.

Otten says while headaches may not occur for all TMJ disorder patients, it’s a frequent symptom.

Therapies

The overall premise for treating TMJ disorders is uncovering all the factors which lead to this painful condition.

“(We) look at all environmental, structural and physiologic factors as well as the genetic susceptibility and host resistance,” Otten says. “One of the primary therapies we use is bite (occlusal) splint therapy.”

This therapeutic device is not a typical night guard but is similar to physical therapy for your face and TM joints.

Otten’s office also teaches their patients how to avoid clenching their teeth throughout the day, as well as other techniques.

“The splint is used mostly at night and at times in the day when the patient may need some relief,” he says. “We can see 90 percent improvements in 90 percent of patients and sustain this over time.

“In general, men will grind their teeth away with very little pain and no physical symptoms,” he adds. “Women have more symptoms affecting the jaw joint and cartilage breakdown. They both require proper evaluation, diagnosis and treatment.”

K-State student Whitsel hopes her treatment will continue to alleviate her pain, which included a headache that persisted nearly seven months.

“I just couldn’t get rid of it,” she says. “I had muscle spasms in my neck and shoulders, too.

“Now my jaw is slowly moving back to where it should be, and I have less joint pain.”