It is a fact that more and more people grind their teeth these days - it is mostly an inevitable consequence of our stressful lifestyles and busy routines. Many Adults suffer from such problems and/or chronic facial pain “i.e. pain related to the muscles of the face”. We have in fact found that many of our patients exhibit some signs or symptoms of such conditions. Known as TMJ disorders “Temporomandibular Joint Disorders/ Temporal Mandibular Joint Dysfunction” or TMD “Temporomandibular Disorders”, it is more common than you may realize. However, many patients who experience it do not realize that their chronic jaw pain (and other related remote symptoms such as headaches and even neck and shoulder pain) is caused by this disorder. It can mess up your sleep pattern, makes you so tired, wrecks your mood and reduces your productivity. Patients do not realize that an examination from their professional dentist could be their best option for finding relief from their chronic aches and unexplained other pains. It is important that patients understand this condition, its causes and how we can help them address their jaw dysfunction by correcting the appropriate underlying issue.

Our temporomandibular joint connects the mandible (jaw bone) to the skull bone, with a cartilaginous articular disc separating both bones. It is a hinge joint that facilitates the opening and closing of the move, in addition to protrusion and retrusion (moving the jaw forwards and backwards) and lateral side to side movement of the jaw. Your TMJ is an anchor for certain muscles. These muscles can be noticeably felt by putting your index finger in your ear, whilst moving your jaw through ranges of motion. The temporomandibular joint is the most frequently used joint in the body. It is used to speak, chew, swallow and yawn. Being such a constantly used joint, it is estimated that 85-90% of the population will experience some problem or discomfort during their lifetime.

What is Bruxism?
First, it is important to understand what bruxism is and what causes this habit that is technically defined as a “parafunctional habit”. It can generally be defined as a condition in which patients usually unconsciously grind or clench their teeth, mostly while sleeping not even aware of it and sometimes during daytime. Many factors can trigger this habit, but by far the most common ones are anxiety and stress.

This abnormal grinding habit causes stress in jaw joints, inflammation and varying degrees of pain that can be sometimes extreme and even with debilitating effects. The problems associated with grinding can be limited to the mouth but in many cases, it can have a radiating effect to other parts of your body.

If after examination it was confirmed that no other contributing factors to bruxism other than stress related, it is important to first be aware that dentists cannot permanently cure it. It is a consequence of a lifestyle - as much as we want you to be relaxed, we cannot make you immediately stop grinding or clenching your teeth. However, we can treat bruxism’s signs and symptoms, control it through different approaches and improve the life quality of the person who suffers from it.



Are you Grinding Your Teeth?
Most people grind or clench their teeth, but not many are aware of it. This habit has multiple consequences, and many of such effects are expressed outside the mouth, including headaches, upper back muscle pain, neck pain and problems in the temporomandibular joint (TMJ), which is the joint connecting the lower jaw to the base of the skull and acting as a sliding hinge to allow lower jaw movement. Most patients who suffer from bruxism cannot relate it to waking up in the morning with a headache, radiating pain in the face, jaw, or neck,. generalized physical discomfort and pain in the jaw area. One of the striking indirect signs of such condition, is that clinchers have a tendency to keep changing their pillows assuming that the pillows are not as comfortable as they should be not knowing that their unidentified clenching habit is the cause of their distress and uncomfortable cranky irritable sleeping pattern.

Common jaw joint problem signs include headaches especially in the morning once waking up, cold sensitive teeth, pain in or around the ear, tenderness of the jaw, pain at the lower jaw angle below the ears and clicking or popping noises when opening the mouth. In many cases, the popping or clicking is harmless, painless and does not impair function. Other indicators to such condition include;
• Jaw pain
• Joint sounds such as crepitation
• Earache pain
• Uncomfortable bite
• Changing bite
• Tinnitus (ringing in the ears)




• Worn-down chipped and fractured teeth
• Gum recession
• Gnashing/teeth grinding
• Neck pain
• Shoulder pain
• Sore cheeks/temples
• Rotational arm movement pain
• Rapid progression of gum disease



• Jaw joint popping sounds during mouth opening once the disc is displaced out of the joint space


Stretching and strain of the muscles and ligaments at the joint area causes
• Face muscles pain
• Difficulty chewing
• Inability to bite all the way down
• Limited mouth opening or pain while yawning


Another consequence is what happens to your smile. The most typical sign of bruxism is worn down, chipped and cracked teeth. When upper teeth grind against lower ones, part of their structure is lost, creating worn down facets that modify the shape of the teeth. These facets are normally spotted during dental check-ups and exams, but sometimes, patients can notice them in front teeth when the case is too severe. Minor- moderate facets may not change the tooth’s shape drastically. However, not treating the case and stopping its progression will eventually alter and disturb the normal occlusion (which is the way the upper and lower jaws bite and move against each other), causing further problems to the jaw joint and additional quicker progressive loss of the teeth structure.

In advanced cases of teeth wear, in addition to teeth sensitivity and lack of aesthetic teeth form, there will be a reduction in the lower 1/3 facial height because of loss in the normal vertical height of the original bite “known as loss of vertical dimension of occlusion”. This bite collapse leads to shortening of the lower face height (which can change one’s appearance, although it may not be obvious to a casual observer), an inverted smile (corners of the mouth sag) with more flattening of the lips and the smile, a toothless smile and frequent cracking or chapping at the corners of the mouth (angular cheilitis).

Causes of Grinding & TMJ Problems
There are many causes of TMJ disorders. Sometimes our emotions get the best of us, especially anger, fear, anxiety, and stress. Many people clench and grind when dealing with these powerful emotions leading to TMJ problems.. A traumatic injury to the chin, jaw, or the joint itself can stretch or tear the ligaments supporting the joint. Missing back teeth and/or poor alignment of the jaws or of the teeth wisdom teeth, arthritis, stressful situations, anxiety, or poor dental treatment that does not respect how the teeth bite together (i.e. high biting points at provided bridges, crowns and even fillings). There are other minor behavioral causes such as chewing and cracking hard materials. Certain medical conditions such as sleep apnea and exposure to a whiplash can also cause this problem. Structural jaw problems present at birth, masses development at the joint area and badly performed jaw surgeries that lead to resorption of the head of the joint, all can contribute to TMJ disorders.

Between your temporal and mandibular bones is an articular disc that allows normal movement of the TMJ to occur. When there are changes to the position and structure of this disc and it’s articulating bones and muscles, TMJ disorders can arise. Sounds and pain during jaw movements can arise once the jaw bones do not correctly move in correlation to the disc that keeps slipping or popping out of its space.

Tooth gnashing (grinding) is also common in children, especially when their teeth emerge. Fortunately, most children grow out of it, and they rarely need treatment. If it continues after all the permanent teeth have come in or if it is severe, however, it may indicate something more serious.

• Bite Misalignment: A misaligned bite can describe crooked teeth, an asymmetrical jawbone, or worn teeth surfaces that interfere with your bite’s pressure disbursement. In any cases, the discrepancy can cause your jaw muscles to strain as they try to realign your jaw every time you bite and chew. This can exhaust or damage your jaw’s joints and muscles. In the cases where this misalignment is caused by provided dental restorations, these should be adjusted and in some cases replaced.

• Excessive Stress: Excessive, chronic stress manifests itself in numerous ways. Physically, it can cause your body’s muscles to remain tense, including the ones in your jaw. Constantly tightened jaw muscles mean that your teeth are constantly grinding, which can damage one or both of your TMJs. Stress can be physical suck as work exertion, psychological and even hormonal such as during period times for ladies. Engaging in stress-relieving hobbies, like walking or exercising can relieve stress and alleviate symptoms of TMJ disorder.

• Arthritis in One or Both Joints: Arthritis can develop for numerous reasons and in virtually any joint within the body. Rheumatoid arthritis, which involves chronic joint inflammation, is common for TMJs, and a leading cause behind TMJ disorder. A thorough examination can help determine if arthritis is the cause of your jaw discomfort, and your dentist can help you develop an appropriate treatment plan to address it.

What Can We Do to Manage Your Grinding & TMJ Disorders?
Depending on your needs and symptoms, you may need a minimally invasive appliance to stop sleep related bruxism and teeth clenching, dental restorations for lost or fractured enamel using crowns and veneers, or correction of your bite’s alignment sometimes with orthodontics to fully restore your good dental health and manage your pain.

Unlike tooth decay and gum disease, there isn’t one specific treatment of bruxism. The causes and effects of the condition are different for each patient, and treating bruxism often depends on addressing an underlying dental or lifestyle issues. For many patients, stress relief techniques can help alleviate jaw tension and pressure, halting the habit and reducing the risk of dental and overall health problems.

• Occasional night grinding does not usually cause any harm or require treatment.

• Minor clenching and grinding that occurs now and then and is related to anger, anxiety, fear, or stress can improve with relaxation and stress management techniques. If that isn’t enough, counseling or medications, such as muscle relaxants or antianxiety medications, may provide relief.

• Lifestyle modifications can also help, such as reducing or avoiding alcohol and caffeinated foods and drinks. Relax your jaw with heat or by putting the tip of your tongue between your bottom and top teeth. Avoid overworking your jaw with chewing gums.

• All previous dental restorations including dental fillings, crowns and bridges, implant restorations and veneers should be examined for their bite. Un-even bite related to these restorations, subconsciously encourages your jaws to forcefully grind to get rid of the high points to get back to the original balanced bite. Adjusting the bite at these restorations or even replacing them will prevent further grinding.

If you have symptoms such as pain or headaches, further treatments can be provided including;

• A Custom Dental Appliance: Since most damage and symptoms occur while you are sleeping and unaware, mouth guards also known as night guards are an excellent treatment option for many patients. This simple appliance is customized to fit your mouth snugly and comfortably. It puts your jaw in a relaxed position eliminating tension in the joint capsule and protects your teeth by keeping them apart. It is easy to get used to, and most patients report they sleep better and more comfortably when wearing it. It can eliminate clenching related headaches and neck/shoulder pains. As an added benefit, these custom appliances can also help reduce or eliminate sleep apnea and TMJ issues.

• Botox Treatments: Botox can be used for bruxism treatment. Produced with botulinum toxin, it works by paralyzing muscles. While Botox is widely used for cosmetic purposed to disable the muscles that cause wrinkles, it also has several other uses, such as a treatment for muscle spasms and migraines. In dentistry, it is commonly used to treat bruxism and TMJ issues.

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• Orthodontic Treatment: A crowded or crooked smile and a bad bite can cause or increase bruxism. Sometimes successful treatment may require straightening and correcting your bite with braces. With a straighter dentition, your bite can rest more comfortably, and you will be less likely to grind and clench.

• Restorative Treatments for Grinders: Because bruxism can cause severe force on your teeth, it is common for patients to experience enamel “outer tooth structure” wear, cracks, broken or loose teeth or even tooth loss in advanced cases. For minor damage, tooth-wear facets can be easily restored and we can reconstruct the lost shape with composite “tooth colored” resin bonded fillings.

To restore teeth that are worn from excessive clenching, our office offers veneers and dental crowns as treatment options . Veneers are ideal for damaged anterior teeth. These thin shells add strength and beauty providing a beautiful smile, while covering flaws and imperfections. If you have a broken or severely damaged tooth, you may require a root canal, a dental crown, inlay/onlay or an overlay to restore the function and strength of your teeth.



Our dentist generally prefers ceramic crowns over metal. Ceramic crowns are more aesthetically pleasing. There is a lower risk for the development of a black line at the gum line. Ceramic restorations can also be made thinner, which requires less tooth reduction, and they will not stain or change color. Ceramics are more bio-compatible than metal which may reduce gum recession. the newest ceramics can stand up to chronic tooth grinding . E-Max crowns offer the best cosmetic results. They are made of two layers: a strong and durable supporting layer called the coping and a lifelike top layer that matches the restoration to the natural teeth. We also offer zirconium crowns, which are considered among the strongest material available for dental crowns.

For tooth loss, options include dental implants, fixed bridges, or a partial removable denture. Each option has its cons and pros that should be explained at every case discussion.

Consciously stopping yourself from clenching can be difficult, which is why it’s crucial to at least take some precautions after the treatment. It is a fact that if you keep grinding or clenching your teeth, your new restorations will also suffer the consequences of bruxism. The forces you put on teeth when grinding or clenching exceed the resistance of any dental material. Accordingly, once your cosmetic and restorative treatments are complete, your dentist can design a night guard to protect them. The night guard should be worn during the night to protect your brand new teeth and smile make-over, or you can opt for muscle relaxant injections to weaken the jaws’s ability to clench and grind involuntarily.

• Temporomandibular Joint (TMJ) Arthrocentesis Procedure
An oral and maxillofacial surgeon will often recommend TMJ arthrocentesis when conservative therapies for TMJ pain relief have not proven to be successful. This procedure is used to provide relief from temporomandibular joint pain and discomfort. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation that may have accumulated in the affected joint by flushing it. Although pain relief is never guaranteed, many patients have found this procedure to be effective in managing their symptoms.

After receiving an anesthetic, the surgeon inserts a sterile needle into the temporomandibular joint space. A syringe is attached to the needle and used to push sterile fluid into the joint space. A second needle is then inserted so that the joint can be washed out. Fluid enters the joint through one needle and leaves out the other. This removes the inflamed fluid from the joint. Some surgeons will also use a steroid (anti-inflammatory medication) at the end of the procedure. It is injected and left in the joint prior to needle removals. Sometimes hyaluronic acid (HA) is injected into the place to facilitate the disc movement at the joint area and alleviate pain and discomfort.

• Open Joint Surgery: There are many types of open joint surgeries. Such surgeries may be needed in cases where the TMJ is degenerating, there are tumors in or around the TMJ, the joint is severely scarred or contains chips of bone and once the joint is fused together by bony growth (ankylosis) after the jaw has been subject to a trauma. The surgeon makes a cut in a skin crease just in front of the ear. This exposes the jaw joint. The surgeon may repair, reposition, or replace the disc with your own tissue or an artificial disc. Scar tissue or bony growths in the jaw joint can also be removed.

How Can You Personally Manage Your TMJ Pain

Simple self-care practices can often be effective in easing symptoms. Visiting a specialized dentist is however important to professionally mange your case based on identifying the cause of the problem and formulating a treatment plan customized to your special needs. Some of the self-care practices include;

• Apply moist heat or cold and massage tender muscle and joints: Heat or ice applications used up to four times per day while resting may relax muscles responsible for causing pain. For heat, microwave a wet towel for approximately 1 minute or until towel is warm and wrap around a hot-water bottle or heated gel pack. For cold, use ice wrapped in a thin cloth on the area until some numbness is felt. Use what feels best. Apply for 15 to 20 minutes, taking care not to burn or freeze skin. It is however advised to use cold packs at the phase of acute sharp pain and start using warm packs later on.

• Avoid foods that irritate your symptoms and chew on both sides: Avoid firm foods, such as french bread or bagels. Avoid chewy food such as steak or dry sticky candy. Cut fruits and vegetables into small pieces. Chewing on both sides will reduce strain. Do not chew gum.

• Avoid events or activities that trigger pain: Use a pain diary to review daily activities that aggravate the pain and modify your behavior accordingly.

• Avoid muscle testing habits and activities that strain the jaw and head muscles: Notice if you do any of these oral habits. Use reminders such as stickers or timers. If noticed, replace negative habits with positive habits such as the “n” tongue position. These activities include:- Conscious day time teeth clenching and grinding, teeth touching or resting teeth together, teeth tapping, biting cheeks, lips, and objects, hard and chewy foods, resting your jaw on your hand, pushing the tongue against the teeth, pushing the jaw forward or to the side, tensing the jaw, jaw strain from musical instruments or scuba diving tools and opening the mouth too wide with yawning or singing.

• Practice general relaxation, meditation and abdominal breathing: This helps reduce your reactions to stressful life events, decreases tension in the jaw and oral habits such as clenching.

• Maintain good jaw posture. Keep your tongue up, teeth apart, and jaw muscles relaxed: Closely monitor your jaw position during the day (waking hours) so that you maintain your jaw in a relaxed, comfortable position. This often involves placing your tongue lightly on the palate behind your upper front teeth (find this position by saying “n”), allowing the teeth to come apart while relaxing the jaw.

• Stretch the jaw and temple muscles: Place two to three fingers between your front teeth for a count to 20: rest and repeat 6 times. Gradually increase range of motion as tolerated.

• Watch Educational Videos on YouTube. Personally performed physical therapy treatment approaches by videos that shows you how to perform TMJ exercises for temporomandibular joint Dysfunction (TMD/TMJ) and minimize your pain.

• Get a good night’s sleep: Avoid caffeinated beverages (e.g) coffee, tea, and soft drinks. Improve sleep environment by reducing light and noise. Get a comfortable mattress and pillow. Reduce stimulating activities in late evening including computer work, video, and exercising. Do not sleep on your stomach.

• Use anti-inflammatory and pain-reducing medications: Short-term or intermittent use of over- the-counter ibuprofen, naproxen, acetaminophen, or aspirin (without caffeine) may reduce joint and muscle pain. Prolonged use daily may contribute to rebound pain and perpetuate the pain. Consider use of combination of analgesic and muscle relaxant in evening. Consult with your primary care provider when taking medications.





It is our goal to achieve maximum improvement with comfort and normal function, while using the least invasive and conservative treatment possible. For some patients, the ideal minimal intervention can be achieved, while for others, depending on the nature and stage of the condition, effective management and control is the maximum goal. When you experience TMJ disorder, grinding, related headaches, shoulder and neck pain, or simply wake up every morning with staggering pain in the jaw and neck area, understanding the exact cause of it is the first step to finding lasting relief, as well as improving your bite’s function and maintaining your oral health, smile and even your looks. . Rather than constantly repairing damage, at Dr. Raed M. Abutteen Dental Center, our aim and focus is on addressing the underlying cause of your presenting complaint and to help you function correctly and to your optimal potential.

If you are worried and would like to learn more about TMJ jaw joint disorders condition and its treatment or think you have some of the above described effects, schedule a consultation with one of our dentists to see how you can protect your teeth, mouth and overall well-being.