Bruxism and the Temporo-Mandibular Joint


“Doctor I feel a sharp pain in my lower posterior teeth”.

These were the words of a young lady in her mid-twenties. She dropped in on a busy day, without a prior appointment and had to be squeezed in, before my eleven o clock appointment.

As she sank on the dental chair, I noticed that she was tensed with a frown on her face, with an attitude edging to words hostility.

Most probably a decayed tooth, my mind consoled me. Without sparking further time, I took myself up the oral examination.

To my dismay, I could not see any decayed tooth. This was not a simple toothache as I had expected it to be.

I asked her to point out the specific area of pain.

Her fingers fumbled towards the angle of the jaw.

Was it a third molar locked inside the jaw..? I needed more information, to make sure.

Tell me about the pain at length I posted a leading question.

Her response was a full five-minute verbal, without ant interruption from my side. The lady has been suffering from pain in her lower back jaw, for six months now.

Initially, it was just an uneasiness in the lower jaw, which soon turned towards lingering dull pain and finally to headache.

She had earlier consulted a dentist, where she had taken an Orthopantomogram (OPG). The radiograph revealed that she had a third molar, which was unlikely to erupt by itself and hence had been surgically removed.

However the pain persisted. Then she visited an ENT surgeon and was cleared off from having any ear problems.

Laundering back into the basics of patient examination, I went on with a full palpation of her chewing muscles. The muscles used for clenching seemed to be firm and tender.

I palpated the region, in front of her ear, to feel the joint between her lower jaw skull bone and found that it was not normal. I used a stethoscope to listen to the joint movements and could hear a click when she opened her jaws.

Her muscles were tender, but the joint was affected. The next thing I did was to find out the reasons behind it.

On further conversation, it was understood that the patient semi consciously clenched her teeth, at the time of stress. After prolonged discourse, I was able to elicit the real culprit behind the ailment stress.

“You are suffering from Awake Bruxism”, I unequivocally declared.

She confirmed my statement by adding that she did occasionally hear small clicks in her ears. The patient was convinced of my diagnosis.

“So, what next…? can I get cured…?” Anxiety boomed in her voice.

I explained her that I would first check for any abnormalities in her bite and would then take a record of her teeth and fabricate an appliance for her to wear.

The appliance known as a hard splint would help hold her teeth, jaws and muscles in a relaxed position. This would help subside the pain gradually.

The patient was convinced of my treatment strategy and hence agreed to it.

Impressions of upper and lower teeth were made and soon the splint was worn by the patient.

A few months later, the patient came back for a check up. Hurrah! The change was very evident. I saw a beaming face, filled with a smile and confidence.

Her pain had vanished and she was attending a counselling program, which had helped her deal with stress in her family and professional life.