Anyone tackle nocturnal bruxism?

[balor123]

I've got nocturnal bruxism and have had it for much of my life. I started grinding in my teens and wore down much of my enamel. I seemed to stop grinding but at some point started clenching instead. I didn't notice it much until the last year or so, though it may have been going on for much longer. Anyone have any success tackling this problem? Its definitely worse when I eat late at night (after 7pm), I think because I'm getting reflux though I don't have many symptoms of it now otherwise. Going to bed at off hours seems to make it worse too (3am for example). However, little seems to make it go away altogether. I wear a night guard and have worn one for 20 years now. I had it remade earlier this year. My ENT suggests that its due to airway issues. An oral surgeon I'm seeing suggests it might be due to my bite (I have an anterior open bite and class 3 malocclusion). Another ENT and dentist said its stress and that I should consider anti-anxiety medication, which I haven't yet though I've strated seeing a therapist instead. What have you all tried? What helped and what didn't? Did it pass on its own and if so how long did it take?

[robysue]

I've worn (and chewed through) night guards for TMJ problems since circa 1986. The guards have always successfully protected my teeth from the harm of chewing and usually kept my TMJ headaches under control. The average lifespan of my guards started out at a bit less than 3 years. But by the mid-to-late 90s, it had shrunk to 18-24 months. So most of my guards were paid for 100% OOP since my dental insurance did not cover but one guard every five years or so as I recall. I never thought much of it and neither did my primary care dentist: I could afford a new guard every 18-24 months (he didn't charge me an outrageous price) and it worked.

Fast forward to fall 2010 when I started PAPing. Like so many other things in my PAP adjustment period, the combination of PAP and TMJ went counter to "common assumptions" Starting PAP triggered some extremely serious clenching, grinding, and chewing on my guard and it cracked in two within a few months of starting PAP therapy. The dentist made me a new guard about 4 or 5 months after I started PAPing (if I recall the timing correctly). And told me to let him know if I started doing serious damage to it. About this time I started noticing the TMJ pain was now noticeable all day long---even though I was using the guard nightly. And (with the dentist's permission) I started to wear the guard during the daytime when the pain was at it's worst as well as at night. And when the guard was less than 2 months old, I noticed a small crack. When I went back to the dentist, he told me that he was no longer comfortable treating my TMJ and that he wanted me to see a TMJ specialist. Turns out that was the best thing my primary care dentist could have possibly said to me.

The TMJ specialist did a lot of testing and bills under a medical code to my health insurance rather than my dental insurance. (Big plus for me.) He designed a full-fledged treatment plan that required a special guard that I wore 24/7 for a period of several weeks combined with a no chew diet and plenty of heat therapy to allow my badly injured TMJ to heal. And then a slow weaning off of the daytime use of the guard and a slow return to a normal diet. And even so, I wound up chewing through the guard. But the TMJs did heal and (eventually) things became really good as far as TMJ and grinding/clenching was concerned. It's now been just over 24 months since I first saw the TMJ specialist, but last March, when everything was going to hell in a handbasket (in terms of TMJ, migraines, tension headaches, and insomnia) I called the TMJ specialist's office and let them know the guard was in bad shape and the pain was returning. They got me in to see one of the techs right away and made me a new guard. And I chewed through it almost immediately. Since then, the TMJ guy has seen me a number of times and made me two more guards: The last guard he made is a different type and it took many more measurements and more effort to make and is made out of a different material. But it's now almost 2 months old and so far the chew marks are minimal. The TMJ guy's goal with this last guard was to design a guard that did NOT inadvertently trigger a positive feedback loop in my brain that encouraged the chewing/clenching like traditional guards seem to do. Apparently my teeth want to close one way and my jaws and TMJ's want to close a different way. The new guard had to be made in such a way as to keep both simultaneously happy so the part of the brain that responds to each input doesn't say, "we need to chew to get rid of this lumpy thing in the mouth that is making the (teeth/TMJ) not happy".

My advice is to find a specialist in TMJ and oralfacial pain who takes the time to work with patients to treat the underlying problem rather than a dentist who just fits the typical TMJ mouth guards.

[balor123]

I saw one briefly but he immediately set down the route of jaw surgery and full mouth reconstruction. He scared me when I asked what the downside would be and he said "well, none". He then referred me to an oral surgeon, who accepts no insurance and that set off a red flag in my mind.

What do you make of the TMJ association's recommendations? They seem to strongly advise against this type of treatment (phase 1, phase 2, and phase 3). For that matter, they seem to recommend against every treatment. It seems like every other dentist around here is a "TMJ specialist" and each has their own spin on things but I can't find very much data at all on the techniques. Anecdotally, examples like yours seem to be common. How do you evaluate these dentists? I like my dentist otherwise but she doesn't seem to think much other than the standard bruxism guard, which is inclined and adjusted for even contact. According to my biofeedback device, my old nightguard had about 30 clenches a night and now I'm at about 200 so it seems to me that the new one is worse but I can't go back to the old one anymore (which was flat) since it doesn't fit.

[robysue]

balor123,

You raise some really good and tough questions. I lucked out with the referral. I was not willing to have any kind of surgery and the TMJ specialist that I saw has never mentioned surgery. His background is dentistry with advanced training in oralfacial pain, NOT oral surgery. There are a couple of professional organizations for health care people in the oralfacial pain care area. I've forgotten there names and I'm off to teach a night class in a few minutes. I'll try to locate their names once I'm done for the night. It may be looking for someone certified by one of those organizations rather than an oral surgeon may be part of the solution.

Part of the problem seems to be an old problem in American culture at large: We Americans seem to value immediate potential solutions, even when they may be painful in the short run, but require little or no change in behavior on our part, rather than slow, incremental solutions that require real work, but are known to work. We want our problems solved yesterday. It's part of why there's so much reliance on surgical and pharmaceutical solutions to health care problems rather than behavioral solutions.

I lucked into a guy who treats TMJ through long term therapy. His goal is to allow the joints to heal. It takes weeks to months of commitment on the patient's part to eat a no-chew and then a low-chew diet. And to wear the guard 24/7 even though it does make you talk with a lisp at the start. And to remember to do the heat treatments. And to have the bi-weekly and then monthly follow-ups to track the progress on how well the TMJs are healing. I can see why a lot of TMJ patients would say at the start of this: Can't you just do some kind of surgery to fix the problem in one step?

All I can suggest is call around and ask questions. Tell the office staff you are looking for a TMJ specialist who does NOT use surgery as the preferred technique for treating TMJ problems. In other words, interview the docs in the way you'd interview any other contractor you planned on hiring for an involved and lengthy project. Make them earn the right to treat you. You may have to make and pay the co-pays for multiple consultant appointments. In the long run, if you're not happy after the first consult, it's wise to NOT go back.

[mrsbongo1]

Hi, Just starting to face this myself, been grinding my teeth for years and wearing night guards. Started CPAP in March of this year, TMJ pain was out of control by September, the neurologist I'm seeing is also a specialist is sleep dentistry. At my first appointment he ordered MRI of brain and neck, gave me exercises to do and a prescription for Cymbalta. Cymbalta is a med used to treat depression but also treats chronic pain. My TMJ pain was so bad I decided to give it a try since the pain pill and muscle relaxants were messing with my CPAP number and keeping my in a stupor most of the day. Cymbalta has been great, the stabbing TMJ pain is almost gone. I go back next week for test results and more treatment. But if your doctor wants to try cymbalta IMHO I would.
Kathy

[balor123]

I don't think I've ever heard jaw surgery and quick used together like that It's a 1-3 year operation. Cymbalta might be ok but its really a last resort option. I think my oral surgeon is right that the long term side effects of medication are probably worse than the surgery itself, at least for someone in early 30s like myself. With addressing the clenching, I suspect that long term outcome won't be good. That kind of wear takes its toll. An ENT suggested a mandibular advancement device. Anyone try that for clenching? I've got an aquaguard to try as well. Interesting to hear that there might be a correlation between CPAP use and bruxism. Mine didn't seem to restart until that point as well. I haven't seen any research along those lines. I've been thinking of trying a tongue advancement device as well. Given that I'm mostly hypopneas, might be enough even w/high AHI. How would I measure impact on sleep apnea absent a sleep study though? I have an overnight oximeter but at my age it doesn't show much - nadir desat was only 90% on my first sleep study, with most of the night +/-95%. It looked like at one point ContecMed was going to release another version with a nasal breathing sensor but that seems to have disappeared.

[fmj13]

Anyone have reviews of the most comfortable guards for this? I am having problems, so much so I can feel the effects during the day. I have had bruxism my whole life.

[balor123]

Here's things I've tried:
- Custom fitted grinding mouthguard from dentist
- Stabilization splint
- Aquaguard (have but not tried yet)
- SleepGuard. Helped but only a little.
- Sleeping upright. No impact.
- CPAP. Maybe restarted? Switched to nasal pillows from face mask, no impact.
- Physical therapy. No impact yet.
- Gabapentin. No impact.
- Flonase. No impact yet.

Next will try:
- Aveo. Hopefully won't bite my tongue off.
- Mandibular advancement device
- TADs to fix my open bite

[Coco_Pazzo]

Visited a Sleep Clinic for preliminary orientation prior to Sleep Study (after using CPAP for six year) and among the things mentioned was a new mouth guard + nasal pillow CPAP. Actually came on CPAPtalk to see if there was any discussion about its effectiveness.

Here's all I know about the device: mytappap dot com

[fmj13]

Visited a Sleep Clinic for preliminary orientation prior to Sleep Study (after using CPAP for six year) and among the things mentioned was a new mouth guard + nasal pillow CPAP. Actually came on CPAPtalk to see if there was any discussion about its effectiveness.

Here's all I know about the device: mytappap dot com

I saw that, no way I could do that. I am looking into getting a custom made mouth guard (just for grinding, not my apnea) after finding an adjustable Sleep Right too uncomfortable.

[purple]

For What is Worth: Not sure if it is related as I do not grind my jaw, but the pain sounds similar, and how it got solved. I started CPAP at straight 11, no pain. After awhile I started to increase my pressure, ending up at 15.5. Sometimes at night, and frequently during the day, I had a strong pain in the jaw joint, AKA TMJ. My doctor told me to see a Dentist, which cost money I did not have.

I did have a friend, who used to eat lunch once a week with a retired dentist. He said to take the first two fingers, and rub the TMJ in a circular fashion for a few minutes. I thought it was a stupid idea. For one thing, I wanted a permanent fix, not another ritual to add to my day. Besides, It HURT.

So of course, being desperate and poor, I tried what he said, and it did alleviate the pain for a few hours.

Two things helped to get rid of the problem. I became fanatical about brushing my teeth, using mouthwash, thereby getting rid of the bacteria in my mouth, jaw. Then I started on a bi level machine. That is, in my case, the problem was that the air pressure was a big culprit in the pain. Now I do not massage my TMJ in a circular way, and I do not hurt there.

None of this might be of any use to you guys.