STRESS AND ITS EFFECT ON THE TEMPEROMANDIBULAR JOINT COMPLEX
Stress forms an undeniable negative consequence of or life due to our current lifestyle. And it portrays itself in our day to day activities physically or psychologically. Stressed people are always complaining of headaches, neckaches, sleeplessness, lethargy, etc. They end up with constant clenching, bruxing or even snoring! How do we dentists cope with it?
Firstly, we need to understand the dental consequences of stress. Any human being, when stress steps in, clenches. It is the neural feedback mechanism that forces our voluntary masticatory muscles to go from isotonicity to hyper tonicity. Unwanted forces on the teeth will lead to their wear and tear.
So what is the difference between clenching and bruxing? Bruxing is a term we normally denote to night clenching. Teeth clenching or grinding -- a behaviour known as bruxism -- is a common problem that can lead to broken teeth, enamel damage, headaches, and temporomandibular joint (TMJ) disorders. The term "bruxism" comes from the Greek word "brychein," which means "to grind or gnash the opposing rows of upper and lower teeth." The American Academy of Orofacial Pain defines bruxism as "diurnal or nocturnal parafunctional activity which includes clenching, gnashing, gritting and grinding of teeth."
Sleep bruxism is simply put a mechanism to save the patient from breathlessness during sleep. Since the tongue is attached to the mandible, any changes in the mandibular position is going to affect the position of the mandible as well. When we sleep all the muscles in our body go to rest or relaxed mode. In that supine position of sleep with the relaxed muscles, the mandible tends to fall backwards dragging the tongue along with it and hence blocking the airway. The clenching or bruxing keeps the mandible in the forward position so as to leave the airway open. This disorder is more prominent in Obstructive Sleep Apnoea (OSA) or Upper Airway Resistance Syndrome (UARS) patients.
Any muscle in constant hyper tonicity ends up being hypertrophic. Hypertrophic muscles shorten and in our case the masticatory muscles and most of all the lateral pterygoid. The disc in the TMJ complex is mainly the extension of the superior head of the lateral pterygoid muscle. When the muscle shortens, the disc is pulled forward and hence cannot be recaptured by the condyle during any mandibular movements ending in clicks or in worse situations, locked jaws. This, finally, results in TMD.
90% of all bruxers end up with TMD but not all of them end up symptomatic with myofacial pain or neck aches or postural problems. We, as dentists, first need to appreciate the fact that the TMJ forms the first point in the postural chain. So, any discrepancy in our bite would eventually turn up as back pains, leg cramps, snoring or even cardiac problems.
As is our protocol as a dentist, we provide these patients with acrylic night guards, with a notion to protect the teeth. But we need to open our thinking horizon and start considering the overall health and wellbeing of the patient, as the TMJ would be the next part of the body to disintegrate.
So, stress needs to be approached in a multi-faceted way. We need to consider the psychological aspects of the patient but equally important is the available airway space. When we deliver just a night guard we ensure relief only for psychologically stressed out patients. When these patients have an airway obstruction, the night guard is not going to be of any help as it would not hold the mandible in the forward position. These are the patients whose night guards are changed every 6 months or so as they wear out.
What needs to be done is provide these patients with oral sleep appliances that keep the mandible in the forward position. And the bite registration is the focal point.
Although stress has always been a thorn in the treatment of TMJ disorders, neuromuscular dentistry has been successful enough to fight its way for the betterment of the patient. But it needs to be tackled with the help of our colleagues such as the ENT, who needs to clear the patient of any other airway obstructions; the psychologist, to help the patient deal with the causes of the stress; the neurologist, who can delete any possibility of any other syndromes.
Everyone stresses out at some point of time in their lives. It’s up to each individual to learn to overcome it. So, let’s all enjoy life, forget stress and live a happy life.
Breathe well, bite well, live well!
I used to have constant headaches for nearly 20 years. I've met lots of ENT surgeons and neurologists and have been consuming their medicines until I heard about Dr. Raj's NMD therapy from a friend of mine who got cured by him. I am really thankful to him for freeing me from my aches. I never realized my tiredness during any physical activity could in any way be related to my snoring.