- The Washington Times - Wednesday, June 11, 2008

To all the other medical afflictions to which humankind is heir, add bruxism - teeth grinding, usually in one’s sleep - and temporomandibular joint (or TMJ) disorder, an affliction of the upper jaw. The two often are related, but either one alone may be enough to have you paying dental bills for a very long time.

The treatment for bruxism normally is having to wear custom-made orthotic devices called mouth or night guards to keep teeth from grinding together - and give a sleeping partner some rest while helping prevent loosening of teeth or the loss of precious enamel. These are molded plastic devices fitted by a dentist or periodontist that some patients wear for life.

Dr. Brad Schneiderman, a Washington dentist, calls the city “a heavy teeth-gnashing town,” citing “the stress and strains of D.C. in general.” He says “probably 25 percent of my patients are either night-guard wearers or could use one.”

You also aren’t off the hook if you are a laid-back woman who avoids cultivating a multitasking lifestyle because women are more likely (8-to-1) than men to be afflicted, says Dr. Arnold Binderman, a periodontist and TMJ specialist who practices in Bethesda and teaches at Harvard, New York University and the University of Michigan. “Women have laxer ligaments than men - a hormonal function, because women’s bodies can expand to have babies - and [the] TMJ requires tight ligaments to keep functioning.”

Dr. Binderman says he considers Washington a barometer of sorts for a problem frequently misunderstood even by some members of the medical profession.

Bethesda resident Debra Norberg, 54, suffered from a throbbing pain in her jaw for years and was told by her regular dentist to “just wear the mouth guard and things will be all right.”

“Dr. Binderman had a different approach, adjusting the guard periodically to change the way I would come down on my teeth,” she says, calling such treatment “real science.”

“People can grind or clench teeth during the day, but we can teach them to relax. At night, they have no control. People do wake themselves up [doing it], but normally your body gets used to this habit,” says Dr. Susan Karabin, spokeswoman for the American Academy of Periodontology, whose practice is “in high-stress East 61st Street Manhattan,” where she reports many patients wear night guards. “A lot more than in the past,” she notes.

She describes the appliance as a hard plastic material with a flat surface custom-made for a person’s bite “so when you grind, it allows you to slide your jaw without locking any individual teeth. … It’s almost pacifying and comforting. People become very attached to them and usually wear them forever.”

She describes TMJ disorders as “muscle spasms in the joint area, which come from stress or tension” so that “even when eating a big hero sandwich, you can dislocate your jaw for a second and stretch the jaw.” Depending on the exact muscles involved, exercises and medications normally are tried before any corrective surgery.

“When you think about it, we are living in a time with a constant background noise of war, and then you throw in bad economic times. You are living under different lifestyles and different stresses,” Dr. Binderman says. “There is a hookup between stress and muscle activity. A normal slight contraction called tonus helps pump blood through muscles. When you are stressed, that tonus gears up and, unknown to you, your muscles are overactive. Then you start to load them up with other things, and they don’t tolerate it, and you get to a symptomatic stage.”

On top of all the pressures, he notes, “certain drugs like Prozac and Effexor can make you grind your teeth to varying degrees. People aren’t always given warnings about this. You ask a physician about this, and sometimes he says, ‘What?’”

Some patients grind their teeth while they work out on exercise machines.

“They are competitive with themselves,” Dr. Binderman says. “They have to wear [mouth guards] while they work out. Women don’t like them, but they are clear plastic and don’t really show.”

The guards take up to 82 percent of the force off the joints, he says. They also relax the closing muscles of the jaw, the ones that usually ache.

Then, too, he adds, “about 35 percent of patients who experience rear-end whiplash injury get TMJ problems. A patient may complain of headaches or earaches, clicking or popping. The sooner the treatment, the better he or she will do.”

Dr. Binderman asks his patients to fill out what he calls a psychological screening test to see if a person suffers from depression or anxiety, discovering that “you can make the finest appliance, and if the patient is depressed, you won’t go anywhere.”

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