clenching teeth at night - help!

[sadpanda]

I think I've always clenched my teeth at night, but I notice it more with braces because when I open my mouth from biting so hard, it really hurts. Is there anything to keep me from doing this when I'm sleeping? I went to a drug store and found mouth guards or something similar, but they all say that you shouldn't wear them if you have braces. Do you think my ortho could help? Any advice? Thanks!

[farmboy]

sadpanda,

I'd bring it up with the orthodontist. And out of curiousity, why shouldn't you wear some kind of bite device with the braces? Does it negate your teeth movement?

In my case, I got braces in part because I had a grinding problem. It seems I do grind less since getting banded (which is good, since I can't wear a splint with my braces, I'm told, but I wasn't told why).


Good luck!

[Talulah]

I think I've always clenched my teeth at night, but I notice it more with braces because when I open my mouth from biting so hard, it really hurts. Is there anything to keep me from doing this when I'm sleeping? I went to a drug store and found mouth guards or something similar, but they all say that you shouldn't wear them if you have braces. Do you think my ortho could help? Any advice? Thanks!

I don't know if I clenched before the braces, but I definitely do now... My jaw is exhausted in the morning, and I sometimes wake up in the middle of the night because of this.
Let me know if you find something to help with this!

[itsabouttime22]

I think I might be doing something similar-although I can't be sure. I have never had grinding or jaw issues before, but the past few days the left side of my jaw is really sore. I don't even notice it at night, but throughout the day it will hurt off and on (especially if I yawn). Is it common to have jaw issues when braced even if you never had them before?

I go for my first adjustment Thurs, so I will bring it up with my ortho and let you know what she says.

[sadpanda]

Thanks! Any advice would help. I just noticed that I clench a lot even during the day. I always suddenly realize that I'm biting down really hard, so I relax my mouth and it hurts. I feel like I'm doing something that is going to have really negative consequences in the future, but I can't stop doing it.

[drrick]

That is because clenching is involuntary. It comes from a sign in the brain.
Most people that clench during ortho tx were also clenchers before but may not have noticed it or the symptoms (headache, neckache, jaw muscle soreness, etc.) many will think the symptoms are from something else for ex sinus problems.

[sadpanda]

Hi Drrick -

Does this mean it's impossible to stop the clenching? Does it have any other consequence besides pain? I realize that I was definitely a clencher before braces, but I never thought of it as a problem until now.

[alimommy1]

Is there a way to stop clenching? I don't do it all the time, but I've noticed you can't really stop it, it just.. happens. I don't remember having a problem with it when I had braces but I do it now - that's why I want to improve my bite so I don't make the edges of my teeth uneven, grrrr.

[WoodWillow]

When I had my braces on as a teenager, I wore a bite plate to keep me from grinding at night. It looked just like my molded post-braces retainer except for the dips for each bracket.

Nothing like being an awkward 13 year old girl at a birthday sleepver with braces AND a retainer. I took a lot of bathroom time! LOL

[drrick]

Hi Drrick -

Does this mean it's impossible to stop the clenching? Does it have any other consequence besides pain? I realize that I was definitely a clencher before braces, but I never thought of it as a problem until now.

That is more or less correct. You cant really stop it but you can mimimize the damage it causes (whether it be pain, tooth wear, cracked teeth, etc)

I usually recommend an NTI device (and I wear one myself) as it reduces the intensity of your clenching. Now you typically cannot wear one with braces but if you have a deepbite placing BU's (turbos, bumps, etc) behind the 2 front teeth can give a similar effect. I have also been researching using botox to help minimize the amount the muscles can 'fire' thus reducing clenchin intensity.

[overfortyish]

Being a longtime sufferer of TMJD (possible causes are my bad bite AND periods of intense stress in my life) and suffering with having cracked a tooth and subsequently had a root canal in that tooth (a molar) which did not work and I eventually had it extracted - as well as major left sided pain in my TMJ and that entire area, headaches, and very TIGHT jaw muscles that cause major neck pain - I have met with a # of doctors/orthos about this issue. I never could find anyone who uses the NTI and I've read alot about it and thought it sounded like a great idea. I did find someone nearby me by going on their website, and I might look into using him.

BUT - and I'd ask this of Dr Rick, how do you treat the TMJD with the NTI but also treat the underlying cause - which is POSSIBLY a malocclusion? I know thousands of people suffer with TMJD for no apparent reason as well. For me, I think it is a combo of things but mostly and unstable bite, that is a crossbite and maybe the open bite too?

If I seek out treatment with the NTI device - won't my pain just return once I get braces??

[drrick]

The CAUSE isnt necessarily the maloclussion. It is the clenching itself.

There are people with HORRIBLE occlusions with no TMJ problems and people with PERFECT occlusions with significant TMJ problems.

That isnt to say the occlusion cannot be a contributing factor (for ex a deep bite with retroclined incisors can give the pt a gret place to clench against) but if you supress the clenching you would be surprised how much relief you can get.

Personally I wear an NTI, so does my wife and one of my assistants (and many former assistants)

We have helped many migraine sufferers, neckache sufferers and those suffering pain from facial musculature.

In fact my TMJ ortho protocol now is if I cant get you comfortable in an NTI I wont put braces on. That isnt to say everything can be 'corrected' with this device but if it cant I let others docs treat.

[overfortyish]

We have helped many migraine sufferers, neckache sufferers and those suffering pain from facial musculature.

GREAT to know! But - can't the NTI actually shift the bite? It says on their website it is a possibility and not all patients with malocclusions are candidates.

>In fact my TMJ ortho protocol now is if I cant get you comfortable in an NTI I wont put braces on. That isnt to say everything can be 'corrected' with this device but if it cant I let others docs treat.

So with someone who has a bad bite and an open bite you would not use the NTI to get them comfy and then put on braces??? Would you do restorations instead?

I've been told I have the following;

Class II Dental
2mm overjet
2mm anterior open bite
Moderate lower crowding
Severe upper crowding
Bi-lateral posterior cross-bite
(Missing all first pre-molars)
Missing lower 2nd molar (had that removed due to failed root canal therapy on fracture tooth)

We've also discussed my open bite could be due to a tongue thrust.

Do I try to treat my TMJD discomfort with the NTI first? Or do braces? Or not do braces at all?

Any thoughts??

[drrick]

Personally I would start you in the NTI if there was a jaw issue.
Get you comfortable first and then proceed with braces (if desired)
Your nightime retainer would have an NTI built in

If you go the restoration route instead of braces I would do the same thing...get you comfortable in the NTI, do the restorations, have you wear the NTI at night afterwards.

[drrick]

also, just because I would likely do it that way does not mean someone else would do it differently. That is just how I tend to approach these situations.