Everyone has heard of teeth grinding and clenching. To oversimplify it, there are “cows” and “rats.” Cows chew side to side and have flat teeth. These are our grinders. Rats bite straight up and down and have pointy teeth that maintain their anatomical shape. These are our clenchers.
There are generally two types of materials for oral appliances used in these patients: soft, resilient, rubbery materials and hard plastic materials. For our “cows” or grinders, we can use soft or hard. The soft mouth guards act to protect the teeth from further wear.
For our “rats” or clenchers, if we use a soft material, the brain thinks that there is food between the upper and lower teeth as it has a chewy consistency. Accordingly, it orders the muscles to exert more force. As it realizes that it is still not breaking down the material between the teeth, the brain sends more signals to the muscles and the problem worsens. It’s as if we are working out and our muscles are cramping up. It feels like a Charlie horse due to the buildup of lactic acid in the muscles.
A hard appliance is more appropriate in this situation. There is a neuro feedback loop called the incisive reflex. The incisor teeth in the front are innervated in a way so that if there is something really hard in between the upper and lower incisor teeth, they send a message to the brain. In an attempt not to break the teeth, the brain sends a signal to inactivate the elevator muscles and activate the depressor muscles. For example, if you have a fork in between the upper and lower teeth and you inadvertently bite down, the signal goes to the brain and it, in turn, tells the muscles “don’t bite down on the fork, you will break the front teeth!” By using a hard appliance, we take advantage of this incisive reflex and, as these signals get conducted, we can deprogram the muscles so that they are not hyperactive. With consistent use, the clenching, along with the teeth soreness and headaches resolve.
Can I tell you a story? Rachel is a college student with a gorgeous smile. When she opens her mouth wide you can hear a loud popping from across the room. She had braces for 4 years. The poor girl is miserable because her joint is so deranged, it is a struggle to eat anything that requires her to open her mouth more than a half an inch.
When she opens, she does so in a serpentine fashion. Instead of opening straight down, she must negotiate some obstacles in her joint and her jaw goes into a zig-zag pattern. She has disharmony of the joint, ligaments and muscles that, in time, lead to degeneration of the joint and more advanced issues.
She is a clencher, so the appliance of choice is an upper hard appliance that is worn every night and as much during the day as possible. It has a flat surface so the lower, naturally pointy teeth cannot find that sweet spot where they fit together like a puzzle in that unhealthy position.
Therefore, with the teeth effectively totally out of the equation, the jaw can move freely wherever it wants to go. Now it can organically suspend where the muscles, ligaments and joint really belong. The joint can go in its happy place; down and forward. This will allow more blood flow and promote natural healing.
Jimmy Kilimitzoglou, DDS, FACD, FPFA, DABOI, MAGD, FAAID, FICOI
ESI Healthy Dentistry
42 Terry Road, Smithtown, NY 11787
Tel (631) 979 7991 / Fax (631) 979 7992