In Wellington three years ago I was privileged to help teach a course on the Temporomandibular Joint, known better to most as the jaw. Only hours before the course, the people of Great Britain had opted to exit the European Union in what has become now a word for the next Oxford Dictionary — Brexit. While we pondered the impact on the world and New Zealand from Brexing, we learned about Bruxing, the nocturnal grinding of teeth and the possible cause from the jaw joint itself. "So what" you may utter through clenched teeth, but wait, consider the eerie similarities:
Brexing: a process of separation, with to and fro negotiations, potentially years in the making.
Bruxing: the coming together of teeth in a frictional back and forth way, years in the making.
Brexing: the state in question will not get into bed with its neighbours.
Bruxing: the person in question is likely not to be invited to bed with the significant other party.
Brexing: waking up every day after the referendum with significant discomfort.
Bruxing: waking up after a night of grinding in significant discomfort.
Brexing: for the Bremain camp, much gnashing of teeth followed.
Bruxing: characterised by much gnashing of teeth.
Brexing: While 100 per cent of Britons are affected by Brexit, 51.8 per cent of Britains actually Brexed.
Bruxing: Ignoring the unreliability of self reporting, Manfredini found between 8 and 31 per cent of people brux, 100 per cent of spouses are affected by a bruxing partner.
As you can see Brexit becomes a fitting analogy or parallel for the one who Bruxes.
Bruxism, a peculiar word, comes from the Greek word ebryxa, which contributes to the root word brykhein, meaning to gnash or grind the teeth at night. It does not coincidentally come from Bruxelles or Brussels, which is Belgium's capital, the home of the European Union.
Britain has wittingly allowed itself into a tight corner, that will create some stress and tension for a while before things get better. So too the jaw, we propose, has become physically restricted by tightness, forced into a corner, altering the ligament that stabilises the jaw in the resting mouth position.
The horizontal fibres of the capsular ligament complex do a fantastic job of guiding the jaw as it moves from closed to 5mm of opening. It also allows the jaw to rotate back on one side and forwards on the other to support the sideways movement known as translation. A tight ligament can develop after trauma such as car accidents, jungle gym face plants, Saturday night fisticuffs or tooth extraction, especially in complicated wisdom teeth removal. The ligament gets sprained and heals with inferior scar tissue. Slowly over time this can impact the functioning of the jaw and its disc. It can also develop with stress and sometimes have no clear reason whatsoever.
In bruxing, it is thought that the tight ligament pulls the jaw hard against the front of its socket. If it stays there a long time the ligament will adapt by shortening. It's easy to see this process in action in another situation. Phone your grandmother and ask her to tell you about her childhood. Keep your elbow bent holding your phone and don't switch arms. Allow a good hour of nostalgia then say your farewells. Notice how tight your elbow feels. Tissues tighten when held in short positions. This is true in the calf and high heel wearing also. Another story for another time maybe. Imagine if that jaw ligament is snuggled up to the front of the joint for years.
That still doesn't explain the grinding, however the astute among you may be thinking that the teeth won't be lining up as nicely if the jaw shifts forward. Now in the night time, if you are able to sleep with your mouth shut, the brain senses the incongruity of the tooth contacts — they just don't line up. It pulls the jaw back in the socket to rectify the imbalance. The digastric muscle does this nicely. Things seem right, now to sleep and relax, but wait, the tight ligament pulls the jaw back and the classic tug of war battle ensues, to be contested all night, or until the mouth drops open to snore or breathe. Yes, I can hear you thinking "simply shove plugs in the nostrils" and you will never brux again. What an idea, but it doesn't solve the problem of the tight ligament, which will go on to cause clicking, then clunking, and maybe locking. Think of the dry mouth as well.
Okay, so what about protecting the surfaces of the teeth with a mouth guard? Seems like a fair solution doesn't it? Alas, once again, the joint will be compromised by pushing the "ball of the joint" forward into the front of the socket causing adaptive tightening, but simultaneously protecting the teeth. Catch 22 situation: symptom-atically solve the issue of teeth wearing down to stumps, while simultaneously compromising joint function.
I propose the solution of physiotherapy salvages both. Treat the cause of the bruxing, the tight ligament, and end the incessant wearing down of the precious teeth.
I was privileged to be asked to speak to a room full of dentists and oral surgeons in Palmerston North in 2017. One in particular spoke of his frustration with treating Bruxers. I think he was sceptical that there was a fix out there and I guess by implication he was having difficulty in getting successes in this population. "If you can fix bruxers I will send you all of mine!" He is now sending me bruxers and other jaw problems from Wellington.
Calling all bruxers. Come and get your horizontal ligament seen to. What have you got to lose? One of my patients showed me the bite splint that his dog bit — obviously the dog thought it was a family bite splint. If you can eschew your splint (excuse the pun), there is a splint eating dog in this very city that has a home for it.
Temporomandibular Joint dysfunction is successfully treated conservatively in the bulk of cases. The oral surgeon I mention is loathe to operate on a difficult delicate biomechanical wonder, and is happy to send Wellingtonian patients up to our little paradise for some timely relief. Watch out for them. I send them to all the best shops in town.