Common Causes of TMJ Syndrome, Nocturnal Bruxism

TMJ Syndrome (also known as “TMD” and “TMJD”) includes diverse symptoms caused by reflexive actions of the muscles of biting and chewing. It comes from brain-muscle conditioning (“muscle/movement memory”) caused by trauma and/or stress.  The term, “TMJ”, refers to the Temporo-Mandibular Joints — the jaw joints.

As with all conditioning, proper training techniques can alter the conditioning that controls the muscles of biting and chewing. An accelerated training process, clinical somatic education), dramatically reduces the time needed to correct TMD/TMJ Dysfunction by retraining the muscle/movement memory that controls biting and chewing.

Dentists commonly categorize TMD/TMJ Dysfunction into different types: joint arthritis at the temporo-mandibular joint (TMJ), muscular soreness (myalgia), articular disc displacement, and bite deviation.

All of these conditions reduce down to the same cause: muscle/movement memory that keeps the muscles of biting and chewing tight.  The same approach can resolve them all (except for “disc displacement without reduction”, which is a surgical situation).

Let’s see how.

Degenerative Arthritis
Degenerative arthritis of the TMJ does not just “happen by itself”, nor does it result from outside influences, like an infection.

It results from excessive compression forces upon the TMJ, imposed by chronically tight muscles of biting and chewing. The joint breaks down under pressure.

Treatment must therefore retrain those muscles to a normal, low tension state, to be effective.

Muscular Soreness (Pain)
Chronically tight muscles develop muscle fatigue — the common “burn” that people go for in athletic training.  People with TMJ Dysfunction experience pain in the ear or on one side of the jaw, from this condition.

Symptoms disappear nearly instantly, once muscles relax. For a lasting reduction of muscle tension and burn, a training process is needed. Faster and slower training processes exist. 

Articular Disc Displacement
The articular disc of the TMJ is a pad that rides between the lower jaw (mandible) and the underside of the cheek bone (zygomatic bone), which goes from below the eyes, in front, to just before the ears on both sides. The TMJ, itself, is located just in front of the ears, and although the TMJ is the “home” position for the lower jaw, the TMJ is a very free joint. The cheek bone acts as a kind of rail along which the lower jaw rides forward and back during jaw movements, out of and back into the temporo-mandibular joint. The articular disc pads the contact between the lower and upper contact surfaces, connected to the lower jaw by a ligament with some elasticity.

When jaw muscles are chronically tight, the articular disc gets squeezed between the two surfaces, upper and lower, and may get dragged out of place by jaw movements (displacement) — a very painful condition.

If the displaced position of the disc is within the rebound capacity of the attaching ligament, the disc can return to its home position (“disc displacement with reduction”), once excessive compression forces ease. If the ligament gets stretched past its rebound capacity, the disc stays out of place (“disc displacement without reduction”).

Bite Deviations
Bite deviations do not, in themselves, cause of TMJ Dysfunction, but they are a manifestation of it.  However, when combined with excessive tension in the muscles of biting and chewing, the sensation of bite deviations get magnified, experienced as the sensation of “misfit”; grinding motions (bruxism) are actually a seeking for the comfort of a fit in a rest position, which is unavailable due to the feeling of upper and lower jaw misfit that bite deviations create.

While something radical like surgery may seem to be a necessary option, it is usually sufficient (and necessary) is to bring the jaw muscles to rest. To do so increases the tolerance (i.e., comfort) of the mismatched situation to the point where it is not disturbing.

The means to do this involves retraining muscle/movement memory of the muscles of biting and chewing.

Trauma
The underlying condition for the others, trauma (a blow to the lower jaw or dental work) triggers the muscles of biting to tighten (“trauma reflex”).

Gum chewing is not a cause, in itself, of TMJ Dysfunction.

I say more about trauma, below.

Conditioning Influences
The jaw muscles, like all the the muscles of the body, are subject to control by conditioned postural reflexes (muscle/movement memory), which affect chewing and biting movements. The reason people don’t go around slack-jawed and drooling, for example, is that a conditioned postural reflex causes the muscles of biting and chewing always to remain slightly tensed, keeping jaws closed. People’s jaw muscles are always more or less tense, even when they are asleep — but the norm is very mildly tense — just enough to keep the mouth closed and lips together.

The degree of tension people hold is a matter of conditioning.

For brevity, I’ll discuss only conditions that lead to TMJ/bruxism and not the normal development of muscle tone in the muscles of biting and chewing.
These influences fall into two categories:

• Emotional Stress
• Physical Trauma

I don’t know of empirical studies that prove which of these two causes is the more prevalent, but from my clinical experience, I would say that physical trauma (and tooth and jaw pain — which induces people to change their biting and chewing actions, and which becomes habitual) is the more common causes of TMJ Syndrome, and also dental surgery, itself. (Consider the jaw soreness that commonly follows dental fillings, crowns, root canals, etc. — soreness that may last for days.)

Emotional Stress
Ever heard the expressions, “Bite your tongue”? “Grit Your Teeth”? “Bite the Bullet”? “Hold your tongue”? “Bite the Big One”? They all have something in common, don’t they? What is that? To someone who regularly represses emotion or the urge to say something, these expressions have literal meaning.

Such repression, over time, manifests as tension held in the muscles of speech — in the jaws, mouth, neck, face, and back — the same as the muscles of biting and chewing.

Physical Trauma
Although people experience trauma to the jaws through falls, blows, and motor vehicle accidents, the most common form of physical trauma (other than dental disease) is dentistry, itself, and it’s unavoidable. Dental surgery is traumatic. The relevant term is “iatrogenic” — which means “caused as a side-effect of treatment”. Every dental procedure (and every surgical procedure) should be followed by a process for dispeling the reflexive guarding triggered by the procedure. (See the video.)

No doubt, this assertion will cause much distress among dentists, and I regret that, but how can we escape that conclusion?

Consider the experience of dentistry, both during and after dental surgery (fillings, root canal work, implants, cosmetic dentistry, crown installation, injections of anaesthetic, even routine cleanings and examinations). Consider the response we have to that pain or even the expectation of pain: we cringe.

We may think such cringing to be momentary, but consider the intensity of dental surgery; it leaves intense memory impressions on the nervous system evident as patterns of tension. (Who’s relaxed going to the dentist? — or coming out of the dentist’s office?) The physical after-effects show up as tension in the jaws and neck, and often in the spinal musculature, as well — and as a host of other symptoms.

Let’s go back to our fond memories of dentistry.

If you’ve observed your physical reactions in the dentist’s surgery station, you may have noticed that during probing of a tooth for decay (with that sharp, hooked probe they use), you tighten not just your jaw (can you feel it?) and your neck muscles, but also the muscles of breathing, your hands, and even your legs. It’s an effort to remain lying down in the surgery station when, bodily, you want to get up and get away from those instruments and the dentist or hygienist wielding them.

With procedures such as fillings, root canal surgery, implants and crown installations, the muscular responses are more specific and more intense. It’s important to ask your dentist about the best way to whiten teeth has never been more popular, even amongst the 50+. For teeth near the back of the jaws, we tense the muscles nearer the back of our neck; for teeth near the front of the jaws, we tense the muscles closer the front of the throat, floor of the mouth and tongue.

This reflexive response has a name: Trauma Reflex.

Trauma Reflex is the universal, involuntary response to pain and to expectation of pain.

It centers at the location of the pain at the time of trauma and is linked to our position at the time of pain. Muscular tensions form as an action of withdrawing, avoiding, or escaping the source of pain:  tensions of the jaw muscles, neck, and shoulders, with muscular involvement all the way into the legs.

In dentistry, with the head commonly turned to one side, in addition to the simple trauma reflex associated with pain, we have the involvement of our sense of position, and not just the muscles of the jaws are involved, but also those of the neck, shoulders, spine.

All of these conditions combine into an experience that goes into memory with such intensity that it modifies or entirely displaces our sense of normal movement and position. We forget free movement and instead become habituated or adapted to the memory of the trauma (whether of dental work or of some other trauma involving teeth or jaws). Our neuro-muscular system acts as if the trauma is still happening, even though, to our conscious minds, it is long past, and the way it acts as if the trauma is still happening is by tightening the muscles that close the jaws.

Since accidents and surgeries address teeth at one side of the jaws or the other, the tensions occur on one side of the jaws or the other. Thus, the symptoms of such tension — jaw pain, bite deviations, and earaches — tend to be one-sided or to exist on one side more than on the other.

The proof of the role of trauma reflex? — the permanent changes of bite and tension of the muscles of biting that have behind them a history of dental trauma — and the changes you see in the video that occur as this man is relieved of those conditioned postural reflexes.

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RELATED ARTICLE:  Symptoms of TMJ Syndrome
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