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How To Know If You Have A TMJ Problem With Your Bite

Problems with the way your teeth fit together occur in many different ways. Some bite problems cause discomfort or even pain, and that pain can masquerade as problems that you would not readily associate with your teeth. Some bite problems can cause major damage to your teeth without producing any obvious discomfort.

There are some pretty simple ways that anyone can detect TMJ when a problem with the bite is causing or at least contributing to pain or discomfort.

The clench test: With your mouth empty so there is nothing between your teeth to bite on, close your teeth together and squeeze hard. If clenching your teeth together causes any sign of discomfort in any tooth, you have a disharmony in your bite.

Teeth that are sensitive to cold often get that way from the extra pounding they take if any part of that tooth strikes before the rest of the teeth contact during closure. Use the clench test to see if the extra sensitivity is related to an uneven bite. Squeeze hard. If you can make any tooth hurt by empty mouth clenching, the bite is probably the main reason for the sensitivity. This is a good way to find out if a new filling or crown is "high." If it hurts when you clench, it is probably not in perfect harmony with a correct bite. You should be able to bite hard and grind your teeth together in all directions without feeling discomfort in any tooth if your bite is perfect. The exception to this is if you have advanced periodontal disease, you may have several teeth that can't accept firm biting, but even then, you should not normally feel pain in a single tooth when biting.

If biting hard causes pain or discomfort in the jaw joint, (you may feel it just in front of your ear), you can suspect a possible relationship between your bite and a temporomandibular joint (TMJ) problem. It may be associated with a structural disorder in your TMJ, but more often the pain is coming from certain muscles that move your jaw joints to accommodate a bite that is not in harmony with your TMJs. Your dentist should be able to diagnose the exact source of the pain.

Look for severe wear on your teeth, as this is another sign that your bite is not in harmony. If you have worn all the enamel off the biting edges of your teeth, you will see a darker colored surface. This is dentin and it will wear down seven times faster than the much harder enamel that you've already worn through. So ask your dentist to evaluate what is causing so much wear. This wear can be especially damaging when it is on your front teeth, so if you notice your lower front teeth have worn down to dentin, have your bite checked. Better yet, don't wait till all the enamel is gone. Schedule a visit to your dentist office. Correcting your bite may stop or at least slow down the wear process.

By Peter E. Dawson, DDS

What Occurs During A Dental Examination

During a dental examination, the dentist examines the soft tissues of the mouth for any abnormalities or pathology (including oral cancer), the teeth for tooth decay or defects, the gum tissues for periodontal (gum) disease, the neck for swollen lymph nodes, the amount of plaque, tartar, and debris on teeth, as well as the need to replace any missing teeth or dental prostheses. Regular examinations by a dentistry professional are crucial to maintaining your dental health and are a necessity in any dental care plan.

Dentists begin the dental examination with a complete dental and medical history, including medications the patient is currently taking. The skin of the face and neck is examined for any abnormalities, especially pigment changes. The lymph nodes in front and behind the ears, under the floor of the mouth and chin, and the midline of the neck, sides, and back of the neck are palpated to determine if any swelling or tenderness is present.

Inside of the mouth, the lips, cheeks, gums, and roof of the mouth are inspected and palpated. During this process, the tip of the tongue is placed on the roof of the mouth just behind the upper teeth for inspection of the front floor of the mouth and sides of the tongue.

The back floor of the mouth, the area behind the lower wisdom teeth, and the back sides of the tongue are inspected by grasping the tip of the tongue with a small gauze sponge and pulling the tongue forward and toward the opposite side of the mouth.

To inspect the back of the throat, soft palate, and tonsil area (sides of the throat), the tongue is depressed with a dental mirror or tongue blade and then a deep breath is taken by the patient.

To detect swelling on the floor of the mouth, the area inside the mouth is felt with the finger of one hand while a finger of the other hand feels below the chin. Salivary gland enlargement, saliva flow, or xerostomia (dry mouth) are determined by milking the major salivary glands to assess the quantity and consistency of saliva.

Today's dentist has many analytic tools available to pinpoint dental and oral diseases. The basic tools are the dental instruments, lights, and radiographs (X-rays). Depending upon the dentist and the individual's dentistry needs, additional diagnostic tests are available. Testing for essential proteins and buffering capacity can evaluate the protective ability of saliva.

To determine tooth decay risks, microbiological testing of saliva can measure the level of decay-producing organisms. Periodontal susceptibility tests, which test for the DNA of gum disease-producing organisms, can be performed to assess an individual's risk for gum disease.

If removable dentures are present, dentists check them for bite, retention, stability, and overall fit. Dental impressions or models also may be taken to study the mouth and tooth structures to initiate fabrication of prostheses. Photographs may be exposed for a variety of reasons, including before and after treatment comparisons.

The level of oral hygiene and home dental care practices are assessed and reviewed. Recommendations for home care devices and products may be made. Instruction and methods for maintaining a good oral hygiene regimen can also take place.

Once basic information about dental health status is gathered, the dentist will be better able to discuss dental care plans that are available.

By Denise J. Fedele, DMD, MS

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