TMJ / Night Guard Question from PatientBabble Lost Archives

Questioner: Pam
Subject: biteguard causing problem
Date Asked: 2012-10-01 13:52:00
Date Answered: today

Question:
QUESTION: Hi, I'm a tooth grinder so I wear a bite guard at night.  This has caused a new problem- something about the way the guard is designed makes me chew my cheek at night. My dentist has no ideas for how to solve the problem.
I have a few ideas but don't know how to pull it off.  I need to attach something to the guard to act as a shield between my cheek and my teeth OR something that would push my cheek a little bit farther from my teeth.  I am looking for solutions to the problem or suggestions for what to attach (I'm hoping fixodent would work). 

Any thoughts?

ANSWER: Hi Pam,

Forget the Fixodent idea for now.

A properly fitted night guard should fit snugly but not too tight.  There should be no magic tricks such as creating a "shield" between your teeth and cheek.

And since you mentioned Fixodent, I am going to guess that your night guard is a little loose, so that's why you think that.  But again, it should fit comfortably on your teeth and not move around or pinch.

Just curious.....is your night guard on your uppers or lowers?  Dentists have different opinions about whether the night guard should be worn on the upper or lower.  Personally, I wear mine on my uppers and I like it that way.

You mention that you are a teeth grinder, but did not say anything about TMJ (Temporal Mandibular Joint) disorder.  So for now, I am just going to assume that you are one of the millions of garden variety teeth grinders that we have in this country.

However, I am going to recommend that you find a dentist that specializes in TMJ.  Why? Because they have a lot of experience in making night guards.  Almost all dentists will say they can make night guards or treat TMJ.  But I don't want you to find a dentist that makes a couple of night guards a month.  I want you to find a TMJ specialist who primarily does this sort of work every day of the month, instead of a general dentist that is a jack of all trades.

Oh, and one more thing....a custom made night guard can be expensive.  Don't be surprised if it is upwards toward $900.00.  So skip the iPad this Christmas and invest in the night guard.  You'll be glad you did.

Good luck Pam and check back in with me on Allexperts.com.

Regards,
Jonathan
PatientBabble

---------- FOLLOW-UP ----------

QUESTION: What is the best way to find a tmj dentist?  
Also, my night guard is not loose, I was trying to come up with a way to attach a shield so my cheek cannot get trapped between the upper teeth and the nightguard on the lower jaw- that is what the fixodent was for (an adhesive safe for the mouth).
This is my second custom guard- I was chewing through the first (I also cracked it in 2 places). The first I paid out of pocket, the second was mostly covered by insurance, but they only cover one per lifetime so I would have to pay out of pocket if I get another. The second one was supposedly made from a harder material but I'm putting grooves in it regardless.
I'm angry that the guards do nothing to treat the problem, if I could afford it, I'd get a biofeedback device that beeps every time I clench my jaw to train me out of it.  Yes, it has given me problems with my ears and pain all the time and I've tried PT for it, but it didn't work.
Before, I was grinding through my teeth but my cheek never got caught. Now it is caught all the time. If I can find a tmj dentist that takes my insurance, I would certainly try that.  for now, I've ordered a boxing guard that covers both upper and lower in the hopes I can give my cheeks a rest!

Answer:
Pam,

I love these kind of questions, because I have seen it all.  While your specific question never happened to me, I feel confident that I can help you.

One of the things that I had mentioned in my original email was to find a dentist that makes these night guards constantly instead of once in a while.  The making of night guards is almost an art, which is perfected through lots of practice.  The night guard I am wearing now took my TMJ dentist about 4 or 5 visits of subtle adjustments and fixes until he got it just right.  This is normal for there to be a joint effort between dentist and patient in getting the right fit....and the comfortable fit.

You did mention that you are wearing your night guard on the lower teeth.  My NOT A DOCTOR opinion is that it works better when you have a night guard on the upper teeth. The reason that I think that is that your lower jaw can sort of float to it's natural position.....where as if you have the night guard on the lower jaw it sort of needs to find the upper teeth to form the bite.  This is all just my own personal experience.  Over the years I have worn night guards on top.....and night guards on bottom.  Personally, I prefer the top.

As far as finding a TMJ dentist, patient referrals are usually best.  Almost better than doctor referrals, because you can never be sure if a dentist has a reciprocal business arrangement to refer patients back and forth.  You can also think of the internet as your next best friend. You would be amazed at how helpful the internet can be in finding a doctor.  Put in search terms like....dentist....TMJ.....night guards, etc.  You need to be able to verify that the dentist is Board Certified.  Another good indicator is seeing what kind of training and university he/she went to.  Although not always the definitive indicator, I find it comforting to know my dentist went to Harvard.

Some of your comments made me think that maybe your uppers and lowers are not aligned properly.  Ask the dentist if he believes a TMJ MRI would be able to provide additional information.  If you do get an MRI.....make sure to specify that this is an MRI for TMJ.   I once went for an MRI and they did not do the "TMJ MRI".  It never occurred to me that there is a special kind of MRI for TMJ Patients.  So I had to go back and do it twice.....and because it was the doctors mistake not to specify the type of MRI, they did not charge me for the first one.

I have never heard of night guards cracking so easily.  Either it is not the best material or maybe your night guard was rocking/warped in a way that made you crack it, because it was not even.  My gut tells me that your temporary fix of using a boxing guard in the meantime would not be recommended.  Try and get to the right dentist as soon as possible to get your night guard professionally made......and try sleeping on your back if you can.

Good luck and check back in here at Allexperts.com.

Regards,
Jonathan
PatientBabble