Healthy Smile: The Pain is Somewhere Over There

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

I heard this complaint a couple of weeks ago, and the week before, I heard the following: “I have a toothache on both the bottom and top, and I can’t pick which tooth is hurting me.” And last and not least, “whenever I chew, I get a pain up to my ear.” Believe it or not, these statements are related and rooted in the same source. When I examined all of these patients, there was nothing glaringly wrong, either visibly or on an x-ray. Yet, all of these problems and issues stem from a biting problem or a misalignment of the teeth. Those who follow me regularly know my mantra regarding teeth and biting. It would be best to keep your teeth apart and your lips together when you are not eating. Teeth only are meant to come together when we eat, not at any other time. This is one reason why gum chewing is so bad for you. Your teeth clash in meaningless action. Chewing food is meaningful, and gum chewing is meaningless. In addition to gum chewing, grinding or clenching does not have any purpose. Your teeth meet and press on each other. These actions of clenching or grinding have far-reaching consequences.

First of all, those actions or habits put continual pressure on your teeth. According to Dental Health Directory Library, the human jaw can apply approximately 68 lbs/sq inch of pressure on the back teeth. If you intentionally clench your teeth, you may increase that force to about 150 lbs/sq inch. However, individuals who clench and grind their teeth subconsciously at night can place up to 1200 lbs/sq inch of force. Teeth were never meant to have continual pressure. The act of chewing applies forces, then lets up, and then re-applies pressure. The pressure is never constant for an extended time. These forces far exceed what a tooth is capable of withstanding. The result can be a fractured tooth, a loose tooth, or a tooth that requires a root canal, as the nerves and blood vessels inside the tooth are irreversibly damaged. Many of the crowns that I make for teeth are done on fractured teeth. These teeth fracture due to excessive forces. Often these harmful habits are the culprit.

In addition to the tremendous forces exerted on the teeth, the jaw bone also is a recipient of these forces. The lower jaw transmits its trauma from excessive forces to the muscles and ligaments that attach the lower jaw to the head. These delicate structures all come together right in front of the ear. This intersection of jaws and soft tissue is called the temporomandibular joint. We call it TMJ for short. Those three letters are mentioned a lot when people have non-descript jaw pain. It is not sinus; it is not tooth related; it is joint inflammation caused by inappropriate biting forces.

So what is the cause of these forces that wreak havoc in our mouths? Sometimes it is stress in our lives that stems from family or jobs. Some people get ulcers, others pull their nails, and others clench or grind. Let me take a moment to say that it doesn’t matter if you are a clencher, grinder, or both. These actions are all bad for you. So one solution is to eliminate the stress in one’s life, and the clenching, etc., get better. Many times that is easier said than done. Some of these oral actions become ingrained habits that are difficult to break. When such a situation exists, the dentist steps in and makes a custom fitted mouth appliance to either help you break the habit or protect your teeth from damage. There are many styles and shapes of these devices. A professional needs to assess you, make recommendations and fit you properly. A patient told me last week, “I was skeptical of your grinding hypothesis. Now that I am wearing a device, I feel great, and everything is comfortable. You have made a true believer out of me.”

So if you find that you have teeth breaking, fillings are always falling out, crowns are popping loose too frequently, or a toothache that you can’t pinpoint, call me at 440.892.1810. Together we can play detective and work on figuring out the problem. You only have one set of teeth; let’s do all we can to care for them.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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