Treatment Options for Bruxism and Facial Pain

Do you clench or grind your teeth? Have you experienced bruxism? You are not alone. As much as 31 percent of the American population has dealt with the effects of bruxism.(1) For those of you that have sought treatment, you have likely ended up frustrated due to that lack of options available. In brief, the lack of treatment options is a direct result of the poor and inconsistent research regarding the condition and the lack of awareness of the viable options to treat symptoms of bruxism.

Causes of Bruxism and Facial Pain

Bruxism and facial pain often come and go. Interestingly this could be due to psychological stress.(2) This can explain the waxing and waning nature of the symptoms but does not make it less painful. Often the activity is subconscious, and the individual is not fully aware they are clenching or grinding until it becomes painful. Additionally, bruxism has been shown to be progressive in some demographics making it a lifelong concern.(3) Long-term clenching or grinding can lead to changes at the joint and ultimately temporomandibular joint dysfunction.(4)

Traditional Treatment Options for Bruxism and Facial Pain

Traditional treatment options include consultations with your dentist to explore the use of night guards and more recently splints. These cause an internal irritation when the individual attempts to clench or grind. Although these treatments have shown promise, the cost can be a deterrent. Specifically, the guards need to be fitted and customized and require routine maintenance. Physical therapy is another option, although as a practicing clinician that has worked closely with TMD patients for over 5 years. However, the long-term effects of physical therapy is marginal. Physical therapy treatment is geared towards symptom reduction and management as opposed to alleviation. Now, with technological advancements and more affordable and portable devices available, surface EMG has become a viable option.

EMG and Bruxism and Facial Pain Management

Surface EMG can detect superficial muscle activity and inform the individual of muscle activity above a pre-determined threshold. The muscles responsible for clenching and grinding are easily palpable on the surface of the jaw. Therefore these are prime candidates for use of EMG. Since the action of clenching and grinding are not conscious alerting the individual of the activity can be helpful in stopping the activity and allowing the symptoms to resolve.

To use, place the electrode on the masseter, the muscle that runs along the jawline near the cheek. Next, establish the level of threshold of muscle activity. This allows for some muscle activity which is normal and not setting the alert off every minute or so. Once the electrodes are placed and the threshold is determined, the device will alert the user when they are clenching or grinding. Eventually, the individual will become more aware of activities that are associated with clenching and grinding, the action itself and can take the necessary steps to decrease the activity.

So, the use of surface EMG can be used at any time to manage the symptoms and improve the condition. Based on the subconscious nature of the activity, the most effective use of EMG would occur before the onset of symptoms. This method allows for long-term management to reduce the return of the activity. The device itself does not treat the underlying cause or the symptoms, it simply alerts the individual of the activity to assist in stopping the activity, but as the saying goes, “knowledge is power.”

Sources

1. Manfredini D, et al. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain. 2013;27(2):99-110. https://www.ncbi.nlm.nih.gov/pubmed/23630682. Accessed October 24, 2018.
2. Hitoshi A, et al. Association between sleep bruxism and stress sensitivity in an experimental psychological stress task. Biomed Res. 2011;32(6):395-399. https://www.jstage.jst.go.jp/article/biomedres/32/6/32_6_395/_article/-char/ja/. Accessed October 24, 2018.
3. Strausz T, et al. Awareness of tooth grinding and clenching from adolescence to young adulthood: a nine‐year follow‐up. J Oral Rehab. 2010;37(7):497-500. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2842.2010.02071.x. Accessed October 24, 2018.
4. Kyung-soo N. Condylar bony changes in patients with temporomandibular disorders: a CBCT study. Imaging Sci Dent. 2012;42(4):249-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534180/. Accessed October 24, 2018.

About the Author

Corey Sylvain is a physical therapist with 16 years of experience working in outpatient orthopedic and home health care. He has advanced skills in manual therapy completing a residency program for manual therapy in the Kaltenborn approach. In addition to traditional physical therapy practice, he holds a masters degree in public health. Outside of his professional role he values living a healthy active lifestyle and the importance of family.

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