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Mouthguards, Jaw Pain and Headaches

Mouthguards are plastic shields which fit over your teeth to act as a cushion or shock absorber in order to protect your teeth from injury. While most understand the need to wear these protective guards during contact sports, damage to our teeth also occurs slowly over time as a result of either habitual clenching of our teeth during the day, or subconscious grinding of our teeth when we are sleeping. This habit, termed bruxism, will over time cause damage and pain to our teeth and jaw joints and may even lead to frequent headaches.

What are Sports Mouthguards?

Sports mouthguards are plastic shields which can be bought off the shelf, or custom made in the clinic to cover our teeth and protect them from injury.  In addition to wearing them during contact sports like rugby, hockey or boxing, there is a tendency to grit our teeth during active exertion such as weightlifting or competitive distance running.  It is also useful in sports where there is a risk of falls such as skateboarding or off-road cycling as the cushioning effect of these guards can protect teeth from fracture and also prevent us from biting our cheeks and lips during falls.

What are Nightguards?

Night Guards are custom-made plastic shields that cover our teeth to cushion them when we grind our teeth.  It has been documented that around 15% of the population grind their teeth when sleeping. While the actual cause is not known, it has been associated with stress, anxiety and sleeping disorders. Night grinding can lead to excessive teeth wear, or to teeth becoming sensitive, loose or even cracked. In addition, excessive wear leads to shortening of the face and increased facial line which affect facial proportion and aesthetics. In some patients, it can also result in headaches.

How do we get a custom-made mouthguard?

While mouth guards can be bought over-the-counter, these do not fit accurately. Our clinic is able to fabricate a custom-made mouthguard within an hour as we have our own laboratory. A mould of your teeth is first taken and a mouthguard made by heating a special plastic material to fit accurately around the model of your teeth. The mouthguard is firm enough to resist your grinding forces yet soft enough to prevent tooth wear.  Mouthguards should be worn during the night if we have a known habit or during the day during sports or if we clench our teeth habitually at work.

What Other Types are mouthguards are there?

Mouthguards can also be modified to help manage snoring. These devices are specially designed to help keep our lower jaw and tongue from falling backwards when we sleep, thus preventing our airway from being compromised. Mouthguards can also be used to straighten teeth or help keep teeth in alignment after braces. These are usually thinner and are termed retainers. Mouthguards can also be modified to be used to hold a tooth bleaching agent in order to whiten teeth. For more information, please consult the clinic. J Oral Rehabil. 2019 Jul; 46(7): 617–623.

What has a toothache to do with jaw pain and headaches?

Pain arises either as a result of irritation of our nerves or the effect of chemicals our body produces in response to injury or infection. It is made worse by stress and underlying emotional factors. As the nerves in our mouth, face and head lie close together and even share some common pathways when sending signals to the brain, it is sometimes hard for us to determine where the source of pain is from as it may come from the tooth itself, from surrounding structures such as the maxillary sinus or the jaw joint, or if could be from central causes such such as migraines and tension headaches.

How does the dentist differentiate one pain from another

An accurate history is important as it helps the dentist pinpoint the cause and severity of the problem. Questions will include the nature, frequency and intensity of the pain, whether there are factors which provide relief or make it worse, and also whether the pain is periodic, cyclical or spontaneous.  A self assessment scale of pain levels is useful so that you can provide feedback if the pain or the treatment given is helping. If the source of the problem cannot be identified, further investigation with an MRI and consultation with a Neurologist may be required to determine the underlying cause.

Pain from the jaw joint (TMJ)

The joint which connects our lower jaw to our upper is called the temporomandibular joint or TMJ for short. It is a common cause of jaw pain or headache in patients who grind their teeth while sleeping or who have a strained biting relationship due to crooked teeth. Some patients may also experience a clicking sound from the joint when opening. In severe cases, it may limit the ability to open one’s mouth fully without pain or the joint may even be dislocated or get stuck in an awkward position when opening or yawning.

How to treat TMJ pain

As in all injuries, rest and a cold compress is the best management though an anti-inflammatory painkiller and a muscle relaxant in combination is sometimes required. In some cases, an injection to the jaw muscle using Botox provides relief as this reduces the bite forces generated. On the longer term, the use of a passive mouthguard and a warm compress helps. If the pain recurs frequently and increases in intensity, a therapeutic device or splint, similar to a mouthguard may be required to change the biting position. Braces or even crowns may also be needed to provide long-term stability.

Headaches

Headaches are a part of life and something everyone has experienced. However if it occurs more frequently than twice a month, it requires further investigation. Though a tooth is often the source of the problem,  we need to also exclude other causes including sinusitis, nerve pain, jaw joint pain, migraines, tension headaches and even high blood pressure or other medical conditions which may require referral to a specialist.  It should also be noted that headaches are often related to stress and anxiety and these factors should also be addressed as part of a long-term plan.

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