Bite, Muscle and TMJ Problems

Occlusal disease is the overload and stress placed on the chewing system, causing severe destructive forces over time. This condition occurs when teeth pathologically come together such as with bruxism (clenching or grinding) and bad bites (disharmony between the teeth, joints, or muscles). Occlusal disease can affect how your smile looks to how your teeth function. It can be an extremely damaging and costly condition if left untreated.

Damage to your teeth:

Early tooth loss
Severe wear over time
Fractures, cracks, and mobility
Pain and sensitivity
Gum recession and bone loss

Makes teeth look:

Thin, short, flattened, or discolored
Uneven, irregular or jagged

It can also damage other structures and tissue leading to a painful condition called TMD (Temporomandibular Disorder). This involves TMJ problems, muscles pain, headaches and other symptoms.

You may not be aware that you brux or have a bite problem.

Many people do not have any symptoms and it’s not until we start seeing signs of abnormal wear to your teeth that we know some form of occlusal disease is occurring. For example, people often do not know that they clench or grind since it happens in their sleep or it is a subconscious habit during the day. Occlusal disease needs to be stopped before the teeth are severely damaged.

How do we treat occlusal disease?

Treatment can be simple or complex, depending on the extent of the damage. The hardest substance in our body, called enamel, covers each tooth. When the enamel is worn away, the softer middle layer (dentin) is exposed. The wear then starts to occur 6 times faster. Teeth are now weaker and more prone to sensitivity, decay, cracks, and breakage.
As the wear progresses with time, problems will worsen without intervention. The further the damage to the teeth, the more treatment needed later. Fillings, crowns, root canals and tooth replacement may be necessary depending on the damage. Comprehensive care is often needed when the damage is extensive. Untreated tooth wear can be costly. This is why it’s so important to catch tooth wear and occlusal disease early, and prevent problems from occurring.
Treatment also depends on what’s causing the problem:
Bad bite


Clenching and grinding teeth outside of normal function is called bruxism.

Habit awareness

Teeth should only touch together when we’re eating or swallowing. At all other times teeth should be apart. During the day, it’s important to become aware of a bruxism habit so you can catch yourself from doing it. Bruxism is an unconscious habit so it’s helpful to have an external cue to tell yourself to keep your teeth apart. For example, every time the phone rings or an overhead page occurs at work, use that as a reminder to keep your teeth separated.

Hard night guard

While you’re sleeping it’s impossible to stop yourself from this damaging habit. A hard night guard (also known as a bite guard or occlusal appliance) can be made to wear at night. It will not stop you from bruxing, but you’ll be grinding on the night guard rather than wearing down your teeth. Hard night guards can help prevent problems, protect teeth, and treat symptoms that can come with bruxism. To learn how to wear and care for your occlusal appliance, read our instructions.

Bad Bites or Malalignment within the Chewing System

Joints, muscles and teeth all work harmoniously as a complex system for us to chew food. If just one part is slightly off, then it can throw the whole system off and cause problems. It’s similar to how a bad alignment with your car can cause faster, excessive tire wear and drifting or pulling to one side. Malalignment within the chewing system can do the same to your teeth and surrounding structures.

Why is a healthy bite (occlusion) necessary?

If there is any instability with the joints, muscles, and teeth working together, it can result in damaging occlusal disease or painful TMD. When occlusion is ideal, there is patient comfort, predictability, long term longevity of teeth and restorations, and beautiful esthetics. When the occlusion is bad (pathologic), there is pain, sensitivity, unpredictability, poor esthetics, failure of restorations, teeth breaking, tooth loss, bone loss and potential need for extensive dentistry to correct the problems. The amount of treatment and cost increases as the damage from occlusal pathology becomes greater with time.

What does a healthy occlusion look like?

Occlusion is how your teeth come together while chewing. A good bite, or healthy occlusion, involves stability and balance between the teeth, joints, and muscles and distributing forces evenly within the chewing system. Destructive forces put onto an unstable system will cause problems for the teeth, muscles or joints. The joint must be completely seated and all teeth touching evenly at the same time. An unstable environment starts when the joint is fully seated but only one or a few teeth are touching or all teeth are touching but the joint is not positioned correctly.
Another principle of a healthy bite is anterior guidance. When back teeth touch, 200 lbs of force are applied from the muscles to the teeth. When only front teeth touch, only 25 lbs of pressure are applied from the muscles to the teeth. Back teeth are designed to handle these heavy loads in an up and down direction all day long. Unfortunately the jaw doesn’t just open straight up and down, but also moves side to side and forward and back. When forces of 200 lbs are put on teeth in any direction other than just straight up and down, teeth will crack, fracture, loosen, wear and/or become symptomatic. It’s the job of the anterior teeth to get the back teeth out of the way when the jaw moves in different directions. This shuts off the muscles from applying any heavy damaging forces in ways teeth are not designed to handle.

How do we treat an unhealthy bite?

We need to bring harmony and proper alignment back to the joints, muscles, and teeth. There are several ways to create a healthy occlusion, depending on the extent of damage that has been done. Orthodontics can move teeth to where they need to be. Sometimes restorative work is needed to repair damaged teeth, replace missing teeth and get the system working as a cohesive unit again. Occlusal appliances are another great tool to help relax tight painful muscles and seat the joints in the proper position. Equilibration can be done to help create ideal contact of teeth by adjusting or recontouring them to get a balanced occlusion again.


Loss of tooth structure, usually as a v shaped notch, right above the gum line is called an abfraction lesion. It can be caused by occlusal disease, where teeth are malaligned and rubbing together in a way that’s causing damage. It could also be caused by the presence of acid from our diet and brushing too hard. These lesions are not caused by decay but they can progress and become problematic if not corrected. Symptoms can arise and teeth become either very sensitive or painful. They can also cause gum loss. These notches are also plaque traps, making it easier for decay to start. The lesions become bigger once it reaches into the softer layer of tooth structure called dentin, making the tooth more susceptible to wear and fracture. These notches can easily be filled in with tooth-colored filling and we can correct what’s causing the abfraction to minimize future damage.


Pain or dysfunction within the face, joints, jaws or muscles is called Temporomandibular Disorder (TMD). Over 40-60% of adults have some sign or symptom of TMD. It is often temporary and will resolve on its own but it can be chronic and develop into further problems. TMD is also cyclical, once you’ve had symptoms, you often get them again. It can be triggered or worsened with stress, arthritis, posture issues, inflammation, and sleep problems. It can be caused by trauma or occlusal disease, such as bruxism or misalignment between the Temporomandibular Joints (TMJ), muscles and teeth as discussed above.

TMD can be an extremely painful condition.
TMD can have a wide range of symptoms. Headaches, earaches and radiating pain along the face, neck or shoulders can occur. The TMJ can have painful joint noises or tenderness to the touch. You may experience limited opening or closing or jaw locking. Chewing or yawning may be painful. Muscles often develop soreness, fatigue and pain. All of the symptoms with teeth under occlusal disease can also occur.

We have conservative TMD therapies that help this painful and frustrating condition. We identify the source of the pain with a thorough history and examination. Radiographs may be taken to get a view of the TM joints. Treatment depends on the diagnosis and can range from self-care instructions, relaxation techniques, occlusal appliances, medication, physical therapy and surgery. Treatment for bruxism and bad bites discussed above also helps with TMD.

Self care instructions:

Simple things that you can do at home that can make a huge difference.

Appliance therapy

Different types of occlusal appliances exist. Which appliance is right for you depends on the diagnosis, since each will treat a different condition. For example, hard night guards discussed above can help with bruxism while other types of appliances will help with sleep apnea. There are full coverage bite guards that help with joint pain. There are anterior bite plane appliances called deprogrammers that help with muscle pain. A deprogrammer is often the appliance of choice. It will help prevent tooth wear from bruxism, treat muscle conditions, and be used to diagnose joint problems. The instructions for how to wear and care for your appliance can be found under Bruxism treatment.

Let us help you relieve the symptoms with a proper diagnosis and treatment plan that can restore you back to better joint health.