In the movie Date Night, a husband and wife, played by Steve Carell and Tina Fey, are getting ready for bed. Fey puts in her night mouth guard—a plastic device that covers the teeth—when Carell politely suggests sex.
“Oh! We can still fool around,” says Fey’s character with a slight lisp. “Let me just, uh …” She then proceeds to remove her mouth guard with a string of saliva attached to it that resembles a slice of four-cheese pizza being pulled apart.
“You know what? No,” says Carell. “Honey, I’m totally fine if we don’t.”
It’s a scene many couples know too well, given that, according to the Academy of General Dentistry, about one in three people clench or grind their teeth at night, and many of them wear mouth guards.
Mouth guards. They might as well call them birth control.
Yet, it may be necessary to toss vanity aside, given that failure to do so could lead to jaw clicking, locking and even headaches and sinus infections.
These are all symptoms of TMJ, or temporomandibular joint disorder, in which the joint connecting the mandible to the skull becomes inflamed.
“A lot of people can pop all their life and not have any pain,” says Dr. Brian Allman of the TMJ Therapy and Sleep Center of Nevada. “But for some people, the popping and clicking will turn into pain.”
For years, Jackie Reilly had nearly every symptom of TMJ except for clicking. “I was having headaches and couldn’t figure out what was going on,” she says. “Sinus infections. Vertigo.” Finally, an ear, nose and throat specialist (ENT) diagnosed her with TMJ. She got a mouth guard from her dentist and was prescribed anti-inflammatory muscle relaxants. When she heard that dental braces could either help, hurt or do nothing, she decided to give them a try, partly because she didn’t want to use muscle relaxants long term. After 19 months of wearing braces, Reilly had them removed this month. She still has some headaches and sinus infections, but, she says, “My hope, my expectation, is it will get better.”
Reilly went to a dentist, an ENT doctor and an orthodontist for help. Allman says there needs to be more collaboration among various specialists, particularly because he’s finding that there’s a large crossover of people with TMJ problems and sleep disorders.
“I think dentists should be learning how to refer for sleep disorders and sleep apnea issues,” says Allman. “I don’t think we should make a bunch of TMJ dentists. I think we should learn to screen for TMJ issues. We should be looking past the teeth, into the throat, evaluating the airways, and referring to our ENTs and airway specialists when appropriate.”
Allman doesn’t think surgery or medications are the answer to TMJ problems. But a mouth guard may be the least of what should be done.
“When I graduated from UCLA 26 years ago, I left with the knowledge that everyone should be in a night guard,” says Allman. “That would be standard procedure. The problem is, what have you done to correct the misalignment of the disc in the jaw and the skull?”
He’s found the most success with an oral orthotic—a device that sits on the top of the back teeth and influences where the jaw moves when it bites down.
“If you click or pop and you’re having pain or headaches, you need to see somebody who knows what they’re doing,” says Allman. “When you have someone clenching their teeth, it doesn’t mean they just need plastic between their teeth. You need to ask why you’re grinding your teeth.”
Reilly can’t help wondering if all this teeth grinding is related to the daily grind.
“I catch myself during the day clenching, and I didn’t even realize I was doing it,” she says. “If you have kids and work, and the economy isn’t helping … I do yoga to try to relax, and that helps. We need to figure out a way to de-stress our lives a bit.”