Defeat Bruxism

What can you do today?

By far, the best source of information I have found for reasonable, unbiased education on the topic of bruxism can be found on Dr. Nissani's bruxism page. If you haven't thoroughly reviewed the material on his page, please do yourself a favor and read it.  Follow the extended links off his pages, there is a lot of great information there as well. There is no shortage of things to try, and some do show promise. 

Before you read on, please recognize that I am not a medical professional.  I’ve done the best I can to read and interpret information from multiple sources and distill it into an understandable format. However, you can and should independently verify anything and everything I say. 

Below I've provided comments about various therapies, devices, support groups, books, etc. Please take a look and use this information as a starting point for your own investigation. Information and knowledge about your condition are your best countermeasures for bruxism. 

Finding good medical help

Finding a good practitioner to help you is extremely important.  However, be very careful in this regard.  I’ve tried to summarize below some common, well supported, conservative treatment methods that should be included in your treatment based on solid scientific evidence. If your practitioner isn’t following some of these basic guidelines, challenge him or her to read some of the papers I’ve referenced here.  I’ve also tried to point out some questionable practices.  Ask for the peer-reviewed paper demonstrating that this or that recommended therapy has positive results.  Ask whether the trials were double-blind, placebo-controlled. (It is likely you will get a lot of blank stares when you ask this question - The bruxism/TMJD world is not famous for providing robust, evidence based therapies.  You have to ask yourself if you want to be the test subject?)  If your questions aren’t answered to your satisfaction, and particularly if your practitioner is pushing any non-reversible therapy prior to the exhaustion of all conservative treatment strategies, strongly consider a second or third opinion.

Daytime bruxism

Don’t neglect the idea that your bruxism may occur while you are awake.  Although it is generally recognized that nocturnal bruxism is responsible for the majority of bruxism related problems, the daytime habit can also play a part and be totally unconscious.  Symptoms like sore jaw or headache that evolve or worsen throughout the day are thought to be a sign that your bruxism may be occurring during waking hours. The techniques for seeing if you have daytime bruxism are many, but the simplest involves using a timer set for 10 or 20 minutes. The idea is that each time the buzzer sounds you will be consciously aware of the position of your teeth at that instant.  You are trying to “catch” yourself in the act of clenching or grinding.  If you spend a good deal of time at the computer, one very easy way to implement this technique is to use your calendar program to set up reminders to check yourself periodically.  You can use the snooze function to have the same reminder come back again and again.  You could also use a watch or cell phone alarm or simple timer to catch yourself at more random moments. This is a very low impact, easy method to rule out day time bruxism.

If you catch yourself clenching or grinding your teeth, take a moment to consciously return your mouth to its proper position, i.e. lips together, teeth slightly apart, tongue on the roof of your mouth touching your gums just behind your front teeth.  The good news is that this method is reported to have good results in permanently correcting the daytime bruxism habit.

Conservative Treatment for TMJD symptoms

Follow this link  for a reasonable summary of truly conservative therapies to try before doing anything else.

Devices

What about my night guard?

Types of night guards. 

There are generally three types;

  • Complete coverage stabilizing appliances (pictured below,) which cover all of either the upper or lower teeth and are specifically designed not to modify your bite.  They are the most common, most studied, most conservative and safe oral device around.

  • Partial coverage appliances cover only some of the teeth and may or may not be designed to reposition the teeth. In general, these have a higher risk of inadvertently (and permanently) modifying your bite.  Generally these have shown no solid advantages over the complete coverage appliances, have higher risk, and are therefore generally to be avoided (with the possible exception of the NTI device, discussed below.)

  • Repositioning appliances may or may not be full coverage and are designed to change the bite of the patient, (permanently and non reversibly,) theoretically in order to “fix” a poor bite and as a result resolve whatever is ailing the patient. As a general rule, studies have shown that these types of appliances offer no benefit over the full coverage stabilization appliance and have far more complications and are to be avoided. 

If your medical practitioner is recommending an oral device different from a full coverage stabilization appliance, I’d encourage both of you to read, understand,  and discuss two excellent and recent review papers on the topic. 1, 2

My history with night guards:

I have had two night guards fitted by dentists. The first was a soft appliance, approximately 1mm thick, covering all of my upper teeth.  I still have that old ratty thing.  My second night guard was a hard acrylic guard.  My dentist claimed that the hard guard would lessen the clenching loads.   The scientific literature indicates that, for most people, they have little or no effect on bruxism levels.  I had the hard guard for about 4 years until I dropped it recently and it shattered. By my recollection, I think I paid about $300 for each guard.  Both guards were initially uncomfortable, but I got used to them.  They both get nasty and stinky, but are manageable.

Night guards and bruxism

Your night guard will almost certainly stop or greatly lessen your bruxism habit……for a few days, or maybe even a week or two. Nearly every study conducted to date has shown this fact to be true.  For a minority of users this reduction may be relatively long-lived.  For everyone else, within a week or two, levels of bruxing are generally back to or even exceeding levels measured before the night guard was put in place.

This fact has led to considerable controversy within the dental and TMJD communities regarding the use of night guards. In order to explain in more detail, it is probably useful to review how night guards address the various symptoms of bruxism. 

A night guard covering all of the teeth will quite likely reduce the wear and tear on your teeth caused by direct, high pressure tooth to tooth contact. This is a real advantage for a night guard and is probably the principal reason most dentists who believe their patients are bruxing will recommend one.  However, as discussed earlier, the mechanical loads experienced during bruxing are unlikely to lessen, and the teeth and jaws still have to bear these loads.  These forces are still likely to cause premature failure of your teeth, even with faithful use of the night guard, particularly if you have existing dental restorative work, (fillings, etc.)  Although this issue is not discussed much in the medical literature, both common sense and my personal experience confirm it. In my case, bruxism has more than likely caused fillings to prematurely crack/loosen leading to further decay, thereby leading to more fillings and more failures.  Finally enough of the tooth was missing that I needed porcelain onlays to reconstruct several of my teeth. Four or five years later, my onlays are on the way out, and the only reliable fix for my teeth recommended by my dentist is full gold crowns. Those crowns are likely to be the first of many. (My own dentist showed me his complete set, standing in place of all of his original molars, also caused by bruxism.) All of this has come with reliable use of a night guard for the past ten years or so, regular trips to the dentist, and good oral hygiene.  Also, this progression has not come as a surprise to my dentist; he even predicted it! 

The utility of night guards for other symptoms of bruxism and TMJD is substantially more difficult to assess.  Because the tooth/jaw loads are essentially unchanged, one would expect symptoms of bruxism related to loading to be unchanged as a result of night guard usage.  However, the situation is far more complicated than this and, although hotly debated, many studies do show that classic TMJD symptoms can respond to the use of a properly designed full coverage stabilization appliance.  The reason for this relief is generally not known.

Bottom line:

  • Avoid any appliance other than a full coverage stabilization type (with the possible exception of NTI-tss device, described below.)

  • Don’t wear your device 24 hours a day; changes in your bite can occur with continuous use.

  • Use a full coverage stabilization appliance to slow (but likely not completely stop) dental damage caused by nocturnal bruxism.

  • Although the true utility of full coverage stabilization splints for symptoms of TMJD is hotly contested in the literature, it is still worth considering a full coverage stabilization appliance for symptoms of TMJD; for reasons that are not well understood, some patients benefit from this therapy. If it doesn’t work, don’t beat yourself up, keep trying different things (hopefully more conservative, non-invasive, reversible therapies.) If it works for a few days or weeks and then your symptoms return, you may have just learned that bruxism is indeed at the heart of your problem.  (A transient reduction of bruxism behavior may have started the healing process, but the bruxism came back and is perpetuating the problem again.)

The NTI-tss device:

Background:

At first glance, the NTI-tss (nocturnal inhibition of trigeminal nociception-Tension Suppression System) appears to deserve serious consideration for bruxers.  The extensive NTI website is well done and the concept makes sense.  The content is relatively readable for the lay-person, the story of an ordinary Joe (a dentist in this case, but still an ordinary dentist) shirking the medical establishment and coming up with a better mousetrap to fix his own debilitating headaches is very appealing. Originally designed for those who have migraines, it also bears FDA approval to treat bruxism.  In my (by no means exhaustive) search, it is the only device that is so labeled by the FDA. I came away from my initial investigation with a gut feel that the NTI was a very solid idea.

My history with the NTI device:

The NTI-tss has to be fit by your dentist.  Previously, I had not been able to convince my dentist to fit one; mumbled concerns about swallowing it during sleep and a follow-up with a TMJ expert were recommended instead.  Now, I think I may have found a better mouse-trap, so I likely won't be pursuing it any more. 

A review posted on the TMJ.org website:

I found the following review from what appears to be a reputable site/organization, TMJ.org on the NTI:

Question: Does the NTI-tss (Niciceptive Trigeminal Inhibition Tension Suppression System) work to relieve bruxism and TMJ diseases and disorders? Are there any concerns regarding treatment with NTI-tss? What is its effectiveness?

Answer: The basic theory behind the NTI appliance is correct in that it prevents clenching and grinding by separating the back teeth, which is the site where such activities generally take place. A full-coverage stabilization appliance can prevent grinding, but does not prevent clenching because there is posterior tooth contact. However, since the NTI appliance fits on only two teeth, it can place a great deal of stress on these teeth and that can be harmful. Also, because of its small size, if it comes off during the night, there is danger that it could be swallowed or aspirated. Finally, because of the small contact area between it and the lower teeth, it cannot be used in patients with certain types of malocclusion. (Response by Dr. Daniel Laskin)"

Clinical studies:

For all of the promise the NTI device has, the clinical studies are a mixed bag. The trial showing efficacy for the purpose of the FDA compared the NTI to a dental bleaching tray, which it is argued is a true placebo, i.e. it was the proverbial “sugar pill” used to convince patients in the control group that they were getting a legitimate treatment. There has been significant controversy over this choice for the control group.  Indeed, in all other randomly controlled studies where the NTI was compared to a full coverage stabilization splint (for better or worse, generally considered the dental appliance standard of care for TMJD) the NTI did not show a statistically significant advantage and at least in one study was significantly worse than a stabilization splint. These clinical studies were for TMJD, not migraine.

Two of the three studies are available on the NTI website; The first shows the NTI and the stabilization splint in a statistical dead-lock with both groups demonstrating significant improvements. The second study again demsonstrated a statistical dead-heat, again with both groups reporting good results.  Per the NTI website, the NTI staff feel that there was a flaw in the second study, but it is somewhat lost on me. The third study (click here to read the abstract), which is not included on the NTI website, reported that the NTI was significantly less effective than the stabilization splint for reduction of TMJD symptoms.  Important findings in this study include the fact that 1 of the 15 original NTI patients developed an impaired bite at the 6 month follow-up, while none of those wearing the stabilization splint had any problems.  Also in this study, the participants were given the opportunity to switch from one splint type to another at the 3 month follow-up; 4 out of 14 subjects (28.5%) of those using the NTI switched to a stabilization appliance due to perceived lack of therapeutic benefit with the NTI while none changed from the stabilization appliance to the NTI.  The results from the latter study were not consistent with the other studies, but deserve attention.

Interestingly, the NTI website makes no effort to provide a rebuttal for the findings in these studies, except for that noted in the second study above. The conspicuous non-inclusion of the (most negative) third study on the NTI website makes me seriously question the objectivity of the NTI group. Additionally, the literature continually recognizes the possibility of the NTI falling out and being aspirated. The first paper reports four documented instances of this happening (three from the FDA website.)  Again, the NTI website does not address this issue except to say that if the device can be removed easily it is not installed properly. If we follow the logic, the NTI must not have been installed properly in several cases, which would imply that it is dependent on the skill of the practitioner installing the device and some aren’t so good at it; Buyer beware.

On the other hand, the other non-randomly controlled clinical trials and anecdotal reports indicate remarkable improvements for many patients using the NTI. For example, studies monitoring the muscles involved in clenching demonstrate that the NTI did indeed lower nocturnal activity over relatively long periods of time.

In summary, the stabilization appliance seems to provide symptomatic relief for a significant portion of typical study populations but no one seems to really know why. The NTI device has a very plausible and understandable mode of operation, but appears to provide no statistically significant advantage over the stabilization appliance.  In addition, reports of aspiration and undesirable changes in occlusion with patients using the NTI demonstrate higher risk with the NTI device.

Expert advice:

Several noted experts in the field that I spoke with are violently opposed to the NTI and believe the FDA study used to approve it was fatally flawed.  These experts made this assertion without any prompting or questions, it just came up in conversation. 

Bottom line:

Perhaps the best approach would be to try the low risk full coverage stabilization appliance first.  If desirable results are obtained, no further action is necessary and very little has been risked.  However, if desirable results are not achieved, perhaps you should discuss the NTI with your dentist.  It is very possible that the NTI and the stabilization appliance will help different people depending on differences in the exact reasons for the pain.

OralSensor:

I know very little about the device except what is on the meager Oral Sensor website.  However, the concept is similar to the taste-based approach in principal except that sound feedback is used.  A word of warning on this device:  I've copied the text of a question from TMJ.org from a user. Have a read:

"Question: I subscribe to the "TMJPatient.com Newsletter" and was told therein that there is a proven way to stop bruxism and relieve by TMJ problems. It is to use a nighttime biofeedback device called an OralSensor Personal Trainer, by Cycurea Corporation. Are there any positive or negative reports from patients or studies of using this or a similar device? "

"Answer: We are not aware of any scientific studies regarding the OralSensor Personal Trainer by Cycura Corporation at this time. In researching your question we discovered the site www.tmjpatient.com is registered to K. Andersen of Anderson-Fox Consulting http://www.networksolutions.com/en_US/whois/ who also happens to be the official correspondent listed for Cycura Corp registered with the FDA.
http://www.zapconnect.com/companies/index.cfm/fuseaction/companies_detail/eregnum/2953683.html.

Bottom line:

I find such underhanded marketing techniques as using a supposedly unbiased and unrelated newsletter to promote your device a good sign that you should avoid a company/product. Overall, the concept has promise but there is absolutely no data to support any utility and unethical marketing techniques would make me avoid this device on principle alone.

This device is no longer on the market.

Grindalert

The Grindalert is a device worn like a headband that is designed to sense the muscles that tense when the jaw clenches and then sound an audible alarm.  The website is reasonable and the concept seems robust.  However, the market reviews are mixed.  Yahoo seems to have more favorable reviews than another website I found.  Another short write-up on a bulletin board also seemed pretty mixed and mentioned poor customer service.  I’ve recently purchased one of these and was sent a personal email from the inventor of the device.  Apparently he licensed his invention to a group who did a poor job of customer service, explaining some of the bad reviews seen in the links above.  He recognized this and has taken back over.  He seems genuine and I expect the customer service will improve.

An important observation is that the device is not approved or even recognized by the FDA.  There is currently very little published data supporting the effectiveness of the device, and what is out there is anecdotal in nature. Based on the communication I received from the owner/inventor, it seems that they are currently in a learning mode with this device, speaking with people who have had the device for some time and trying to understand what is working/not working.  He recognizes some serious shortfalls with the design (the contacts breaking free at night is the biggest, but not the only issue. If you don’t sleep on your back and remain in that position through the night, it seems likely that you will dislodge the electrodes and render the device useless.)  Even if the device works properly, it is not clear it will help.

My experience with the device

In an effort to better understand competing products, I purchased a Grindalert.  First impression was good.  Packaging was very professional, the band is reasonably comfortable, extra batteries and even a screwdriver were included.  Second impression was bad.  I turned on the device and it malfunctioned.  After a bit of tweaking, I replaced the batteries with the new ones and now the unit appears to be working properly. 

The unit does appear to do what it claims. It will sound an audible alarm when I clench my teeth, even lightly.  It will also register a really big yawn, a really exaggerated blink, and a normal raising of the eyebrows.  It will also sound very briefly when I swallow, something I didn't realize I did so frequently without this device.  Sometimes my swallows are associated with my teeth touching, also something I didn't realize I was doing.  I'm not sure if this is normal? 

My initial impression is that this would be an excellent device to truly rule out daytime bruxing, if you are willing to wear the contraption (probably not suitable for use outside of the house, unless you are truly desperate and really don't care what people think.)

OK, time for the real test, wearing it at night.

Hour 0:  I have my taste-based approach appliance loaded and I put the headband on.  As I suspected, I am totally unable to trigger the alarm by using my jaw (my teeth are too far apart to involve the temporalis muscle.)  I check to make sure that the device is still working: Raising my eyebrows does the trick.  I'm aware that the headband feels different, but I think I'll be able to sleep with it. Here goes:

Hour .5:  I'm just dozing off and I notice the buzzer going off, in a very sleepy kind of a way. Unfortunately I'm not the only one who notices.  My wife startles from a deep sleep and gives me a look that clearly indicates my experiment is not welcome in our bed. I'm afraid this is the end of the night-time testing for the Grindalert.  I'm not sure why it went off - my suspicion is that it lost contact with my forehead, although I hadn't really even started my nightly sleep gymnastics.  A few caveats on my wife hearing the buzz.  First, we happened to be pretty close when it happened.  Second, we have a six month old newborn and this in turn has two effects. It seriously reduces my wife's amusement at being woken up and it may also sensitize her to small noises coming from the baby monitor.  You will have to decide for yourself if this will be an issue.

Day 2:

Another trip through the instruction book yields more information.  It turns out there is a way to "dial in" the sensitivity of the unit to the contraction of your temporalis muscle.  I turned down the sensitivity to the lowest setting.  Now, no yawn, eyebrow raise, or other extreme facial contortion will cause the beeper to go off.  I also learned that the beep can be turned off, so I tried to wear it for several nights in  a row.  The unit is also equipped with a counting function which will count the number of times you clench your teeth together for more than 2 seconds.  My results, either with the taste-based approach installed or with only a standard full coverage appliance installed were the same - No clenching was recorded.  This is very interesting, because I verified that the unit would count up each time I manually clenched.  Also, during my nodding off period without the taste based approach, I was aware of short clenching bursts that apparently lasted less than 2 seconds.  These bursts, if sufficiently forceful, are still likely to cause damage. 

Surprisingly, even with my relatively restless sleep pattern, the device stayed put and did not detach on any night.  This was unexpected.

Bottom line:

There is a strong lack of evidence for the utility of this device for night time use, and the inventor recognizes serious shortcomings.  Desentization to the tones, which aren't really very loud, seems a strong possibility. On the other hand, your sleeping partner or roommate may find the tones annoying (or even unacceptable) as my wife did. 

However, the concept makes sense and based on my experience the device does what it says it does, i.e. provides a feedback signal when you clench.  Some seem to have found relief with it and the downside seems limited to the cost combined with the very real possibility it won’t work for you and you will be stuck with whatever symptoms/degradation of dental health may be associated with your condition during a trial period. A money back guarantee helps and it seems more likely that the new management will honor it.

Surgery/Modification of bite/Other non-reversible therapies

While it is likely that surgery or other non-reversible therapies is indicated for some severe TMJD problems, the evidence showing its effectiveness in controlled trials is generally lacking and it really should be an absolute last resort after all other treatment options are exhausted.  Even then, second and third opinions should be obtained before moving ahead and I’d choose my practitioner very carefully.  Read the "Read before you do anything drastic" section of this website and connect with others that are considering or have had surgery at this website: TMJ surgery:  

Bruxism Causes:

The following is a list of causes or suspected causes for bruxism.  I’ve tried to limit the list to things that may be actionable. 

Occlusal factors:  The most recent research indicates there is very little reason to believe that deficiencies or irregularities in a persons occlusion will lead to bruxism.  If a medical specialist says otherwise and wants to do something to “fix” your bite in order to “cure” your bruxism, tell him or her to pull this paper and explain why this review paper is wrong.3  (Maybe there is a good reason, but this should keep him or her honest.)

Stress:  This appears to be a fairly strongly contributing factor.  Try to reduce stress in any way you can, including stress at work, getting exercise, dealing with anger or frustration, yoga, relaxation, etc.

Snoring/Obstructive Sleep Apnea syndrome:  It is thought that these sleep behaviors may be related to bruxing, potentially by disturbing sleep patterns.  Although far from conclusive, receiving treatment for these conditions may help bruxism.

Selective Serotonine Reuptake Inhibitors (SSRIs):  There is some evidence that SSRIs may contribute to bruxism.  If you think your bruxism is related to starting these drugs, talk with your doctor. 

Amphetamine or Amphetamine-like drugs:  This class of drugs may contribute to bruxism.

Alcohol, smoking, and caffeine also may be related to bruxism

Diseases which may be connected with bruxism:  Basal Ganglia Infarcation, Cerebral palsy, Down Syndrome, Epilepsy, Huntingon’s Disease, Leigh disease, meningococcal septicaemia, multiple system atrophy, Parkinson’s disease, post-traumatic stress disorder, and Rett Syndrome.  The links between these diseases are not necessarily strong, but may be a starting point for discussions with your healthcare professional.

Books/CD's:

 

Taking Control of Tmj: Your Total Wellness Program for Recovering from Tempromandibular Joint Pain, Whiplash, Fibromyalgia, and Related Disorders by Robert O. Uppgaard. I ordered and read this book and feel Dr. Uppgaard has some reasonable thoughts and practices.  Dr. Uppgaard advocates a very conservative approach (stress reduction, yoga/stretching, jaw exercises, good posture, massage, etc.)  In other words, it is a totally non-invasive, reversible approach which seems very unlikely to have unwanted side effects. He also talks about the nature of the TMJ disorder and various causes.  I've been purposely avoiding doing anything that Dr. Uppgaard recommends in order to change as few variables as possible, thus giving the taste-based approach as fair an appraisal as I can.  His reviews on Amazon are generally very good, so it seems some do get relief.  The book only costs about $10, what do you have to lose?

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Editionby Clair Davies, Amber Davies, and David G. Simons

In my opinion, everyone with even minor chronic pain should buy this book irrespective of their TMJD history.  It discusses a very under-diagnosed source of chronic pain, namely trigger points in muscles.  Interestingly, trigger points by definition are located some distance away from the site of the pain (from several inches to feet in some cases), hampering the ability of a clinician who is not familiar with trigger points to understand the true cause of the pain. If you are suffering from chronic TMJD pain and have not been evaluated for trigger points as the cause, be sure you are before you do anything rash.  If your medical care provider gives you a slack-jawed, deer-in-the-headlights look when you mention trigger points, it is a sign that they are not keeping up with the latest developments in their field. This stuff is becoming more mainstream and many TMJD textbooks and scholarly articles include trigger point identification and treatment as an essential and early step in the treatment of TMJD patients. It’s also amazingly simple to at least provide temporary relief. 

A few personal examples:

·         I currently am loaded with trigger points in the muscles adjacent to my scalp and in my neck and shoulders, most likely as a result of my long-term love affair with bruxism.  Pressing on some of these points can reproduce the most horrific headache I have ever experienced. Other points refer pain to my jaw or teeth, behind my eyes (which I went to the doctor for once,) or even my ears.  I have also read that trigger points could be responsible for some of my teeth (unfortunately the ones that have had the most work done on them) not responding well to anaesthetic.  Although these trigger points have not caused significant chronic pain for me (outside of the odd headache), their presence in a latent state is not a good sign and was quite likely to lead to more serious problems in the future, at least with continued bruxing and lack of treatment.

·         I was sidelined with a shoulder injury for about 5 years, during which time I saw every expert in my area, had my shoulder scoped, had MRI and CT scans, etc. The prognosis was always the same, my shoulder was in great shape but still hurt.  Physical therapy made the situation worse.  Eventually they gave up on me and I gave up on having a fully functional shoulder.  Finally, chiropractic care for a stiff neck solved the shoulder issue too.  The problem, which still recurs occasionally:  A trigger point located about 4 or 5 inches from my shoulder that I can now relieve in about 5 minutes.  Same thing with my other shoulder, which started acting up recently when I was swimming a lot.

·         I had a recent problem with my knee acting up after long bike rides.  Went to a specialist, had an MRI, endured physical therapy.  In this case, the physical therapy helped, but it also included a therapy that helped to deactivate a trigger point in my IT band, close to my hip.  It still flares up now and then, but I know how to fix it now and again can resolve the pain in about 5 minutes or so.  The trigger point in my IT band exactly reproduces the sharp pain in my knee!

·         In both of these latter cases, the so-called specialists I saw had no concept that trigger points could be causing the pain, so I went through needless expensive diagnostic procedures and lived with the respective problems for far too long (years instead of days.)

The book is inexpensive, the problem is real and very often undiagnosed, and the author does a fabulous job of explaining how everything works with techniques for self care.  He also spends a good deal of time on the areas that can cause TMJD related pain.  If you have chronic pain, (TMJD or otherwise) buy and read this book, you won’t regret it.

Eliminate TMJ and Teeth Grinding by Scott Sulak (Audio CD - Oct 2003)  A hypnotherapy CD targeted specifically to reduce teeth grinding. Has some reasonable reviews on Amazon, again, it's pretty inexpensive, what do you have to lose?

If you type in "TMJ" on Amazon there are a number of other books, CD's, and DVD's.  Most are fairly inexpensive; I'll leave it to you to evaluate as you see fit.

Web resources for further learning/support groups

The TMJ Association Website:

My take is that the TMJ Association is a pretty reasonable place to get reliable information on TMJ/TMD disorders.  At least you will find out what a miserable mess the TMJ world is and how to operate with caution before trying any invasive, non-reversible techniques. 

From the The TMJ Association

"The TMJ Association (TMJA) is a patient based advocacy organization, whose mission is to provide information on Temporomandibular Joint and Muscle Disorders (TMJDs) to the patients, public and healthcare professionals. We offer support to those who suffer from TMJDs. We advocate for basic and clinical scientific research that will eventually yield the causes of TMJDs, as well as treatments scientifically proven to be safe and effective. We serve as a national resource center for TMJDs.

We are not physicians or healthcare providers, and therefore the opinions that we express are those based upon our personal experiences, patients who contact us, and our general research on the subject.

We would like to share with you what we have learned over the years by talking with patients and professionals around the country and reading the literature. With little research to fall back on, there are no easy answers to the many questions we all have. We hope this general information will provide assistance as you make your healthcare decisions."

Message Boards for further learning and support:

TMJA Association MySpace page: Fairly limited, but worth a look

TMJ surgery:   Appears to be a fairly well developed site.  I would highly recommend that you spend a fair amount of time here if you are contemplating TMJ surgery,

Daily Strength is a message board website devoted to connecting sufferers from a wide variety of maladies.  They have a TMJ section, which I recently joined.  The content is somewhat limited;  My sense is that if you read the Nissani website and this one you will be the expert there, but the strength in those communities come from the numbers, so sign up and see if anyone can help or if you can provide advice for another. 

Again, please follow up on your own; taking personal control of your bruxism condition and learning everything you can ultimately holds the most promise for you to find a satisfactory resolution.

Am I missing something important?  Any comments?  Contact me here.

The information contained on this Web site does not constitute medical advice, nor is it a substitute for medical advice. Always consult with your doctor before starting any treatment.

1          Clark, GT, Minakuchi, H: Oral Appliances, TMDs An Evidence-Based Approach to Diagnosis and Treatment, Chicago, 2006, Quintessence, pp. 377-390

2          Dao, TTT, Lavigne, GJ.: Oral Splints: The Crutches For Temperomandibular Disorders and Bruxism? Crit Rev Oral Biol Med 9:345-361, 1998

3          Lobbezoo F, Naije M: Bruxism is mainly regulated centrally, not peripherally, Journal of Oral Rehabilitation 28:1085 -1091, 2001