The TMJ (temporomandibular joint, or “jaw joint”) is one of the most complex joints in the body and
often requires a well-rounded team of healthcare professionals to treat effectively. In this month’s blog,
I sat down with Dr. Kevin Friesen from Steinbach Dental Clinic to discuss the connection between the
TMJ and our teeth, and to learn about his approach to treating Temporomandibular Dysfunction
(TMD).
Dr. Friesen has been practicing dentistry for 26 years, with a special focus on TMJ and orthodontic
treatment for the past 13 years. In 2013, he noticed orthodontic issues in his daughter’s bite but was
unsure how to address them. This led him to pursue additional post-graduate training and TMJ-focused
education. Over the past 13 years, he has achieved a high success rate in treating TMD cases.
Dr. Friesen, what do you see as the most common dental contributors to TMJ disorders?
There are many dental contributors to TMJ disorders, but a lower jaw that is positioned too far back
relative to the upper jaw is probably the most common. Deep overbites, narrow upper jaws or steep jaw
lines can also prevent the lower jaw from fitting into the joint as it should. In most cases, TMJ
disorders involve a combination of skeletal and dental misalignment, both of which affect the position
and function of the joints.
What is malocclusion, and how does it impact TMD?
Malocclusion means the teeth are not biting together properly. When the teeth are unbalanced, it often
reflects an underlying jaw problem.
Malocclusion can create interferences—undesirable tooth contacts—during movements such as side-toside or forward and backward. If one tooth contacts sooner than the others (for example, due to a high
point or uneven filling), it can trigger the jaw muscles to contract. If those muscles enter a state of
hypercontraction, this can damage the jaw joints over time. When the jaw is not positioned correctly,
the teeth will not align properly either.
Is bruxism (clenching or grinding of the teeth) usually a stress-related issue, a dental issue, or
both?
Stress can be an aggravating factor which may trigger bruxism, but the underlying problem is usually
an unstable jaw position. When the jaw is out of position, tooth alignment may be affected. This can
create interferences that trigger muscle contraction and grinding.
In some individuals with a collapsed airway, clenching the teeth during sleep might actually be the
body’s way of keeping the airway open. Unfortunately, this has the undesirable effect of damaging the
teeth in the process.
No matter what the cause of the clenching or grinding is, it is very detrimental for the teeth and jaws.
How do mouth guards help the jaw? Do they simply protect the teeth from wear?
There are different types of mouth guards, and they serve different purposes.
The most common type is a flat-plane splint. This appliance covers either the upper or lower teeth and
has a flat biting surface designed so that all teeth contact evenly. These splints do not typically stop
clenching or grinding. While they may reduce some pain symptoms, their primary purpose is protective
—they act like a helmet for the teeth, preventing direct tooth-to-tooth wear.
Other appliances are designed specifically to reduce clenching and grinding. These are commonly
called deprogrammer appliances. They position the jaw slightly downward and forward and prevent the
back teeth from touching. Only the lower incisors are allowed to make contact with a bite pad.
When the back teeth contact each other—or contact material placed between them—the masseter,
temporalis, and medial pterygoid muscles are triggered to contract. These muscles are less likely to
contract when force is applied only to the incisors. As a result, the deprogrammer appliance can reduce
clenching and grinding. By slightly protruding the jaw, it may also help maintain an open airway,
offering the secondary benefit of reduced snoring.
A third type of appliance is a mandibular repositioning splint. This device is designed to reset the jaw
and recapture the displaced discs within the jaw joints. They are typically worn during the day along
with a deprogrammer appliance at night. These appliances are sometimes followed by orthodontic
treatment (braces) to move the teeth into the new (corrected) jaw position.
When does clicking or popping matter—and when is it harmless?
Clicking and popping in the jaw are very common and sometimes do not require treatment. If there are
no orthodontic problems, no functional limitations, no progression over time, no evidence of damage or
trauma, and no pain symptoms, it may simply be monitored.
However, if clicking progresses to intermittent locking—when the disc is displaced forward and does
not return to its proper position— or is associated with any of the above conditions, this can lead to
more significant problems and should be evaluated and treated.
What is the single most important thing people should understand about the teeth–jaw
connection?
From my perspective, the most important principle is early diagnosis and intervention. It is far better to
address a developing problem than wait until it becomes established.
Ideally, children should have an orthodontic consultation before the age of 8 or 9. This allows for
assessment of jaw growth, tooth position, airway development, breathing patterns, and muscle habits
such as bruxism.
At any age, TMJ symptoms or unexplained pain—such as earaches, headaches, neck and shoulder pain,
or pain behind the eyes—should prompt a dental assessment.