The Role of Dental Health in TMJ Disorders

SUMMARY

The health of the teeth and gums can play an important role in TMJ disorders, because they influence the stability of the bite and the state of tension in the jaw muscles.  Diseases of the teeth or gums can trigger or exacerbate TMJ disorder symptoms by decreasing bite stability or by reflexively increasing resting jaw muscle tensions, and improving the health of the teeth or gums can relieve TMJ disorder symptoms by decreasing resting jaw muscle tensions. 

THE ROLE OF DENTAL HEALTH IN BITE STABILITY
One way dental diseases contribute to TMJ disorders is by causing teeth to shift, which destabilizes the bite.  For example, a cavity on the side of one tooth can cause the neighboring tooth to tip into the space, which  causes the opposite side of the tipping tooth to shift upward and interefere with the bite.  Gum disease can shift teeth by changing the support provided by the bony socket that houses them.  
 
THE IMPORTANCE OF BITE STABILITY
A stable bite is needed for the jaw muscles to obtain healthy exercise.  Unless the sensory nerves surrounding the teeth signal widespread relatively simultaneous tooth contact (a stable bite), the jaw muscles cannot fire strongly.  Their guarded behavior increases resting tensions, which reduces resting circulation; and it also prevents them from getting healthy exercise, which is characterized by strong functional firings separated by short periods of nearly complete relaxation.  
 
A stable bite is also needed to maintain healthy TMJs.  The bite determines the bracing position, the “home base” for the jawbone.  Any shifting of teeth shifts the bracing position for the jawbone and thereby also the pressures exerted at the TMJs.  Joints all over the body are designed to acquire a perfect fit between the bones by continually remodeling to better fit the pressures there.  If the bracing position of the jawbone is inconsistent, the TMJs will not have a fixed target for their remodeling activity, and they may never acquire sufficient goodness of fit to maintain joint health.
 
THE PATH TO DENTAL HEALTH
Improving dental health requires cleaning your teeth, massaging your gums, and getting good routine dental care.  The goal is not to sterilize your mouth or kill as many germs as possible, but to grow a healthy microbiome which protects your tissues from pathogens much like growing a healthy garden prevents an invasion by weeds.  Your oral microbiome is affected not just by how often you brush and floss, but also by what you eat, how much stimulation your gums receive, and your overall state of health. 
 
CAVITIES
Cavities can occur anywhere food gets trapped, because bacteria digesting the trapped food produce acid which eats holes in the enamel. The vast majority of cavities occur where food accumulates between the teeth or in the valleys on the tops of the teeth during the first two decades of life when the mouth tends to be more acidic.  After the second decade, gum disease becomes a more important threat to dental health.  New cavities should not become a problem again unless dry mouth due to various drugs or old age prevents saliva from rinsing away the sugars and buffering the acids created by bacteria, leading to gumline or root surface cavities after gum recession has left a space where plaque accumulates.  
 
GUM DISEASE 
In adulthood, most mouths become more alkaline (less acidic) and start depositing minerals in the form of calculus at the gumline rather than dissolving minerals from the enamel on the tops and sides of the teeth.  At the same time, the gums receed, leaving large spaces where plaque can accumulate and food can be trapped around the roots of the teeth.  The trapped food and plaque causes periodontal (gum) disease. Preventing periodontal disease requires regularly removing any food that gets stuck between the teeth and any plaque that accumulates at the gumlines.  
 
PLAQUE 
Plaque is the white paste of flour and water that forms around the necks of the teeth at the gumlines.  If left undisturbed, plaque picks up minerals from saliva and hardens, forming a structure much like a coral reef - with tunnels and crypts where bacteria can hide.  This calculus (or tartar) is the same material that gets scraped off your teeth by the dental hygienist.  It must be removed regularly to prevent gum disease.
 
GUM MASSAGE
Keeping the gums healthy also requires massaging them.  Our gums evolved with an almost constant source of rhythmically alternating compression and release.  Chewing stayed close to the gums, because the teeth never got long from gum recession.  Each compression of the gums during a chew pumped out the old blood, and each release of compression after the chew allowed in new blood.  However, in many adults today, the combination of soft food and receeding gums has eliminated this natural massage provided by chewing.  
 
The best tool for recreating natural gum stimulation is the rubber tip.  This little pointed cone of rubber was included on the end of every toothbrush for the better part of a century until it was removed for marketing reasons - it lasts too long. The dental companies have been instead moving toward disposeable materials.  Rubber tips are still available, but they must be purchased separately.  The rubber tip should be rubbed along the gumline from one tooth to the next and pushed forcefully but briefly into the space between each pair of teeth.  With each push, the gums turn white when they lose the old blood, and they turn pink again when new blood flows back in to replenish the tissues.
 
 FLOSSING
There has been some debate recently about the effectiveness of flossing.  Flossing is a technique for removing food that has been stuck between adjacent teeth. Bristle brushes, various picks, and a water pick can also remove food stuck between the teeth.  If you have one or more areas where food gets stuck between adjacent teeth every time you eat, you'll need to remove it every time after you eat.  Flossing is one way to do that.  
 
TOOTHPASTE
Most toothpaste contains an abrasive, flouride, and a sweetener.  Abrasives are necessary to scour the surfaces, and flouride serves as a mineral.  Some toothpastes also contain herbs and essential oils or whitening agents.
 
Bentonite clay is a good alternative for those who want a more natural toothpaste.  Clay is naturally abrasive, and it contains flouride; however it also contains all the other trace minerals that were contained in all our food and water during evolution.  Scientists have discovered the need for about 10 of those trace minerals.  Those are extracted from rock or clay and then packaged for sale in supplements.  However, it's very likely that other trace minerals are also important to health, even though we don't yet understand why.  Thus it makes sense to consume small amounts of clay daily.  There are many herbalists and nutritionists who recommend swallowing a teaspoon of clay daily.  You can also get those minerals simply by brushing with clay.