ABOUT OROFACIAL PAIN & DYSFUNCTION
(NL: "GNATHOLOGIE")
"Gnathologie" comes from the Greek word "gnathos," meaning 'jaw', and "-logie", meaning 'the science of'. Dentist specialized in 'Orofacial Pain & Dysfunction' (NL: tandarts-gnatholoog) treats conditions such as facial pain, headaches, problems with the chewing muscles and jaw joints, tooth wear, and sleep disorders. Sometimes these conditions coexist and aggravate each other. Certain oral habits, such as clenching and grinding (bruxism), can contribute to these conditions.
WHEN DOES "GNATHOLOGIE" PROVIDE
A SOLUTION?
If you suffer from the following complaint(s), you can contact us for an appointment with the dentist specialized in 'Orofacial Pain & Dysfunction':
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Facial pain
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Headache
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Jaw pain: pain in the chewing muscles and/or jaw joints (also called TMD, see paragraph below)
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Difficulty opening the mouth
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Sounds in the jaw joint (such as clicking or popping)
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Ringing in the ears (tinnitus)
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Toothache with no known cause
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Grinding / clenching (bruxism)
Temporomandibular Disorder (TMD)
Temporomandibular Disorder, or TMD for short, refers to problems with the chewing muscles and/or jaw joints. These problems can manifest in various ways:
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Pain – for example, tense or tired chewing muscles, pain in the jaw, temples, or around the ear. Sometimes this radiates to the head, neck, or molars (referred pain).
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Dysfunction – such as difficulty opening or closing the mouth, limited mouth opening, or sounds in the jaw joint (popping, clicking, or grinding)
TMD often develops in the context of prolonged overload of the masticatory system, through persistent gritting one's teeth. Besides physical factors, stress, emotions, and lifestyle also play a significant role.
That is why at UNCLENCH we take a biopsychosocial approach: we consider the whole – body, behaviour and context – to arrive at sustainable treatment.
HEADACHE
Many people call any severe headache a "migraine." But migraine is actually just one of many types of headaches. There are also tension headaches, cluster headaches, and headaches related to masticatory system disorders (TMD).
You may even have both migraines and headaches caused by TMD. If only one of these headaches is treated, the headache may keep coming back or feel worse than it needs to be. Therefore, it's important to thoroughly investigate which types of headaches you have so that each one can be treated effectively.
At UNCLENCH, we'll work with you to determine the role of TMD in your headache symptoms, and whether other headache diagnoses are likely contributing to your pain. We collaborate with pain specialists, for example, if needed.
BRUXISM
Bruxism is clenching or grinding the teeth, through sustained tension in the masticatory muscles without tooth contact. Many people consider this a major culprit because it can cause pain, muscle fatigue, or tooth wear. Nowadays, bruxism is sometimes treated with botox, which can temporarily weaken the chewing muscles.
However, bruxism isn't always negative. It can also play a protective role, for example, in sleep disorders, or be your body's way of processing distress. Therefore, it's important to carefully consider the context: when is bruxism harmful, and when not?
Moreover, botox isn't a long-term solution. It's expensive, requires frequent repetition, and your body can eventually become resistant. It makes you dependent on treatments, while bruxism often doesn't require treatment at all. In selected cases, botox can be supportive, provided it is part of a multidisciplinary approach and not a replacement for self-management and preventive strategies.
At UNCLENCH, we believe in a different approach: self-management. This means gaining insight into your symptoms, understanding the contributing factors, and learning how you can influence them. Only when bruxism actually causes pain or damage, we do work together to find appropriate treatment. This way, you stay in control, instead of becoming dependent on temporary solutions.
SLEEP DISORDERS
Sleep disorders such as snoring and sleep apnea are common. Sleep apnea causes breathing stops in the sleep, thereby the sleep quality is reduced. This can disrupt the brain and nervous system's pain regulatory functions. This increases the risk of pain persistence. In addition, sleep bruxism (grinding or clenching during sleep) is often seen with sleep apnea, which places additional tension on the chewing muscles and jaw joints, potentially perpetuating TMD pain.
There are also significant connections with other complaints. For example, gastric reflux is more common with sleep apnea, which can lead to tooth wear due to stomach acid. Bruxism can play a role in this because it stimulates saliva flow, thus your own body protecting the teeth against acid.
It's also important to know that an occlusal splint (clench / grinding mouthguard), often used in TMD treatment, can actually worsen untreated sleep apnea in some cases. Keep in mind that if you have (silent) gastric reflux, an occlusal splint can trap acids around your teeth for longer, which can lead to faster progression of tooth wear. Therefore, thorough screening for sleep disorders beforehand is so important.
I screen patients for signs of sleep disorders. The diagnosis and treatment plan for sleep apnea are always determined by a sleep specialist, following a referral from a general practitioner. I have experience performing MRA (Mandibular Repositioning Appliance) procedures and evaluations, and I always consider sleep as part of the overall picture of symptoms.
TOOTH WEAR
Tooth wear can arise from various causes. Sometimes it's due to mechanical stress (such as grinding or clenching), sometimes to chemical influences (acid from food or stomach acid), and often to a combination. For this reason, it's essential to conduct a thorough and careful intake. In plain language, this means we investigate whether tooth wear is primarily related to what you eat and drink, to habits like clenching or grinding, or to factors within your own body.
We'll also discuss your needs together: do you primarily want your teeth to look better (aesthetic), or are you more interested in improving your chewing and function? At the end of the intake, we'll discuss the results of the examination and develop a treatment plan. This can range from active monitoring (tracking progress), using preventative measures (such as nutritional or lifestyle advice, or an occlusal splint), to restorative treatments. You'll always receive a clear explanation of the pros and cons of the various options.
Advice for monitoring tooth wear: When changing your dental practice, always bring your complete patient file, including all (x-ray) images. Ask your dentist to occasionally take photographs of your teeth with a camera, and have dental models made and kept in a safe place. This allows for a better assessment of the progression of tooth wear, which is important for appropriate advice and any decisions regarding restorative intervention.
"THE WAY WE SEE THE
"PROBLEM IS THE PROBLEM"
- STEPHEN R. COVEY
MY VISION
Symptoms such as pain, tooth wear, and sleep disturbances can occur independently or in combination. For example, we see patients with severe tooth wear due to grinding or clenching, without experiencing TMD pain. Everyone is different: one person clenches and has no TMD pain, while another experiences TMD pain without tooth wear. Not every symptom is the same. This demonstrates the importance of taking a broad view of all the contributing factors.
Pain is often the main reason people seek help, but its cause usually lies in a complex interplay of factors. Physical overload (chewing muscles and jaw joints) as well as tension, emotions, sleep, and lifestyle often play a role in head and neck complaints. Expressing emotions is crucial in this regard: pent-up tension and emotions can manifest physically, which can translate into pain. The nervous system can become disrupted in this process: when it is "on" for extended periods, pain is amplified and perpetuated.
That's why, in my treatment, I look not only at the location where you experience pain, but also at the factors that fuel it. Together, we'll explore which puzzle pieces are at play in your situation and how we can calm your nervous system. My goal is to provide you with insight and tools so you can take control of your symptoms. We call this self-management: learning to understand what's happening in your body and how you can influence it. When necessary, we collaborate with other specialists in a multidisciplinary team. This way, we ensure an approach that not only reduces pain but also helps you function and live better in the long term.
