International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS IN DENTISTRY 293
may be thought of as an orthopedic condition, which is manifested by the skeletal
malalignment of the mandible to the cranium and the neuromuscular imbalance of
the muscles of mastication and associated musculature of the head and neck. When
the lower jaw is jolted out of its habitual closure pattern, the teeth do not meet
properly and abnormal stress is placed on just a few teeth. The neuromuscular
apparatus protects these teeth by preventing complete closure, which results in
fatigue of the muscles of mastication. The consequence of this unphysiologic
positioning is jaw dysfunction, muscle spasm and pain. The cycle is perpetuated till
the opposing teeth are adjusted to meet comfortably and the habitual cycle of pain
is extinguished.
Effectively managing TMD requires a two-pronged approach of physically
eliminating the noxious dental stimulus and mentally relaxing the muscles of
mastication and muscles of facial expression. The use of medication and massage
of sore muscles may expedite the healing process. Treatment of the physical
etiology may be as simple as polishing ®llings that have expanded with the course
of time. Other treatment options may range from wearing a specially designed `bite
guard' appliance during sleep or when stress is experienced during the day), to
comprehensive orthodontic treatment and full mouth reconstruction with dental
implants, crowns and bridges. But it may be impossible to determine the proper
bite relation as long as the supporting muscles are in the clenched or braced
posture. Resolution of the disorder requires a coordinated effort. The patient needs
to learn how to relax the muscle of mastication and the dentist needs to adjust the
bite for optimal comfort. Learning how to relax the muscles and cease diurnal and
nocturnal clenching and tooth grinding is no easy task. Approaches range from
wearing orthodontic dental appliances or using thin splints, to taking tricyclic
antidepressants, to undergoing biofeedback training, to psychiatric counseling, to
relaxation/hypnosis training.
The 5-minute relaxation exercise described earlier) has proven to be a potent
means of helping the patient relax so that the teeth can be equilibrated. After the
teeth have been adjusted, the exercise is bene®cial in helping the jaw relax into the
new position. If the muscles are still tense, it's all right to touch the area and
massage the tension out. The relaxation exercise, followed by the head, face and
jaw massage, should be done several times throughout the day during the acute
phase and as needed when there is the sense that a headache is about to erupt.
The cause of bruxism is obscure and disputed. One suggested cause is anatomic
interferences of opposing teeth during function or at rest. Children who have
nervous disorders exhibit signs of bruxing more frequently Peterson & Schneider,
1991).
Though bruxism during childhood has few long-term sequelae, the teeth may be
permanently damaged. An extended period of forceful bruxism can result in tooth
surface abrasion, fracture, or pulpal exposure or necrosis. Destructive affects to the
periodontium and tooth structure may be suf®cient to cause pain and soreness
during mastication. If habit suppression is deemed appropriate and/or necessary,