Tinnitus, also known as ear ringing, is a distressing condition that affects millions of people worldwide, sometimes without being aware of it until it evolves into a severe case.
While its exact causes are varied and can be elusive in many cases, recent research has shed light on a potential link between bruxism (or teeth grinding), TMJ, and the development or exacerbation of tinnitus.
Today, we’ll aim to explore this intriguing relationship, delving into the mechanisms behind this connection and examining potential management strategies.
Let us hope that by understanding this complex interplay between TMJ, bruxism and tinnitus, we can offer new insights into managing ear ringing and improving the quality of life for those who experience this often debilitating condition.
Definition of Bruxism or Teeth Grinding
Bruxism, also known as teeth grinding, is a condition characterized by the involuntary clenching or grinding of teeth. It is often an unconscious habit that can occur during the day or at night while sleeping, known as sleep bruxism or nocturnal bruxism.
One of the primary causes or risk factors is stress and anxiety, which can lead to involuntary clenching or grinding of the teeth. It can also be a result of an abnormal bite or misaligned teeth, as well as side effects from certain medications or substances like caffeine or alcohol. Other factors such as sleep disorders like sleep apnea, genetics, and lifestyle habits like smoking or excessive chewing can contribute to the development of bruxism as well.
Although the term bruxism might be relatively new for many people, it’s a well-known disorder affecting even popular celebrities. Figures such as George Clooney, Brooke Shields, and Chrissy Teigen have been open about their struggle with the condition.
Symptoms of Bruxism
Teeth grinding can be identified through a range of specific symptoms. Recognizing these sign and symptoms is crucial in managing bruxism and preventing its potential consequences:
- Jaw pain: Bruxism can cause discomfort or pain in the jaw muscles, especially upon waking up in the morning.
- Facial pain: Grinding the teeth exerts pressure on the muscles and tissues of the face, leading to orofacial pain (pain felt in the mouth, jaws, and face) or soreness.
- Headaches: Bruxism can cause frequent headaches, especially in the temples or at the back of the head.
- Tooth sensitivity: Grinding the teeth can wear down the enamel and expose the underlying dentin, leading to tooth sensitivity to hot or cold temperatures.
- Tooth damage: Bruxism can result in worn down, flattened, or chipped teeth, as well as damage to dental restorations such as fillings or crowns. Tooth damage due to bruxsim also puts individuals at higher risk of tooth decay, cavities, and tooth loss.
- Sleep disturbances: Sleep bruxism can disrupt sleep patterns, leading to bad night sleep.
- Ear pain: Some individuals with bruxism may experience ear pain or discomfort, which can be a result of excessive pressure on the jaw joint. This symptom can also be tied to tinnitus itself.
- Cheek biting: Grinding the teeth can lead to unintentional biting of the cheeks, causing pain or sores.
- Shoulder or neck pain: Excessive muscle activity during teeth grinding can also cause discomfort or pain in the neck and shoulder muscles.
- Sleep partner disturbance: Sleep bruxism patients won’t be the only ones experiencing bad night sleep, as their sleep partners can also be disturbed and awakened by the sounds of clenching and grinding of teeth at night.
Temporomandibular Joint Disorder: What is it?
Temporomandibular joint disorder, sometimes called temporomandibular joint dysfunction but commonly known as TMJ disorder or TMD and TMJ, is a condition that can lead to jaw pain and muscle discomfort. TMJ disorder affects the joint connecting the mandible or jawbone to the skull, causing problems with jaw movement and function.
One common cause of TMJ disorder is teeth grinding. The constant grinding and clenching of teeth can put excessive pressure on the temporomandibular joint, leading to inflammation, pain, and muscle tension. The jaw joint is very close to the inner ear, a key component of the sounds we perceive, and this is where a possible link with tinnitus comes into play.
While sometimes cited as a cause of bruxism, the inverse can also be true. Both of these conditions can be present in a single patient.
Tinnitus Symptoms and Definition
Tinnitus is a condition characterized by the perception of sound in the absence of any external sound source. It is commonly referred to as a “ringing in the ears,” but the perceived sound can also be described as buzzing, hissing, or whistling. It can be temporary or chronic, and it can vary in intensity.
A 2014 study showed almost 10% of the general U.S. population had some form of tinnitus. However, other studies worldwide have resulted in up to 15% of the population suffering from it. Many famous and renowned people in history, above all musicians, have suffered from the condition. People like Eric Clapton, Bob Dylan, Liza Minnelli, Dave Grohl, Demi Lovato, Barbra Streisand, and Roger Taylor. Even other celebrities whose careers took them through many a sound stage, like David Letterman, William Shatner, and even Ronald Raegan.
It is often associated with hearing loss or damage to the auditory system, specifically damage to the hair cells and bone structure in the cochlea or the inner ear. The cochlea is the part of the auditory system that converts sound waves into electrical impulses that travel from the auditory nerve to our brains, which then interprets them as sounds.
There are a variety of underlying medical causes to it, including age-related hearing loss, exposure to loud noise, earwax blockage, ear infections, ear injury, certain medications, and conditions such as high blood pressure, Meniere’s disease, and temporomandibular joint (TMJ) disorders. In some cases, it may also be a symptom of a more serious underlying condition, such as a brain tumor or cardiovascular disease.
Hearing loss or ringing can have a significant impact on a person’s quality of life, causing sleep disturbances, difficulty concentrating, and emotional distress.
There are two main types of tinnitus: objective and subjective, and understanding them is crucial to effectively managing it.
Diagnosis
One commonly used tool to diagnose and assess the severity of tinnitus is through a physical examination and questionnaire. The questionnaire design consists of a series of questions that aim to gather information about the individual’s experience with the condition, including the perceived loudness, pitch, and frequency of the sound, as well as the impact it has on their daily life. The questionnaire selection may also inquire about the possible causes or triggers of tinnitus, such as exposure to loud noises or certain medical conditions.
The responses obtained from the questionnaire can provide valuable insights into the nature and impact of the condition on the life of individuals with tinnitus. By assessing the severity and characteristics, healthcare professionals can tailor treatment approaches to suit the specific needs of each patient. The questionnaire can also be used to track changes in tinnitus symptom severity over time, allowing for the evaluation of treatment effectiveness and the identification of potential triggers or patterns associated with the condition.
Objective Tinnitus
Objective tinnitus refers to a specific medical condition characterized by the perception of sound that can be heard by both the individual experiencing it and others around them. Objective tinnitus can be measured and confirmed by a healthcare professional.
Subjective Tinnitus
Subjective tinnitus, also known as non-objective, is a condition characterized by the perception of sound that is only audible to the individual experiencing it. Unlike the objective type, which can be heard by a healthcare professional during an examination, subjective tinnitus is typically heard only by the person affected. Here, the sound of tinnitus manifests as a constant or intermittent ringing, buzzing, hissing, or roaring sound in the ears.
There is also a subset of subjective tinnitus called somatic tinnitus, which is when it’s caused by a musculoskeletal problem, which in many cases can be TMJ or bruxism.
Managing ear ringing caused by subjective tinnitus often involves addressing the underlying causes, such as stress, anxiety, or dental issues. Treatment options may include stress management techniques, a hearing aid, cognitive behavioral therapy, biofeedback, dental splints, and lifestyle modifications.
Relationship Between Bruxism, TMJ Disorder, Tinnitus
The relationship between bruxism and temporomandibular disorder (TMJ) has been studied extensively, revealing a potential link to the development and exacerbation of tinnitus.
Constant grinding of teeth can put excessive pressure on the jaw joints and jaw muscles, leading to TMJ disorder. This disorder affects the chewing muscles, along with the ligaments and bones in the jaw, causing pain, jaw stiffness, and difficulty in opening and closing the mouth.
While the exact mechanism behind the tinnitus and TMJ or bruxism link is not fully understood, it is believed that the inflammation and muscle tension associated with TMJ disorder can contribute to the development or worsening of ringing in the ear.
This is because the temporomandibular joint (TMJ) is located near the inner ear, where the cochlea is located. The cochlea plays a crucial role in converting sound waves into electrical signals that the brain can interpret as sounds. Due to their close proximity, if the TMJ becomes irritated and inflamed, it can potentially alter the blood flow through the inner ear and harm not only the cochlea but also other structures of the inner ear, like the trigeminal nerve. If this happens, there’s an increased possibility of tinnitus developing. In fact, some people with TMJ have been found to alter the sound of tinnitus in their head with their jaw movements. This is called somatosensory tinnitus.
One major reason why the condition is linked so much to nocturnal bruxism instead of its diurnal type is that the tinnitus loudness is most distinguishable during the night when there are little to no environmental sounds. The constant grinding of teeth at night from either bruxism or temporomandibular disorder can lead to many uncomfortable and painful symptoms, among them tinnitus.
Several studies have found a higher prevalence of ear ringing in individuals with bruxism or TMJ disorders compared to those without these conditions. One study from Brazil published in 2014 showed that up to 76% of TMD patients had it, a much higher rate than that of the general population.
Another major study published in 2019 found TMJ in 36% of subjects with severe tinnitus. The tinnitus in patients was present in the form of discomfort from loud noises and problems tolerating sound.
Treating Tinnitus From TMJ or Bruxism
In order to find some relief from tinnitus related to bruxism or TMJ disorder, it is essential to address and manage these underlying conditions.
This may involve interventions such as dental splints or mouthguards to prevent teeth grinding, physical therapy exercises to relieve TMJ-related tension, and stress management techniques to reduce jaw clenching.
Muscle relaxants can also help, as blood flow to the ear and inflammation are known to be linked to ringing sounds in the ear. The relaxants will lower blood pressure, giving some relief from tinnitus, especially during the night and after a day full of stress and muscle tension.
As we’ve seen, the relationship between bruxism, temporomandibular joint disorder (TMJ), and tinnitus is complex.
Bruxism can contribute to TMJ disorder, which in turn can cause or worsen tinnitus symptoms.
Treating tinnitus caused by TMJ or bruxism involves addressing the underlying causes and managing symptoms through various approaches such as dental interventions, stress management, and relaxation techniques.
Even if further research is needed to fully understand the mechanisms, we can already develop effective treatment strategies for managing teeth grinding and TMJ disorder and thus provide some hope to individuals with tinnitus.
