by Kay F. Thompson, DDS
In today’s world there is an increase in all kinds and sources of stress. Individuals deal with stress in the ways they have been taught: “Keep a stiff upper lip”, “Hold on tight”, “Grin and bear it”, “Get a grip!” and “Bite the bullet”. All of these clichés admonish the individuals to maintain tension and tight control to get through the stressful situation. Frequently this control is maintained by gritting their teeth or clenching their jaws, both of which, if prolonged, can result in an extremely painful response.
For individuals who display bruxism and the resultant temporo-mandibular dysfunction, sometimes working with them and teaching them to utilize autohypnosis can be enough to alter this stress response. Not only is it a reframing, it is symptom substitution, by offering a “good” response for the “bad” one they acquired.
The first thing I am interested in doing is validating the behavior of the patients. I explain that the response that they developed was an appropriate one at the time at which they developed it. It was the only safe way they could respond to the situation. In body language, it may have been their effort to “bite back words” or “swallow insults”, when they had a teacher, employer, or relative who would berate them in a circumstance where they were not able to speak out in their own defense, or retaliate.
It may also have been a response to pressure put on them when someone they loved was sick, and the patients wished to hide their emotions. They learned to protect themselves by grinding their teeth or clenching their jaws, generally during their sleep. This behavior then generalized into a learned response, or habit, to any type of stress. Now, I explain to them, I am going to teach them how to change that habit pattern.
I teach the patients how to go into trance. Then they learn how to utilize autohypnosis. I tell them the following, while they are in trance: “This stress response habit uses energy in a negative way. We are going to convert this negative energy, this destructive energy, into a positive, constructive energy. Every time that your teeth come together to grind, that will be the signal for that negative, destructive energy to run from your jaw, down through your neck, across your shoulder, down through your arm and into your hand, where you will clench your fist to convert that negative energy into a positive, constructive energy.” I repeat that message.
Next, to help effect that change and motivate them, I provide a logical reason why it is beneficial for them to do this. With someone who plays golf, it is to improve their golf swing. For a tennis player, it is a way to improve their backhand. With an older woman who is not interested in exercise or sports, this isometric exercise is a way to keep the upper arm from getting fat and flabby. These are all designed to motivate the individual.
Taking it outside the office
I add to the instructions by giving them something to squeeze in their hand, such as a piece of flexible plastic pipe, a hand exerciser, or a piece of foam rubber. They are instructed that when they go to bed they are to hold this item in their hand, to encourage them to convert their negative energy into positive energy. (The same instructions regarding holding the exerciser would apply even if they are daytime “clenchers”.)
The patients are reassured that they will sleep well, but they will squeeze their exerciser on instructions from the “back of their mind” or unconscious while they are asleep, and that they need not awaken to make the energy transfer. Since the habit originates in the unconscious and they cannot control it consciously, they have no trouble accepting that rationale. As the exercise begins to be effective, they will also comment on the relief in their jaws in the morning, and the tired feeling in their hand.
To end the appointment, I have the patients rehearse their assignment, to make sure we both understand the procedure. I see them after a couple of weeks to discuss their progress. I expect that most people will show significant improvement and pain relief in three appointments if this is truly a retained learned behavioral response.
Referral to psychological counseling
If the problem is a manifestation of a deeper psychological symptom, and two or three appointments does not result in a change, then I will suggest to them that it does not seem to be making the difference it should by now. I tell them that I think that possibly there is some additional reason why they are retaining the habit, and ask them if they would be interested in a consultation with my friendly psychologist down the street. Patients appreciate the help you have offered them, and are generally willing to investigate further by making an appointment for the consultation.
One of the common methods of treating bruxism involves making a splint that covers the teeth and is worn at night. This splint reduces the ability to grind and abrade the teeth, but does not preclude the activity itself. The patient often will wear through the splint and have to have a new one made, whether it is a soft and pliable one or a hard plastic one. It does not reduce the grinding behavior, it reduces the detrimental effect of the behavior on the teeth and jaws.
When one is to treat bruxism, one must first make certain that there are no prematurities on the teeth (high spots on teeth or fillings, etc.), which will cause grinding in an effort to “even” the occlusion. It is also appropriate to have radiographs and/or other diagnostic tests to rule out any physiologic causes which should be corrected.. If the grinding continues, it can destroy the temporo-mandibular joint relationship. If there is already severe demonstrable damage to the temporo-mandibular joint, surgery may be necessary to correct the problem. If the surgery does not alleviate the grinding, the pain will continue.
The hypnosis approach is used when physiologic causes have been ruled out or corrected and the bruxism continues. Some of the indications include:
1.) Complaints of jaw soreness and tiredness, especially in the morning.
2.) Headaches and/or earaches with no other cause
3.) The occlusion of the teeth is damaged, and the teeth are physically worn down on the chewing surfaces.
4.) Severe and often radiating pain in any combination of the following: the teeth, jaws, cheeks, head, neck and down the back.
5.) Beginning deterioration of the TM joint.
Who can use this?
Not all patients are willing to accept the fact that stress can have contributed to their pain, nor that they can learn to change that response. Some patients prefer the surgical route as the “simple” physical solution. Many patients are referred by an oral/maxillofacial surgeon who does not feel that surgery is a necessary or appropriate treatment. The majority of patients who are referred or choose autohypnosis as their treatment are successful.
Part of the treatment consists of a complete history, including discussion of the stressors in their life. It is my opinion, with no data to substantiate it since these are clinical patients and not experimental subjects, that often recognition and discussion of the sources of stress make the chance for successful treatment much better. My estimate is that 75-80% of my patients succeed in changing their stress response.
Outcomes that can be expected
The eventual outcome, as reported by the patients, seems to be that as they improve, they gradually cease using the exerciser. Occasionally someone will report to me that they had stopped using it, but then a crisis arose and they felt the stress begin again, so, without bothering to tell anyone, they simply went back to using their exerciser, and the stress reduction capability returned.
One patient who had been quite successful in using the exerciser to reduce his nighttime bruxing was also a “fearful flier.” On one trip from the northeast US to Australia, he dropped the exerciser into his coat pocket as he was leaving for the airport. During a stopover in the Philippines, he called his wife and asked her to let me know that it had been the most pleasant flight he had ever had – he was even able to eat the meals served. He said it was because he used the stress reduction exercise during the flight.
Another patient had been recommended as a potential candidate for surgery since splints had not reduced the pain from bruxing. At the time she was going through a painful separation and divorce, which necessitated her re-entering the job market and worrying about child care. After some discussion of the possible relationship between her bruxism and the stress she was going through, she agreed that they might be related. She learned the autohypnosis/exercise routine and agreed to practice it three times a day as well as during the night. Her headaches were significantly diminished immediately. As she continued practicing the exercise, her jaw pain was eliminated.
This use of hypnosis to reduce/eliminate bruxism is a safe, non-invasive treatment that teaches the individual an acceptable substitute for a painful and potentially damaging behavior.