TMJ & Occlusion



Occlusal disease

TMJ disorders

If you suffer from jaw pain, you are not alone. It is estimated that a quarter to a third of Canadians suffer from a disorder of the jaw joint, also known as the temporomandibular joint or TMJ. The TMJ is the most complex joint in the body. TMJ damage and pain can occur for two main reasons:

  • Physical trauma : an accident, a blow to the chin or the head, a fall or even a whiplash can cause damage to one or both TMJs.

  • A malocclusion : a lack of harmony between the bite and jaw joints. A malocclusion can also cause damage to the jaw joints. The consequences of a malocclusion can be disastrous and the damage to teeth, gums and joints can become severe and irreversible and over time one can begin to suffer from « occlusal disease ».

Occlusal disease

Occlusal disease is a group of consequences that arise from a malocclusion. Here are some of those consequences :

  • Tension headaches and migraines
  • Neck and back pain
  • Posture problems
  • Tooth sensitivity
  • Excessive tooth wear
  • Fractures and dental cracks
  • Excessive dental mobility
  • Bruxism (excessive grinding or clenching of teeth)
  • Gingival recession (gum recession)
  • Ear pain
  • Damage of TMJs with or without pain
  • Cracking of TMJs with or without pain
  • Muscle spasms

Dr. El-Samra obtained his certification from the Canadian Institute of Occlusion in 2014. Thanks to the principles acquired by this certification, he can treat and manage TMJ problems (temporomandibular joint or jaw joint) through conservative, non-invasive care. Eight out of ten cases can be managed without surgery, with an equilibrated night guard and/or dental equilibration.


Three out of four Canadians grind their teeth at night. Teeth grinding, or bruxism, can cause significant damage to the teeth and jaw joints and premature aging of the masticatory system. It is a major factor in the development of occlusal disease. It is extremely important to prevent and manage it, despite the fact that it is often undetectable by the person who grinds.

Bruxism can cause one or more of the following problems:

- Wear, fracture, mobility and / or tooth sensitivity

- Gingival recession or loosening of the gum

- Pain and / or cracking of the jaw

- Tension headaches and migraines

- Neck pain and back pain

Equilibrated Night Guard

An equilibrated night guard, followed by a dental equilibration, help protect teeth and joints from the devastating effects of bruxism to preserve their long-term health and integrity.

An equilibrated night guard is a high-precision acrylic dental appliance that is worn usually on the lower teeth. This device helps passively position the jaw in its most stable position, which helps treat pain associated with TMJ disorders.

It differs from a regular night guard in that it is precisely and meticulously adjusted once a month for several months by the dentist, by guiding the jaw into its most stable position. This position promotes the elimination of problematic muscle tension and the reduces excessive forces on the TMJs, which helps prevent, reduce, manage and even eliminate TMJ pain, tooth grinding, tooth sensitivity, dental fractures, headaches and migraines and even recession of the gums.

Monthly adjustments are necessary to re-equilibrate it, as TMJ inflammation decreases, which changes the bite. The symptoms should then start to improve. The TMJs eventually regain their stability and the dentist confirms this when he no longer sees any change in the contacts of the teeth on the appliance during two consecutive adjustment sessions. At that point, the symptoms should be completely alleviated in most cases.

Occlusal Equilibration

Dental occlusion is how the lower teeth contact the upper teeth and function together in relation to the best position of the jaw joints, called TMJs (temporomandibular joints). Establishing ideal occlusion is very important if we are to ensure that we maintain our health and comfort in the short and long term, avoid occlusal disease and preserve the integrity and longevity of all our dental restorations.

It is estimated that over 90% of people suffer from a malocclusion. It is one of the most common sources of oral health problems. These problems can become debilitating, hence the importance of establishing a harmonious occlusion as soon as a malocclusion is diagnosed. A malocclusion detected and treated earlier can prevent serious problems that are expensive and difficult to treat later.

Occlusal equilibration, or balancing the bite, is often the treatment needed to establish a harmonious bite. It helps eliminate problematic contacts that interfere with the perfect relationship between teeth when the TMJs are in the correct position called "condylar seating". This is a conservative and precise treatment that should be performed after the dentist confirms that the TMJs are stable.

Also, an occlusal equilbration is always performed at our office after every orthodontic treatment. If the teeth need to be aligned to fix the bite first, an equilibration is necessary to precisely perfect the bite.

The process of occlusal equilibration

To perform an equilibration, the dentist gently and delicately manipulates your jaw to its ideal position. This ideal position of the jaw is called a “centric relation” or “seated condyle”. Meanwhile, the assistant holds special carbon papers between the top and bottom teeth to mark premature contacts. These contacts, called interference, are then removed by the dentist by grinding them very precisely and selectively, as they interfere with the best position of the jaw.

This process is repeated several times during the session until the teeth close perfectly together. The amount of enamel adjusted varies from case to case, but the dentist always makes sure, before starting, that it will be minimal and conservative without compromising the structure of the teeth. An equilibration actually prevents loss of tooth structure by preventing wear and fractures in the long run and creating harmony between teeth and TMJs.

Immediately after an equilibtration, most people will feel an unprecedented comfort in the teeth and jaw. Dental sensitivities will start to subside. Headaches and migraines are eliminated or reduced in frequency and intensity. The risks of consequences of the malocclusion listed above are reduced considerably.

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Dr. El-Samra and the team at D Dental Office are pleased to offer you advice related to your oral health. It is our mission to help you maintain a healthy smile.