docJaw pain can be due to a number of problems. One problem that is often talked about as a potential source of jaw pain is “the bite.” The bite refers to how the upper and lower teeth fit together when the patient is chewing. This topic is marred by controversy. Some dentists feel that a bad bite can cause jaw pain, while others may feel completely the opposite. Let’s look at the available evidence and see if a bad bite can cause jaw pain, TMJ, or even headaches.
Bad Bite Definition
We’ve all heard the term “bad bite.” But, what does it mean? What makes a bite bad? Is there only one kind of bad bite? Does the bad bite become good after a while?
- Bad Bite – A Number of Reasons
The term “bad bite” was mainly coined by dentists and orthodontists to communicate to patients how their bite compares to the normal. No patient has ever run to the dentist complaining of a bad bite! So, a more proper term may be an “abnormal bite” instead of a “bad bite.” And there are many reasons why the bite can be considered abnormal. Looking at millions of people’s teeth and their bite, it was noted that over half of the population people (about 60%) have a very similar-looking bite. This was used as the baseline definition of normal. The remaining 40% of the people had a different bite compared to the larger group. So their bite was deemed as somewhat defective, abnormal, or bad.
- The Bite – A Ghost Organ
In discussing “the bite” we need to understand that the bite is not a real organ, like our heart, lungs, nose, toes, etc. The bite is referring to how the upper and the lower teeth fit together when the patient chews their food or wants to swallow. When the top and bottom teeth are not in contact, the patient technically does not have a bite. And conversely, the longer the patient has their teeth together, the longer the bite exists.
- Bad Bite – A Continuum
For the sake of understanding “the bite” better, let’s make an analogy to something like obesity. A person can be slightly over their ideal weight. Or they can be extremely overweight as in severe obesity. Both are considered weight-related problems but to varying degrees. The same can be said for a bad bite. A bite can be considered bad for reasons that are minimal (e.g. slight crowding in the lower front teeth) or for reasons that are quite severe (i.e. “buck” teeth, crossbite, etc.). So in considering the impact of the bite on jaw pain, the severity of the bad bite needs to be considered.
- The Bite and the Force Behind It
What is often overlooked when looking at a bite, is how much force the patient puts into it. For example, let’s consider making a fist. Now consider how hard you are squeezing your fingers together. You can squeeze super hard or hardly at all. The same thing happens when we chew food or swallow. We can generate excessive force with our muscles while chewing or swallowing, or we can generate a normal amount of force. As we’ll see below, the force behind the bite has a big impact on jaw pain and TMJ.
Bad Bite and Jaw Pain – A Cause or A Correlation
If a bad bite caused jaw pain, everyone with a bad bite would have jaw pain. But this is not the case. There are lots of people with a bad bite that don’t have any jaw pain. And, there are patients with a “good” bite that have jaw pain.
So then do we say that a good bite causes jaw pain? Of course not. What this means is that there is no causation between the bite (good or bad) and TMJ. The patient’s bite doesn’t result in TMJ all by itself. Similar to high blood pressure and a heart attack. Having high blood pressure by itself does not cause a heart attack. Otherwise, we’d see all professional athletes dropping dead. However, there is a correlation between patients with certain types of “bad” bites and TMJ.
When we defined a bad bite earlier, we saw several factors that need to be considered when talking about the bite. Specifically, we need to consider the type of the bad bite and its severity. We also need to look at the force patient generates while biting as well as the length of time the patient bites.
- Type of Bad Bite
The problems with a bad bite can be broken down into functional and esthetic problems. An esthetic problem is why most patients consider getting braces. They don’t like their smile for some reason and want it improved. A functional problem is one that interferes with normal functions of the jaw while the patient is talking or chewing. Of these two types of problems, it is usually the functional problems that have a higher tendency of causing jaw pain or TMJ.
- The Severity of the Bad Bite
There are many ways to consider the severity. For our purposes let’s look at the severity in one of two forms: shifting vs non-shifting. If the bad bite causes the patient to shift their lower jaw in any direction much different than their resting jaw position, then it’s considered to be of a shifting type. If on the other hand, the patient’s jaw position isn’t much different compared to the resting position, then it is a non-shifting condition. Of the two forms, the shifting is the more severe. In other words, patients with a bad bite that have shifting jaw position as well, tend to have more problems with jaw pain and TMJ.
- The Force of the Bite
Returning to the fist analogy from earlier, we can bite gently or bite really hard. The amount of force the patient generates when biting down (or clenching) can vary tremendously not just in between patients. The force also varies based on the patient’s mental status and stress level. When considering the impact of force on jaw pain, there is a strong correlation between patients who bite hard and jaw pain as opposed to patients who don’t bite hard.
- Length of Time the Patient Bites
In a normal resting position, there is no tooth to tooth contact between the upper and lower teeth. In an abnormal resting position, the patient’s upper and lower teeth are in contact. This increases the amount of time that the “bite” exists. The more tooth to tooth contact the patient has at rest, the higher the likelihood of developing jaw pain or TMJ.
Bruxism – the X Factor
Bruxism is an umbrella term used to refer to the clenching and/or grinding of the teeth. Bruxism is considered a harmful habit, like chewing tobacco. The longer (and harder) the patient bruxes, the more likely they will develop jaw pain. Bruxism dictates whether a patient will develop jaw pain in the long run. In other words, if you compare 2 patients with equally bad bites, the one that tends to brux more will have a higher likelihood of developing jaw pain and TMJ.
Bad Bite – No Clear Link to Jaw Pain and TMJ
A bad bite doesn’t cause jaw pain or TMJ by itself, contrary to what some may say. There need to be several unhealthy elements present to make jaw pain more likely. Of the factors reviewed, the force and the length of time that a patient bites are key factors in jaw pain. What is also equally important is unhealthy habits like bruxism. A patient with a bad bite but no harmful habits can be free of jaw pain. And a patient with a healthy bite can suffer from jaw pain in the presence of harmful habits like clenching.
The “bite” is a multifaceted concept. Not only is it influenced by multiple factors like tooth size and position, but it can also be impacted by the presence of habits such as bruxing. Dr. Eslampour has years of experience treating patients for jaw pain and TMJ. Contact us now to get a handle on your jaw pain and TMJ.