[26] Abnormalities of occlusion (problems with the bite) are often blamed for TMD but there is no evidence that these factors are involved. Chronic Tooth Grinding or Clenching Grinding or clenching the teeth can put a great deal of stress on the temporomandibular joint and, over time, cause ongoing pain. Having a history of arthritis, gout, or a weakened immune system can increase your risk for infectious arthritis. [31] At its simplest, an occlusal adjustment involves selective grinding (with a dental drill) of the enamel of the occlusal surfaces of teeth, with the aim of allowing the upper teeth to fit with the lower teeth in a more harmonious way. [1] Sleep bruxism is mainly characterized by "rhythmic masticatory muscle activity" (RMMA) at a frequency of about once per second, and also with occasional tooth grinding. For example, in the United Kingdom, the term pain dysfunction syndrome is in common use. [4], According to the most recent analyses of epidemiologic data using the RDC/TMD diagnostic criteria, of all TMD cases, group I (muscle disorders) accounts for 45.3%, group II (disc displacements) 41.1%, and group III (joint disorders) 30.1% (individuals may have diagnoses from more than one group). [5] However, these factors are poorly understood,[6] and there is disagreement as to their relative importance. [57], US assessment is also indicated where there is need to identify the correct position of the joint spaces for infiltrative procedures, arthrocentesis, and viscosupplementation. Sensation of malocclusion (feeling that the teeth do not meet together properly). Patients with Fibromyalgia Fibromyalgia can cause pain throughout the body, including in the head, neck, shoulders, and jaw. This condition is common but also serious. In: StatPearls [Internet]. 2008, National Institute of Dental and Craniofacial Research, International Association for the Study of Pain, International Classification of Headache Disorders, International Classification of Diseases 10th revision, transcutaneous electrical nerve stimulation, Surgery for temporomandibular joint dysfunction, American Society of Maxillofacial Surgeons, "Management of Temporomandibular Disorders. Depending on various factors like your age, activity level, and the severity of your bunion, your surgeon will choose one of many surgical procedures, including osteotomy (bone realignment), arthrodesis (joint fusion), resectional arthroplasty (removal of the damaged joint), or exostectomy (removal of the bunion bump only). The Best Methods for Treating Your Bunion Pain. He has an active clinical practice at Methodist Willowbrook Hospital in Houston, Texas. Facial muscle changes. Waltham, MA: UpToDate Inc. Hern, S.; Vicenzino, B.; and Smith, M. Non-surgical treatment of hallux valgus: a current practice survey of Australian podiatrists. of Americans experience tooth pain per year. Menisci are pieces of cartilage in your knee. [49] Conversely, TMD is an important possible cause of secondary otalgia. Often, pain from jaw injuries lingers, often because people fail to seek treatment. If you know or suspect you have obstructive sleep apnea, find out how Dr. Katherine S. Phillips can help you find relief. You may also need it if one of your tendons is torn and cant heal on its own. [48], It has been suggested that massage therapy for TMD improves both the subjective and objective health status. Long-term bruxism can cause shorter teeth. [5][59] Electromyographic monitoring devices of the associated muscle groups tied with automatic alerting during periods of clenching and grinding have been prescribed for awake bruxism. Repeatedly bending your knees or bleeding in your bursae can cause a sudden onset of bursitis symptoms. [35] Due to the proximity of the TMJ to the ear canal, joint noises are perceived to be much louder to the individual than to others. It can also increase the risk of several diseases, including high blood pressure, stroke, heart disease, diabetes, temporomandibular joint disorder , and some headache syndromes. Pausing in your breathing during sleep is usually a symptom noticed by a spouse or partner. If the jaw joint degrades, patients may start to experience the same type of pain in the jaw that they do in other joints. While asleep, mostly during periods of sleep arousal, Pain worst on waking, then slowly gets better, Pain worsens throughout the day, may not be present on waking, Usually clenching, occasionally clenching and grinding, Unclear, little evidence of a relationship, Stronger evidence for a relationship, but not conclusive. [4] A more complete list of synonyms for this topic is extensive, with some being more commonly used than others. Sleepiness or lack of energy during the day, even after a full night's sleep: Fatigue is the most common sign of sleep apnea. [medical citation needed], Sometimes TMD pain can radiate or be referred from its cause (i.e. [7] This usually involves a dental examination, and possibly electroencephalography if a seizure disorder is suspected. The temporomandibular region is the area around the jaw, mouth, and ears. An ear, nose, and throat specialist can help evaluate you and determine whether a surgical fix could improve your sleep apnea symptoms. The pain discourages use of the masticatory system (a similar phenomenon in other chronic pain conditions is termed "fear avoidance" behavior), which leads to reduced muscle flexibility, tone, strength and endurance. [5] In 1931, Frohman first coined the term bruxism. WebA rotator cuff impingement is a type of injury that causes shoulder pain. Many other conditions also have the same symptoms. There are two main types of bruxism: one occurs during sleep (nocturnal bruxism) and one during wakefulness (awake bruxism). One of the questions we get at REstore TMJ & Sleep Therapy is whether temporomandibular joint disorders (TMD) can cause tooth pain. Medications. The relationship of bruxism with temporomandibular joint dysfunction (TMD, or temporomandibular pain dysfunction syndrome) is debated. 3. [29] People with TMD have been shown to have higher levels of anxiety, depression, somatization and sleep deprivation, and these could be considered important risk factors for the development of TMD. Abfraction is another type of tooth wear that is postulated to occur with bruxism, although some still argue whether this type of tooth wear is a reality. It has been suggested that the natural history of TMD is benign and self-limiting,[24] with symptoms slowly improving and resolving over time. [8] The ICSD-R states that sleep bruxism may occur in over 50% of normal infants. National Institutes of Health Technology Assessment Conference Statement", "Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings", "The relationship of whiplash injury and temporomandibular disorders: a narrative literature review", "Temporomandibular Disorders (TMD) Policy Statement", "Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders", "Classification of Chronic Pain, Part II, B. Studies have suggested that it may even be more beneficial than occlusal splint therapy, and has comparable effects to relaxation techniques. [5][25][15] The findings of one study, which used self-reported tooth grinding rather than clinical examination to detect bruxism, suggested that there may be more of a relationship between occlusal factors and bruxism in children. 2. Pay attention to the amount of sleep you actually get on a regular basis and how much sleep you need in order to function at peak efficiency. Awake bruxism is thought to be usually semivoluntary, and often associated with stress caused by family responsibilities or work pressures. Ice your knee to control swelling. However, it shouldn't be a common occurrence when you get a normal amount of sleep. In addition, other muscles around the face can enlarge to compensate for the dental changes. [10] Another report suggested a link between episodes of sleep bruxism and a supine sleeping position (lying face up). Dr. Phillips has years of experience treating TMDs and addressing the often painful symptoms that go along with these disorders. For the range of diseases affecting the joint, see. Expert reveals the long term damage you could be causing", "International Classification of Diseases 10th revision", "Behandeling van bruxisme. If these muscles are tense or have been damaged due to a TMD, it could result in tooth pain. TMJ disorders are chronic conditions that rarely go away on their own.Besides tooth pain, TMDs are often accompanied by headaches, pain behind the eyes, ear pain, popping or clicking in the joint, or limited range of motion. Experts say choosing between knee repair and knee reconstruction surgery isn't a simple decision. Quite simply, yes, TMJ disorders can cause tooth pain. However, if your discomfort is compounded by other specific symptoms, then the cause might be related to TMD. pain, limitation of movement, clicking) dysfunction of the temporomandibular joint. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. [23] Females with TMD are more likely to be nulliparous than females without TMD. [55] However, the issues lies in the fact that it is impossible to determine whether certain patient groups would benefit more or less from a radiographic examination. TMD describes symptoms related to disorders of the TMJ. [65], In the Bible there are several references to "gnashing of teeth" in both the Old Testament,[66] and the New Testament, where the phrase "wailing and gnashing of teeth" describes what an imaginary king believes is occurring in the darkness outside of his son's wedding venue. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. The ICSD-R listed diagnostic criteria for sleep bruxism. [2], In a subset of people with TMD who are not helped by either noninvasive and invasive treatments, long term use of opiate analgesics has been suggested, although these drugs carry a risk of drug dependence and other side effects. Diplomate, American Board of Dental Sleep Medicine, Diplomate, American Board of Orofacial Pain, Dr. Phillips serves TMJ & Sleep patients in: The Woodlands TX | Spring TX | Conroe TX | Tomball TX | Cypress TX | Houston Texas | Kingwood TX | Humble TX | Katy TX, 2021 by REstore TMJ & Sleep Therapy | Kashif J. Piracha, MD, is board-certified in internal medicine and nephrology. Occasionally, adverse effects may occur, such as bruising, but this is quite rare. Once tooth wear progresses through the enamel layer, the exposed dentin layer is softer and more vulnerable to wear and tooth decay. A grinding or tapping noise during sleep, sometimes detected by a partner or a parent. It has been shown that the type of research into bruxism has changed over time. [15] A small minority of dentists continue to prescribe occlusal adjustments in the belief that this will prevent or treat TMD despite the existence of systematic reviews of the subject which state that there is no evidence for such practices,[37] and the vast majority of opinion being that no irreversible treatment should be carried out in TMD (see Occlusal adjustment). Only 20% of patients need to proceed to surgery. A hit to the knee at a bad angle can tear the ACL, for example. How to examine a foot and what to do with a bunion. Sleep apnea headaches have certain symptoms that make them stand out from typical headaches. If a TMD is causing your teeth to ache, traditional tooth pain treatments will most likely prove ineffective. TMD disorders are a group of more than 30 conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. Another systematic review investigating the relationship between orthodontics and TMD concluded the following: "There is no evidence to support or refute the use of orthodontic treatment for the treatment of TMD. https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=979. Over-the-counter NSAIDs, or nonsteroidal anti-inflammatory drugs, can be an effective way to calm redness, swelling, and pain from plantar fasciitisparticularly if symptoms have been present for less than 6-8 weeks. If bunion symptoms do occur, they usually develop over time, well after the bump has formed. Which one is best for treating heel pain and plantar fasciitis? Improper massaging could worsen the tooth pain, so make sure you seek out professional treatment. Each lateral pterygoid muscle is composed of 2 heads, the upper or superior head and the lower or inferior head. The causes of bruxism are not completely understood, but probably involve multiple factors. Trigger finger causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. Content is reviewed before publication and upon substantial updates. cyclobenzaprine), and others. Part of this is due to the wide range of symptoms TMJ disorders can exhibit. [22] Stressful periods such as examinations, family bereavement, marriage, divorce, or relocation have been suggested to intensify bruxism. Some people are at higher risk of developing a TMJ disorder. Teeth grinding is the most common cause of jaw pain. Prim Care. [52] This method involves 2 diagnostic axes, namely axis I, the physical diagnosis, and axis II, the psychologic diagnosis. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. If you have a toothache, you should see your dentist. Factors that can cause or contribute to bunions include: Yes. By exercising the right muscles like the tongue and jaw you reduce teeth grinding. Contact us today to learn more about your options for treatment of mild to moderate sleep apnea using oral appliances. The best way to determine how to treat sleep apnea is to start with a medical diagnosis . Hold it and then straighten your hand. [1] However, others argue that there is insufficient evidence to draw such a conclusion. Current Medical Diagnosis & Treatment 2019New York, NY: McGraw-Hill; http://accessmedicine.mhmedical.com/content.aspx?bookid=2449§ionid=194443900. [86] Related conditions that are also claimed to be treatable by chiropractic include tension headaches and neck pain. Dr. Phillips creates individualized treatment plans that include customized oral appliances worn during sleep to help patients diagnosed with OSA who cannot tolerate CPAP or who prefer the convenience of a mandibular advancement device. All rights reserved. [6] In the 1960s, a periodontist named Sigurd Peder Ramfjord championed the theory that occlusal factors were responsible for bruxism. [61] In 978, Taiping Shenghuifang by Wang Huaiyin gave a similar explanation and three prescriptions for treatment.[62][63]. How Can You Differentiate TMJ Pain from a Toothache? [13] It has also been called a functional pain syndrome,[6] and a psychogenic disorder. Find out more below. [18] Overall, two hypotheses have dominated research into the causes of TMD, namely a psychosocial model and a theory of occlusal dysharmony. Prosthet Orthot Int. To theorize upon this observation, some have suggested that due to a tear in the back of the joint capsule, the articular disc may be displaced forwards (anterior disc displacement), stopping the upper head of lateral pterygoid from acting to stabilize the disc as it would do normally. When the bodys joints arent in proper alignment, it can result in jaw clenching and grinding. [29] There is a suggestion that treatment of factors that modulate pain sensitivity such as mood disorders, anxiety and fatigue, may be important in the treatment of TMD, which often tends to attempt to address the pain directly. Is Physical Therapy Needed After Bunion Surgery? If youre regularly suffering from tooth pain and a common dental issue doesnt appear to be the culprit, you may be suffering from a TMD. [15] BoNT injections are used in bruxism on the theory that a dilute solution of the toxin will partially paralyze the muscles and lessen their ability to forcefully clench and grind the jaw, while aiming to retain enough muscular function to enable normal activities such as talking and eating. [15] However, there is much disagreement between proponents of these techniques on most of the aspects involved, including the indications and the exact goals. WebHealthCentral combines medically vetted health information with personal stories and advice from patients to provide you with the tools and inspiration to navigate life and make informed choices. Botulinum toxin solution ("Botox") is sometimes used to treat TMD. Treatment for most patients includes wearing a wrist brace at night, stretching exercises, hand therapy, and steroid injections. There are plenty of home remedies and first aid treatments for conditions like runners knee and tendinitis. Hurn SE, Vicenzino BT, Smith MD. While not all snorers have OSA, loud snoring is a warning sign that you're struggling to get air through obstructions. Treatment of a bunion is only required if it is causing symptoms. [61][58] It allows three-dimensional evaluation of the axial, coronal and sagittal plane. 2018;26(19):e396-e404. People who grind their teeth during the day can make conscious changes to reduce their teeth grinding. It is rarely used. Clicking of the jaw joint may also develop. That erosion can lead to ongoing pain that seems to worsen with time. It is thought that in humans, clenching the teeth may be an evolutionary instinct to display teeth as weapons, thereby threatening a rival or a predator. Some patients will periodically return with splints with holes worn through them, either because the bruxism is aggravated, or unaffected by the presence of the splint. [12], Persons with TMD have a higher prevalence of psychological disorders than people without TMD. Here are our tips for relieving your nighttime foot pain. Healthline Media does not provide medical advice, diagnosis, or treatment. That being said, if every day dental concerns are ruled out, the tooth pain may also be a symptom of a temporomandibular disorder. In many cases, a mouth splint, like the ones we provided here by Dr. Phillips can be very effective. [17] In the United States, the term temporomandibular disorder is generally favored. It has been suggested that TMD may develop following physical trauma, particularly whiplash injury, although the evidence for this is not conclusive. "[35], As an alternative to simply reactively repairing the damage to teeth and conforming to the existing occlusal scheme, occasionally some dentists will attempt to reorganize the occlusion in the belief that this may redistribute the forces and reduce the amount of damage inflicted on the dentition. Getting a good night's sleep is critical to your overall health. Teeth grinding can change the appearance of your teeth, causing them to look shorter and make chewing more difficult. Given the strong association between awake bruxism and psychosocial factors (the relationship between sleep bruxism and psychosocial factors being unclear), the role of psychosocial interventions could be argued to be central to the management. Evol Med Public Health. Less commonly, a bunion may form next to the small toe, and this is referred to as a "bunionette" or "tailor's bunion." [19] It is thought that the periodontal ligament may respond to increased occlusal (biting) forces by resorbing some of the bone of the alveolar crest, which may result in increased tooth mobility, however these changes are reversible if the occlusal force is reduced. [35] The ligament directly associated with the TMJ is the temporomandibular ligament, also termed the lateral ligament, which really is a thickening of the lateral aspect of the fibrous capsule. Doctors sort these injuries into three grades based on your symptoms and how much damage the impingement causes: Rotator cuff impingement is most common in older adults and athletes, but 20% of all people will get it at some point in their lives. The best way to ease foot pain at night is to develop a toolkit of therapies that address the root cause of foot pain while relieving symptoms so you can get a full nights rest. Waking up gasping or choking is your brain's way of forcing you to start breathing again. [10], Temporomandibular disorders were described as early as ancient Egypt. A common example of a deflective interference is an over-erupted upper wisdom tooth, often because the lower wisdom tooth has been removed or is impacted. Medical Device & Doctor Among people who have taken ecstasy, while dancing it is common to use pacifiers, lollipops or chewing gum in an attempt to reduce the damage to the teeth and to prevent jaw pain. However, there are certain risk factors that could make you more likely to suffer from OSA. Group I are muscle disorders, group II are disc displacements and group III are joint disorders,[10] although it is common for people with TMD to fit into more than one of these groups. Recovery from knee surgery can take some time. Your symptoms could come on quickly if an injury is to blame. [12] TMD has been considered as a type of musculoskeletal,[13] neuromuscular,[14] or rheumatological disorder. [4] The pain in the muscles of mastication caused by bruxism can be likened to muscle pain after exercise. The force from grinding may also crack teeth, causing pain and affecting oral health. It is unclear whether people with bruxism tend to notice problems with the bite because of their clenching and grinding habit, or whether these act as a causative factor in the development of the condition. The most commonly noted warning signs of sleep apnea are loud snoring and feeling tired during the day despite a full night's sleep. High heels can make matters worse by forcing the toes even deeper into the narrowed tip. Phys Sportsmed. to observe the presence or absence of wear on the splint after a certain period of wearing it at night. Symptoms include a dull throbbing behind your kneecap, especially where your knee meets your femur, or thigh bone. [26], The general term "degenerative joint disease" refers to arthritis (both osteoarthritis and rheumatoid arthritis) and arthrosis. Based on these data occlusal adjustment cannot be recommended for the treatment or prevention of TMD. Still, compresses rarely provide long-term relief.If your tooth pain is the result of an underlying TMD, treating the disorder itself should provide long-term pain relief. Understanding what TMJ pain feels like can help you determine what questions you might need to ask your doctor and how it could impact your diagnosis. Estrogen may play a role in modulating joint inflammation, nociceptive neurons in the trigeminal nerve, muscle reflexes to pain and -opioid receptors.[6]. Patellar tendinitis (jumpers knee) and quadriceps tendinitis are specific subtypes of this condition. If you tear either one of these ligaments, youll typically hear a popping sound, followed by swelling. To grind the front teeth, most people need to posture their mandible forwards, unless there is an existing edge to edge, class III incisal relationship. Rheumatoid arthritis, an autoimmune joint disease, can also affect the TMJs. [28] Examples may include dopamine agonists, dopamine antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors, alcohol, cocaine, and amphetamines (including those taken for medical reasons). $7.99 Formatting. In some cases, patients with sleep apnea may need to set aside more time for sleep. The main muscles involved are the masseter, temporalis and medial and lateral pterygoid muscles. Lifestyle changes, such as wearing protective kneepads and going to physical therapy, can help you manage pain and experience fewer symptoms. If this is an intentional citation to a retracted paper, please replace, CS1 maint: multiple names: authors list (, Contemporary Oral and Maxillofacial Surgery fifth edition; Hupp, ellis, and tucker. Allowing the affected area to rest for a sufficient time can help. Behavioral approaches in research declined from over 60% of publications in the period 196686 to about 10% in the period 19972007. several studies use self-reported bruxism as a measure of bruxism, and since many people with bruxism are not aware of their habit, self-reported tooth grinding and clenching habits may be a poor measure of the true prevalence. Optimizing weight, including losing excess weight, can help prevent or decrease symptoms of sleep apnea, minimizing the need for treatment. The intent is for the brain to interpret the nerve sensations as undesirable, automatically and subconsciously reducing clenching force. Each TMJ is classed as a "ginglymoarthrodial" joint since it is both a ginglymus (hinging joint) and an arthrodial (sliding) joint,[41] and involves the condylar process of the mandible below, and the articular fossa (or glenoid fossa) of the temporal bone above. Signs You Might Have Sleep Apnea It can be difficult to recognize the signs of sleep apnea since they occur when you're sleeping. Headaches occur upon waking at least 15 days out of each month. [8], A 2013 systematic review of the epidemiologic reports of bruxism concluded a prevalence of about 22.131% for awake bruxism, 9.715.9% for sleep bruxism, and an overall prevalence of about 831.4% of bruxism generally. Take a look inside your mouth to check for any cavities, chips, or cracks which may be causing the pain. She will develop a customized treatment plan to best meet your individual needs. Occlusal splints are usually employed as a treatment for bruxism, but they can also be of diagnostic use, e.g. Though the implementation of stress reduction techniques such as yoga, exercise, and meditation requires a person to be awake, they can also help with nighttime teeth grinding. Protecting Your Oral Health A key component of taking care of your overall health is protecting your teeth. Using 3D imaging, REstore TMJ and Sleep Therapy creates custom bite orthotics that will address the underlying disorder and result in long-term pain relief.If you're interested in learning more about how Dr. Phillips treats TMD, view our practice's TMJ disorder treatment page. [1] It is generally accepted that increased occlusal forces are able to increase the rate of progression of pre-existing periodontal disease (gum disease), however the main stay treatment is plaque control rather than elaborate occlusal adjustments. However, there are some key differences between the two types of headaches. Furthermore, occlusal splints are probably ineffective for awake bruxism,[4] since they tend to be worn only during sleep. Most often, OSA sufferers wake so briefly that they have no memory of the occurrence. Treatment of TMD may then significantly reduce symptoms of otalgia and tinnitus, as well as atypical facial pain. 1988;8(6):331-6. (2008). Broken bones in your knee will need to be assessed by a healthcare provider. Tehraninasr A, et al. Additional benefits of imaging the TMJ are as follows:[53], When clinical examination alone is unable to bring sufficient detail to ascertain the state of the TMJ, imaging methods can act as an adjuvant to clinical examination in the diagnosis of TMD. TMD has been suggested to be associated with other conditions or factors, with varying degrees of evidence and some more commonly than others. Ideally, patients should sleep in a maximized side-sleeping position, carefully moderated to ensure that the airway remains open at night. What does TMJ pain feel like? Trauma, both micro and macrotrauma, is sometimes identified as a possible cause of TMD; however, the evidence for this is not strong. A cold compress can help reduce any swelling present and will also numb pain. Nicotine stimulates release of dopamine, which is postulated to explain why bruxism is twice as common in smokers compared to non-smokers.[5]. 2004;(1):CD000964. 2009;2:23. doi:10.1186/1757-1146-2-23, Mortka K, Lisiski P. Hallux valgus-a case for a physiotherapist or only for a surgeon? restricted mandibular movements), and joint pain. A stabilization splint is only intended to be used for about 23 months. Sudden or ongoing pain can be a symptom of something more. [9] TMD is the second most frequent cause of orofacial pain after dental pain (i.e. RDC/TMD considers temporomandibular disorders in 2 axes; axis I is the physical aspects, and axis II involves assessment of psychological status, mandibular function and TMD-related psychosocial disability. Exercises and MT are safe and simple interventions that could potentially be beneficial for patients with TMD. Wrist Brace Carpal Tunnel, Night Support Brace with Wrist Splint, Adjustable Straps, Hot/Ice Pack, Hand Brace for Women and Men, Right Hand, Small/Medium, Tendinitis, Arthritis, Pain Relief 4.6 out of 5 stars 3,467 If you're trying to determine whether your frequent headaches are migraines or sleep apnea headaches, consider these key differences between the two: Sleep apnea headaches occur upon waking, while migraines can occur any time day or night. You may notice a variety of potential symptoms. "If a boy clenches, he hates his family for not being prosperous; if a girl clenches, she hates her mother for not being dead."()[68]. Each TMJ is covered by a fibrous capsule. Luckily, TMDs are treatable, especially if you seek professional help. [54] It is reasonable to conclude that plain film can only be used to diagnose extensive lesions. Another source divides the causes of bruxism into three groups, namely central or pathophysiological factors, psychosocial factors and peripheral factors. But are all over-the-counter NSAIDs alike? Learning more about TMJ disorder and how it affects your teeth, can help you determine if your tooth pain is caused by TMD. 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