Gum Bleeding: Is It Linked to Jaw Issues and Stress?

Q: Gum Bleeding: Is It Linked to Jaw Issues and Stress?

Hello： I recommend that you seek treatment at a larger medical center (such as National Taiwan University Hospital or Veterans General Hospital) for a multidisciplinary approach. <br>Start with the fundamental treatment of the temporomandibular joint (TMJ), followed by interventi

Bleeding while brushing teeth?

Hello Doctor, I am 24 years old.
About two years ago, I experienced an acute inflammation of the temporomandibular joint (TMJ), which made my entire jaw very uncomfortable, although I could still open my mouth partially.
Since then, I have become aware of this condition.
I recall that around middle school, I started noticing a clicking sound when I opened my mouth.
In the two years following the acute inflammation, I have experienced occasional pain, but I am unsure if it is joint pain, as my periodontal condition is also quite poor.
I have had occasional bleeding while brushing my teeth, perhaps once a year.
Since college, I have been aware of having multiple cavities, so I have been very attentive to my dental health and have put a lot of effort into caring for my teeth.
I use dental floss and brush my teeth as instructed by my dentist every day.
However, about six months ago, I began experiencing tooth pain without a specific location, and I was subsequently diagnosed with mild periodontal disease and underwent full-mouth treatment.
Since then, I have been experiencing bleeding while brushing almost every week, especially in the four corners at the back, where several of the back teeth have deep cavities.
I know I need to confront this disease, and I believe I have made every effort with dental floss, interdental brushes, and single-tufted toothbrushes, but I have not seen corresponding improvements.
I sometimes notice that I have a habit of clenching my teeth, which seems to occur mostly during sleep, and perhaps this contributes to the occasional pain in my TMJ.
However, I am uncertain whether the pain is coming from the joint or the teeth.
Additionally, my dentist has mentioned that I have a deep bite; when I bite down, my upper front teeth completely cover my lower front teeth.
I have regular dental check-ups every six months and have consulted different dentists about my condition, but they all indicated that there are no cavities that need treatment and advised me to continue maintaining thorough oral hygiene.
Regarding the TMJ, the dentist has helped me with massages for relaxation and prescribed muscle relaxants, as well as suggested that I try to reduce some of my life stress (though the dental issues themselves cause me quite a bit of stress...).
I also have tinnitus, which was checked by an ENT specialist with no issues found.
I have read online that some doctors suggest that TMJ can also cause tinnitus, and sometimes the tinnitus is severe enough to affect my sleep.
My main questions are: Is the recurring bleeding from my teeth related to my poor periodontal condition, as well as my teeth clenching and high stress, which may be contributing to my TMJ issues? Can TMJ symptoms include tinnitus? Should I seek treatment for my TMJ or correction for my deep bite as soon as possible? I apologize for the disorganized questions, but dental issues have been troubling me for a long time, and I frequently visit the dentist without achieving a complete resolution.
Thank you.

Miss Zhong, 20~29 year old female. Ask Date: 2021/08/10

Dr. Lin Jiayong reply Dentistry

Hello: I recommend that you seek treatment at a larger medical center (such as National Taiwan University Hospital or Veterans General Hospital) for a multidisciplinary approach.
Start with the fundamental treatment of the temporomandibular joint (TMJ), followed by intervention from a periodontist.
Once both the joint and teeth are stable, you can consider orthodontic treatment.
For the tinnitus aspect, you may also want to have an oral surgeon confirm if it is related to the joint.
If emotional issues arise, please involve a psychiatrist.
Sincerely, Lin Chia-Yung, Department of Dentistry, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2021/08/10

More Info

Understanding the connection between gum bleeding, jaw issues, and stress is crucial for addressing your concerns effectively. Based on your description, it seems you are experiencing a complex interplay of dental health issues, temporomandibular joint (TMJ) dysfunction, and stress-related symptoms.

Firstly, the bleeding gums you are experiencing can indeed be linked to periodontal disease, which is characterized by inflammation and infection of the gums and surrounding tissues. Poor dental hygiene, such as infrequent brushing or flossing, can exacerbate this condition. However, even with diligent oral care, factors like stress and jaw clenching can contribute to gum bleeding. When you clench your teeth, especially during sleep, it can lead to increased pressure on the gums and surrounding structures, potentially causing inflammation and bleeding.

Your history of TMJ dysfunction, characterized by pain and discomfort in the jaw, can also play a significant role in your dental health. TMJ disorders can lead to muscle tension and pain, which may cause you to unconsciously clench or grind your teeth (bruxism). This behavior not only affects the jaw joint but can also lead to gum irritation and bleeding due to the excessive force applied to the teeth and gums. Additionally, the stress associated with managing dental issues can further exacerbate these symptoms, creating a cycle of discomfort and anxiety.

Regarding your question about ear ringing (tinnitus), it is indeed possible for TMJ disorders to contribute to this condition. The TMJ is located near the ear, and dysfunction in this joint can lead to referred pain or pressure sensations that may manifest as tinnitus. This connection is not uncommon, and addressing TMJ issues may help alleviate some of the ear-related symptoms you are experiencing.

As for treatment, it is essential to address both the periodontal disease and the TMJ dysfunction. Here are some steps you might consider:
1. Dental Care: Continue regular visits to your dentist for cleanings and check-ups. If you haven't already, ask about a comprehensive periodontal evaluation to assess the extent of gum disease and discuss potential treatments, such as scaling and root planing.

2. TMJ Treatment: Consult with a dentist who specializes in TMJ disorders. They may recommend a custom night guard to prevent teeth grinding and alleviate pressure on the jaw. Physical therapy, exercises, and relaxation techniques can also be beneficial.

3. Stress Management: Since stress can exacerbate both dental and TMJ issues, consider incorporating stress-reduction techniques into your routine. This could include mindfulness practices, yoga, or other relaxation methods.

4. Orthodontic Evaluation: Given your deep bite and the potential for misalignment to contribute to your symptoms, an orthodontic evaluation may be warranted. Correcting bite issues can relieve pressure on the TMJ and improve overall dental health.

5. Follow-Up: Keep an open line of communication with your healthcare providers. If your symptoms persist or worsen, don’t hesitate to seek further evaluations or referrals to specialists.

In summary, your gum bleeding is likely multifactorial, involving periodontal disease, TMJ dysfunction, and stress. Addressing these interconnected issues holistically will be key to improving your oral health and overall well-being. Don't hesitate to advocate for yourself in seeking the appropriate care and treatment options that address all aspects of your condition.

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