Bruxism is a medical term for a condition where a person grinds, gnashes, or clenches his/her teeth. Clenching or grinding one's teeth during sleep is known as sleep bruxism. A person can unconsciously clench their teeth together during the day also. Sleep bruxism is thought to be a movement disorder related to sleep. Individuals who grind or clench teeth while sleeping also tend to have other sleep disorders like sleep apnea and snoring. Treatment is not needed if the bruxism is mild. However, if the bruxism is severe and frequent, then it can cause jaw dysfunction, teeth damage, headaches along with other problems. Most of the times bruxism occurs during sleep, due to which majority of the individuals are not aware of it. People who grind their teeth during sleep often wake up with a constant, dull headache or jaw soreness. People with sleep bruxism often learn of their condition from their family members or their bed partner who hear them grinding their teeth during the night. Bruxism is a sleep disorder which is quite common and affects around 12% of the adult population and about 20% of the children. Bruxism tends to decrease with age. Stress is thought to be one of the important causes of bruxism. Individuals who have sleep bruxism may not be aware of it until its complications start to develop. For this reason, it is essential to identify the signs and symptoms of bruxism along with regular dental checkups so that early treatment is started.
Causes of Bruxism (Teeth Grinding)
The exact cause behind bruxism is not clearly understood. Some of the factors which are thought to cause bruxism are:
- Psychological factors, such as stress, anxiety, anger, tension and frustration.
- Having a type A personality, such as aggression, competitiveness or being hyperactive.
- Other sleep disorders, such as snoring or sleep apnea.
- Malocclusion or abnormal alignment of the upper and lower teeth.
- In children, bruxism can occur as a response to pain from teething or earache.
- Acid reflux from the stomach and into the esophagus.
- Certain antidepressants or psychiatric medications can also cause bruxism.
- Teeth clenching or grinding can be done by a person as a method to cope with something or focus on something.
- Bruxism can occur as a complication from disorders, such as Parkinson's disease or Huntington's disease.
Risk Factors for Bruxism (Teeth Grinding)
- Stress, frustration and anger increase the risk for bruxism.
- Children more commonly grind their teeth during sleep and it decreases as they grow up.
- Having an aggressive personality increases the risk of bruxism.
- Use of stimulants, such as tobacco, caffeinated beverages, alcohol, illegal drugs like methamphetamine increases the risk of bruxism.
Signs & Symptoms of Bruxism (Teeth Grinding)
- Sometimes the grinding of the teeth can be loud enough to wake the person sleeping next to the patient.
- The tooth enamel will be damaged and the deeper layers of the tooth can be seen.
- Teeth become fractured, loose, chipped or flattened.
- Tooth sensitivity will be more.
- Patient can experience facial/jaw soreness or pain.
- Patient will have earache, though there won't be any problem with the ear.
- Tense or tired jaw muscles.
- Patient will experience a dull, constant headache upon wakening up.
- Mucous damage on the inside of the cheek.
- Teeth indentations/impressions can be seen on the tongue.
- Patient can also have a locked jaw and is not able to close or open it completely.
Investigations for Bruxism (Teeth Grinding)
Patient should go for regular dental exams during which the dentist will look for signs of bruxism, such as changes in the teeth and mouth. The dentist will also assess the changes at every visit to see if they progress and to determine if any treatment is needed. The dentist will ask questions about patient's general health, type of medications he/she is taking, sleep habits etc. The extent of the bruxism is determined by assessing the tenderness/soreness in the jaw muscles, damage to the teeth and tooth misalignment. X-rays can be taken to further assess the damage to inside of the cheeks, the teeth and the underlying bone.
During examination, other disorders which cause similar ear and jaw pain can be diagnosed, such as temporo-mandibular joint (TMJ) disorder. If any psychological component is responsible for teeth grinding or some other sleep-related disorder is suspected, then the dentist will refer the patient to a counselor, therapist or a sleep specialist.
Treatment for Bruxism (Teeth Grinding)
In most of the cases, treatment is not required. Children with bruxism will outgrow this habit without any treatment; whereas, in most of the adults, the bruxism isn't severe enough to require treatment. However, if the teeth grinding is severe that it causes other problems like pain, increased teeth sensitivity, headache etc. then treatment is required; and it consists of the following:
- Dental approaches consist of ways to improve or preserve the condition of the teeth. These approaches will not stop bruxism; however, they will help in preventing and correcting the damage to the teeth.
- Patient is told to use mouth guards and splints to keep the teeth separated so as to avoid the damage which occurs as a result of teeth grinding and clenching. Mouth guards and splints can be made of soft materials or hard acrylic and they fit over the upper or lower teeth.
- Dental correction is done to the teeth which are misaligned. This helps with bruxism which occurs due to dental problems. In severe bruxism there is an excessive tooth grinding which has caused lot of damage and wear and tear of the teeth leading to tooth sensitivity along with inability to properly chew. In such cases, the dentist will reshape the chewing surfaces of the teeth or will use crowns. In some cases, oral surgery or braces are recommended.
- If bruxism occurs as a result of psychological components, such as depression, stress, anxiety then there are certain therapies which will help in managing and preventing teeth grinding. These therapies include stress management where the patient is counseled on how to manage stress and is also directed on strategies on relaxation, exercises and meditation.
- Behavior therapy is recommended to patients where they are shown the proper way to position the mouth and jaw and told to practice this position.
- Biofeedback consists of complementary medicine and procedures to help control the muscle activity in the jaw.
- Medications generally are not of much help for bruxism and research is still going on to determine their effectiveness. Some of the medications used for bruxism include: Muscle relaxants where the patient is told to take one before going to sleep for a short duration of time.
- Botox (OnabotulinumtoxinA) injections help in severe bruxism where the patient is not responding to other treatments.
- If bruxism occurs as a side effect of some medication, then the doctor may change that medication or prescribe a different one.
Lifestyle Modifications for Bruxism (Teeth Grinding)
- Reducing stress by exercising, taking a warm bath and listening to music helps in reducing as well as preventing bruxism.
- Always maintain good sleeping habits which help in reducing sleep disorders, which can cause bruxism.
- Try to avoid stimulants, such as coffee, caffeinated tea, tobacco, alcohol, smoking after dinner as these can exacerbate bruxism.
- Patient should go for regular dental exams to identify and correct bruxism on time.
- Before going to bed, hold a warm washcloth against both of your cheeks. This will help in relaxing your jaw muscles and in preventing teeth grinding.