Bruxism

Bruxism

Also called: Teeth Grinding, Clenching

Summary

Bruxism refers to a chronic clenching of the jaws and grinding of the teeth. The habit is most common in children under the age of 5, but adults also engage in bruxism.

Bruxism tends to occur most often during deep sleep, particularly in the early part of the night. In addition, bruxism may occur during waking moments when a person feels particularly stressed or anxious. Because bruxism often occurs when a person is asleep, sleep partners, roommates, siblings or parents often become aware of the habit before the patient.

The exact cause of bruxism remains unknown. Stress appears to be a major contributor to bruxism. It also occurs more often in people whose top and bottom teeth are not aligned properly (malocclusion).

In most cases, bruxism is a minor condition that poses no real health threat. In more severe cases, bruxing can cause morning headaches or earaches. In extreme cases, tooth enamel may begin to wear down, exposing the inner layers of the teeth. Teeth also may become flattened or chipped.

Patients who notice signs of bruxism are urged to schedule an appointment with a dentist. In other cases, signs of bruxism – such as wear on the teeth – may be noticed by the dentist during a routine dental exam.

Most cases of bruxism require no treatment. Treatment is necessary in more severe cases to prevent symptoms such as jaw pain or destruction of tooth enamel. A technique called biofeedback can help reveal when patients are most likely to brux, or clench their teeth. This information can help patients better modify their clenching and grinding behavior. Relaxation techniques and use of a custom-fit mouth guard during sleep also are used to treat bruxism.

About bruxism

Bruxism is a chronic clenching of the jaws and grinding of the teeth. Bruxism is relatively common, especially in children under 5. In older children and adults, bruxism often occurs in people ranging from the late teens to 40s, or those who are under excessive stress or who have certain personality types. Teeth grinding, or bruxing, appears to decrease in most people as they age.

Bruxism occurs when a person tightly clamps the top and bottom teeth together. It is particularly likely to involve the back teeth. In addition, many people who clench their teeth also grind them in a sideways, back-and-forth movement. Both clenching and grinding put pressure on the muscles, tissues and other structures surrounding the jaw. This may cause pain, wearing down of the tooth enamel and other symptoms.

Bruxism tends to occur most often during deep sleep, particularly in the early part of the night. Many patients are not aware that they clench or grind their teeth overnight. In addition, bruxing may occur during waking moments when a person feels particularly stressed or anxious. For reasons that are not completely understood, people tend to grind their teeth with less frequency as they get older.

The exact cause of bruxism remains unknown, but it tends to occur more often in those whose top and bottom teeth are not aligned properly (malocclusion). Stress also is suspected as a major contributor to bruxism. People who experience high levels of nervous tension (e.g., anger, pain, frustration) are more likely to brux, as are people who have an aggressive, anxious or very competitive nature.

Caffeine, nicotine, tobacco, cocaine and amphetamines appear to increase the risk of bruxism. Use of antidepressants also has been associated with some cases of bruxism, as have illnesses and injuries such as Huntington’s disease (progressive disorder involving wasting of nerve cells in the brain), Parkinson’s disease (progressive deterioration of the nerve cells in the brain that control muscle movement), rare neuromuscular diseases and brain injuries. Bruxism has also been associated with post-traumatic stress disorder (PSTD) and temporomandibular joint disorder (TMD).

Signs and symptoms of bruxism

In many cases, patients will not experience any symptoms of bruxism, despite grinding their teeth or clenching their jaw. However, in other cases patients may experience a series of symptoms that collectively are known as temporomandibular joint disorder, or “TMD.” In some cases, patients may experience headaches, earaches (due to the temporomandibular joint’s location next to the ear canal), jaw or facial pain, and other problems. When people grind their teeth during sleep, the bruxism may be audible to roommates or sleep partners.

In severe cases, bruxism may fracture dental fillings or wear down tooth enamel, exposing the dentin of the teeth. Teeth also may become flattened or chipped.

Other complications associated with severe bruxism include:

  • Chewed tissue inside the cheek
  • Increased tooth sensitivity to hot and cold
  • Tense facial and jaw muscles
  • Tongue indentations

These symptoms appear to result from a combination of factors, including a person’s stress level, the duration and severity of clenching and grinding, the alignment of a patient’s teeth, posture, diet, sleeping habits, and relaxation levels.

Diagnosis methods for bruxism

Patients who experience any of the signs or symptoms typically associated with bruxism are urged to schedule an appointment with their dentist. In other cases, signs of bruxism – such as wearing of the teeth – may be noticed by the dentist during a routine dental exam. Roommates and bed partners also may report hearing the sound of grinding at night while the patient is sleeping. This should be reported to the dentist as well.

The dentist will check for tenderness in the jaw muscles and other abnormalities of the mouth and jaw. Flattened tips of the teeth also may indicate that the patient is bruxing. X-rays may be ordered to more closely inspect any damage that may be associated with bruxing.

A physician may be consulted to determine if there are underlying causes of bruxism, such as a neurological problem. In addition, the dentist or physician will ask certain questions to try to pinpoint the cause of a patient’s bruxing. These include:

  • Does the patient have a history of dental health problems?
  • Does the patient have any health conditions of note?
  • Does the patient take medications regularly?
  • Does the patient use alcohol or caffeine? If so, does usage occur at night?

If the dentist suspects that the patient is bruxing, he or she will monitor the patient’s teeth in subsequent visits to see if additional wear is occurring. If this trend becomes apparent, a treatment plan will be formulated.

Treatment options for bruxism

In most cases, no treatment is required for minor bruxism. Treatment becomes necessary to prevent or alleviate jaw pain or destruction of tooth enamel. When treatment is required, it focuses on managing clenching and grinding behaviors to the greatest extent possible.

Daytime bruxism is easier to treat than the nighttime variety. Patients may be taught to treat their condition through behavior modification. They learn to properly rest the tongue, teeth and lips in ways that relieve jaw discomfort, keep the teeth apart and the lips closed.

Biofeedback also is sometimes used to treat bruxism. In this technique, an electronic instrument is used to measure the muscle activity in a patient’s mouth and jaw. This information reveals what types of events or thoughts are likely to cause a patient to brux. The patient then can be taught to be aware of these times of high bruxing, and to modify behavior accordingly. 

Nighttime bruxing can be much more difficult to treat. Patients who experience pain or wearing of the dental enamel may need to wear a custom-fit mouth guard that protects their teeth during sleep. These mouth guards – also known as splints – are usually very effective at protecting the patient’s teeth. There are many different types. Some fit over a person’s top teeth, while others fit over the bottom teeth. However, in some cases the splints actually make clenching worse or become less effective over time.

Over-the-counter mouth guards also are available and are less expensive than custom-made guards. However, they may not fit as well around the teeth and can dislodge during bruxing.

Both daytime and nighttime bruxing can often be treated by teaching the patient relaxation techniques that reduce stress. Exercise and meditation can help reduce a patient’s stress levels. In rare cases, patients may be so stressed that they may benefit from psychotherapy. Patients who learn techniques to better manage their anxiety are likely to reduce their clenching and grinding.

If treatments fail to reduce cases of severe bruxing, the patient may be referred to an oral surgeon who can inject botulinum toxin directly into the jaw muscles. This helps reduce muscle contractions.

Prevention methods for bruxism

Stress is believed to be a major contributor to bruxism. Learning to relax can reduce the incidence of grinding and clenching. It also helps to consciously relax the face and jaw muscles during the day until the habit of facial relaxation becomes ingrained. Massage therapy of the neck, shoulders and face may further encourage relaxation.

Other steps that may help discourage clenching and grinding include:

  • Avoid eating hard or chewy foods like nuts, candies and steak
  • Drink plenty of water
  • Get plenty of sleep
  • Limit use of alcohol, tobacco and caffeine

Regular dental examinations give dentists the opportunity to monitor a patient’s teeth and note early signs of bruxism.

Questions for your doctor regarding bruxism

Preparing questions in advance can help patients to have more meaningful discussions regarding their treatment and prevention options. The following questions related to bruxism may be helpful:

  1. How can I discover whether or not I am bruxing?
  2. I have regular jaw pain. Should I schedule an appointment with a dentist, or with my physician?
  3. How will you diagnose my bruxism?
  4. What is the likely source of my bruxism?
  5. Why do you suspect that my bruxing is serious enough to require treatment?
  6. What are my treatment options? What are the risks or drawbacks?
  7. What are the potential consequences if my bruxism is left untreated?
  8. How can I teach myself to better relax?
  9. What other steps can I take to discourage bruxing?
  10. How can an injection of botulinum toxin help me? Will I need additional injections?
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