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Clenching and Grinding

Do you suffer from painful jaws or experience headaches in the morning? Does your spouse complain that you keep him or her up all night? Have your teeth become more sensitive to cold, touch, or other stimuli? If so you may be one of the millions of people who unknowingly suffer from bruxism (tooth grinding).

Bruxism, commonly known as tooth grinding, is the clenching together of the jaws accompanied by the grinding of the lower set of teeth with the upper set. Bruxism is a subconscious behaviour so many people do not realize that they are doing it! Often it is the partner who tells them about the nighttime sounds that their bruxism produces. During sleep, the biting force (the force at which the jaws clench together) can be up to six times greater than the pressure during waking hours. Consequently, significant damage is much more likely to occur and a person often wakes with headaches.

How common is bruxism?

The condition is the third most common form of sleep disorder, after sleep talking and snoring. Research indicates that people who brux are more likely to snore, have pauses in breathing during sleep and develop sleep apnoea. Bruxism affects between 10-50% of the population depending on the particular study sited. In the USA about half of adults grind their teeth at night, and about 20% (over 40 million people) grind their teeth in a destructive way. Most people who grind their teeth are over 25 years old, and the disorder affects women and men equally. Children also grind their teeth, but usually in response to discomfort caused by colds, ear infections or allergies. Most cases of bruxism in children resolve on their own without causing tooth damage or other problems.

What causes bruxism?

To date the cause of bruxism is not completely understood. There seems to be a variety of contributing factors. In some cases, the problem is abnormal alignment of upper and lower teeth (malocclusion), but the most common are emotional factors such as daytime stress, anxiety, anger, pain and frustration. Certain sleep disorders such as sleep apnoea can trigger grinding of the teeth as well. People who are competitive, aggressive or rushed may also be at greater risk for bruxism. Use of alcohol and some types of medications may worsen teeth grinding.

Problems Associated with Bruxism

  • Sore Facial Muscles
  • Headaches
  • Ear-Aches

A common cause of tension headaches, migraine headaches, and jaw pain is overuse of clenching muscles. The muscles used to chew food are the same ones responsible for bruxism. Consequently, these muscles often feel sore or tender in the morning. This may make the jaw feel tight or may cause pain when the sides of the mouth are touched. Often this muscle pain is referred meaning that it manifests itself as a headache, earache, or neck pain. Research has shown a significant decrease in the frequency of migraines with the effective treatment of bruxism.

Tooth Wear Bruxism can cause the teeth to be ground down becoming significantly shortened and appear flat. The enamel may become so worn that the inside of the tooth (called the dentin) is exposed. If untreated, the wear can become so severe that root canal treatment and crowns become necessary.

Sensitive Teeth

As the enamel of the tooth is worn away by bruxism the underlying dentin layer of the tooth is exposed. This causes the tooth to become sensitive to cold, pressure, and other stimuli.

Fractured Teeth and Fillings

High pressure created from bruxism can cause permanent damage to your teeth, including cracked and chipped enamel. If bruxism isn't treated it can lead to gum damage and loss of both natural teeth and damage to restorations.

Temporomandibular Joint (TMJ) Damage

Bruxism can cause damage to the temperomandibular joint. This is the "hinge" which connects the lower jaw to the upper jaw allowing us to chew and talk. This can lead to temporomandibular joint disorder.

Symptom checklist

You could be suffering from bruxism if:

  • You have jaw or facial pain on awakening that lessens throughout the day
  • You have headaches or earaches in the morning that go away later in the day
  • Your sleep partner complains that noise is keeping them awake at night
  • Your teeth become sensitive to cold, pressure, or other stimuli
  • You have indentations on your tongue
  • The tips of your teeth appear flattened

What could be done?

If you think you might be grinding your teeth at night, the first thing to do is visit your dentist to assess any possible damage. Part of your clinical examination would include: checking the joints and muscles for tenderness or clicking or difficulty moving; and reviewing your complete medical history (so it is important to keep your dental office record up-to-date). Your dentist may take x-rays and may make a “cast” of your teeth to see how your bite fits together. Your dentist may also request specialized x-rays for the TM joints.

Management is focused on preventing permanent damage to your teeth and to reduce pain caused by bruxism. There are several ways this may be done. Your dentist will recommend what type of treatment is needed for your particular problem.

The use of splints

Many scientific studies have shown that splints are extremely effective in preventing or reducing headaches and jaw pain associated with bruxism. In a recent clinical trial, the new mini-splints were shown to significantly reduce or eliminate migraine and migraine-associated pain. It is considered breakthrough technology in that there is, when used as directed, no risk of side effects associated with it compared to many current pharmaceutical migraine therapies. 
 The mini-splint is a small, removable, prefabricated, clear resin matrix oral insert that a dentist fits to the patient’s front teeth to be worn while sleeping. With the device in place, the intense activity of the temporal muscle (which closes and clenches the jaw) is suppressed to less than 1/3 of maximum by preventing any contacting of the back molar teeth. By reducing this neuromuscular activity, migraine headache pain is reduced or prevented all together, as well as the associated tension-type headaches. The mini-splint also provides total protection during sleep when the forces of bruxism are at their greatest. Traditional full cover splints extend further back to cover all the teeth. These are very effective in protecting teeth from extensive wear caused by bruxism.

Have regular dental check-ups

Dental examinations are the best way to screen against bruxism, especially if you live alone or don't have a sleep partner who can observe bruxism at night. Your dentist can best monitor the progression of bruxism in your mouth and jaw with regular visits and examinations.

Reduce stress

Keeping your life stresses to a minimum can reduce your risk of developing bruxism. The less anxiety and tension you feel, the better chance you have of avoiding bruxism. Utilizing the following methods will help deal with excessive stress and minimize bruxism: Muscle relaxation; exercise; massage; counselling; social support; goal setting.

Inform your sleep partner

If you have a roommate or partner, ask him or her to be aware of any grinding or clicking sounds that you might make while sleeping. Your sleep partner can then let you know if he or she notices any teeth-grinding sounds in the night.