Bruxism is the practice or habit of grinding, clenching, or gnashing one’s teeth. Given today’s world, the most surprising thing about bruxism is that we don’t all have it.
In dentistry terms, bruxism is an involuntary, chronic, and usually nocturnal habit of teeth grinding. A person with bruxism is often unaware of having it, at least until the symptoms make discovery inescapable.
Cases of grinding and clenching teeth are increasing
In a survey conducted last March by the American Dental Association (ADA), 70% of responding dentists reported a recent increase in patients experiencing teeth grinding and clenching.
“Our polling has served as a barometer for pandemic stress affecting patients and communities seen through the eyes of dentists,” said an ADA spokesperson. “The increase over time suggests that stress-related dental conditions have become substantially more prevalent since the onset of coronavirus.”
So, it seems an informational update on bruxism could be appropriate and useful.
How did bruxism get its name?
It may sound like a harsh Eastern European political philosophy, but “bruxism” is actually derived from a Greek word (brychien), which means gnashing of teeth. The word “bruxism” in the context of oral health was first used by Bertrand Frohman, MD, in a 1931 treatise entitled “Application of Psychotherapy to Dental Problems.”
Sleep bruxism and awake bruxism
Bruxism is generally separated into two semi-distinct problems: sleep bruxism, which occurs nocturnally, and diurnal (or awake) bruxism, which happens during the day.
Nocturnal bruxism is considered a sleep disorder, related in some respects to conditions such as snoring and intermittent cessation of breathing during sleep, a.k.a. sleep apnea.
What are the symptoms of bruxism?
Sleep bruxism and awake bruxism exhibit the same symptoms, which may include:
- Teeth grinding during sleep, which may be audible enough to wake a sleep partner.
- Flattening, fracturing, chipping, or loosening of teeth.
- Tooth wear eroding the tooth enamel, which may, in turn, expose inner layers of the affected teeth.
- Increased tooth pain or sensitivity.
- Tired and/or tight jaw muscles, or a sore jaw that becomes locked in either a closed or open position.
- Jaw pain, facial pain, neck pain, or earache. This pain can emanate from facial muscles or from the temporomandibular joint (TMJ), where the jaw joint connects to the skull. In other words, bruxism can be a cause of temporomandibular disorders.
- Headaches emanating from the temples.
- Soreness from biting damage to the inside of the cheek.
- Sleep disruption. Bruxism can be disruptive enough to often wake the patient.
What causes teeth grinding?
The Sleep Foundation acknowledges that “it’s usually not possible to identify one single cause for why people grind their teeth.”
However, the Sleep Foundation joins with the Mayo Clinic in identifying several factors that appear to increase the risk of incurring bruxism. These risk factors include:
Stress and anxiety
These seem to head each and every list of bruxism’s causes.
Bruxism is common in young children, especially those with ADHD (attention deficit hyperactivity disorder). This sort of bruxism usually disappears with age.
Having an aggressive, competitive, or hyperactive personality can increase the risk of bruxism.
Negative lifestyle choices
According to the Mayo Clinic, lifestyle choices such as smoking tobacco and/or excessive use of alcohol or recreational drugs, are sometimes linked to bruxism.
One potential cause of bruxism is not related to a patient’s psychology. Malocclusion, or bad bite, is a condition in which the patient’s teeth don’t properly fit with each other.
Mixed dentition is a stage of a child’s teeth development where the emerging permanent teeth are larger than the baby teeth, causing occlusal misalignment. This condition naturally causes a subconscious effort (i.e., teeth grinding) to create proper alignment.
A side effect of various antidepressant medications
The medications most often linked with bruxism are SSRIs, which, ironically enough, are prescribed for depression, anxiety, panic disorder, the downside of bipolar disorder, and other conditions requiring stress management.
Bruxism does not always require treatment. Most children who have it outgrow it without lasting harm. Many cases, however, both juvenile and adult, are serious enough to require treatment.
Naturally enough, the treatment options correspond to the identified causes. When the cause appears to be malocclusion or mixed dentition, orthodontic appliances that fit over the teeth, known as “mouth guards” or “night guards,” are often the appropriate remedy.
Night guards can protect your teeth from Bruxism?
A night guard is a dental appliance made of resilient materials. They are designed to deal with the consequences of bruxism by protecting the top teeth from grinding down the bottom teeth. When properly fitted, they also redistribute the grinding forces, relax the masticating muscles, stabilize TMJ disorders, and thus reduce bruxism and its consequences.
Although they do not eliminate the underlying cause when bruxism is from mental and emotional difficulties, night guards are critically important to reduce the terribly negative effects of clenched jaws and grinding teeth.
Although generic over-the-counter models are available, custom-made night guards are preferable. They are made from impressions of the patient’s own dentition and are more comfortable than the over-the-counter models. Comfort increases patient compliance for obvious reasons; who wants to wear something that is uncomfortable?
Treating anxiety and teeth grinding
When stress and anxiety cause bruxism, strategies for mental and physical relaxation are most appropriate. Psychotherapy may eliminate or reduce the patient’s anxious response to stressors.
Biofeedback is a treatment that uses electronic instruments to measure muscle activity. It can teach patients to reduce that activity when the biting force becomes excessive.
Bruxism pain relief
Physicians and dentists have prescribed a wide array of medications to treat bruxism. These include benzodiazepines, anticonvulsants, beta-blockers, dopamine agents, Botox, and muscle relaxants.
While these medications have been frequently found to be effective against bruxism, many of them are inappropriate for long-term use.
Last thoughts on bruxism
Bruxism is mysterious enough to be fascinating. Its origins are ambiguous, myriad, and vague. Its treatments are correspondingly complex.
Bruxism has considerably less intellectual appeal to the patient who suffers from it. Fortunately, for those who don’t naturally and painlessly outgrow bruxism, an array of effective remedies is available.
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Two of the most trusted and respected periodontists and holistic dentists in Southern California comprise the board-certified husband and wife team of Dr. Abdy Moshrefi, DDS, and Dr. Nazanin Daneshmand, DDS.
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