Bruxism is the technical term for grinding and/or clenching your teeth together. Clenching refers to when your teeth are touching each other in one position, whereas grinding is sliding the teeth over each other via side to side or front to back movements. In normal circumstances, your upper and lower teeth would only be touching when you are eating. Most of the time people are unaware that they are clenching or grinding and only come to realise it after experiencing a complication of bruxism or when their dentist notices the tell-tale signs of it during their regular check-up. Some people unconsciously clench their teeth during the day whilst others do it in their sleep.
Signs that may indicate you clench or grind your teeth:
- Frequently chipped or cracked teeth
- Teeth have taken on a ‘flattened or worn’ appearance
- Jaw, neck or face pain
- Frequent dull headaches, particularly in the morning
- Tight or fatigued jaw muscles
- Difficulty fully opening or closing the jaw
- Increased tooth sensitivity
- Bite marks on the tongue and cheek
Complications of bruxism:
Although most people will grind their teeth at some point in their lives, it does not usually cause any significant issues. Problems begin to arise when grinding becomes a prolonged habit or is particularly forceful. Chronic grinding can wear down the hard outer layer of the teeth, the enamel, resulting in exposure of the softer, more sensitive layer beneath known as dentine. As enamel breakdown becomes more severe and widespread, so does tooth sensitivity. Frequent grinding can also lead to chipping or cracking of teeth, fillings, or major restorations such as crowns.
Clenching and grinding your teeth places a great deal of strain on the temporomandibular joint (TMJ) and its associated muscles. One way to think of it is that for the muscles of the jaw, bruxism is the equivalent of a heavy workout. If you spend a few hours in the gym, you’re likely going to be sore the next day – this is the same for if you spend the night clenching or grinding in your sleep and one of the reasons why some people wake up with pain in their jaw, face, or a tension headache.
One of the lesser known complications of bruxism is temporomandibular disorder, or TMD for short. TMD is a term used to describe dysfunction of the TMJ that can present as jaw or facial pain, difficulty opening and closing the jaw, or an uncomfortable or uneven bite. Muscle spasm, inflammation and displacement of the joint structures as a consequence of chronic clenching or grinding can cause recurrent but often self-limiting problems with the TMJ. Treatment for TMD is usually conservative and successful in the majority of people.
What causes bruxism?
The causes of bruxism are varied and often difficult to determine. It can be the result of psychological, physical, or external factors or a combination of all of them. Below is a list of possible contributing factors to clenching and grinding:
- Stress and anxiety
- Intense concentration
- Certain medications
- Large amounts of alcohol or caffeine
- Malocclusion of the teeth
- Certain medical conditions e.g. sleep apnoea
What treatment options are there for bruxism?
Treating bruxism is a balance of identifying and reducing the causative factors where possible, limiting complications, and controlling symptoms.
When there is a psychological element such as stress involved, patients are encouraged to try relaxation techniques and focus on being aware of times when they notice themselves clenching or grinding and actively stop themselves from doing it.
Correction of malocclusion:
If a malocclusion issue is present, correction of this can also reduce bruxism.
One option to reduce the strain on the jaw and damage to the teeth is to have a custom night guard or splint made. A night guard is a plastic oral appliance, similar to a mouth guard, that acts as a cushioned barrier between the upper and lower teeth. Not only does it prevent damage to the teeth themselves, but it also reduces the tension in the TMJ and surrounding muscles. There are several different kinds of night guards, each with a varying degree of coverage and thickness. ‘Boil and bite’ style mouthguards are available to purchase from some pharmacies, however these are often ill-fitting and ineffective. Your dentist will be best placed to discuss which kind of night guard will be most suited to your individual circumstances. Dr Kathleen Ling finds that night guards are generally well tolerated, with some people just requiring a bit of extra time to adjust to having something in their mouth while they are asleep. Night guards are usually partially covered by private health insurance depending on your level of cover.
Physiotherapy can also be beneficial for some people. Specialised head and neck physiotherapists can assess the TMJ and provide manual therapies and advice on strategies to reduce clenching and grinding.
If none of the above methods are effective or are poorly tolerated, another option to consider is neurotoxin. Yes, this is the same product used for anti-wrinkle injections! Also known as Botox, Dysport and Xeomin. Botox is a viable treatment method for bruxism if excessive muscle contraction is contributing to your grinding. As botox works by temporarily relaxing the muscle it is injected in to, injecting it into the muscles of the jaw helps to lessen the force of contraction of the muscle, and hence the force of clenching or grinding.
Dr Aoibheann O’Brien has been using botox to treat bruxism for a number of years and has found that following treatment, people often report a reduction in tension headaches, jaw and facial pain. Most of her patients experience relief for around three months, however this can vary depending on individual factors. Once the acute episode of bruxism has been brought under control, the other treatments outlined above are revisited in an effort to prevent further episodes. If botox is thought to be an appropriate treatment option for you, your dentist will talk you through the process and any associated risks and benefits. Although some private health insurers do cover botox for bruxism, it is not the norm, so we advise checking with your insurer prior to proceeding with the procedure.
It is important to note that no single treatment is effective for all cases of bruxism and that responses to treatment can vary from person to person. If you think you may be clenching or grinding your teeth, give us a call or make an appointment to chat to one of our friendly dentists about how we can help protect your teeth and jaw. In the meantime, happy brushing and flossing and we’ll see you at your next check-up!