What You Need to Know About Bruxism

Bruxism is a condition in which a person grinds, gnashes, or clenches the teeth using the jaw muscles. It may occur unconsciously while sleeping (nocturnal bruxism) or when a person is awake (awake bruxism). Bruxism could involve all the teeth, or it could occur as a result of grinding or clenching the front teeth only.

Bruxism is a tension-related disorder. When bruxism is severe it can cause frequent headaches, a disruption in sleep pattern and more. Sleep bruxism, associated with arousal during sleep, is a specific type of sleep-related movement disorder. People who grind their teeth in their sleep are more likely to snore and are also at high risk for sleep disorders such as sleep apnea.

Sleep apnea is considered a very serious sleep disorder, whereas a person’s breathing is interrupted (multiple times) during sleep. This can lead to a lack of adequate oxygenation to the brain and other parts of the body.

Many people with bruxism are not aware that the grinding of teeth is happening—that is, not until symptoms are noted. Most often, symptoms—in the form of destruction of the teeth—are discovered by the dentist. This is the reason it’s important to know the symptoms and seek regular dental care.

For example, nocturnal bruxism is often worse when a person first wakes up, then it gets better as the day goes on. On the other hand, awake bruxism may not involve any symptoms at all in the morning, but symptoms often worsen as the day progresses.

Signs and symptoms of bruxism may include:

• Hypersensitivity of teeth
• Neck pain or soreness
• Severe facial pain
• Aching jaw muscles
• A locked jaw (that will not open or close properly)
• Pain that feels like an earache (with no symptoms of ear infection or other ear problems)
• Damage to the inside of the cheek (from the chewing motion of teeth)
• Dull headache (which may begin in the temples)
• Tension headaches
• Frequent early morning headaches (headaches which occur upon arising)
• Damage to dental work (such as crowns or restorations/fillings)
• Abnormal tooth wear (flattened, chipped, or loose teeth or worn enamel) 
• Teeth grinding or clenching (may be noticed by a sleep partner or may be noisy enough to wake a person up)
• Disruption of sleep (possibly due to waking up to the sound of grinding)

According to the Journal of Indian Prosthodontic Society, awake bruxism is more common in women and nocturnal bruxism occurs equally in women and men.

Interestingly, the two different types of bruxism—nocturnal and awake—are thought to have different origins, although, the exact cause of bruxism is not completely understood. Some experts believe bruxism may involve multiple factors. “Sleep bruxism is considered a sleep-related movement disorder. People who clench or grind their teeth during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing (sleep apnea),” says Mayo Clinic. 

According to Mayo Clinic, “Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration or tension. Or it may be a coping strategy or a habit during deep concentration. Sleep bruxism may be a sleep-related chewing activity associated with arousals during sleep.”

Other causes of bruxism may be linked to an underlying medical condition. For example, one study discovered that some study participants with neurological disorders (such as Huntington’s disease, cranial nerve [nerves that arise from the brain stem] disorders and drug-resistant epilepsy) exhibited symptoms of awake bruxism.

Other causes that may be associated with bruxism include:

• Certain types of medications (such as antidepressants)
• Withdrawal from medications
• Missing or crooked teeth
• An abnormal bite
• Other underlying medical conditions missing or crooked teeth

There are several factors that may increase a person’s risk of having bruxism, these include:

• Stress
• Anxiety
• Anger
• Frustration
• Age (bruxism is most common in children and usually subsides during adulthood)
• Having a specific personality type (such as aggressive, competitive, or hyperactive people are at higher risk)
• The use of certain medications (such as antidepressants)
• Smoking tobacco
• Drinking alcohol
• Using drugs
• Drinking caffeinated beverages
• Having an immediate family member with bruxism
• Having a mental health disorder

In addition, certain medical conditions can increase the risk of bruxism. These include:

• GERD (gastroesophageal reflux disorder)
• Epilepsy
• Night terrors
• Sleep apnea (and other sleep-related disorders)
• ADHD (attention-deficit/hyperactivity disorder)

In most instances, bruxism does not result in severe complications. But, if the condition is severe, it could cause serious problems such as TMJ (temporomandibular joint disorder). This is a condition of the jaw, involving a clicking noise that may be heard when the mouth is opened or closed.

It may also result in loose or broken teeth, damage to crowns (implants, root canals, bridges, or dentures may even be needed overtime), damage to the jaw, hearing loss, and changing the shape of a person’s face.

A sleep partner often hears the person with bruxism grinding the teeth during sleep, and that may be the first time a person with bruxism is alerted to the fact that grinding is occurring. With kids, it’s often the parents who notice their child’s teeth grinding.

Another common way that bruxism is diagnosed is during a dental exam is that the dentist checks the teeth for evidence of grinding upon a routine check-up. If the initial signs of bruxism are noted, the dentist may take some time to evaluate whether the symptoms are progressive and determine if treatment is required. The dentist may check for jaw muscle tenderness, dental problems (such as worn or broken teeth), damage to the inside of the cheeks, damage to the underlying bone tissue (X-rays may be taken for this evaluation), and/or severe complications (such as TMJ).

A person suffering from mild bruxism may not need any treatment at all, but those with severe cases may require intervention for jaw disorders, headaches, teeth that are damaged, and other symptoms. 

There are several treatments currently being utilized for bruxism, but very little clinical research study evidence to support the claims of any particular treatment being successful.

This may involve a sleep study to evaluate teeth grinding episodes and determine if sleep apnea is present. A referral to a psychiatrist or licensed therapist may be needed if severe anxiety or other psychological issues are involved.

Dental preventative measures may include splints or mouth guards (to prevent damage to teeth caused by grinding), or dental correction of teeth that have excessive wear and interfere with the ability to properly chew food.

Other treatment modalities aimed at preventing or alleviating bruxism include stress management, contingent electrical stimulation (a procedure that inhibits jaw muscle activity during sleep), medications (such as muscle relaxants or anti-anxiety drugs), and/or botox injections (for those who don't respond to other treatments).

Treatment may be required for related/underlying causes of bruxism. These conditions could include neurological disorders or GERD. In addition, discontinuing the medication may be required if bruxism occurs as a result of a side effect of a specific drug. You may also need to address sleep-related disorders you may be experiencing.

Although there are no known treatment strategies that will cure all types of bruxism, there are some ways to minimize the grinding such as:

• Minimize or eliminate caffeinated drinks and foods such as coffee, tea, and chocolate.
• Avoid alcoholic beverages.
• Refrain from chewing on items (such as pens, pencils, or other items).
• Avoid gum chewing or chewing on sticky foods such as candy (chewing conditions the jaw muscles to adapt to chronic clenching and increases the likeliness of grinding).
• Try to be mindful when clenching or grinding of teeth occurs during the day and deliberately focus on stopping. One strategy that may be helpful when grinding is noticed is to place the tongue between the teeth.
• Place a warm compress against the cheek, position it in front of the earlobe (this helps to relax the jaw muscles).
• Wear a night guard.
• Exercise regularly to reduce stress.
• Take a warm, relaxing bath before going to bed at night.
• Employ relaxation techniques and/or meditation to help alleviate stress.
• Get a massage to reduce muscle tension.
• Get professional help for anxiety, severe stress, anger, or emotional problems.

It’s important to consult with the healthcare provider if any of the common symptoms of bruxism are noted. If a child is grinding the teeth (during sleep or when awake) a dental consultation should be made to assess the severity of the problem.

Although the symptoms of bruxism are not always severe and treatment may not be required, it’s vital to have an assessment done by a professional healthcare provider. Serious complications and symptoms that require prompt treatment may occur, and there is no way to know for certain how severe symptoms of bruxism are without a dental/medical consultation.