Here at Loop Perio, we help our Chicago area patients with the full range of dental and oral problems. Sometimes providing long-term effective treatment requires addressing both the damage in the mouth and the patient’s behavior that contributes to it. In cases of tooth decay and gum disease, for example, the actual cause is infection, but the patient’s lack of an effective daily oral care regimen or neglect of regular cleanings and checkups can contribute to the buildup of harmful bacteria, plaque, and tartar.
Sometimes there’s even an actual, indisputable cause-and-effect link between a patient’s behavior and what we see in his or her mouth. One such condition is bruxism. Bruxism is persistent, extreme teeth grinding or clenching of the teeth. There are two kinds, awake bruxism and sleep bruxism.
In awake bruxism, but the patient may or may not be aware of the teeth grinding. Either way, the behavior has likely become habitual and not under his or her conscious control.
In sleep bruxism, it’s impossible for patients to know about their teeth grinding or teeth clenching behavior unless some observer tells them. Sleep bruxism is classified as a movement-related sleep disorder, and those who suffer from it are more likely to suffer from other sleep disorders like sleep apnea and snoring as well.
Teeth grinding is fairly common in children, but because their mouths change and grow quickly, it may not require treatment. Many outgrow the habit when adolescence arrives. Teeth clenching is more likely to persist, cause damage, and require treatment in adults. Overall, more than 40 million Americans, children and adults, suffer from some form of bruxism.
What Causes Bruxism?
The cause of bruxism isn’t fully understood in every case. In children, it’s often related to misaligned teeth or the pain resulting from teething or earaches. In adults, it’s sometimes associated with an abnormal bite, teeth that are missing or crooked, anxiety, tension, frustration, and/or stress. It can also be a habit during intense mental effort or some form of coping strategy, a side effect of certain medications, or a consequence of some other disorder.
As noted above, sleep bruxism in particular is often associated with other sleep disorders and can be viewed as a sleep-related chewing activity associated with arousals during sleep.
Bruxism Risk Factors
Whatever the causes of a particular patient’s bruxism, researchers have identified certain risk factors. These include the following:
A family history of bruxism, particularly sleep bruxism. The condition tends to turn in families.
Bruxism is more common in children although they are less likely to suffer significant damage as a result and more likely to stop their teeth grinding without treatment.
Stress, anxiety, anger, and frustration
A hyperactive, competitive, or aggressive personality type.
The presence of certain other disorders including dementia, gastroesophageal reflux disorder (GERD), Parkinson’s disease, epilepsy, attention-deficit/hyperactivity disorder (ADHD), night terrors, and sleep apnea.
Certain medications and other substances. Bruxism can be a side effect of some psychiatric medications including particular antidepressants although this is uncommon. There’s evidence that caffeinated beverages, tobacco, alcohol, and recreational drugs also increase the likelihood of bruxism.
Bruxism Signs and Symptoms
It’s advisable to discuss the possibility of bruxism with your dentist if you’re experiencing any of the following:
Teeth grinding or teeth clenching, possibly sufficiently loud to wake the person sleeping next to you.
Loose, chipped, flattened, or fractured teeth.
Tooth sensitivity or pain.
Tooth enamel that’s worn down far enough to expose a deeper layer of the tooth.
Soreness or pain in the jaw, neck, or face.
Tight or tired jaw muscles.
A jaw you can’t open or close completely.
Damage to the inside of your cheek from chewing.
A dull headache that starts in the temples.
An earache even though there’s no actual problem inside the ear.
Bruxism Effects and Complications
If left untreated, severe bruxism, particularly in adults, can produce the following unfortunate results:
Damage to teeth, fillings, restorations, crowns, or the jaw.
Disorders of the temporomandibular joints (TMJs.) The TMJs are located right in front of the ears, and if they’re damaged, you may hear clicking when opening or closing your mouth.
Arthritis in the TMJs in late adulthood.
Severe jaw or facial pain.
Gum recession. The same mechanical pressure that damages teeth and produces pain can cause gums to recede.
Can Bruxism Be Prevented?
It would be tricky to prevent bruxism from ever happening in any sense because no one can predict that teeth grinding or teeth clenching are going to happen before they do. However, once you become aware you’re doing this, there may be measures you can undertake that will help arrest the behavior:
Avoid or limit foods and beverages containing caffeine. These include chocolate, coffee, and colas.
Practice good sleep habits.
Don’t drink alcohol or smoke.
Don’t chew a lot of gum.
Don’t chew on ice, pens, pencils, or anything that isn’t food.
Train yourself to become aware of teeth clenching or teeth grinding during the day. If it’s happening, fight the habit by resting your tongue lightly behind your upper front teeth with your teeth and lips slightly separated.
Most importantly, do whatever your dentist and other healthcare professionals recommend. Of course, for them to address the problem of bruxism, someone must first diagnose it.
The good news is that your dentist is checking for bruxism as a matter of course whenever you go in for a routine visit. If he or she picks up on any warning signs, changes in your teeth and mouth over the next few visits will reveal whether the condition is actually present and you need treatment.
Once dentists determine the need for treatment, the next step is to figure out the cause of the bruxism. They do this by asking questions about sleep habits, daily routines, medications, stress, and general dental health.
They must also make a thorough assessment of the extent of the bruxism. That typically involves checking for the following:
Obvious dental abnormalities like missing or broken teeth.
Less obvious damage to teeth, the inner cheeks, and the bone underlying the teeth. This is generally checked partly through the use of X-rays.
Sore or tender jaw muscles.
You can help your dentist make an accurate, comprehensive evaluation by being ready to provide the following:
Your medical history.
A list of all medications including over-the-counter ones.
A list of your symptoms, even including ones that you don’t think are relevant to the condition of your mouth. If one of the symptoms is pain, note when it occurs, for instance, when you wake up or at the end of the day. Additionally, be prepared to tell the dentist when symptoms started, whether they’re intermittent or continuous, how severe they are, what if anything makes them better, and what if anything makes them worse.
Information about chronic stress, recent stress, or significant life changes.
As already mentioned, bruxism doesn’t always require intervention. But severe bruxism is sometimes best addressed by a team of healthcare professionals working in concert.
Treating Bruxism in the Dentist’s Office
The dentist is your first line of defense in the fight against bruxism. He or she is the professional who will relieve pain and other symptoms by repairing the damage teeth grinding or teeth clenching has already done.
In this regard, the specific treatment naturally depends on the kind of damage present. The dental professional may need to use crowns or reshape chewing surfaces to relieve discomfort and restore functionality. A periodontist can address severe gum recession with gun grating and severe bone loss with bone grafting.
The dentist may also advise the use of splint or mouth guards, Typically made either of soft materials or hard acrylic and designed to fit over the upper or lower teeth, splints and mouth guards prevent damage from teeth grinding or teeth clenching by keeping teeth separated. They can be particularly useful if the patient suffers from sleep bruxism.
Essential as these interventions may be, however, none of them will actually stop a person from teeth clenching or teeth grinding in the future. To accomplish this, the dental professional may refer the patient for additional treatment.
Treating Bruxism in the Sleep Medicine Specialist’s Office
When sleep bruxism is the problem, a sleep medicine specialist may be able to help. The intervention is likely to involve a sleep study to evaluate episodes of teeth grinding in one’s sleep and assess for the presence of sleep apnea or other sleep disorders.
Treating Bruxism in the Physician’s Office
If it’s been determined that the bruxism is a byproduct of another condition like GERD, a doctor can provide relief by treating the underlying cause. It the bruxism is a side effect of medication, the physician may be able to prescribe a different one.
So far, the research on the effectiveness of medication to treat bruxism itself is inconclusive. Still, certain patients may benefit if a physician prescribes muscles relaxants at bedtime for a brief period, temporary use of antidepressants or anti-anxiety drugs, and, if other interventions haven’t helped, Botox injections.
Treating Bruxism in the Mental Health Professional’s Office (and Elsewhere)
If stress, anxiety, or other emotional or personality issues are contributing to the bruxism, counseling can help. So can meditation and relaxation training. If you’re trying to stop teeth grinding or teeth clenching by changing your habits but having trouble doing so, biofeedback can be useful.
If you suffer from bruxism, the dental professionals at Loop Perio can provide the thorough evaluation, treatment, and referrals you need to provide long-lasting relief. We invite you to contact us for a consultation today.