What Is Bruxism?

What Is Bruxism?

Bruxism is a repetitive movement disorder in which a person routinely grinds, clenches, or gnashes their teeth using the jaw muscles. Bruxism can involve all the teeth or only the front teeth and can also include symptoms ranging from headaches or facial pain to temporomandibular joint (TMJ) disorder.

Certain medications increase the risk of bruxism, so sometimes a prescription change could be all it takes to ​resolve the condition. Other people may need more help, such as taking measures to relieve stress (people often grind their teeth when they're nervous or under pressure) or wearing a mouth guard during sleep.

Types

There are two types of bruxism, and their symptoms and causes can differ:

• Awake bruxism (AB), also called diurnal bruxism, occurs when people are awake and symptoms often worsen as the day progresses. It is more common in women.
• Sleep bruxism (SB), also called nocturnal bruxism, occurs during the night, and symptoms are often worse when a person first wakes up. It is more common in men.

Symptoms

Most of the time, bruxism is not severe enough to cause major problems, and symptoms can range from person to person depending on whether they grind their teeth during the day or overnight.

Signs and symptoms of bruxism may include:

• Aching jaw muscles
• Chewed places on the tongue or cheek
• Damage to teeth (e.g., chips fractures, worn enamel, flattened tops, loose teeth) 
• Disruption to sleep due to waking up from the sound of grounding
• Earaches (with no symptoms of an ear infection or other ear problems)
• Headaches (including tension headaches from day grinding and morning headaches for nighttime bruxism)
• Neck pain or soreness
• Noise from the grinding or clenching that wakes your sleeping partner
• Severe facial pain
• Teeth that are very sensitive to cold, heat, or pressure
• Temporomandibular joint (TMJ) disorder

Diagnosis

It's often the sleep partner or parent who first notices the symptoms of bruxism in their loved one as they may hear them grind their teeth during the night.

Bruxism is often diagnosed during a dental exam, during which time the dentist will check for worn or broken teeth, damage to the inside of the cheek, jaw muscle tenderness, and TMJ. Your dentist may also take an X-ray to determine if there's been any damage to the underlying bone tissue.

Since bruxism can cause sleep apnea, you may also be required to undergo a sleep study to evaluate teeth grinding episodes and determine if a sleep-related disorder is present.

Causes and Risk Factors

There are lots of reasons a person may grind their teeth. There are also several factors that may increase a person’s risk of having bruxism, which include:

• Age: Kids are more likely to grind their teeth than adults. In fact, sleep-related bruxism affects 15% to 40% of children compared to 8% to 10% of adults.
• Emotions: Frustration, stress, tension, anxiety, and suppressed anger are all potential culprits behind teeth grinding. 
• Genetics: Bruxism tends to run in families. Children are nearly two times more likely to have bruxism if a parent had the condition.
• Medication: Research shows that certain medications are known to cause bruxism, including those that are used to treat psychiatric conditions. It's thought that these drugs cause changes in the central nervous system that lead to teeth grinding and jaw clenching. Examples of such medications include antipsychotics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine).
• Personality: Aggressive, competitive, or hyperactive people are at higher risk for bruxism.
• Substance use: Cigarette smoking, caffeine, alcohol, and recreational drug use may increase the risk of bruxism.

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

• Aattention-deficit/hyperactivity disorder (ADHD)
• Dementia
• Epilepsy
• Gastroesophageal reflux disorder (GERD)
• Night terrors
• Parkinson's disease
• Sleep apnea (and other sleep-related disorders)

Treatment

Bruxism is highly treatable. The key to successful treatment is to figure out what is causing you to grind your teeth and then target your treatment to the cause. 

Therapy

When chronic stress or anxiety is driving you to gnash and grind your teeth, it may be helpful to see a therapist.

Counseling can also help with sleep habit modification and relaxation techniques. If other efforts fail to help you stop grinding your teeth, biofeedback may be worth trying. This is a method that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw. 

Mouthguards and Splint Therapy

If you're a night grinder, a mouthguard (also known as an appliance or occlusal splint) may be helpful. Some guards fit over the top teeth while others fit over the bottom teeth. They may be designed to keep your jaw in a more relaxed position or to provide some other function.

One such splint, for example, called the NTI-tss, fits over just the front teeth in order to keep the back teeth (molars) completely separated. This positioning is based on the theory that most clenching is done on the back teeth. With the NTI, the only contact is between the splint and a bottom front tooth. In studies, the NTI-tss splint has been found to help prevent bruxism.

Medications

There is some evidence that certain medications may be helpful in managing bruxism. Muscle relaxants and even Botox injections have shown promise as temporary antidotes for teeth grinding when it's not caused by a medication or underlying condition.

If your bruxism is caused by medication, your doctor may consider either changing your dose or putting you on a different medication.

Coping

If your bruxism is causing you pain, try these steps at home to help:

• Don't chew gum as this can make the pain worse.
• Stay away from hard candies, nuts, steak, and other foods that are difficult to chew.
• Try to relax your face throughout the day. Self-massage may be helpful.
• Feel for small, painful nodules called trigger points that can cause pain throughout your head and face.
• Manage stress. Take a bubble bath, go for a walk, or listen to your favorite music. Learn relaxation exercises such as mindfulness, deep breathing, or meditation.
• Change your behavior. Discuss techniques for practicing proper mouth and jaw positioning with your dentist. 
• If you tend to grind in your sleep, don't have foods or beverages that contain caffeine before bed. Alcohol and smoking in the evening also can trigger bruxism worse.
• Stay on top of your dental care so that your dentist can monitor any damage you might be doing to your teeth.
• Practice good sleep hygiene.