Bruxism

Bruxism (BRUK-siz-um) is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth together during the day or grind them at night, which is called sleep bruxism.

Bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems. Because you may have sleep bruxism and be unaware of it until complications develop, it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Symptoms

Signs and symptoms of bruxism may include:

  • Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
  • Teeth that are worn down, flattened, fractured or chipped
  • Worn tooth enamel, exposing deeper layers of your tooth
  • Increased tooth sensitivity
  • Jaw pain or tightness in your jaw muscles
  • Tired jaw muscles
  • Earache — because of severe jaw muscle contractions, not a problem with your ear
  • Headache
  • Chronic facial pain
  • Damage from chewing on the inside of your cheek
  • Indentations on your tongue

When to see a doctor

  • Your teeth are worn, damaged or sensitive
  • You have pain in your jaw, face or ear
  • Others complain that you make a grinding noise while you sleep

Causes

  • Anxiety, stress or tension
  • Suppressed anger or frustration
  • Aggressive, competitive or hyperactive personality type
  • Abnormal alignment of upper and lower teeth (malocclusion)
  • Other sleep problems
  • Response to pain from an earache or teething (in children)
  • Complication resulting from a disorder, such as Huntington's disease or Parkinson's disease
  • An uncommon side effect of some psychiatric medications, including certain antidepressant

Complications

Severe bruxism may lead to:

  • Damage to your teeth (including restorations and crowns) or jaw
  • Tension-type headaches
  • Facial pain
  • Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth

Preparing for your appointment

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

  • Be aware of any pre-appointment restrictions. For instance, if you have been seen for bruxism-related problems in the past, records of what was identified and what treatment you received may be helpful to have with you.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements that you're taking.
  • Write down questions to ask your doctor or dentist.

What to expect from your dentist

We will ask you a number of questions, such as:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous, or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, seems to worsen your symptoms?

What you can do in the meantime

Take steps to reduce stress in your life and avoid the triggers that cause anxiety for you. Even if the cause of your bruxism is unknown, reducing stress is good for your general health.

Tests and diagnosis

During regular dental exams, we will check for physical signs of bruxism, such as:

  • Unusual wear and tear on your teeth
  • Continued breakdown of dental restorations, including loss of crowns
  • Tooth fractures
  • Tooth sensitivity

If you have any of these signs, your dentist will look for changes in your teeth and mouth over the next visits to see if the process is progressive and to determine whether you need treatment.

If your dentist suspects that you have bruxism, he or she will try to determine its cause by asking questions about:

  • Your general dental health
  • Your daily medications
  • Whether you routinely drink alcohol or caffeinated beverages, especially during the evening
  • Your sleep habits, especially about any unusual grinding sounds heard by your sleeping partner during the night

To evaluate the extent of bruxism, we will check for:

  • Tenderness in your jaw muscles
  • Obvious dental abnormalities, such as broken or missing teeth or poor tooth alignment
  • Damage to your teeth, the underlying bone and the inside of your cheeks, usually with the help of X-rays

Therapies

  • Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation,.
  • Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.
  • Splints are usually constructed of hard acrylic and fit over your upper or lower teeth. Mouth guards are available over-the-counter and from your dentist. Your dentist can make a custom mouth guard to fit your mouth. Mouth guards are less expensive than are splints, they are softer than splints, and over time they may dislodge during teeth grinding. In addition, mouth guards may actually increase bruxism in some people.
  • Correcting misaligned teeth may help if your bruxism seems to be associated with dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and although it will correct the wear, it may not stop the bruxism.
  • Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. We can show you the best position for your mouth and jaw.

Medications

In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism.