sleep bruxism

A guide to sleep bruxism (teeth grinding)

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Bruxism is a condition affecting up to 10% of the adult population and is characterised by the grinding, gnashing and and clenching of the teeth and jaws.

Often sleep bruxism may only be a mild problem, requiring little if any treatment. On the other hand,  a serious case, left untreated, can cause acute pain and permanent damage to your teeth and gums.  (Please note this article concentrates on sleep bruxism as opposed to awake bruxism which has a different pathology.)

Sleep bruxism happens subconsciously and many who suffer are completely oblivious to their nocturnal behaviour. Unless the patient can identify the symptoms early on, bruxism can often go unnoticed for long periods of time, causing unnecessary damage.

Bruxism can also classified in two ways:

  • primary bruxism occurs with no other underlying medical condition
  • secondary bruxism  is the result of an existing condition, including psychological illness or as a side effect of medication

Teeth grinding causes

The exact causes of bruxism are, like many sleep disorders, still unknown. In the past, diagnoses tended to focus on physical causes such as malocclusion, a misalignment of the teeth. More recently, research has linked sleep bruxism to multiple possible causes including psychological factors, dopamine levels and existing sleep disorders.

However, there are a number of common factors that are now accepted to cause an increase in the likelihood of bruxism occurring. They include:

  • stress and anxiety
  • mental disorders
  • side effects of medication (esp. antidepressants)
  • use of stimulants ie caffeine, nicotine, alcohol
  • abnormal bite, crooked teeth

Of these, stress is the biggest reason for grinding teeth at night, accounting for 70% of cases according to some studies. Another important point is that sleep bruxism rarely occurs in isolation. It is much more prevalent in those with an existing sleep disorder. The disorder most commonly linked with bruxism is obstructive sleep apnea (OSA).

Bruxism symptoms

A large proportion of bruxers (bruxism sufferers) are unaware they have a problem, because the teeth grinding occurs when they’re asleep. But if you think you’re at risk, there are some tell tale signs you can look out for. One of the more common symptoms of bruxism is waking up with headaches, either sharp or dull. This is a result of tensing the jaw muscles and facial muscles for long periods of time, resulting in residual pain.

Studies also show that sleep bruxism can result in reduced quality of sleep, so restlessness that can otherwise not be explained may be an indicator as well. Here’s a list of some of the main symptoms of sleep bruxism.

Physical symptoms

  • headaches
  • earache
  • tired jaws
  • chronic facial pain
  • facial myalgia (muscle pain)

Oral symptoms

  • worn, loose or fractured teeth
  • sensitive teeth
  • gum inflammation
  • tongue indentations
  • worn tooth enamel

If one or more of these symptoms appear simultaneously on a regular basis, then it is important to consult a dentist who can determine whether or not bruxism is the culprit, before serious damage is done to your teeth.

Teeth grinding in children

Bruxism occurs in up to 20% of children under 11 but the causes and symptoms may differ. It may occur very early on when baby teeth are first emerging, or later when the child grows a full set of teeth. Usually this habit dies out quickly. Sometimes, teeth grinding in children is linked to night time breathing difficulties. Some of the possible causes may be:

  • enlarged tonsils
  • allergies
  • existing sleep disorders ( esp. OSA)
  • dehydration

If you are concerned about your child, ask your dentist to have a look and see if any preventative measures are necessary.

Temporomandibular  joint (TMJ) disorder

The temporomandibular joint (TMJ) connects the skull to the lower jawbone. TMJ disorder (TMJD) is a blanket term for a range of problems caused by pain in this area. Bruxism is one of the most common causes of TMJD due to the repetitive clenching or grinding of teeth. TMJD can cause acute pain if left untreated so it’s important to recognise if you are at risk. Some of the symptoms of TMJ disorder include:

  • pain in the jaw when opening the mouth, chewing, or yawning.
  • uncomfortable clicking or popping in the jaw.
  • you are unable to open your jaw wide

TMJ treatment  options include rest, the use of anti-inflammatory drugs, and physical therapy. In some cases, splints or bite blocks might be used for a short period of time. Surgery or dental work are only necessary in the most serious cases.

Treatment for sleep bruxism

For mild cases, treatment isn’t always necessary, but if your bruxism is causing pain or discomfort there are a number of ways to relieve the symptoms. Here’s a rundown of some of the most popular treatments for teeth grinding:

Behavioural changes
Dealing with stress can be one of the most effective ways to combat bruxism. Counselling is an option if you need to talk through your problems, alternatively you may find some of the following therapies useful for relaxation and altering your teeth grinding habits:

  • meditation
  • biofeedback
  • hypnotherapy
  • acupuncture
  • massage
  • sleep hygiene
  • TMJ exercises

Mouthguards and dental appliances

You can buy a mouth guard for teeth grinding over the counter, or get your dentist to fit one specifically for your mouth. Also known as a splint, theses devices create a barrier between your upper and lower teeth protecting them from further damage.

An occlusal splint, also known as a bite guard, night guard or bite plate, is custom-fitted for your mouth and looks similar to a standard mouth guard. A mandibular advancement device (MAD) is a newer treatment often prescribed for sleep apnea or snoring. It works forcing the jaw forward, preventing the chance of teeth grinding. Although expensive, they are a non-invasive and reversible treatment.

Medication

Anti-anxiety medications such as Clonazepam has shown to be effective but for treating bruxism, the problems of addiction and drug tolerance  make this a poor solution in the long term.