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 clench or grind them at night (sleep bruxism).
Sleep bruxism is considered a sleep-related movement disorder. People who clench or grind their teeth (brux) during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing (sleep apnea).
Mild bruxism may not require treatment. However, in some people, 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.
Signs and symptoms of bruxism may include:
- Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
- Teeth that are flattened, fractured, chipped or loose
- Worn tooth enamel, exposing deeper layers of your tooth
- Increased tooth sensitivity
- Jaw or face pain or soreness
- Tired or tight jaw muscles
- Pain that feels like an earache, though it's actually not a problem with your ear
- Dull headache originating in the temples
- Damage from chewing on the inside of your cheek
- Indentations on your tongue
When to see a doctor
See your doctor or dentist if:
- 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
- You have a locked jaw that won't open or close completely
If you notice that your child is grinding his or her teeth — or has other signs or symptoms of bruxism — be sure to mention it at your child's next dental appointment.
Doctors don't completely understand what causes bruxism. Possible physical or psychological causes may include:
- Emotions, such as anxiety, stress, anger, frustration or tension
- Aggressive, competitive or hyperactive personality type
- Abnormal alignment of upper and lower teeth (malocclusion)
- Other sleep problems, such as sleep apnea
- Response to pain from an earache or teething (in children)
- Stomach acid reflux into the esophagus
- An uncommon side effect of some psychiatric medications, such as phenothiazines or certain antidepressants
- A coping strategy or focusing habit
- Complication resulting from a disorder such as Huntington's disease or Parkinson's disease
These factors increase your risk of bruxism:
- Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration.
- Age. Bruxism is common in young children, but it usually goes away by the teen years.
- Personality type. Having a personality type that is aggressive, competitive or hyperactive can increase your risk of bruxism.
- Stimulating substances. Smoking tobacco, drinking caffeinated beverages or alcohol, or taking illegal drugs such as methamphetamine or Ecstasy may increase the risk of bruxism.
In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:
- Damage to your teeth, restorations, crowns or jaw
- Tension-type headaches
- Facial pain
- Disorders that occur in the temporomandibular joints (TMJs), located just in front of your ears, which may sound like clicking when you open and close your mouth
It's usually best to see your dentist first, though you also may see your primary care provider if your dentist feels it's necessary. In some cases when you call to set up an appointment, you may be referred to a sleep specialist.
Because appointments can be brief, it's a good idea to be well-prepared.
What you can do
To get ready for your appointment:
- Gather relevant medical records, for instance, if you've been seen for bruxism-related problems in the past.
- Make a list of any symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment. If you experience pain, make a note of when it occurs, such as when you wake up or at the end of the day.
- Make a note of key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or other supplements you're taking and the dosages.
- Prepare questions to ask your doctor or dentist.
For bruxism, some basic questions to ask include:
- What's likely causing my symptoms or condition?
- Are there other possible causes?
- What kinds of tests do I need?
- Is my condition likely temporary or long-term?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions I need to follow?
- Should I see a specialist? Will my insurance cover that?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
What to expect from your doctor or dentist
Your doctor or dentist is likely to 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?
During regular dental exams, your dentist likely will check for signs of bruxism. If you have any signs, your dentist will look for changes in your teeth and mouth over the next several 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, medications, daily routines and sleep habits.
To evaluate the extent of bruxism, your dentist may 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
A dental exam may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint (TMJ) disorders, other dental problems or an ear infection.
If your dentist suspects a significant psychological component to your teeth grinding or a sleep-related disorder, you may be referred to a therapist, counselor or sleep specialist. A sleep specialist may conduct more tests, such as assessment for sleep apnea, video monitoring and measuring how often your jaw muscles tighten while you sleep.
In many cases, treatment isn't necessary. Many kids outgrow bruxism without treatment, and many adults don't grind or clench their teeth badly enough to require therapy. However, if the problem is severe, treatment options include certain dental approaches, therapies and medications. Talk to your doctor about what may work best for you.
If you or your child has bruxism, your doctor may suggest ways to preserve or improve your teeth. Although these methods may prevent or correct the wear to your teeth, they may not stop the bruxism:
- Splints and mouth guards. These are designed to keep teeth separated to avoid the damage caused by clenching and grinding. They can be constructed of hard acrylic or soft materials and fit over your upper or lower teeth.
- Dental correction. Correcting teeth that aren't properly aligned may help if your bruxism seems to be related to dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to reshape the chewing surfaces of your teeth or use crowns. In certain cases, your dentist may recommend braces or oral surgery.
Certain therapies may help relieve bruxism, such as:
- 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, such as exercise or meditation.
- Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Ask your dentist to show you the best position for your mouth and jaw.
- Biofeedback. If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary medicine that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw.
In general, medications aren't very effective for treatment of bruxism, and more research is needed to determine their effectiveness. Examples of medications that may be used for bruxism include:
- Muscle relaxants. In some cases, your doctor may suggest taking a muscle relaxant before bedtime, for a short period of time.
- OnabotulinumtoxinA (Botox) injections. Botox injections may help some people with severe bruxism who don't respond to other treatments.
If you develop bruxism as a side effect of a medication, your doctor may change your medication or prescribe a different one.
These self-care steps may prevent or help treat bruxism:
- Reduce stress. Listening to music, taking a warm bath or exercising can help you relax and may reduce your risk of developing bruxism.
- Avoid stimulating substances in the evening. Don't drink caffeinated coffee or caffeinated tea after dinner, and avoid alcohol and smoking during the evening, as they may worsen bruxism.
- Practice good sleep habits. Getting a good night's sleep, which may include treatment for sleep problems, may help reduce bruxism.
- Talk to your sleep partner. If you have a sleeping partner, ask him or her to be aware of any grinding or clicking sounds that you might make while sleeping so that you can report this to your doctor.
- Schedule regular dental exams. Dental exams are the best way to identify bruxism. Your dentist can spot signs of bruxism in your mouth and jaw with regular visits and exams.
July 22, 2014
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