Bruxism (Teeth Grinding)

Overview

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 when you're awake (awake bruxism) or clench or grind them during sleep (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.

Symptoms

Signs and symptoms of bruxism may include:

• Teeth grinding or clenching, which may be loud enough to wake up your sleep partner
• Teeth that are flattened, fractured, chipped or loose
• Worn tooth enamel, exposing deeper layers of your tooth
• Increased tooth pain or sensitivity
• Tired or tight jaw muscles, or a locked jaw that won't open or close completely
• Jaw, neck or face pain or soreness
• Pain that feels like an earache, though it's actually not a problem with your ear
• Dull headache starting in the temples
• Damage from chewing on the inside of your cheek
• Sleep disruption

When to see a doctor

See your dentist or doctor if you have any of the symptoms listed above or have other concerns about your teeth or jaw.

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.

Causes

Doctors don't completely understand what causes bruxism, but it may be due to a combination of physical, psychological and genetic factors.

• Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration or tension. Or it may be a coping strategy or a habit during deep concentration.
• Sleep bruxism may be a sleep-related chewing activity associated with arousals during sleep.

Risk factors

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 adulthood.
• Personality type. Having a personality type that's aggressive, competitive or hyperactive can increase your risk of bruxism.
• Medications and other substances. Bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants. Smoking tobacco, drinking caffeinated beverages or alcohol, or using recreational drugs may increase the risk of bruxism.
• Family members with bruxism. Sleep bruxism tends to occur in families. If you have bruxism, other members of your family also may have bruxism or a history of it.
• Other disorders. Bruxism can be associated with some mental health and medical disorders, such as Parkinson's disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea, and attention-deficit/hyperactivity disorder (ADHD).

Complications

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
• Severe facial or jaw 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

Diagnosis

During regular dental exams, your dentist likely will check for signs of bruxism.

Evaluation

If you have any signs, your dentist looks 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.

Determining the cause

If your dentist suspects that you have bruxism, he or she tries 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
• Other 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 health conditions.

Referral

If your bruxism seems to be related to major sleep issues, your doctor may recommend a sleep medicine specialist. A sleep medicine specialist can conduct more tests, such as a sleep study that will assess for episodes of teeth grinding and determine if you have sleep apnea or other sleep disorders.

If anxiety or other psychological issues seem related to your teeth grinding, you may be referred to a licensed therapist or counselor.

Treatment

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, options include certain dental approaches, therapies and medications to prevent more tooth damage and relieve jaw pain or discomfort.

Talk with your dentist or doctor to find out which option may work best for you.

Dental approaches

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. 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 to repair the damage.

Other approaches

One or more of these approaches may help relieve bruxism:

• Stress or anxiety management. If you grind your teeth because of stress, you may be able to prevent the problem by learning strategies that promote relaxation, such as meditation. If the bruxism is related to anxiety, advice from a licensed therapist or counselor may help.
• Behavior change. 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 method that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw.

Medications

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.
• Botox injections. Injections of Botox, a form of botulinum toxin, may help some people with severe bruxism who don't respond to other treatments.
• Medication for anxiety or stress. Your doctor may recommend short-term use of antidepressants or anti-anxiety medications to help you deal with stress or other emotional issues that may be causing your bruxism.

Treating associated disorders

Treatment for associated disorders may include:

• Medications. If you develop bruxism as a side effect of a drug, your doctor may change your medication or prescribe a different one.
• Sleep-related disorders. Addressing sleep-related disorders such as sleep apnea may improve sleep bruxism.
• Medical conditions. If an underlying medical condition, such as gastroesophageal reflux disease (GERD), is identified as the cause, treating this condition may improve bruxism.

Lifestyle and home remedies

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 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 you can report this to your dentist or 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 during regular visits and exams.

Preparing for your appointment

You may start by seeing your dentist or your primary care doctor. In some cases when you call to set up an appointment, you may be referred to a sleep medicine specialist.

What you can do

Prepare for your appointment by making a list of:

• Relevant medical history, for instance, past bruxism-related problems and information on any medical conditions.
• 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.
• Key personal information, including any major stresses or recent life changes.
• All medications, including over-the-counter medications, vitamins, herbs or other supplements, you're taking and the dosages. Let your doctor know about anything you've taken to help you sleep.
• Questions to ask your dentist or doctor.

Basic questions to ask your doctor may include:

• What's likely causing my symptoms?
• 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?
• Should I see a specialist?
• 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?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer questions from your doctor so that you can spend time on areas you want to focus on. Some questions your doctor may ask include:

• 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?