Bruxism

Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.

Causes of Bruxism

People can clench and grind without being aware of it. It can happen during both the day and night, although sleep-related bruxism is often a bigger problem because it is harder to control.

There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms.

Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:

  • How much stress you are under
  • How long and tightly you clench and grind
  • Whether your teeth are misaligned
  • Your posture
  • Your ability to relax
  • Your diet
  • Your sleeping habits

Bruxism Symptoms

Clenching the teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).

Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners.

Symptoms of bruxism include:

  • Anxiety, stress, and tension
  • Depression
  • Earache (due in part because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
  • Eating disorders
  • Headache
  • Muscle tenderness, especially in the morning
  • Hot, cold, or sweet sensitivity in the teeth
  • Insomnia
  • Sore or painful jaw

Tests and Exams

An exam can rule out other disorders that may cause similar jaw pain or ear pain, including:

  • Dental disorders
  • Ear disorders, such as ear infections
  • Problems with the temporomandibular joint (TMJ)

You may have a history of a high stress level and tension.

Treatment of Bruxism

The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.

The following self-care steps may help relieve pain:

  • Apply ice or wet heat to sore jaw muscles. Either option can help.
  • Avoid eating hard foods like nuts, candies, and steak.
  • Avoid chewing gum.
  • Drink plenty of water every day.
  • Get plenty of sleep.
  • Learn physical therapy stretching exercises to help restore the action of the muscles and joints on each side of the head to get back to normal.
  • Massage the muscles of the neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout the head and face
  • Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
  • Try to reduce your daily stress and learn relaxation techniques.

To prevent damage to the teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.

A well-fitting splint should help reduce clenching. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.

There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn't work, another may.

A splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.

After splint therapy, orthodontic adjustment of the bite pattern may help some people. Surgery should be considered a last resort.

Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.

In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.

Prognosis (Outlook)

Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.

Potential Complications

  • Depression
  • Eating disorders
  • Insomnia
  • Increased dental or TMJ problems
  • Fractured teeth
  • Receding gums

Nightly grinding can awaken roommates or sleeping partners.

When to Contact a Health Professional

See a dentist immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions, from arthritis to whiplash injuries, can cause TMJ symptoms. Therefore, see your dentist for a full evaluation if self-care measures do not help within several weeks.

Grinding and clenching does not fall clearly into one medical discipline. There is no recognized TMJ specialty in dentistry. For a massage-based approach, look for a massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage.

Dentists who have more experience with TMJ disorders will typically take x-rays and prescribe a mouth guard. Surgery is now considered a last resort for TMJ.

Prevention of Bruxism

Stress reduction and anxiety management may reduce bruxism in people prone to the condition.

References

Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 68.

Review Date: 2/25/2014
Reviewed By: Ilona Fotek, DMD, MS, Palm Beach Prosthodontics Dental Associates, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2014 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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