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Bruxism (aka teeth grinding)

written by Samantha Tillapaugh from The Debtist

We all have habits and tendencies. I’d be the first to admit that some of them are not good - such as always needing to eat a sliver of dessert after dinner, or never drying our good knives after washing them. I have a history of even worse habits during my teen years, such as chewing my nails, or chewing on the caps of pens, neither of which are good for my teeth. But like most habits, these I have direct control over, and I can change them whenever I so please, like when chewing on your nails turned from cool to gross. Unfortunately, there are some habits that are subconscious, and therefore much more difficult to break. An example of such a habit is teeth grinding, otherwise known as bruxism.

I am a heavy bruxor, meaning that I have the tendency to grind my teeth at night. Like so many others, it was undiagnosed until I landed myself in a dental chair due to a painful ache on my lower left tooth. I was prepared for a root canal and a crown, convinced that something this painful must be caused by a severe infection involving hateful bacterial species. So I was surprised when my co-worker showed me the x-ray and there was an absence of any signs of decay. Wait, then was going on?

Bruxism!

Bruxism is the subconscious habit of grinding your teeth. It is also considered a sleep-movement disorder. It is not uncommon for people who have other sleep disorders (such as snoring or sleep apnea) to grind their teeth as well. While some people grind their teeth from side to side, others chomp and chew, and yet others, like myself, clench really, really hard. It has even been reported by loved ones that their partner’s grinding habits are so loud it keeps them up at night! However, most people who grind their teeth are undiagnosed until they start to experience pain. The pain can be anything from mild to severe, and can be persistent or transient. Sometimes, bruxism is so severe that it causes to the teeth to fracture! This can then cause you to lose your tooth, depending on how it breaks. In order to prevent this from happening to you, it’s important to be aware of the most common signs and symptoms, as well as to try and protect your teeth from the effects of heavy grinding.

Bruxism

Signs and Symptoms

There are many signs and symptoms for bruxism, and they are different for every person. The severity depends on the frequency, duration, and weight of your bruxing habits.

Common sign and symptoms include:

  • Abfraction Lesions – These look like little chipping of your teeth around the gum line. Teeth are anchored in the jaw, and when we clench and grind, we are causing these teeth to flex in all sorts of directions. As they flex, the part of the tooth closest to the gumline (where it is most tightly anchored) experiences the most stress, causing these areas to be prone to chipping.
  • Flat Occlusion – As we grind our teeth, we are slowly grinding away at the top portion of the enamel. Eventually, heavy bruxism may lead to completely flat teeth.
  • Fractured Teeth – Under the stresses of grinding and clenching, part of the tooth itself can give way and fracture. Teeth with large existing fillings are more prone to fracturing than a complete tooth or a tooth with a crown. When we start to see the first signs of cracking or microfracture, we want to take precaution and monitor the tooth closely. Sometimes, it may be beneficial to remove the cracked portion and place a crown, to help prevent any unpredictable and unfavorable fractures in the future.
  • White Lines Inside the Cheeks – Look inside your cheek to see if there is a white striation. These are formed from the repetitive sucking motion related to teeth clenching and grinding.
  • Tight or Tired Jaw Muscles – It may be that you are spending the entire night working your jaw left and right. Your jaw joints may then get tired, or feel very tight. If you ever wake up in the morning with a soreness in your jaws, you may have just experienced a night of heavy grinding!
  • Tooth Pain or Sensitivity – Teeth can experience sensitivity to hot, cold, or pressure if they are continually experiencing trauma from bruxism. There are nerves running to each tooth, and repetitive trauma to the tooth can cause these nerves to become hypersensitive. If treated right away, the hypersensitivity can be reversible.
  • Migraines and earaches – The nerves that innervate your teeth run up along the sides of your head. If they are hypersensitive, they can also cause migraines and earaches.
  • Sleep Disruption – Some people wake up in the middle of the night due to the sounds of bruxism. Others awaken due to aches and pains. Untreated bruxism can definitely take away a good night’s rest!

Causes of Teeth Grinding

The exact cause of bruxism is difficult to pinpoint. It could be a myriad of factors, so it’s important to evaluate whether any of the following apply to you.

  • Stress or Anxiety – The most common cause of teeth grinding is stress. I will always ask my patients if they are experiencing any stressful events in their lives lately when they report bruxism. Most people identify a difficult time at home, or a job change, or a recent move. Identifying the cause of stress and trying to manage or decrease it is really helpful in treating bruxism!
  • Abnormal Bite – Children often time experience grinding when their teeth first erupt and again when their adult teeth start to erupt. Sometimes they outgrow it, and sometimes they don’t. I have also noticed that bruxism is more common when people are missing teeth. A theory would be that an abnormal bite or a bad occlusion can lead to grinding.
  • Side Effects of Medications – Some medications are known to cause grinding. If you have recently started taking a new medication, ask your doctor whether grinding could be a possible side effect. Antidepressants, for example, have been shown to cause grinding.
  • Weight Gain and Sleep Disorders – Recent weight gain can make breathing more difficult when one is sleeping. Soft tissues around the neck and throat tends to push downward when we are lying down, thus obstructing the airway. This can lead to a number of sleep disorders, including snoring, sleep apnea, and grinding!

How to Protect Your Teeth from Grinding

There are many ways to protect our teeth! Unfortunately, since grinding is subconscious, eliminating the habit can be very near impossible to do. Therefore, we must find other ways to help prevent further wear and tear on our pearly whites!

  • Wear a Night Guard

Getting a night-guard is the best way to protect your teeth from the effects of bruxism. Since bruxism is a subconscious habit, it can be difficult to catch yourself doing it, let alone to stop yourself from grinding or clenching. A night guard is a protective plastic piece that sits on either your upper teeth or on your lower teeth. The plastic piece acts as a barrier between upper and lower teeth while you are grinding, so that you are not placing as much forces on your teeth and you aren’t wearing them down. The upper night guard works really well, but can feel very bulky for some. The lower night guard is a much more comfortable fit for first time users. You have the option of either buying universal night guards over-the-counter or making a custom-fit night guard with your dentist. Off course, the custom-fit night guard will protect your teeth better, but I can understand if you don’t want to spend that much money until you’ve tried an over-the-counter one to see if you can tolerate sleeping with a night guard. It will take awhile for you to get used to! It took me about two weeks. One thing is for sure: Once I started wearing my night guard, the pain went away. And if I ever forget, the pain will come back, which shows me that the night guard is doing its job!

  • Reduce Stress

There are many ways to reduce stress. I was first diagnosed with bruxism during dental school, which no doubt was a very stressful time. I find that I clench my teeth while I work or concentrate on something. When I involve myself in stress-reducing practices, I find that I clench less. Below are some ways to alleviate stress or anxiety.

    • Avoid stressful activities an hour before bed.
    • Drink caffeine-free tea in the evening after dinner.
    • Avoid screens in the last hour before bed. Try reading a book instead, or listening to calming music.
    • Choose exercises such as yoga in the late evenings, rather than hitting the gym and working out.
    • Write positive events or affirmations down. Gratitude has been shown to decrease stress and anxiety levels greatly. Try a 5-minute journal.
    • Spend time with your family, friends, or pet.
    • Practice deep breathing, and letting thoughts go.
  • Lose Weight

If you’ve recently gained weight and have noticed that you started grinding your teeth, try to get back to your previous weight. As mentioned above, weight gain is a common cause of grinding. Many patients have found success in decreasing bruxism by simply losing weight.

  • Regular Dental Visits

Regular dental visits are important when you grind your teeth. Make sure your dentist knows of your bruxism. They will be able to detect early signs of tooth fracture. When you start to see a hairline fracture, it shows that your tooth is giving way underneath all those chewing forces. You want to treat a small fracture with caution. It may be that a crown will be needed in the near future to cover the tooth and help protect it. A small crack can grow into a big one, and there is never any telling when and how a tooth will break. Sometimes, a tooth breaks and we can save it with a filling, a crown, and/or a root canal. However, other times, it breaks in a completely unfavorable way, and you may end up losing your teeth. Speak with your dentist about the best preventative practices you can engage in to save your teeth!

The Debtist

Samantha Tillapaugh is a practicing general dentist in Orange County, CA and is a lifestyle blogger at thedebtist.com.