Are you having headaches in your temples? Is your jaw sore and tired when you wake up in the mornings? Does your dentist say that your teeth are getting worn? You might be clenching your jaw or grinding your teeth at night (or sometimes even during the day).
Grinding your teeth, also known as bruxism, can be associated with some medical conditions, such as anxiety. Sometimes it occurs during periods of concentration. Bruxism is a very common condition. It occurs in 9-31% of adults.
Why should you care about bruxism?
Untreated bruxism causes damage to the teeth and mouth and can cause problems with the muscles of the jaw. This can lead to headaches, neck pain, joint problems in the hinge joint of the jaw (temporomandibular joint), and hearing problems. People with bruxism generally suffer from poor sleep compared to people without bruxism. Bruxism can be associated with dislocation of the jaw in more severe cases.
What causes bruxism?
Bruxism is generally felt to be related to poor alignment of the teeth or due to psychoemotional conditions such as stress, anxiety, or depression. Bruxism is also associated with sleep apnea and snoring. It can be associated with some types of medications. Smoking, alcohol, caffeine, and taking drugs can also contribute to the development of this condition. There may also be a genetic link to bruxism, as most people have a close family member that also has bruxism. Bruxism is an involuntary action. Most people don’t realize that they are grinding their teeth.
Bruxism doesn’t occur continuously at night, it is generally a small movement that happens during certain stages of the sleep cycle.
How is bruxism diagnosed?
Bruxism can frequently be diagnosed based on symptoms and physical exams. Your dentist can frequently diagnose this condition based on an examination of the enamel on your teeth. The most definitive way of diagnosing bruxism is by sleep study or polysomnography. Polysomnography isn’t typically needed to diagnose bruxism, but it can help look for other conditions that cause similar symptoms, such as sleep apnea.
What are the short-term complications of bruxism?
Bruxism has many short-term consequences. Pain is one of the more common symptoms. You can develop headaches, facial pain, muscle tightness, sleep problems for both you and your partner, loose teeth, ear pain, and gum problems. Your partner may have difficulty sleeping because of the noise that bruxism causes.
What are the long-term complications of bruxism?
Bruxism can have many complications, both long-term and short-term. The short-term effects associated with bruxism can turn into long-term health complications if not treated.
Damaged teeth are a common complication associated with bruxism. In the long term, bruxism can cause the teeth to be squared and worn. The wearing of the enamel can cause exposure of the nerves which makes the teeth more sensitive and can cause pain. The wearing of the enamel also means that you’re more prone to cavities.
Damage to the teeth and clenching of the muscles can also change the alignment of the teeth and jaw. The alignment of the teeth can also affect whether you develop other problems associated with bruxism.
Gum damage can also occur from long-term bruxism. The pressure on the teeth causes stress on the gums. This can cause inflammation of the gums and allows for the loosening of the teeth.
Temporomandibular joint pain affects a sliding hinge joint where your lower jaw connects to your upper jaw. Powerful muscles that attach to the two bones allow your jaw to open and close to speak and chew food. Clenching of those muscles can cause inflammation to develop in the joint and can cause arthritis over the long term.
More about the TMJ
TMJ pain is one of the more painful chronic conditions caused by bruxism. It can also be caused by other conditions, including genetics, arthritis, or jaw injury. This condition usually causes pain or tenderness of the jaw, aching in the ear, pain in the TMJ joint, pain or difficulty chewing, and locking or clicking of the joint that can make it difficult to open your mouth and chew.
TMJ dysfunction can be diagnosed during a dental evaluation or by your primary care doctor. They can review your symptoms and evaluate how you open and close your mouth. Sometimes, imaging can be used to determine how bad the damage to the joint is.
TMJ pain can be treated in several different ways. Many of the disorders associated with TMJ will resolve on their own and don’t require any specific treatment. Medications for TMJ center on the pain associated with the disorder. Physical therapy will sometimes help correct the locking and improve physical function. Sometimes intraoral appliances or surgery may be required. Surgery is generally a last resort for treating TMJ disorders.
How is bruxism treated?
To get treatment for bruxism, you should start by talking with your healthcare provider or dentist. You have many treatment options available. Some of the treatments center on treating the pain associated with the condition. Other treatments center on treating some of the underlying symptoms contributing to the symptoms. The last category of treatments is directed at treating the long-term complications associated with Bruxism.
As discussed previously, alcohol consumption, caffeine intake, and snoring can contribute to bruxism. Treating sleep apnea can be beneficial for many different conditions and general health. Quitting alcohol use as well as decreasing your caffeine intake may also help. Stopping smoking may also benefit your health and decrease bruxism. Tooth grinding is twice as likely to occur in people who smoke and drink.
If high levels of stress are associated with bruxism, then it follows that treating the high stress levels may help decrease the grinding. Relaxation techniques and sleep hygiene practices may help improve symptoms and overall sleep. In some cases, more formal techniques, such as therapy for cognitive behavioral therapy (CBT), may be beneficial.
Physician and Awareness Measures
Some treatment focuses on awareness of the activities. Keeping the lips open and the teeth apart and training yourself to be aware of these behaviors. Practicing relaxing the jaw when awake. Yoga and other awareness measures, such as mindful meditation, may also be beneficial.
Treating the symptoms associated with bruxism may involve decreasing inflammation or improving the function of the TMJ. Anti-inflammatories can help decrease pain. Muscle relaxants can also be used in some cases.
Treat the Underlying Cause of the Grinding
There is a strong association between anxiety, depression, and bruxism. Treating the underlying cause of the problem may help decrease the grinding. Talking to your healthcare provider about any underlying anxiety and depression can help them choose the right medication for you.
Physical therapy may benefit some patients with bruxism. Exercises to relax the jaw and strengthen the jaw muscles can decrease pain and help correct some of the physical measures, such as being unable to fully open your mouth. Other physical treatments, such as ultrasound and moist heat, may help decrease the inflammation in the TMJ and muscles of the jaw. Sometimes transcutaneous electrical nerve stimulators (TENS) or acupuncture can be used to help with the symptoms. The evidence is not as clear as to benefit, but some patients may benefit from these therapies.
Occlusal Appliances (Intraoral Appliances)
Your dentist may recommend and fit you with an oral appliance to help with your symptoms. They are known as nightguards, splints, stabilization appliances, occlusal splints, interocclusal splints, or bruxism splints. These are soft or firm devices that are inserted over the teeth. These will definitely protect your teeth from grinding, but research is mixed on the benefits of these devices. The simplest type of device is an over-the-counter mouth guard that you can boil and bite, such as those used by football players and other athletes.
Surgical and other Medical Procedures
If none of the other available treatments have worked, surgical or other medical procedures may be beneficial.
Injections include botulin toxin, which is used to decrease muscle spasms. The evidence on this treatment is limited. Prolotherapy involves injecting a solution into the joint to try to repair it. Prolotherapy is also limited. Arthrocentesis involves pushing fluid into the joint to try to break up adhesions and remove inflammatory compounds. This doesn’t usually help with symptoms long term.
Surgery is a last resort. There are both arthroscopic (with a camera) and open procedures that may help more with the long-term side effects of the bruxism than the bruxism itself. Surgery usually focuses on the TMJ. This can be used if there is the destruction of the joint or there are severe limitations to opening the mouth that can’t be otherwise corrected. Implants can also be used to replace the joint if necessary.
Bruxism is a serious health condition that can cause long-term health ramifications. If you’re experiencing the symptoms of bruxism, you should talk with your healthcare provider or dentist about the best options for treating this condition and its long-term complications.
Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.