Excessive tooth grinding and jaw clenching is known as “Bruxism.” It’s an oral “parafunctional” activity unrelated to normal jaw functions like eating and talking. Although the actual root cause or causes of bruxism aren’t clearly understood by healthcare professionals, statistics show anywhere from 50 to 96 percent of adults grind their teeth at some point in their life. Bruxism also regularly occurs in up to one-third of children, but it is most common in adults ages 25 to 44. However, it’s important to note that most people do clench or grind their teeth on occasion.
What Is Bruxism?
There are two types of bruxism — tooth grinding that occurs while sleeping (sleep bruxism) and grinding done while awake (awake bruxism). Sleep bruxism is more common and generally creates more damage to the teeth, jaw and gums than awake bruxism. Tooth grinding during the day is also damaging, but it’s thought to have different causes than night bruxism. Curiously, awake bruxism is more common in women. However, asleep bruxism is equally divided between males and females.
Like many disorders, bruxism can be mild and irregular. Many people are unaware they grind their teeth until it’s noticed by others, whether it’s a sleep partner who hears tooth grinding at night, colleagues who observe grinding at work or school or the dentist who sees the telltale signs during an examination. Mild bruxism can occur for a short period and then disappear, never to return. Chronic, or long-term bruxism, may be life-long and require significant intervention to control further damage.
Many people subconsciously grind their teeth for years without realizing it. They may experience the symptoms, feel the effects of tooth grinding and suffer the dental damage without actually realizing what’s occurring. In order to know how to stop tooth grinding, bruxists must be aware of the suspected causes, recognize the symptoms and be informed about how to treat and prevent excessive tooth grinding.
Symptoms of Excessive Tooth Grinding
Bruxism symptoms are divided into two categories. There are physical symptoms exhibited by the overall body and oral symptoms that are observed in the mouth. Symptoms can be mild and start to warn of a potential problem that, left unchecked, may lead to serious dental damage such as teeth worn to stumps and costly repairs like bridges, crowns, extractions, implants or dentures. Other symptoms may be severe but unrecognized as being caused by tooth grinding.
These are the common physical and oral symptoms of tooth grinding:
• Headaches are the main sign of a tooth grinding problem
• Temporomandibular joint (TMJ) discomfort of the jaw
• Facial myalgia or face muscle pain
• Shoulder tightness and stiffness
• Limitation of mouth opening
• Cracking and popping in jaw movements
• Sleep disruption, including that of bed partner
• Abnormal tooth wear
• Fracture of teeth
• Misalignment of jaw
• Inflammation and recession of gums
• Loose teeth
• Loss of teeth
Headaches are by far the most common physical symptom of bruxism. It’s estimated that tooth grinders are three times more likely to experience headaches compared to non-grinders. Earaches are also a common symptom.
Misalignment and dislocation of the jaw often result from prolonged or chronic bruxism. The excessive force from grinding the lower mandible against the upper mandible eventually produces a change in muscular structure that misshapes the jaw’s natural alignment. The effects of tooth grinding can actually change the appearance of one’s face, including a protrusion of the jaw, an offset of the jaw and an unnatural smile.
Cracking or popping of the mandible hinge is another red flag that a tooth grinding problem exists. This again is the result of excessive force being placed on the jaw and facial muscles. The popping occurs when the jaw is opened and a slippage of the temporomandibular hinge point (TMJ) occurs. This may or may not be audible to another person, but it will certainly be noticed by the bruxist.
Sleep interruption is commonly experienced by both the person who grinds their teeth and their sleep partner. Bruxists often are restless sleepers who toss and turn, waking their partner from the motion as well as the sound of tooth grinding.
Physical discomfort radiating from the jaw and facial muscles can manifest in other locations such as the neck, shoulders, arms and lower back. This extremity pain can be acute or chronic and mild or severe. Intense pain from tooth grinding is rare.
Significant tooth wear only occurs after long-term or severe tooth grinding. Many of the common symptoms of bruxism will have been evident for a considerable while before dental damage like loose, worn teeth and infected gums result. Recognizing the oral and physical signs of tooth grinding is the first step in understanding the problem and being able to seek treatment.
Causes of Tooth Grinding
Why bruxism occurs is not always clear. In the dental profession, the belief that tooth grinding and dental occlusion are casually related is widely held — however, recent research finds little evidence to support this. There are a number of interactions that cause a person to grind their teeth, and it’s often a combination of factors that lead to bruxism.
Additionally, there is no firm pattern as to who is more likely to grind their teeth, when they will do it and whether it will be occasional or continual. Usually, bruxism will result from a combination of these factors:
• Sleep disorders
• Lifestyle factors
• Abnormal bite
Sleep disorders are the leading cause of tooth grinding, and it’s no coincidence that the majority of grinding occurs at night. Of the many sleep disorders, Obstructive Sleep Apnea is the most severe and almost always results in bruxism events.
Lifestyle factors that cause tooth grinding include excessive alcohol consumption, smoking and gum chewing. Caffeine intake from tea, coffee, soft drinks and chocolate also contribute to tension which manifests in grinding teeth. Recreational drugs such as cocaine, ecstasy and amphetamines are similar contributors to bruxism.
Stressors such as anxiety, employment or financial concerns, illness, addictions and marital strife are widely associated with the inability to relax, whether by day or by night. Studies have shown that around 70 percent of asleep tooth grinding cases are triggered by a subconscious worry that creates tension in the jaw and facial muscles. Without a doubt, stress in its many forms and psychological components is a leading contributor to tooth grinding.
Medications can have side effects that create the conditions leading to bruxism. These include psychotropic medicines that affect the mood, like selective serotonin reuptake inhibitors (SSRIs). Examples of these antidepressants are fluoxetine, sertraline and paroxetine.
Neurological illnesses such as Parkinson’s Disease and Huntington’s Disease are known to be associated with both awake and asleep tooth grinding. As well, abnormal bite caused by misaligned and/or missing teeth greatly contributes to a pattern of bruxism.
Overall, healthcare professionals concur it’s usually a combination of these factors that lead to people grinding their teeth. While stress may be the biggest culprit, it’s well-known that stress is caused by many underlying issues.
• Facial distortion
• Psychological issues
• Compounded illness
Causes of Daytime Bruxism
While bruxism typically occurs during sleep, teeth grinding can also happen during the day as a result of anxiety and stress. Many people unconsciously clench or grind their teeth in the daytime in response to work stressors, eventually causing jaw soreness, headaches and teeth damage.
Daytime bruxism is often caused by:
- Teeth misalignment: abnormal bite or an uneven smile
- High-stress work environment: often deadline-focused and increased performance standards
- Tension: short-term emotions that arise daily
- Medications: some medications, like antidepressants, have side effects that affect your mood and can lead to bruxism
To reduce bruxism caused by stress and anxiety, begin by seeking counsel with a trained professional, increase your physical activity, keep hydrated, avoid stress-inducing foods and beverages like caffeine and alcohol and consult with your dentist.
How to Stop Teeth Grinding
The best solution for bruxism is identifying and dealing with the underlying cause or causes. Treatment for bruxism is normally done in two forms. Occlusal management is the use of mechanical devices to physically stop the tooth grinding. Behavioral management is dealing with the lifestyle and stress issues that are contributory to the problem.
Occlusal management is performed with:
• Occlusal splints
• Occlusal bite guards
• Mandibular Advancement Devices (MADs)
• Regular dental checkups
• Dental correction
Behavior management includes:
• Habit breaking
• Lifestyle adjustments
• Sleep therapy
• Cognitive Behavior Therapy (CBT)
• Muscle relaxation
Healthcare professionals are able to develop a specialized treatment plan that may include many of these steps. Once a tooth grinding problem is identified, it’s imperative that immediate action is taken to prevent further damage to the teeth or jaw, while a holistic approach is taken to identify the factors contributing to the individual’s bruxism and the steps necessary to eliminate the cause(s).
The simplest and most effective form of mechanical intervention is what’s commonly known as a bite guard. While normally worn at night, these devices, which are similar to sports mouth guards, can also be worn while awake if the bruxism problem is severe enough. These devices help prevent tooth damage from clenching or grinding by keeping teeth separated.
Economical bite plates can be purchased off the shelf in pharmacies or they can be custom-made and fitted by a dentist. Custom work can be much more expensive, but a properly fitting, custom occlusal appliance will feel much more comfortable, and is therefore more likely to be worn routinely.
All mandibular advancement devices are custom-made. These are expensive appliances that typically bring the bottom mandible (jaw) forward of the upper mandible and are used when sleep disorder is the probable cause of tooth grinding. They’re the preferred treatment when bruxism is caused by sleep apnea.
Regardless of which occlusal device is implemented, it’s important to know that they’re only able to control the problem — not cure it.
Your dentist can help you with behavior management techniques with your occlusal device, including how to properly position your mouth and jaw. If you have difficulty with behavioral changes, you can also begin biofeedback. If sensitivity or a reduced ability to chew have developed because of tooth wear, your dentist may need to adjust the chewing surfaces of the affected teeth or use crowns to help fix the damage.
Why Do Children Grind Their Teeth?
About 14 to 17 percent of children have bruxism, often beginning as soon as the child’s upper and lower teeth come through the gums. Around one-third of children will most likely still have bruxism as adults. Teeth grinding in children is common and could be caused by a range of psychological, physiological and physical factors. However, the exact cause of bruxism in toddlers and children — like adult causes of teeth grinding — are still relatively unknown.
Diagnosing bruxism in children can be somewhat difficult since they are unaware they are grinding their teeth. To determine if your child is grinding their teeth during sleep, listen for sounds while they sleep or note if your child complains of a sore jaw or pain while chewing.
Your child’s bruxism may be caused by one of the following factors:
- For babies eight to 12 months old, teeth grinding could be the result of the learning process. When babies first cut their teeth, they may grind them as a way to ease the pain in their gums. Most infants outgrow the habit, but until then, give your baby a cool teething ring to reduce teeth grinding.
- Sometimes baby tooth grinding is the child’s response to growing, and this can’t be prevented. Once permanent teeth grow in, the child will stop.
- Teeth grinding may be a response to earache pain.
- In toddlers and children, teeth grinding my be a response to anxiety and stress. Studies show those with bruxism have elevated hormone levels — test-taking, relocating to a new school, nightmares, new siblings being born, arguments with siblings or parents and weaning from breastfeeding can all be anxiety-inducing for children. Bruxism caused by stress will only diminish once the cause of the stress is managed and dealt with.
- Malocclusion, or imperfect positioning of teeth when the jaw is closed, also encourages teeth grinding. This could be caused by abnormal alignment of the upper and lower teeth or jaw misalignment.
- Gum inflammation, known as gingival inflammation, as the result of poor oral hygiene can also promote teeth grinding. This is particularly true for children who don’t brush their teeth.
- For children and adolescents taking anti-depressants, bruxism may be a side effect of those medications.
- Children with brain injuries or developmental disorders such as cerebral palsy, Down syndrome or epilepsy have a higher chance of developing bruxism.
- If the bruxism occurred suddenly, evaluate any new medications your child is taking and consider switching to a different brand or a new medication.
- Stomach acid reflux in the esophagus is another possible cause of bruxism.
- Bruxism may be the result of medical issues like dehydration, nutrition deficiencies, allergies, asthma or hyperactivity.
- Teeth grinding may also be passed genetically from a parent.
Tips to Prevent Your Child’s Teeth Grinding
If you suspect your child is grinding their teeth, schedule a visit with your child’s dentist, pediatrician or a sleep therapist. To help your child with bruxism, make sure they are staying properly hydrated during the day and have a balanced and healthy diet. For teeth grinding as the result of excessive stress or anxiety, it’s imperative to help your child manage any stressors and talk with them about and through their issues as much as possible — reassurance helps children deal with stress. Also, take part in stress-relieving activities, particularly with younger children, such as warm baths, bedtime stories and soothing music.
Make sure your child sleeps well and gets enough rest. Tired children may experience development or behavioral issues.
Tips to help your child sleep better include:
- Following consistent bed routines
- Establishing a relaxing bedtime setting
- Interacting with your child at bedtime without television, computers, games or mobile devices
- Keeping your child away from age-inappropriate content
- Not letting your child fall asleep while being held, rocked, fed a bottle or nursing
- At bedtime, not letting your child eat or drink foods with caffeine, like soda or chocolate, or take medications with stimulants such as cough medicine or decongestants.
Preventing Teeth Grinding
As with so many ailments, an ounce of prevention is worth a pound of cure. As soon as a tooth grinding issue is identified, a dentist appointment should be made to assess the severity of the problem and take measures to control and treat the bruxism.
Early intervention is vital to prevent grinding damage to the teeth and subsequent problems in the gums, jaw and facial muscles. Education about the symptoms, causes and treatment of bruxism is also a critical prevention step. Being aware of the issues makes early treatment much more effective and will greatly reduce long-term damage from tooth grinding.
The Anderson Dental Group is comprised of professional care providers well-versed in the signs, symptoms, causes, effects, treatment and prevention of Bruxism. If you are concerned about teeth grinding, call our office at 928-474-4581 to book a dental appointment for the treatment of tooth grinding and other oral care.
We also offer comprehensive dental care for adults and children throughout Payson, AZ and the surrounding areas including preventative care and X-rays, dental implants, teeth whitening and root canals. We strive to create a comfortable atmosphere for all of our clients. For all new patients, we offer a free dental exam and X-rays as well as emergency dental services. Payson Dental office for an exam in order to schedule an appointment completing our online scheduling form.