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Teeth grinding

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Teeth grinding



Introduction

Bruxism is the medical term for grinding the teeth and clenching the jaw.

People sometimes grind their teeth without it causing any symptoms or problems. But regular, persistent teeth grinding can cause jaw pain and discomfort and wear down your teeth. It can also cause headaches and earache.

 

Most cases of teeth grinding (nearly 80%) occur subconsciously during sleep. It's usually associated with contributing factors, such as stress or anxiety.

Bruxism also affects people when they're awake, although this is more likely to be clenching the teeth and jaw, rather than grinding their teeth. Most people do it subconsciously while concentrating or when they're in stressful situations.

Many people with bruxism find it will come and go. It's likely to be worse during stressful periods.

 

What causes bruxism?

Bruxism almost always occurs in association with other factors. About 70% of bruxism cases that occur during sleep are thought be related to stress and anxiety.

There's also an association between bruxism and obstructive sleep apnoea (OSA). OSA is a sleep disorder where your breathing is interrupted during sleep. How bruxism and OSA affect each other isn't currently fully understood.

Teeth grinding can also be caused by taking antipsychotic and antidepressant medication, particularly a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs).

Your lifestyle can also have an effect. For example, regularly drinking alcohol, smoking and using recreational drugs such as ecstasy and cocaine increases your risk of bruxism.

Doctors sometimes refer to teeth grinding caused by an underlying condition as primary bruxism. Teeth grinding associated with a medication, condition or lifestyle factors is often known as secondary bruxism.

 

Treating bruxism

There are a number of possible treatments for teeth grinding, but only a few have been shown to be effective.

Behavioural therapies and the use of mouth guards or mouth splints can be effective in managing the symptoms associated with bruxism.

Mouth guards and mouth splints work in the same way by reducing the sensation of clenching or grinding teeth, and also help prevent any wear on the teeth.

Other treatments, such as muscle-relaxation exercises and sleep hygiene, may also help manage your symptoms.

If you grind your teeth while you're asleep, you may need to wear a mouth guard or mouth splint to protect your teeth from further damage.

If you have an anxiety or stress-related problem, a course of cognitive behavioural therapy (CBT) may be recommended. The aim of CBT is to help you manage your problems by changing the way you think and how you act.

It may be possible to break the habit of teeth grinding using habit-reversal techniques.

Making some simple lifestyle changes, such as giving up smoking (if you smoke), reducing your alcohol consumption and managing stress may also help.



Bruxism is the medical term used to describe teeth grinding and jaw clenching 


 

Who's affected by bruxism?

Teeth grinding affects more than six million people in the UK. But the severity of the symptoms and the frequency of grinding varies. It can occur in both children and adults, although it is most common in adults between the ages of 25 and 44.






 

Children's teeth

From brushing their first tooth to their first trip to the dentist, here's how to take care of your children's teeth

 

Symptoms of teeth grinding 

Teeth grinding (bruxism) can cause different symptoms, including facial pain, headaches and worn-down teeth.

Some of the symptoms of bruxism, such as facial pain, will often disappear when you stop grinding your teeth. Others, such as tooth damage, can be permanent and may need dental treatment.

Possible symptoms of teeth grinding include:



headaches



facial muscle pain (facial myalgia)



earache



tightness and stiffness in the shoulders



pain and stiffness in the jaw joint and surrounding muscles (known as the temporomandibular joint)



sleep disruption (both to you and your partner) 



Symptoms that affect the mouth include:



worn teeth, which can result in short teeth, increased tooth sensitivity and possible loss of teeth



fractured teeth or fillings



difficulty opening your mouth



It's important to note tooth wear only occurs in severe cases of bruxism and not everyone who grinds their teeth will have it.

If your teeth become worn through grinding, you may need dental treatment to avoid developing further problems, such as infection or a dental abscess.

 

When to see a doctor or dentist

You should see your dentist if:



your teeth are worn, damaged or sensitive



you have pain in your jaw, face or ear



your partner complains that you make a grinding sound in your sleep



Tell your dentist if you think you're grinding your teeth. They'll check your teeth and jaw for signs of bruxism, help work out the possible causes, and suggest appropriate treatment.

See your GP if you grind your teeth and you have high stress levels or anxiety. They'll be able to recommend treatment to help manage your stress, which may alleviate your teeth grinding symptoms.

 


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Causes of teeth grinding 

The causes of teeth grinding (bruxism) aren't always known, but it's usually linked to other factors, such as stress and anxiety or sleep problems.

 

Stress and anxiety

Teeth grinding can be associated with mental or psychological problems, such as stress and anxiety.

Studies have shown around 70% of cases of sleep bruxism are caused by stress or anxiety, which affects people subconsciously while they're asleep.

High levels of work-related stress can have a significant adverse affect on your sleep and trigger episodes of sleep bruxism.

Being stressed or anxious may also cause you to clench your jaw or grind your teeth. 

Bruxism can also sometimes be caused by taking certain antidepressants used to treat depression and anxiety.

 

Sleep disorders

Studies have shown people who snore or have a sleep disorder, such as obstructive sleep apnoea (OSA), are more likely to grind their teeth while they're asleep. OSA causes your breathing to be interrupted while you sleep.

The link between bruxism and OSA has only been identified fairly recently, and the exact relationship between the two conditions isn't fully understood.

You're also more likely to grind your teeth if:



you talk or mumble while asleep



behave violently while asleep, such as kicking out or punching



you have sleep paralysis (a temporary inability to move or speak while waking up or falling asleep)



you experience hallucinations (seeing or hearing things that aren't real) while you're semi-conscious



 

Medication

Bruxism can sometimes occur as a side effect of taking certain types of medication. These include some psychotropic medicines that affect your mood, such as antidepressants and antipsychotics.

In particular, bruxism is sometimes linked to a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). Examples of SSRIs include paroxetine, fluoxetine and setraline.

Although there's an increased risk of developing bruxism if you're taking these medications, you may not develop any symptoms.

 

Lifestyle

Certain lifestyle factors can also increase your chances of developing bruxism. These include:



drinking alcohol excessively



smoking



using recreational drugs, such as ecstasy and cocaine



drinking caffeinated drinks, such as tea or coffee (six or more cups a day)



 

Teeth grinding in children

Around 1 in 5 children up to the age of 11 are reported to have bruxism, although the real figure is probably higher as it's often not noticed by parents.

Teeth grinding often occurs after a child develops their first teeth and again after they develop their permanent teeth. The habit usually stops after the adult teeth are fully formed.

After teething, a child may grind their teeth for the same reasons that adults do. For example, it may occur at stressful times, such as during school exams.

 

Treating teeth grinding 

Recommended treatments for bruxism (teeth grinding) include behavioural therapies and using mouth guards or mouth splints.

Other treatments, such as muscle relaxation exercises and sleep hygiene measures, may also help you manage your symptoms.

 

Mouth guards and mouth splints

If you grind your teeth while you're asleep, you may need to wear a mouth guard or mouth splint at night.

These even out the pressure across your jaw and create a physical barrier between your upper and lower teeth to protect them from further damage. They can also reduce any grinding noises you make at night.

Mouth guards are similar in appearance to those used in sports such as boxing. They're usually made out of bendy rubber or plastic and can be made by your dentist to fit your mouth. You'll usually have to pay for this type of custom-made dental appliance.

Mouth guards are also available to buy from your local pharmacist. However, it's unlikely to fit as well as one made by your dentist.

A mouth splint (also known as an occlusal splint or bite plate) is made from harder plastic and fits precisely over your upper or lower teeth.

Mouth splints are no more effective than mouth guards in reducing the symptoms of bruxism. They tend to last for years, whereas mouth guards usually last for less than a year. However, mouth splints are more expensive.

Although mouth guards and splints may help reduce muscle activity in your jaw at night, they're only able to control the condition, not cure it.

 

Treating the underlying cause

Psychological treatments, such as cognitive behavioural therapy (CBT), can be used to treat any underlying psychological problems, such as stress and anxiety, that may be causing you to grind your teeth.

CBT aims to help you manage your problems by changing the way you think and how you act. A specially trained therapist will encourage you to talk about how you think about yourself, the world and other people, and how your actions affect your thoughts and feelings.

If your bruxism is stress related, it's important that you try to relax and get a good night's sleep. There are a number of things you can do to help you wind down before you go to bed. These include:



yoga



deep breathing



massage



reading



having a bath



listening to music



Different things will work for different people. Your GP will also be able to recommend some additional stress management techniques.

 

Breaking the habit

Habit-reversal techniques are designed to break your teeth grinding habit. However, there's no scientific evidence to suggest that using habit-reversal techniques will cure bruxism.

If you grind your teeth while you're awake, it might be useful to record how often you grind your teeth each day. You can then work out when you're more likely to do it and why – for example, when you're concentrating or stressed.

Being more aware of your habit will make it easier to break. To break the habit, you could train yourself to relax your jaw when you feel yourself grinding or clenching. For example, you could open your jaw slightly or gently place your tongue between your upper and lower teeth.

Habit-reversal techniques may be used by a specially trained therapist, or you can try them yourself using a computer programme or self-help book. Your GP will be able to advise you.

 

Treating and preventing dental problems

It's important that you have regular dental check-ups and that any problems caused by your teeth grinding are treated as soon as possible to prevent further damage.

For example, if your grinding leads to a cracked tooth and is left untreated, the nerve in your tooth could die and a dental abscess might develop. As a result, you may need to have root canal treatment.

In severe cases, your tooth could actually split in two. If this happens, your dentist won't be able to save the tooth and it will need to be taken out.

Dental problems, such as misaligned, cracked, crooked or missing teeth, can usually be treated with reconstructive dental treatments, such as false teeth, overlays and crowns.

These treatments can sometimes reshape the chewing surface of your teeth and stop you grinding. You'll usually have to pay for this type of dental treatment and it can often be expensive.

Find and choose a dentist.

 

Medication

Medication isn't usually used to treat bruxism. But non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help relieve any pain or inflammation you have around your jaw as a result of grinding your teeth.

In some cases, your GP may suggest taking a muscle relaxant before you go to bed to help relieve your symptoms.

If you develop bruxism as a side effect of taking antidepressant medication, your GP may suggest changing your medication. But you should never stop taking medication that's been prescribed for you without consulting your GP first.
Teeth grinding