BRUXISM

Bruxism is the medical term for teeth grinding.

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 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 antipsychotics and antidepressants, particularly a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs).

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.

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 teeth become worn through grinding, dental treatment is needed to avoid developing further problems, such as infection or a dental abscess.

A dentist should be sought if:

  • teeth are worn, damaged or sensitive
  • pain is experienced in your jaw, face or ear
  • your partner complains that you make a grinding sound in your sleep

Tell the 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.

The importance of stress management is emphasized which may alleviate teeth grinding.

 

Treating teeth grinding 

Recommended treatments for bruxism include behavioural therapies and using mouth guards or mouth splints.

Other treatments, such as muscle relaxation exercises and sleep hygiene measures, may help in managing the symptoms

Mouth guards and mouth splints

Due to the risk of teeth damage due to teeth grinding, mouth guards or mouth splints maybe used at night to protect the teeth from being worn out.

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

Mouth guards are similar in appearance to those used in sports such as boxing. They’re usually made out of a pliable rubber or plastic. They maybe custom-made by your dentist for a snug fit. Ready made mouth guards are also available. 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 and mouth guards are equally effective in reducing the symptoms of bruxism. Mouth splints may last longer, whereas mouth guards usually last for less than a year.

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 stress and anxiety, which are triggers to teeth grinding, may be managed through cognitive behavioral therapy (CBT).

The role of CBT is to empower the self to manage problems by changing the way one thinks and act. A trained therapist will guide the course of treatment by facilitating discussions about how one thinks about the self, the world, other people, and how actions affect thoughts and feelings.

Since bruxism is said to be related to stress, the imporatance of rest and relaxation is emphasized. There are a number of realaxational techniques, which include:

  • yoga
  • deep breathing
  • massage
  • reading
  • having a bath
  • listening to music

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 teeth grinding occurs during waking hours, then a diary could be useful by recording the time and frequency teeth grinding occurs and the associated events when it occurs.

Awareness of ones habit will make it easier to break the habit. To break the habit, jaw relaxation techniques may be done when the urge of teeth grinding or jaw clenching is felt. For example, openning the jaw slightly or gently placing the tongue between the upper and lower teeth may be done.

Habit-reversal techniques may be used by specially trained therapists, or even could be guided through a computer programme or self-help book.

Treating and preventing dental problems

Regular dental check-ups are neccessary especiallybecause problems caused by teeth grinding should be managed immediately to prevent further damage.

For example, when teeth grinding causes a chip in the tooth and is left untreated, the nerve inside the tooth may be damaged and a dental abcess may develop, leading to the need for a root canal.

In severe cases, fragmentation of the tooth may happen and saving the tooth will be impossible. The dentist may need to extract the tooth.

Dental problems, such as misaligned, cracked, crooked or missing teeth, can usually be treated with reconstructive dental treatments, such as dentures, overlays and crowns. These treatments can sometimes reshape the chewing surface of your teeth and stop grinding.

Medication

Medication isn’t necessary to treat bruxism. But non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help relieve any pain or inflammation caused by teeth grinding.

In some cases, a muscle relaxant may be recommended before going to bed to relax the jaw.

If bruxism develops as a result of taking antidepressants, your doctor may suggest shifting to another type of medication. But it should be emohasized not to stop the prescribed medication without consulting your doctor.

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