Grinding your teeth

Grinding your teeth, or bruxism as we call it in dentistry, is a condition that I observe daily in my practice, but many patients I meet don’t have a clear understanding of the significance of their symptoms or whether something should be done about it.  So, I offer up here five things that everyone should know about bruxism.

 

1.  You might not think you grind your teeth…

While there are some patients who know they clench or grind their teeth, the percentage of those unaware is very high—up to 80% in some studies.  People often associate grinding their teeth with hearing a sound, and in some cases this is true (just ask your sleeping partner)!  However, not all bruxers make sound when their teeth come together in an unnatural way.  The best way to determine if you have a bruxism habit is to have your dentist check for it during your next exam. 

2.  Awake bruxism is more common, but night bruxism may cause more damage.

We often categorize a bruxism habit as happening primarily during the day (awake bruxism) or primarily while one is sleeping (nocturnal or night bruxism).  Awake bruxism is usually characterized by more of a clenching habit than a true, full grinding habit.  Night bruxism, on the other hand, usually involves a “clench and grind” habit that is rhythmic and repetitive.  And while awake bruxism is more common, the rhythmic clench and grind of night bruxism tends to lead to more unfavourable signs and symptoms. 

3.  Women, you probably out-clench your male counterparts…at least during the day.

Awake bruxism is slightly more prevalent in females than males, but most studies don’t show a difference between men and women during the night.  But hang on guys—you’re not off the hook.  Because more damage is done during night bruxism, and because of convenience, oral appliances for treating bruxism are usually worn at night.  This means men and women are equally likely to have treatment.

4.  Long term consequences may extend well beyond the present signs and symptoms.

Besides the sore jaw muscles and premature tooth wear that patients are often aware of, there is a host of secondary symptoms associated with a chronic and untreated bruxism habit.  Clenching and grinding require hyperactive head and neck muscles, which can cause headaches and can also lead to poor positioning and discomfort in the temporo-mandibular joint (TMJ).   Attrition of the enamel surface of the teeth from bruxing can expose the deeper dentin layer of a tooth, which is much more prone to cavity formation and sensitivity.  In more severe bruxism, tooth fracture and even tooth loss may occur.

5.  Appliance therapies are good, but not all equal.  Occlusal therapy must be done cautiously.

Bite plates, splints and night guards are all names given to oral appliances meant to help protect against bruxism.  Most are designed to provide a protective surface between the teeth to take the brunt of grinding abuse.  Others are designed to reposition the jaw in such a way that the actual habit of clenching or grinding is corrected or inhibited.  In either case, bruxism appliances are a conservative and effective way to treat the condition.  Occlusal therapy or equilibration involves changing the shape, contour or contact points of your natural teeth to allow your teeth to fit together more favourably.  As this treatment is irreversible, it is not usually the first mode of treatment pursued.  Occlusal therapy also assumes that the “problem” causing a bruxism habit in the first place is how the teeth fit together, which is rarely the case.