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Bruxism (Tooth grinding or clenching)

Overview

Bruxism refers to the clenching, grinding, or gnashing of teeth. It usually happens subconsciously, either during waking hours or during sleep.

A combination of psychological, physical, and genetic factors has been associated with bruxism.

  • Anger, frustration, stress, anxiety, or tension may cause awake bruxism, which serves as a coping mechanism for activities involving deep concentration.
  • Sleep-related chewing activities associated with arousals may cause sleep bruxism.

The following factors have been shown to increase the risk of bruxism:

  • Stress: Increased levels of anger, frustration, and anxiety can cause the grinding of teeth.
  • Age: While bruxism is common before and during early adolescence, it usually disappears by adulthood.
  • Personality type: People that are competitive, aggressive, or hyperactive may be at an increased risk of developing bruxism.
  • Family history: People with family members who have bruxism or a history of it may develop this condition.
  • Medications and other substances: Some psychiatric medications, such as antidepressants, are associated with uncommon side effects, such as bruxism. Consumption of caffeinated beverages or alcohol, recreational drug use, and smoking tobacco may increase the risk of developing bruxism.
  • Other disorders: Some neurological disorders, such as attention-deficit/hyperactivity disorder, epilepsy, and Parkinson's disease-related dementia, and sleep-related disorders, such as sleep apnoea and night terrors, have been associated with an increased risk of developing bruxism.

The symptoms of bruxism include:

  • Loud teeth grinding or clenching (that may awaken the sleep partner)
  • Enamel erosion, leading to the exposure of the deeper layers of the tooth
  • Fractured, chipped, flattened, or mobile teeth
  • Heightened tooth pain and/or sensitivity
  • Stiffness in the jaw muscles (difficulty in opening or closing the jaw completely)
  • Soreness or pain in the jaw, neck, or face
  • Sleep disruption
  • Dull headache originating in the temples
  • Pain that feels like, but is actually not, an earache

Bruxism is diagnosed based on the presence of the aforementioned signs during routine dental examinations.

Treatment is not necessary in many cases, given that many bruxism disappears among many children without treatment and that in many adults, the teeth grinding or clenching is not severe enough to warrant therapeutic interventions. However, for cases of severe bruxism, dentists prescribe specific dental approaches, therapies/habits, and medications to prevent further tooth damage and provide relief from pain or discomfort:

  • Dental approaches: Dentists often suggest methods to prevent the wear and tear of the teeth or improving dental health; however, these may not be effective in stopping bruxism. These methods include:
    • Application of mouth guards and splints: These devices, often prepared using hard or soft acrylic materials, are fit onto the upper or lower teeth; thus, they help separate the teeth and prevent the damage caused by tooth grinding/clenching.
    • Dental correction: When the bruxism is severe, i.e., wear and tear of the tooth has led to heightened sensitivity or difficulties in chewing/eating, to repair the damage, the chewing surfaces may need to be reshaped, followed by the insertion of dental crowns.
  • Other approaches: Bruxism may also be treated using one or more of the following approaches:
    • Management of anxiety and stress: Adopting strategies that promote relaxation, such as meditation, and/or guidance from a licensed therapist or counsellor, may be effective if the bruxism is a result of psychological stress or anxiety.
    • Behavioural changes: The dentist may recommend appropriate jaw posturing/alignment and mouth and jaw exercises as behavioural changes to suppress teeth grinding/clenching.
    • Biofeedback: If changing behaviours/habits is difficult, biofeedback, i.e., the use of monitoring procedures and equipment to teach patients how they can control muscle activity in the jaw, may be effective.
  • Medications: Generally, treating bruxism using medications has not been shown to be effective; further research is needed to determine the efficacy of medications and develop effective medicines for this condition. The following medications may be used for treating bruxism:
    • Botox injections
    • Muscle relaxants
    • Anti-anxiety or anti-stress medications
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