Bruxism is the involuntary grinding of the teeth against each other, often but not always during sleep. Teeth grinding can result in substantial wear and damage to the teeth. The second form of bruxism is clenching, in which the jaws are held tightly shut in an involuntary action.
Determining when bruxism is occurring
Identifying teeth grinding is usually not difficult: a “bruxer” may self-identify; that is, they might come right out and say that they are a grinder or clencher. Alternatively, a bruxer’s sleep partner may identify their partner as a bruxer: they are often in a position to see or hear their partner “bruxing” in their sleep.
Visual signs can also indicate bruxism: a dentist in the normal course of patient care might see visual signs of bruxing, such as worn or cracked teeth and fillings, or overdeveloped jaw musculature. Visual signs might also be observed when a dentist is assessing a patient’s suitability for implants or other dental procedures.
Non-visual signs can also indicate teeth grinding; a clicking mandibular joint might indicate damage from bruxing, or a patient might complain of facial pain or tightness in the jaw, particularly on waking.
Types of bruxism
Bruxism can be divided into two types: nocturnal or daytime. Apart from differing by the time of day, the type of condition involved can also differ. Nocturnal bruxism is most often associated with grinding (although clenching can also occur), while daytime (waking) teeth grinding is most often manifested as clenching.
This division of types of disease also connects to differing causalities. The causes of nocturnal teeth grinding (or “sleep bruxism”) are not fully understood but it’s generally accepted that it is “centrally driven”; that is, through the central nervous system. Nocturnal teeth grinding is also associated with several contributing factors, such as genetics (bruxism is seen to occur in some families more than others); stress; caffeine, alcohol, tobacco, and amphetamines; and medications. Among medications contributing to nocturnal bruxism, SSRIs (selective serotonin reuptake inhibitors) are most connected to teeth grinding. These are typically seen as anti-depressants, anti-convulsants, or antipsychotic medications.
Daytime bruxism is also connected to emotional stress and amphetamine use but also can be contributed to by postural and physical stresses such as repetitive stress and slouching. Dentists have noticed a significant increase in teeth grinding among their patients during the COVID-19 pandemic, presumably related to the increased stresses of the time.
The numerous problems caused by bruxism (sleep disturbance for bed partners, waking with tightness or pain, cracked teeth and fillings) are really offset by a single slight benefit: a bruxer will likely have strengthened bone structure.
Why treat bruxism?
Numerous reasons exist for treating bruxism. Treatment can relieve patients of pain, resolve sleep disturbance for bed partners, reduce waking with pain or tightness in the jaw, increase the range of jaw motion, and most importantly reduce or prevent further damage to the teeth and fillings in the forms of cracking and wear.
Unfortunately, the treatment measures available to a dentist will not “cure” bruxism; instead, they are intended to manage it by reducing the strains bruxing imposes on the teeth. Additionally, no one treatment is universally effective.
Typical treatment approaches include dental appliances, behavioural therapies, sleep hygiene, botox, changing contributing medications, and home care protocols.
Dental appliances (night guards) are essentially tooth guards that are plastic or acrylic, covering either the upper or lower arch. The appliance is worn overnight and separates the upper and lower teeth. Bruxism that occurs during sleep when the appliance is worn will be less likely to result in damage to the teeth and fillings, as they are physically separated and the stresses resulting are reduced. The appliance needs to fit snugly, be balanced with even contacts between teeth, not permit sliding, and not cause the patient pain.
Behavioural therapies are less successful and can be expensive.
Sleep hygiene can contribute to a better night’s sleep, but appears unlikely to decrease the amount of bruxing.
Botox treatment of bruxism can be expensive and accompanied with unwanted side effects (dry mouth, muscle atrophy, jaw fatigue), but can decrease the force generated in clenching. Botox treatment is typically reserved for extreme cases of bruxism.
Changes to medications that can contribute to bruxism might be helpful, but it’s important not to replace otherwise successful SSRIs simply in the attempt to reduce bruxism. The first-line approach is the use of effective dental appliances.
Home care protocols include cutting food into small pieces and avoiding hard, sticky, or chewy foods. The goal is to reduce overworking of the jaw muscles, a source of jaw pain. Pain can also be reduced by passive stretching exercises. Note that these home care protocols do not prevent or reduce bruxing, but they can reduce its detrimental effects.