This is a frequently under examined issue in the mouth, and is often at the root of many dental problems.
Bruxism is the term referring to clenching or grinding of teeth. Normally when we bring our teeth together, nerve endings in the teeth, the jaw muscles and jawbones alert the brain that the mouth is fully closed, and not to exert further pressure. You can test this yourself, by pretending to chew something - as you do so, you’ll note that on bringing the teeth together, you automatically release without applying significant pressure. During bruxism, this is different; instead of releasing the pressure when the teeth meet, as expected, the muscles continue to exert an excessive force, causing overloading of the teeth, their supporting jaw bone and the active muscles. Bruxism can occur during the day, or the night:
Awake Bruxism: This is is often described as tensing the jaw or clenching the teeth, usually in response to something. Quite a few patients have found themselves doing this for example whilst driving in a car!
Sleep (Nocturnal) Bruxism: This is a similar clenching of the jaw muscles and the grinding of teeth, but whilst asleep instead. The difficulty of course is that you cannot consciously control your teeth grinding because you will not be aware that you are doing it. Stress is the most common promoter, and the amount of bruxism often waxes and wanes proportionately to stress levels being experienced at that point in life.
SIGNS OF BRUXISM
There are several signs of bruxism, although patients may range from being symptom free to suffering several of them:
- • Grinding Sounds - Some people make distinct grinding or tapping sounds with their teeth, particularly if bruxing at night; it is most often the bed partner who is aware of it!
- • Worn teeth - Clenching and grinding exerts untoward force upon the teeth. This causes excessive wear (attrition) upon the teeth, visible initially as faceting of the teeth, but if continued unchecked, causes the teeth to become worn down.
- • Chipped Teeth - Some people who clench and grind move their jaw around as they do so, This can cause fragments of teeth to break away, often seen as the edges of the front teeth, or corners of the back teeth, particularly those with fillings.
- • Tooth Fractures - The action of the jaws can be compared to that of a nutcracker; with the jaw joints being adjacent to the ears, the back molar teeth experience the highest forces in the mouth. Bruxists often have fracture lines in the back teeth, and those teeth that have had to be repaired with fillings, and thus have had their integrity compromised are most prone. Repeated episodes of bruxism can lead to corners of these teeth breaking away. Teeth with such fracture lines often become symptomatic, and develop “Cracked Cusp Syndrome”, in which an intermittent, short lived sharp pain (sometimes described as an electric shock), lances through the teeth when chewing. As the fracture deepens within the tooth, the symptoms become more frequent, and sensitivity to temperature often becomes apparent.
- • Abfraction Cavities - The overloading of the teeth during bruxism commonly causes little cavities to develop at the necks of the teeth where they emerge from the gum, which changes the appearance of the teeth, and can make them more sensitive.
- • Sensitivity - The nerves within the teeth can be irritated by the abnormally high forces loading the tooth structure, and combined with fracture lines and abfraction cavities, sometimes cause the teeth to become more sensitive.
- • Bone Loss - The amount of bone present around a tooth can become compromised when it is overloaded. Long term, this results in the teeth feeling loose, and can contribute to premature loss of teeth.
- • Soreness or Aching of Jaw & Facial Muscles - Bruxism results in the muscles clenching too hard and being over-exerted. If you have ever had a hard workout at the gym, you will recognise the subsequent muscular discomfort that this produces, and the jaw muscles are no different! If you place your fingers over your temples and move your jaw around, you will feel the underlying (temporalis) muscles flex; they can often prove unexpectedly tender to only mild pressure.
- • Headaches & Migraines - The temporalis muscles, which cover the temples, are major chewing muscles. The soreness in these often manifests as a headache, particularly noted on waking up. Bruxism is also a known trigger for some kinds of migraine.
- • Soft Tissue Damage - Bruxists sometimes bite themselves causing direct trauma; the increased friction of the tongue and cheeks against the teeth can also result in a benign whitish line and pattern imprinted into them.
- • Sleep Disturbances - Nocturnal bruxism commonly affects sleep, with sufferers experiencing difficulty sleeping, disturbed shallow sleep, or very vivid dreams.
Following diagnosis of bruxism, your dentist will discuss what treatment options are available. For some people, it is most appropriate to simply monitor the situation. For others, we will discuss the various treatment modalities, and help select the most suitable approach to protect the mouth. The solutions available are the soft bite guard, Michigan splint, and the Sleep Clench Inhibitor (SCi). Of these, the latter is often highly effective. We tend not to use soft bite guards nowadays, as they can exacerbate bruxism issues in some patients.