Bruxism (Teeth Grinding): Symptoms, Causes, Treatment, and Diagnosis

Bruxism (BRUK-siz-um) is medical terminology for the habit of grinding teeth and clenching the jaw.

Regular and continuous teeth grinding may lead to excessively worn out teeth with pain and discomfort in the jaws.

It can also be the reason for headaches and earaches in some people. Most of the time, teeth grinding may occur subconsciously during sleep (sleep bruxism), and is commonly associated with factors such as stress and anxiety.

Sleep bruxism is considered as a sleep-related movement disorder. People who grind their teeth during sleep are more likely to have other sleep disorders such as snoring and pauses in breathing (sleep apnea).

While awake, bruxism is more likely to be clenching of the jaw and teeth rather than teeth grinding.

Most people do it when they are concentrating on something or when subjected to stressful conditions.

Most people with mild bruxism feel the condition to be a transient one and do not require any treatment.

You may be unaware of your sleep bruxism until development of complications. Therefore, it is necessary to seek regular dental care and be aware of the signs and symptoms of bruxism.

The signs and symptoms of bruxism include:

Teeth grinding that may be too noisy and awaken your sleep partner
Teeth that are flattened, fractured, chipped or loose
Abrasion of the tooth enamel, exposing the deeper layers of your tooth
Increased tooth sensitivity to hot, cold, or sweets
Soreness or tenderness in the jaw muscles, especially in the mornings
Tightness of the jaw muscles
Pain in the ear (earache) as the temporomandibular joint is in close proximity to the ear canal
Dull headache felt at the temple area
Damage from chewing on the inside of your cheek
Indentations on your tongue
Stress, anxiety, and tension
Insomnia
Depression

See your doctor or dentist when you notice that:

Your teeth are worn out, damaged or sensitive to hot or cold foods
You have pain in the jaws, face or ear
Others tell you of the grinding noise you make during sleep
You have difficulty opening or closing the jaw completely or locked jaw
If you notice that your child has the habit of grinding their teeth or other signs or symptoms of bruxism, please mention it at your child's next visit to the dental office.

The definite cause of bruxism has not been understood completely. People with the habit of grinding their teeth actually do it involuntarily, without being aware of it.

Sleep-related bruxism is often a hard problem to control and daily stress may be the triggering factor in most people.

Possible physical or psychological causes of bruxism include:

Abnormal alignment of upper and lower teeth (malocclusion)
Sleep problems such sleep apnea
Response to an earache or teething in younger children
Reflux of stomach acid into the esophagus
Emotional disorders such as anxiety, tension, stress, anger, and frustration
Aggressive, competitive or a hyperactive type of personality
Rare adverse reactions to psychiatric medications such as phenothiazines or certain antidepressants
As a coping strategy or focusing habit
As a complication of disorders such as Huntington's disease or Parkinson's disease

You may approach your dentist first for evaluation.

Your dentist may feel the need to refer you to a primary care physician or sleep specialist if the condition is serious enough.

Collect all relevant medical records, for example, if you've been prescribed treatment for bruxism-related problems in the past.

Write down all symptoms you are experiencing, including the ones which seem unrelated to the reason for the appointment. If you have pain, make a note of when it occurs, such as when you wake up in the morning or at the end of the day.
Note down your key personal information, including any recent major stressful life changes.
Make a list of all current medications, vitamins or other supplements you are on and their dosages.

Some basic questions you may ask regarding bruxism include:

What is the likely cause for my symptoms or condition?
Are there any other possible causes?
What kind of diagnostic tests do I need?
Is my condition temporary or long-term?
What is the best available treatment?
Are there any alternatives to the primary approach you are suggesting?
I have been diagnosed with other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?

Your doctor or dentist will ask you a number of questions, such as:

When did you first notice your symptoms?
Do your symptoms appear occasionally or have they been continuous?
What is the severity of your symptoms?
Does anything seem to improve or worsen your symptoms?

During your regular check-up, your dentist will check for the signs of bruxism.

If you have any signs supporting bruxism, your dentist will observe changes in your teeth and mouth for the upcoming several visits.

This is done to check whether the process is progressive and to find out if treatment is needed.

Your dentist will try to find out the most likely cause by gathering information about your general dental health, medications, daily routine and sleep habits.

In order to further evaluate the extent of bruxism, your dentist may examine for:

Tenderness in your jaw muscles
Evident tooth abnormalities, such as broken or missing teeth or misalignment
Damage to your teeth, the underlying bone and the inside of your cheeks, with the help of X-rays

A careful dental examination may reveal the presence of other disorders such as temporomandibular joint (TMJ) disorders, an ear infection or other dental problems that can mimic the jaw or ear pain of bruxism.

You may be referred to a therapist, counselor, or sleep specialist if your dentist suspects the involvement of a significant psychological component or a sleep-related disorder.

A sleep specialist performs more sophisticated tests, such as assessment of sleep apnea, video monitoring and measurement of the frequency of your jaw muscle tightening while you sleep.

In most people with bruxism, medical treatment is not required.

Most children outgrow this habit without any treatment and most adults may have mild bruxism that does not require therapy.

However, in severe cases, treatment options include certain dental approaches, therapies, and medications.

Talk to your dentist about what suits the best for you.

Dental approaches: If you or your child have the habit of teeth grinding (bruxism), your doctor may suggest methods to preserve your teeth. The following methods can prevent the wearing of your teeth, but are unable to stop the bruxism.
Splints and mouth guards: These are designed to keep the upper and lower teeth separated, and to avoid the tooth damage caused by clenching and grinding. These are appliances made up of hard acrylic or soft materials and can fit well over your upper and lower teeth. A splint protects the teeth from the pressure of clenching.
Orthodontic correction: Correction of the teeth that are misaligned may be helpful if your bruxism is related to dental problems. In severe cases of bruxism in which the tooth abrasion has caused sensitivity or the inability to chew food properly, your dentist will consider reshaping the chewing surfaces of your teeth or placement of crowns.

Therapies

Certain therapies may help relieve bruxism, such as:

Stress management: If your teeth grinding habit is related to stress, you may be able to manage the stress by adopting professional counseling or strategies that promote relaxation, such as exercise or meditation.
Behavioral therapy: You may be able to modify the behavior by practicing proper positioning of your mouth and jaw
Biofeedback: If you find it difficult to change your habits, you can benefit from biofeedback, a branch of complementary medicine that makes use of monitoring procedures and equipment that teaches you to control muscle activity in your jaw.

Medication

Generally, medications are not effective in the treatment of bruxism, and more research is necessary to determine their effectiveness.

Certain medications that may be prescribed to relieve symptoms of bruxism include:

Muscle relaxants: Your doctor may suggest taking a muscle relaxant before going to bed, for a short period of time.
Onabotulinum toxin A (Botox) injections: Botox injections may be suggested in people with severe bruxism that does not respond to other treatments.

These lifestyle modifications are necessary in order to cope with bruxism:

Manage your stress well: Listen to soothing music, take a warm bath or do mild exercise to relax yourself. This may reduce your risk of developing bruxism.
Avoid use stimulants in the evening: Avoid drinking coffee after dinner, and alcohol and smoking during the evening, as these can worsen bruxism.
Avoid chewing gum and biting on hard foods such as nuts and candies
Drink lots of water everyday
Apply ice/wet heat to sore muscles of your jaw
Practice good sleep habits: Get a good night's sleep to reduce bruxism
Perform physical therapy stretching exercises that can help in restoration of action of the muscles
Schedule regular dental check-ups: Your dentist can identify signs of bruxism at an early stage if you schedule regular visits to your dentist.

The factors that increase your risk of developing bruxism include:

Stress: Increased stress and anxiety can make teeth grinding a persistent habit.
Age: Bruxism is common in children, but they may outgrow this habit once they reach their teenage years.
Personality type: If you have an aggressive, competitive or hyperactive personality type, then you are at an increased risk for bruxism.
Stimulating substances: Smoking tobacco, the use of caffeinated drinks or alcohol or taking illegal drugs such as methamphetamine may increase your risk of developing bruxism

In most cases, bruxism does not lead to serious complications.

Severe cases of bruxism may cause complications such as: