Bruxism (Clenching/Grinding
Teeth)

Bruxism (Clenching/Grinding Teeth): Overview

Alternative Names: Teeth grinding

Bruxism is characterized by grinding of the teeth and is typically accompanied by clenching of the jaw.

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In most people, bruxism is mild and not a health problem.  While bruxism may occur at any time of the day or night, bruxism during sleep causes the majority of health issues and can even occur during short naps.  Bruxism is one of the most common sleep disorders.

Incidence; Causes and Development; Contributing Risk Factors

Being more common in children than in adults, bruxism has been estimated to occur in 5% to 20% of the 3-17 year old age group.  In younger children it often stops by the time the second set of teeth appear.  In adults, bruxism is more prevalent in athletes, military tank drivers, compulsive over-achievers and those involved in very meticulous work.

The precise cause of bruxism is unknown, though it is thought that certain medical conditions can trigger bruxism, including digestive ailments and anxiety.

Chewing is a complex neuromuscular activity that is controlled by subconscious processes, controlled by the brain.  During sleep, subconscious processes (for example, walking or chewing) may become active, while the higher control (the brain) is inactive, resulting in (for example) sleep-walking or bruxism.  Some bruxism activity is rhythmic (like chewing), and some is sustained (clenching).  Researchers classify bruxism both as a habitual behavior, and as a sleep disorder.

The following factors are associated with bruxism:

  • Disturbed sleep patterns and other sleep disorders such as obstructive sleep apnea, hypopnea, snoring, moderate daytime sleepiness;
  • Misalignment of teeth, in which the upper and lower teeth make imperfect contact;
  • High consumption of caffeinated drinks and foods, such as coffee, colas, and chocolate;
  • High levels of blood alcohol;
  • Smoking;
  • High levels of anxiety, stress, work-related stress, irregular work shifts, stressful profession and ineffective coping strategies;
  • Drug use, such as SSRIs and stimulants, including ecstasy, MDA, amphetamines, including those taken for medical reasons;
  • Hypersensitivity of the dopamine receptors in the brain;
  • GHB and similar GABA-inducing analogues, when taken with high frequency;
  • Disorders such as Huntington's and Parkinson's diseases;
  • Obsessive Compulsive Disorder.

In some cases the body's survival mechanism attempts to keep obstructed airways open through bruxism because bruxism causes a muscle in the back of the throat to spasm and thus keep the airway open.  Examples of airway obstructions include enlarged tonsils or adenoids, a collapsible windpipe, and sleep-disordered breathing, including obstructive sleep apnea.

Bruxism has been observed in patients with organic brain damage and with the use of Levodopa.

Signs and Symptoms

Abraded/chipped teeth (in extreme cases, waking up with tooth chips in the mouth); facial pain; oversensitive teeth; tense facial and jaw muscles; headaches; dislocation of the jaw; damage to the tooth enamel, exposing the inside of the tooth; a popping or clicking in the temporomandibular joint (TMJ); tongue indentations; damage to the inside of the cheek.

The effects of bruxism may be quite advanced before sufferers are aware they brux.  Abraded teeth are usually brought to the patient's attention during a routine dental examination.  Only about 5% of 'bruxers' go on to develop symptoms, such as jaw pain and headaches, which will require treatment.  In many cases, a sleeping partner or parent will notice the bruxism before the person experiencing the problem becomes aware of it.

Bruxism can result in abnormal wear patterns of tooth surfaces, weakened tooth structure, and fractures in the teeth.  Over time, dental damage will usually occur.  Bruxism is the leading cause of tooth trauma and a significant cause of tooth loss and gum recession.

In a typical case, the canines and incisors of the opposing arches are moved against each other with a side-to-side action.  This movement can lead to the wearing down of the cutting edges of the teeth.  People with bruxism may also grind their rear teeth, which will wear down the ridges of the surface.  Bruxism can be loud enough to wake a sleeping partner.  Some individuals will clench the jaw without significant sideways movement.  Teeth that have holes in them from tooth decay or dental drilling may collapse, as the pressures exerted by bruxism can be extremely high.

Doctors commonly see patients with the following symptoms of bruxism:

  • Anxiety, stress, and tension
  • Depression
  • Earache
  • Eating disorders
  • Headache
  • Insomnia
  • Sore or painful jaw.

Diagnosis and Tests

Bruxism can sometimes be difficult to diagnose visually as it is not the only cause of tooth wear.  Over-vigorous brushing, abrasives in toothpaste, acidic soft drinks and abrasive foods can also be contributing factors, although a trained professional should be able to differentiate the cause.  Additionally, the symptoms may be difficult for a physician to link initially to bruxism.

The most reliable way to diagnose bruxism is through EMG (electromyographic) measurements.  These measurements pick up electrical signals from the chewing muscles and is the method used in sleep labs.

Another method of diagnosis using EMG is available in disposable form under the trade name BiteStrip.  The BiteStrip is a self-contained EMG module that adhesively mounts to the side of the face over the masseter muscle.  The BiteStrip can only do one night of measurement and does not display the clench count or total clenching time, but rather provides a single-digit display related to bruxism severity.

Treatment and Prevention

Early intervention by a dentist is advisable, or damage may become severe.

Sufferers are sometimes advised to slip their tongue between their teeth when they become aware of clenching, as this self-protective measure prevents further clenching.

Klonopin (Klonazepam): Anti-anxiety medication and anti-convulsive/antispasmodic.  It is useful in dealing with muscle twitching.  Restless Leg Syndrome and night time grinding of the teeth (bruxism).

Ongoing management of bruxism is based on minimizing the abrasion of tooth surfaces by the wearing of an acrylic dental guard, or splint, designed according to the shape of an individual's upper or lower teeth from a bite mold.  Mouthguards are obtained through visits to a dentist for measuring, fitting, and ongoing supervision.  Although mouthguards are a first response to bruxism, they do not in fact help cure it.

Other treatments include:

  • Nociceptive trigeminal inhibitor devices – An NTI appliance fits on top of the teeth and alters the angle at which the jaw opens, by covering only the front teeth and preventing the rear molars from coming into contact;
  • Biofeedback – these devices provide sound, electric shock or taste feedback when they sense jaw muscle activity;
  • Botox – an expensive but often effective treatment, only lasting about 3 months;
  • Dietary supplements – Taking certain combinations of dietary supplements may alleviate bruxism; pantothenic acid, magnesium, and calcium are mentioned on dietary supplement websites.  Calcium is known to be a treatment for gastric problems, and gastric problems such as acid reflux are known to increase bruxism;
  • Damage repair – Damaged teeth can be repaired by replacing the worn natural crown of the tooth with prosthetic crowns.

The jaw clenching that often accompanies bruxism can be an unconscious neuromuscular daytime activity, which should be treated as well, usually through physical therapy (recognition and stress response reduction).

Prognosis

Eventually, bruxism shortens and blunts the teeth being ground and may lead to facial muscle pain, TMJ dysfunction and headaches.  In severe, chronic cases, it can lead to arthritis of the temporomandibular joints.

If enough enamel has been abraded, the softer dentin will be exposed, and abrasion will accelerate.  This opens the possibility of dental decay and tooth fracture, and in some people, gum recession.

References and Further Information

[Bruxism: How to Stop Tooth Grinding and Clenching, Leung, Alexander K.C., MB, BS and Robson, W.  Lane M., M.D., Postgraduate Medicine, June 1991;89(8):pp.167-71]

Conditions that suggest Bruxism (Clenching/Grinding Teeth):

Dental

Sensitive Teeth

Many people are unaware that they clench or grind their teeth while asleep.  Signs can include sensitive or even chipped teeth.

Tooth Loss

Severe tooth grinding can gradually destroy teeth by causing them to wear down, chip or fracture.

Periodontal Disease - Gingivitis

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed.

Environment / Toxicity

Mercury Toxicity (Amalgam Illness)

People with mercury amalgam fillings who grind their teeth or chew gum can suffer additional mercury release.

Musculo-Skeletal

TMJ Problems

Although the link is not clear, stresses on the jaw caused by bruxism can lead to TMJ dysfunction.  The muscles that stabilize the joint become fatigued from frequent clenching and/or grinding of teeth.

Symptoms - Head - Mouth/Oral

Risk factors for Bruxism (Clenching/Grinding Teeth):

Allergy

Allergy to Foods (Hidden)

Hidden food allergies may contribute to the chronic clenching of teeth.

Allergic Rhinitis / Hay Fever

Allergy may play a role in bruxism.  It is reported that bruxism is more frequent in those experiencing periods of allergic rhinitis or asthma.

Mental

Stress

Teeth-grinding is often stress-related.

Nutrients

Magnesium Requirement

According to Ploceniak, prolonged magnesium administration nearly always provides a cure for bruxism.  This confirms an earlier report which claimed remarkable reductions and sometimes disappearance in the frequency and duration of grinding episodes in six patients who took assorted vitamins and minerals (which included 100mg of magnesium) for at least five weeks.  When the supplement intake stopped, the symptoms returned.  [Bruxism and Magnesium, My Clinical Experiences Since 1980, by C.  Ploceniak (Translated from the French by James Michels)]

Calcium Requirement

Cheraskin & Ringsdorf (1970) studied the effects of nutritional supplements on teeth grinders or clenchers.  Of these, 16 took calcium, vitamin A, vitamin C, Vitamin B5 (pantothenic acid), iodine, and vitamin E.  When surveyed a year later, they reported that bruxism vanished.  In contrast, the 15 bruxers who only took vitamins A, C, E and iodine showed no improvement.  It seemed reasonable to conclude that the active agents were calcium and pantothenic acid (vitamin B5).

Respiratory

Asthma

Allergy may play a role in bruxism.  It is noticed that bruxism is more frequent in those experiencing periods of allergic rhinitis or asthma.

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Bruxism (Clenching/Grinding Teeth) can lead to:

Dental

Periodontal Disease - Gingivitis

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed.

Recommendations for Bruxism (Clenching/Grinding Teeth):

Dental

Dental Appliance

A plastic mouth guard can protect the teeth from harm in cases of bruxism at night.  A bite plate is a removable plastic device which prevents teeth from coming together.  In some cases, such as with an overbite, it may eventually improve the bite.

Electrical

Biofeedback

Studies support the conclusion that heavy bruxers have reduced frequency of clenching early on with biofeedback treatments.

Lab Tests/Rule-Outs

Test for Food Allergies

Teeth grinding may be aggravated by certain foods in some individuals.

Mineral

Calcium

See the link between Bruxism and Magnesium.

Iodine

People who clench and/or grind their teeth in their sleep can reduce this by taking up to 8 drops of Lugol's (potassium iodide) daily or periodically.

Magnesium

Until further research is done, the best strategy may involve taking the following on a daily basis: magnesium, calcium and pantothenic acid.  If bruxism subsides, it is advisable to continue taking these supplements, but perhaps at a lower dosage.  If no improvement is observed after 2 months, another approach should be tried.

Psychological

Stress Management

Treatment may include stress reduction and creating a positive home environment.  Psychological stress is considered a significant cause.

Counseling

Bruxism is sometimes due to strong emotions such as resentment, frustration, anger, grief, or fear, and can result from a dysfunctional family situation.

Vitamins

Vitamin B5 (Pantothenic Acid)

See the link between Bruxism and Magnesium.

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