Bruxism - Signs, Symptoms, Causes, & Treatment
Bruxism is the medical word for destructive teeth grinding or clenching that takes place unconsciously. This may occur while a person is awake but many people who have this condition unknowingly grind their teeth together during sleep. It can affect people of all ages. It may be purely habitual and related to the muscle memory of chewing, or it can be secondary to an underlying problem like stress, GERD, a sleep related breathing disorder, or as a side-effect of some medications.
Bruxism may come and go over the course of one’s lifetime; in children it is more common during the years when they are actively losing their baby teeth and new permanent teeth are erupting. Periodic bruxism can be seen in children as well as adults during times of increased stress.
Bruxism is a destructive condition, and it is important that we recognize it so that the cause can be identified, and we can discuss the need for treatment. Not all bruxism is treated equally and treating bruxism without understanding the cause can result in more serious, potentially even life-threatening problems.
The most common symptoms of bruxism are chipped/broken teeth/fillings/crowns, tooth sensitivity, headache, facial pain , & Temporomandibular joint pain.
The most common signs we see are on the teeth themselves in the unique patterns of cusp tip pits, wear facets, attrition, scalloped tongue, and abfraction.
There are many reasons why bruxism should not be ignored. One of the most important reasons is that damage caused by bruxism is likely to lead to tooth which plays a key role in long-term health and life-expectancy. The second is that bruxism may be a sign of more serious health problems like obstructive sleep apnea. Undiagnosed sleep apnea can lead to depression, obesity, heart attack, stroke, and even death.
We watch carefully for these signs & symptoms so that we can begin a conversation with you to determine our next best steps, intervene early, and avoid long-term health problems and increased expense resulting from leaving it untreated.
You may hesitate to treat this condition because the prevention of bruxism may not be covered by your insurance; however, the damage that can occur if it is left untreated is likely to cost up to 50x more and it is almost never covered by traditional dental insurance policies.
I frequently encounter patients who have the opportunity to stop the damage being caused by bruxism early, but they are hesitant to treat their bruxism. They may have difficulty believing they have this problem because it's hard for them to imagine that they could be grinding their teeth while they sleep without being aware of it. Others know it's happening, but they don’t see the value in treating it, or they have intentions to address it later when they feel it has become a problem. The problem with this plan is that it is difficult to see how much damage has occurred when you are only losing 1mm of enamel over the course of a decade. The loss is slow and gradual, and its progression can be perceived as little to none at all. Eventually, these patients will come across an old photo and suddenly realize how much tooth structure they have lost. Often by the time they discover this and are ready to correct it they have lost 3-4mm of tooth structure...on both their top and bottom teeth (For most people this is a 30% loss of the height of their tooth). This loss of tooth height is now causing their jaw to overclose and they are starting to have painful symptoms of Temporomandibular joint disorder. Unfortunately, for most the expense to restore this amount of tooth loss is out of reach, especially when compared to the small expense it would have taken to prevent it from progressing.
It can be difficult to determine whether a patient is currently causing damage to their teeth from bruxism. Generally speaking, patients with active bruxism will exhibit a few of the signs and a few of the symptoms making it fairly easy to determine that a diagnosis of bruxism is the correct assessment. When a patient shows some of the signs of bruxism but does not complain of any symptoms associated with bruxism it can be a bit more challenging to determine whether they are an active bruxer or simply have a history of bruxism. Since a large number of patients with nocturnal bruxism are unaware of their condition, one cannot rely on patient self-reporting for a definitive diagnosis. With the exception of the scalloped border of the tongue, also called “crenations”, the oral signs of bruxism are cumulative and therefore remain present even if a patient no longer has bruxism. Evaluating the patient’s history of symptoms related to bruxism and whether those symptoms have resolved or persist can be helpful in making an accurate assessment of their current condition. Even with this information, it can still be challenging to determine the current status without a bedmate or eye-witness account. The most accurate source of information may need to be obtained from a home sleep study that monitors the action of the chewing muscles responsible for bruxism. This is also the most reliable way to screen for a potential sleep related breathing disorder. At Dillard Dental Services we use a NOX T3 monitoring system that we loan out to our patients when we need more information related to their sleep habits. Based on the results of this free-screening, we are able to safely determine whether bruxism is currently a problem and whether our patients need to consult with their physician regarding a potential sleep-related breathing disorder prior to their bruxism being treated. This also prevents us from further obstructing the airway by placing a mouthguard in a patient with undiagnosed obstructive sleep apnea.
When the screening results indicate destructive bruxism without any indication of a sleep related breathing disorder, we can safely and effectively treat their bruxism with one of the many traditional methods.
There are multiple options for treating Bruxism. The best method for treating this problem will differ from patient to patient depending on their signs, symptoms, and individual preferences. The underlying cause, severity, time of day, and material preferences are all factors we consider when choosing the best treatment.
- Mouthguards – A mouthguard is the most common solution for patients combating bruxism. A mouthguard may be made from moldable thermal plastics or hard acrylic and its primary function is to prevent the upper and lower teeth from touching when it is worn and should be worn regularly during any time that your bruxism is taking place. This layer of material will prevent further destruction to chewing surfaces of the teeth but may not actually stop the grinding or clenching action and therefore may not provide any relief from headaches, muscle pain, or abfraction that occur secondarily to bruxism. Sometimes this added layer is enough to interrupt the muscle memory cycle and therefore does prevent the grinding or clenching action. They can be worn during the daytime or nighttime as long as they don’t prevent that person from carrying out their daytime activities. There are a variety of over the counter and custom mouthguards available for treating bruxism with designs that allow speech to occur more easily. Generally speaking, over-the-counter mouthguards are less expensive but can be difficult to mold and are often bulky preventing use during the day. They can also cause or exacerbate TMJ problems if not fitted properly. *A mouthguard is only safe to use for bruxism when obstructive sleep apnea has been ruled out as the cause.
- NTI-TSS device – A variation of a mouthguard, this device is fitted chairside by a dentist and it is meant to be worn only on the front teeth. The NTI-TSS device helps by stopping the grinding of the rear molars and it does this by reducing the ability of the temporalis muscle to contract.
- Botox® – Botox® works by relaxing the muscles responsible for clenching and grinding, lessening the force with which they can contract. Botox® weakens the muscles to the point that the teeth cannot grind against each other with great force, but it does not weaken the muscles to the point that chewing is affected.
In addition to the above-mentioned treatments, a combination of relaxation exercises, stress, and anxiety management along with biofeedback are used to treat Bruxism. Once the bruxism is under control, different dental procedures such as crowns, gum grafting, and crowns to lengthen the teeth can be used to restore your teeth and smile.
Still have a question about bruxism, please get in touch with us.