January 22, 2007

Bruxism/Teeth Grinding


Bruxism is the medical term for grinding, gnashing or clenching your teeth. This condition affects both kids and adults.

Some people with bruxism unconsciously clench their teeth together during the day, often when they feel anxious or tense. Most kids who have bruxism — and some adults with the condition — grind or gnash their teeth during sleep, usually in the early part of the night. This is called sleep bruxism.

In most cases, bruxism is mild and may not even require treatment. However, it can be frequent and violent and can lead to jaw disorders, headaches, damaged teeth and other problems. Unfortunately, people with sleep bruxism usually aren't aware of the habit, so they aren't diagnosed with the condition until complications occur. That's why it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Signs and symptoms
The signs and symptoms of bruxism may include:

Teeth grinding or clenching, which may be loud enough to wake your sleep partner
Teeth that are worn down, flattened or chipped
Worn tooth enamel, exposing the inside of your tooth
Increased tooth sensitivity
Jaw pain or tightness in your jaw muscles
Earache — because of violent jaw muscle contractions, not a problem with your ear
Dull morning headache
Chronic facial pain
Chewed tissue on the inside of your cheek

Doctors don't completely understand the causes of bruxism. In some adults, abnormal alignment of upper and lower teeth (malocclusion) may contribute to the problem.

More often, psychological factors cause bruxism, including:

Anxiety, stress or tension
Suppressed anger or frustration
Aggressive, competitive or hyperactive personality type

In children, bruxism may be related to growth and development. Some researchers think children brux because their top and bottom teeth don't fit together comfortably. Others believe that children grind their teeth because of tension, anger, allergy problems, or as a response to pain from an earache or teething. Bruxism occurs in up to 30 percent of children, often around the ages of 5 and 6. It's particularly common in children with cerebral palsy or severe mental retardation. But most children outgrow bruxism before they get their adult teeth.

In some cases, bruxism isn't caused by stress or dental problems. It can be a complication of another disorder, such as Huntington's disease or Parkinson's disease. It can also be an uncommon side effect of some psychiatric medications including antidepressants

Risk factors
These factors increase your risk of bruxism:

Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration.

Age. Bruxism is common in young children, but usually goes away by age 10. In adults, the condition is common between the late teen years and the 40s. It tends to decrease with older age.

Caffeine, nicotine and other drugs. Using caffeine, tobacco, cocaine or amphetamines seems to increase the risk of bruxism

When to seek medical advice
Because bruxism often goes unnoticed, be aware of its signs and symptoms. See your doctor or dentist if you have worn teeth or pain in your jaw, face or ear. Also consult your doctor or dentist if your bed partner complains that you make a grinding noise while you sleep.

If you notice that your child is grinding his or her teeth — or has other signs or symptoms of this condition — be sure to mention it at your child's next dentist appointment.

Screening and diagnosis
During regular dental exams, your dentist likely will check for physical signs of bruxism, such as unusual wear and tear on your teeth, broken dental restorations and tooth sensitivity. If you have any of these signs, your dentist will look for changes in your teeth and mouth over the next several visits to see if you need treatment. You may also be asked to return for additional exams.

If your dentist suspects that you have bruxism, he or she will try to determine its cause by asking questions about your stress level, your general dental health, your daily medications, and whether you routinely drink alcohol or caffeinated beverages, especially during the evening. If you share your bedroom, your dentist may also ask your roommate or bed partner about your sleep habits, especially about any unusual grinding sounds heard during the night.

To evaluate the extent of bruxism, your dentist will examine your mouth and jaw, checking for tenderness in your jaw muscles and any obvious dental abnormalities, such as broken or missing teeth or poor tooth alignment. Your dentist will also inspect your teeth, the underlying bone and the inside of your cheeks for damage caused by bruxism. He or she may make a series of X-rays of your mouth and jaw.

A dental examination may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint disorders or other dental disorders. If your dentist suspects that you have an ear infection (otitis media), he or she will probably refer you to your primary care provider for further examination and treatment. If your dentist suspects a significant psychological component to your teeth grinding, you may be referred to a therapist or counselor

In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:

Damage to your teeth or jaw
Tension-type headaches
Facial pain

Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth.

In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't brux badly enough to require therapy. However, if the problem is severe, treatment options include:

Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help to talk about your child's fears just before bed or to help your child relax with a warm bath or a favorite book.

Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to your teeth. Your dentist can make a custom mouth guard to fit your mouth. Over-the-counter mouth guards are available and they're less expensive than custom guards, but they generally don't fit well and can dislodge during bruxing. If your bruxism seems to stem from dental problems, your dentist may also correct misaligned teeth. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth.

Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses.

During a biofeedback session, a therapist applies electrical sensors to different parts of your body. These sensors monitor your body's physiological responses to stress — such as teeth grinding — and then feed the information back to you via auditory and visual cues. These cues may take the form of a beeping sound or a flashing light. With this feedback, you'll start to associate teeth grinding or clenching with stress and learn to change your behavior. You may also be given a portable biofeedback device that you use at home. Your therapist will explain how it works.

Medications. In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. Botulinum toxin (Botox) injections may help some people with severe bruxism that hasn't responded to other treatments.

These self-care steps may prevent or help treat bruxism:

Limit alcohol, tobacco and caffeine. Cutting down on your daily intake of alcohol, tobacco and caffeine — or giving up these substances entirely — may help, because they seem to make bruxism worse.

Reduce stress. Keeping your life stresses to a minimum can reduce your risk of developing bruxism. The less anxiety and tension you feel, the better chance you have of avoiding bruxism.

Consult your sleep partner. If you have a roommate or bed partner, ask him or her to be aware of any grinding or clicking sounds that you might make while sleeping. Your sleep partner can then let you know if he or she notices any teeth-grinding sounds in the night.

Have regular dental exams. Dental exams are the best way to screen against bruxism, especially if you live alone or don't have a sleep partner who can observe bruxism at night. Your dentist can best spot signs of bruxism in your mouth and jaw with regular visits and examinations

Adapted from: Mayo Foundation for Medical Education and Research