By Jeffrey Bassman, DDS, PC
In part two of this article, grinding and clenching will be discussed further with potential treatment.
In part one of the article on grinding and clenching of the teeth, both were discussed as a form of bruxism. Bruxism is the involuntary gnashing, grinding, or clenching of teeth. It is usually an unconscious activity, whether the individual is awake or asleep. The actions are often associated with fatigue, anxiety, emotional stress, or fear, and frequently triggered by occlusal irregularities (the way the teeth fit/come together improperly). Issues with TMJ/TMD can also contribute to grinding and clenching.
The prevalence of bruxism can possibly decrease or increase with age, with the highest prevalence during childhood and the lowest in people over 65. Many people clench or grind their teeth on occasion. However, only a small percentage of people do so with regularity and have problems as a result of it. Bruxism does not occur consistently but rather can occur episodically during certain periods of a person’s life. Most people who brux during sleep are not aware of it unless they are told that they grind their teeth by a parent or bed partner, or by their dentist who finds evidence of wear on their teeth. People may also experience broken or cracked teeth, tooth pain, and other discomfort, including gum issues, headaches, TMJ/TMJ and facial pain. Signs or symptoms that may be suggestive of sleep bruxism may also include morning jaw pain, jaw fatigue or stiffness, clicking or popping of the jaw joints that is worse in the morning, significant tooth wear, and enlarged jaw muscles. Since bruxism can be inconsistent over a person’s lifespan, the presence of tooth wear does not necessarily mean that a person is currently bruxing.
Sleep bruxism can generally be diagnosed by a dentist after taking a history and performing a clinical examination. However, on occasion, an overnight sleep study performed by a physician/sleep lab may be required. The treatment of sleep bruxism usually includes the use of a bite guard or splint that is worn at night over the lower teeth. I usually make soft or hard acrylic mouthpieces, and almost exclusively on the lower arch because these are much more comfortable. The main purpose of a bite guard is to reduce the wearing down of the teeth, but it also may provide symptomatic relief of jaw pain and dysfunction. Over-the-counter mouth guards are not recommended. This type of guard may be an upper, but it is not very comfortable and may induce additional muscle spasms and grinding. The short-term use of medications, such as a muscle relaxant, may also be beneficial, but usually is not very effective.
Q: What causes bruxism?
A: The exact cause of bruxism is not known, however, it has been found to be associated with several factors, such as daytime stress, anxiety, obstructive sleep apnea, loud snoring, heavy alcohol use, caffeine, smoking, and certain antidepressant drugs. Recently, studies have shown that bruxing episodes during sleep are preceded by an increase of brain activity and heart rate. This suggests that central nervous system factors may play an important role in the initiation and continuation of bruxing.
Q: How is bruxism diagnosed?
A: The dentist can usually diagnose bruxism by taking a thorough history and performing a clinical examination. A history of jaw discomfort or fatigue upon awakening in the morning, along with a finding of excessive tooth wear or enlarged jaw muscles is very suggestive of sleep bruxism. In addition, frequently awakening with a headache in the morning may be due to bruxism. Generalized tooth sensitivity without any other explanation may be a symptom of sleep bruxism. If, in addition to sleep bruxism, a person also has symptoms of a sleep disorder (sleep apnea,) such as a history of interrupted breathing during sleep or excessive daytime sleepiness, a physician specializing in sleep medicine should be consulted. I make a specialized mouthpiece (which has upper and lower mouthpieces held together with connectors) which can work to help with sleep apnea and also prevent grinding during sleep. A CPAP machine is still the gold standard for sleep apnea, but will not address the issue of grinding!
Q: How is bruxism treated?
A: Daytime bruxism, clenching, can sometimes be treated by behavioral modification and habit reversal. This may be as simple, even though not really effective, as making the person aware of the habit and then placing visual cues around the home and work area to alert the person to check and be sure that their teeth are apart. A problem may develop, though, that by making one more aware of the clenching habit, they may end up clenching more! That is why many of my patients wear a custom, soft-plastic lower mouthpiece during the day. This mouthpiece is especially beneficial, depending upon the occupation and activities of the person who wears the mouthpiece. For difficult cases, psychological counseling may be necessary.
Bruxism may be quite challenging at times. An animal with fleas may even create a situation with youngsters or adults, where the fleas somehow become embedded into the saliva and create grinding and clenching. A consultation is highly recommended.
Dr. Jeffrey Bassman operates the Center for Headaches, Sleep & TMJ Disorders at 141 East 46th Street, Davenport. His office can be contacted via phone, 563-391-1525; fax, 563-345-6325; email, jbassmantmj@gmail.com; and on the web at www.jbassmantmj.com.