Has your bed partner told you that you grind your teeth at night? Do you wake with a sore jaw or headache? Are your teeth worn down, feel loose, chipped, or even broken? If so, you might have bruxism.
It is estimated that 40 million Americans grind their teeth, and 5-10% of teeth grinders have symptoms severe enough to cause significant damage to their teeth or dental fillings and crowns.
What is Bruxism?
Bruxism is characterized by an unconscious act of grinding, gnashing, or clenching one's teeth tightly together. It is classified by two main types: awake bruxism (occurring during wakefulness) and sleep bruxism (occurring during sleep). The two types are distinctly separate in that the damage to teeth caused by sleep bruxism is usually much more severe. They are further distinct from each other in the belief of causes for the disorders, and the prevalence of the disorder: "women are more likely than men to have awake bruxism while sleep bruxism has no gender prevalence." (source)
Sleep bruxism falls under the category of sleep disorders known as sleep related movement disorders. This class of sleep disorders is characterized by physical movement during sleep, which may be uncontrollable or involuntary. Other disorders within this class are periodic limb movement disorder (PLMD), restless leg syndrome (RLS), sleep related leg cramps, and sleep related rhythmic movement disorder.
Untreated bruxism can lead to many dental problems such as broken teeth, loose teeth, worn-down teeth, enamel damage, headaches, and temporo-mandibular joint (TMJ) disorders.
What Causes Sleep Bruxism?
As of yet, doctors are unsure of the exact causes of bruxism although there is evidence that it is linked to sleep related arousals in which the cardiac and respiratory systems show a rise in activity. These arousals can take place up to 15 times an hour during sleep. Arousals during sleep are often accompanied by increased muscle activity such as in the jaw, which can be a source of teeth grinding.
These arousals are also typical in people who have other sleep related breathing disorders such as sleep apnea and snoring. Bruxism is often found in patients suffering from sleep apnea possibly as an unconscious response to the collapsed airways by tightening the jaw muscles to prevent restrictions of airflow.
Other sleep disorders have been found to be associated with bruxism including parasomnias such as: sleep paralysis, sleep talking (somniloquy), and REM sleep behavior disorder.
Bruxism can also be a side effect of mental disorders, stress, anxiety, and other intense emotions. It's estimated that "nearly 70% of bruxism cases are the result of stress or anxiety." [source]
Bruxism is found more often in people with certain personality types that are aggressive, competitive, or hyperactive.
It is sometimes found to be a coping strategy for stress or anxiety similar to lip biting, cheek biting, tooth tapping, and object biting/chewing
In children it has sometimes been found as a response to pain from earaches or teething.
Some physical conditions can lead to bruxism such as stomach acid reflux in the esophagus, an abnormal alignment of the upper and lower teeth (malocclusion).
Risk factors for bruxism can also come from side effects to taking certain psychoactive substances such as tobacco, alcohol, caffeine, and psychiatric medications for anxiety and depression. These substances often increase the likelihood of increased arousal during sleep.
Treatment for Bruxism
Mild cases of bruxism may not require treatment but moderate to severe symptoms can cause long-term problems such as jaw pain, headaches, and teeth damage. If your symptoms include pain, discomfort, disturbed sleep (for you or your bedpartner), or damage to teeth you may want to contact your dentist or a sleep specialist for a consultation.
Have a sleep study
Like many other disorders, treating bruxism is often about finding the root cause of the disorder. If a sleep disorder is believed to be the root of the problem, scheduling a consultation with a sleep specialist may help diagnose (or rule out) a sleep disorder. Treatments for obstructive sleep apnea have been shown to dramatically reduce the prevalence of bruxism.
Therapies and Medications
If your teeth grinding is caused by stress, anxiety, or mood disorders, treating those afflictions can relieve your symptoms of bruxism.
Stress management and relaxation techniques can help relieve possible intense emotions that cause you to clench or grind your teeth as a response.
Behavior therapy such as practicing proper jaw and mouth positions can help to condition you to stop grinding your teeth.
Medications such as muscle relaxants taken before sleep can help reduce the likelihood of jaw muscle tension.
Speak with your Dentist
While last on this list, speaking with your dentist is probably the first step you should take if you discover that you grind you teeth at night. During routine exams your dentist will look for wear or other signs of teeth grinding. If you do not regularly see a dentist you should schedule an appointment immediately as the damage can be permanent or costly to fix. Your dentist will ask you about your health, habits, and other factors, which may reveal the source of your bruxism.
Your dentist will also likely recommend a dental appliance to either prevent you from grinding your teeth or at least prevent damage to them.
Splints and mouthguards are usually the most recommended form of controlling bruxism. It should be noted that splints are not a cure for bruxism, but merely a form of protection for your teeth. Worn at night, a splint keeps the teeth separated and prevents damage caused by grinding as well as eliminating the sounds that may disturb your bedpartner.
Mandibular Advancement Devices (MADs) are similar to a mouthguard in that they are worn orally. However, instead of preventing your teeth from coming together, they push your lower jaw down slightly and pull your tongue forward. MADs are a common dental treatment for obstructive sleep apnea as keeping the tongue in a forward position prevents it from collapsing back into the airways. MADs have also been shown to be effective in treating bruxism both with and without comorbidity of obstructive sleep apnea.
At The Alaska Sleep Clinic we specialize in treating dozens of sleep disorders found in thousands of patients every year. If you believe that you may have bruxism (or any sleep related disorders) and want help exploring potential diagnosis and treatment options, feel free to contact us by clicking the link below.