What is bruxism?
Bruxism is a medical term that describes the act of grinding the teeth and clenching the jaw.
Sometimes, people grind their teeth without it causing any symptoms or problems. However, regular and persistent teeth grinding can cause pain and discomfort in your jaw and it can wear down your teeth.
Read more about the symptoms of bruxism.
Most cases of teeth grinding (nearly 80%) occur subconsciously during sleep. It is usually associated with contributing factors, such as [stress or anxiety] (see below).
Bruxism also affects people when they are awake, although this is more likely to be clenching the teeth and jaw, rather than grinding. Most people do it subconsciously while they are concentrating.
What causes bruxism?
Bruxism almost always occurs in association with other factors. About 70% of bruxism cases that occur during sleep are thought be related to stress and anxiety.
There is also a strong association between bruxism and obstructive sleep apnoea (OSA). OSA is a sleep disorder where your breathing is interrupted during your sleep.
Teeth grinding can also be caused by taking certain antidepressants. Your lifestyle can also have an effect. For example, regularly drinking alcohol, smoking and using recreational drugs, such as ecstasy and cocaine, increase your risk of bruxism.
Doctors sometimes refer to teeth grinding that is caused by an underlying condition as "primary bruxism" and teeth grinding associated with a medication, condition or your lifestyle as "secondary bruxism".
Read more about the causes of bruxism.
There are a number of possible treatments for teeth grinding but only a few have been shown to be effective.
Behavioural therapies and the use of mouth guards, mouth splints and mandibular advancement devices (MADs) are recommended treatments for bruxism.
Other treatments, such as muscle-relaxation exercises and sleep hygiene, may also help manage your symptoms.
If you grind your teeth while you are asleep, you may need to wear a mouth guard, mouth splint or a MAD at night to protect your teeth from further damage.
If you have an anxiety or stress-related problem, a course of cognitive behavioural therapy (CBT) may be recommended. CBT aims to manage your problems by changing how you think and act.
It may be possible to break the habit of teeth grinding using habit-reversal techniques.
Making some simple lifestyle changes, such as giving up smoking(if you smoke), reducing your alcohol consumption and [managing stress] may also help.
Read more about treating bruxism.
Symptoms of bruxism
Teeth grinding (bruxism) can cause different symptoms including facial pain, headaches and abnormal tooth wear.
Some of the symptoms of bruxism, such as facial pain, will often disappear when you stop grinding your teeth. Others, such as tooth damage, can be permanent.
Possible symptoms of teeth grinding include:
- facial muscle pain (facial myalgia)
- tightness and stiffness in the shoulders
- pain and stiffness in the jaw joint (known as the temporomandibular joint)
- sleep disruption (both to you and your partner)
Symptoms that affect the mouth include:
- worn teeth, which can result in short teeth, increased tooth sensitivity and, possibly, the loss of your teeth
- gum inflammation or receding gums
- loose or sensitive teeth
- difficulty opening your mouth
It is important to note that tooth wear only occurs in severe cases of bruxism, and not everyone who grinds their teeth will have tooth wear.
If your teeth become worn through grinding, you may need dental treatment to avoid developing further problems such as infection or a dental abscess.
When to see a doctor or dentist
You should see your dentist if:
- Your teeth are worn, damaged or sensitive.
- You have pain in your jaw, face or ear.
- Others complain that you make a grinding sound in your sleep.
Talk to your dentist if you think you are grinding your teeth. They will check your teeth and jaw for signs of bruxism, help you work out the possible causes and suggest appropriate treatment.
Make an appointment to see your doctor if you grind your teeth and you have high stress levels or anxiety problems. They will be able to recommend treatment to help manage your stress, which may alleviate your teeth grinding symptoms.
Read more about treating bruxism.
Causes of bruxism
The causes of teeth grinding (bruxism) are not always known, but it is usually linked to other factors, such as stress and anxiety or sleep problems.
Stress and anxiety
Teeth grinding is often associated with mental or psychological problems, such as stress and anxiety.
Studies have shown that almost 70% of sleep bruxism cases are a result of stress or anxiety that affects people subconsciously while they are asleep.
High levels of work-related stress can have a significant adverse affect on your sleep, and trigger episodes of sleep bruxism.
Being stressed or anxious may also cause you to clench your jaw or grind your teeth.
Studies have shown that people who snore or have a sleep disorder, such as obstructive sleep apnoea (OSA), are more likely to grind their teeth while they are asleep. OSA causes your breathing to be interrupted while you sleep.
You're also more likely to grind your teeth if you are:
- talking or mumbling during sleep
- behaving violently during sleep, such as kicking out or punching
- sleep paralysis: a temporary inability to move or speak while waking up or falling asleep
- experiencing hallucinations (seeing or hearing things that are not real) while you are semi-conscious
Bruxism can sometimes occur as a side effect of taking certain types of medication. These include some psychotropic drugs (medicines that affect your mood), such as antidepressants and antipsychotics.
Bruxism may be linked to a type of [antidepressant] and [setraline].
Certain lifestyle factors can also increase your chances of developing bruxism. These include:
- drinking excessive amounts of alcohol
- using [recreational drugs], such as ecstasy and cocaine
- drinking caffeinated drinks, such as tea or coffee (six or more cups a day)
Teeth grinding in children
Some estimates suggest that 15%-33% of children grind their teeth regularly.
It usually occurs after they develop their first teeth and again after they develop their permanent teeth. The habit usually stops after the adult teeth are fully formed.
After teething, a child may grind their teeth for the same reasons that adults do. For example, it may occur at stressful times, such as during school exams.
Treatment for bruxism
Behavioural therapies and using mouth guards, mouth splints or mandibular advancement devices (MADs) are recommended treatments for bruxism.
Other treatments, such as muscle-relaxation exercises and sleep hygiene measures, may also help you to manage your symptoms.
Mouth guards, splints and MADs
You may need to wear a mouth guard or a mouth splint at night. These devices prevent tooth movement by evening out the pressure in your mouth.
A mouth guard or splint also creates a physical barrier between your upper and lower teeth to protect them from further damage. They also help reduce any grinding noises that you make at night.
Mouth guards are similar in appearance to those used in sports such as boxing. They are usually made out of bendy rubber or plastic and can be made by your dentist to fit your mouth. You will usually have to pay for this type of custom-made dental appliance.
Mouth guards are also available to buy from your local pharmacist. However, it is unlikely to fit as well as one that is made by your dentist.
A mouth splint (also known as an occlusal splint or bite plate) is made from harder plastic and fits precisely over your upper or lower teeth. A splint will usually be more expensive than a mouth guard.
Mouth guards and mouth splints may help reduce muscle activity in your jaw at night. However, they will only be able to control the condition, not cure it.
Mandibular advancement devices (MADs) are usually used to help manage sleep problems, such as obstructive sleep apnoea (OSA) and snoring. Research has shown that they can also be effective for treating sleep bruxism.
The device consists of two mouth guards (one for the top teeth and one for the bottom teeth) that are welded together. It is worn in your mouth at night and holds your bottom jaw forward and closed while you are asleep.
MADs have been shown to significantly reduce the amount of bruxism activity when worn at night. However, they may be more painful to wear than mouth guards or splints.
Treating the underlying cause
Psychological treatments, such as cognitive behavioural therapy (CBT), can be used to treat any underlying psychological problems, such as stress and anxiety, that may be causing you to grind your teeth.
CBT aims to help you manage your problems by changing how you think and act. A specially trained therapist will encourage you to talk about how you think about yourself, the world and other people, and how your actions affect your thoughts and feelings.
If your bruxism is stress-related, it is important that you try to relax and get a good night’s sleep. There are a number of things you can do to help you wind down before you go to bed. These include:
- deep breathing
- having a bath
- listening to music
Different things will work for different people. Your doctor will also be able to recommend some additional stress management techniques.
Breaking the habit
Habit-reversal techniques are designed to break your teeth-grinding habit.
If you grind your teeth while awake, you could record the number of times you grind your teeth each day. You can then work out when you are more likely to do it and why; for example, when you are concentrating or stressed.
Being more aware of your habit will make it easier for you to break. To break the habit you could train yourself to relax your jaw when you feel yourself grinding or clenching. For example, you could open your jaw slightly or gently place your tongue between your upper and lower teeth.
There is no scientific evidence that using habit-reversal techniques will cure your bruxism.
Habit-reversal techniques may be used by a specially trained therapist, or you can try them yourself using a computer programme or self-help book. Your doctor will be able to advise you.
Treating and preventing dental problems
It is important that you have regular dental check-ups and that any problems caused by your teeth grinding are treated as soon as possible to prevent further damage.
For example, if your grinding leads to a cracked tooth which is left untreated, the nerve in your tooth can die and a dental abscess could develop. If this is the case, you may need to have root canal treatment.
In severe cases, your tooth could actually split in two. If this happens, your dentist will not be able to save the tooth and it will need to be taken out.
Dental problems, such as misaligned, cracked, crooked or missing teeth can usually be treated with reconstructive dental treatments, such as false teeth, overlays and crowns. These treatments can sometimes reshape the chewing surface of your teeth and stop you from grinding.
You will usually have to pay for this type of dental treatment and it can often be expensive.
Medication is not usually used to treat bruxism. However, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve any pain or inflammation you have around your jaw as a result of grinding your teeth.
In some cases, your doctor may suggest taking a muscle relaxant before you go to bed to help relieve your symptoms.
If you develop bruxism as a side effect of antidepressant medication, your doctor may suggest changing your medication. Never stop taking medication that has been prescribed for you without first consulting your doctor.
Matt Leslie, 39, has ground his teeth since childhood, but it was only when his dentist told him he was a bruxist that he realised the problems his teeth grinding could cause.
"I remember from an early age my parents telling me to 'stop grinding my teeth', so I suppose it's been a bad habit from an early age. I didn't realise the problems it could cause until I was much older.
"I first noticed a problem with my jaw when I was at university. It began clicking quite regularly when I ate or yawned, so I visited my doctor to see if there was a problem. He asked me lots of questions about whether I had been hit playing sport or if I'd been in a fight, but there wasn't an obvious explanation. He told me to take anti-inflammatories and that there was nothing to worry about. The clicking never went away, but I've got more used to it over the years.
"It was only when my dentist told me I am a bruxist, about eight years ago, that things started to fall into place. My dentist explained that I grind my teeth, and to such an extent that it was causing dental problems. It was the likely cause of my clicking jaw too.
"During more visits to my dentist it became clear that the lower left side of my jaw was rife with problems. I had ground my back teeth down to a sharp point and had some cracked teeth too.
"In short, my nightly grinding was slowly wearing down my teeth.
"Over the last few years I've had to have root canal work and crowns put in place and have also been fitted with a mouth splint.
"The mouth splint I have is made out of a fairly stiff clear plastic and is moulded exactly to fit over my lower teeth and correct my bite. I have worn it nearly every night for the last four years and had to replace it once when it cracked. I don't think it has stopped me from grinding my teeth at night, but at least it is protecting my teeth from any further damage.
"Since I've been aware of bruxism and its effects, I have started to realise how it affects me on a daily basis. I can't eat very chewy or crunchy food, such as crusty bread, because it really makes my jaw ache and gives me a headache. Also, very occasionally I wake up and can't open my jaw because it feels so stiff.
"I mostly grind my teeth at night, but I do catch myself grinding during the day sometimes, especially when I'm concentrating on something. My colleagues have to tell me I'm doing it!
"I'm not sure why I grind my teeth. I don't feel stressed and don't suffer from any sleep disorders.
"I think, for me, bruxism is a bad habit that started young and is going to be hard to break. It doesn’t cause me daily pain so it's difficult to know what to do about it. I'd like to find some ways I could try to break the habit."
After finally having a mouth guard fitted, Karen Smith, 40, now feels in control of her bruxism.
"I think it was about five years ago that my dentist first told me I was grinding my teeth.
"During a routine check-up he said my teeth were worn down, especially the ones at the back. He then asked if I ever felt any tension in my jaw and asked me to open my mouth wide and close it again.
"I did feel some tension, but my teeth didn't hurt and I wasn't experiencing any other symptoms, so it didn't seem like much of a problem. I went away and didn't think about it much.
"At further check-ups my dentist always mentioned the grinding and told me about the possible risks to my teeth, including the fact that the grinding can weaken them and lead to cracks and loosening. He suggested getting a mouth guard, but as I still wasn't experiencing any symptoms, it didn't seem like a priority.
"I finally did something about it last year. I had wanted to get all my silver fillings replaced with nice white ones for a while and decided to treat myself to the dental work after getting a new job. After having the fillings done I started experiencing a really sharp shooting pain on the right-hand side of my jaw. After paying a lot of money for all the dental work to be done I didn't want anything to be wrong, so I went back to my dentist to check that everything was ok.
"My dentist was away so I saw another dentist who told me the shooting pain was a consequence of an abnormal bite that had been made more prominent after the work on my fillings. It was probably making me grind my teeth more, which was leading to the shooting pain.
"The dentist recommended a mouth guard for my lower teeth, which would correct my bite and hopefully stop me grinding as well. I had a fitting for the mouth guard, which involved having a cast made of my teeth, and I got it a few days later. It was made out of a flexible rubber that absorbs the shock of clenching and grinding, and is also non-abrasive so it doesn't wear your teeth down.
"Wearing the mouth guard took a bit of getting used to. But I wore it every night for three weeks and, sure enough, the shooting pain went away."