how to prevent grinding teeth in your sleepExtreme teeth grinding can break teeth, destroy dental work, give sufferers morning headaches and jaw pain, as well as wake up their sleeping companions. For nighttime grinders, a mouthguard can help protect the teeth.
Imagine having power three to ten times greater than what is required to crack a walnut. Imagine that force slamming into your mouth. You just had a mental image of bruxism, often known as tooth grinding. The Greeks of antiquity called this gnashing sound "brukhé," meaning grinding. The majority of experts agree that bruxism nowadays is more complex and changeable than that: Bruxism, which is described by some as a "habit" and by others as a "disease," is the repetitive activation of the jaw muscles that involves grinding, clenching, bracing, or thrusting in Awake clenching, also known as daytime or awake bruxism, and nocturnal and daytime bruxism are related but distinct illnesses with a range of therapeutic options. Some individuals combine the two pursuits. Experts say that while clenching is a known parafunctional jaw habit, bruxism is the term used to describe grinding one's teeth. James M. Uyanik, DDS, a clinical assistant professor and the manager of the NYU Orofacial and Head Pain Clinic at the New York University Faculty of Dentistry in New York City. Almost half of all children go through a period of nighttime grinding, while up to one-third of the general U.S. population experiences bruxism at some point in their lives, according to the Academy of General Dentistry, a professional organization of general dentists from the United States and Canada. If Google searches are any indication, research shows bruxism has risen since the COVID-19 pandemic began — not surprising, given bruxism’s link to stress. Still, oral health professionals such as Anne Clemons, DMD, a general dentist with the Cleveland Clinic in Ohio, say bruxism is dramatically underreported — "especially these days.” This may be partially due to the fact that many gnawers and grinders are unaware that they are bruxing. “Eighty percent of the time, when I tell someone that they’re grinding, they’re hearing it for the first time,” says Lokesh Rao, DDS, of Westchester Dental Design in Yonkers, New York.
Who’s at Risk for Teeth Grinding?According to a study published in 2019 by the Journal of Research in Medical Sciencesout of Isfahan University, many youngsters who grind outgrow the problem before adulthood. Those who continue into maturity and those who acquire the habit later in life range from occasional bruxers to powerful gnashers who can shatter dental work. “Anyone can be a bruxer,” says Dr. Uyanik. But some people are more at risk than others. The stressed “Someone undergoing major changes or facing stressful events, such as moving to a new location, starting a new job, dealing with a birth, a marriage, a death, or a divorce in the family, is at particular risk,” Uyanik says. A study published in the September 2019 issue of the International Journal of Environmental Research and Public Health found a strong positive correlation between perceived stress levels and the amount of grinding. This relationship was dramatically, albeit anecdotally, illustrated in an ABC News story from July 2021, about U.S. dentists reports of cracked teeth and broken dental work — casualties of intense grinding — soaring during the pandemic. “Even when people are oblivious to their own grinding,” Dr. Rao says, “stressful background conditions can increase it, and this pandemic has been a major one.” Problem sleepers With the majority of bruxers overworking their jaw muscles overnight, Dr. Clemons begins the diagnostic journey with queries about sleep. “I’ll ask whether it’s good and restful, or if there’s some other disorder involved,” she says. For example, a misaligned bite (when the bottom and top teeth don’t properly meet) and breathing problems during sleep, such as nocturnal asthma and sleep apnea, can occasionally contribute to nighttime bruxism. Indeed, nighttime bruxism is often considered a sleep disorder that calls for people to have their overnight behavior monitored and analyzed. “It could be critical in identifying possible additional sleep and breathing concerns that may contribute to or be related to bruxism events while sleeping, so they don’t go unaddressed,” Clemons says. Caffeine or alcohol users and abusers Excessive consumption of coffee or alcohol can increase the tendency to grind, possibly by altering sleep patterns through overstimulation and dehydration, respectively. Tobacco and recreational drugs may also be bruxism risk factors. Genetically predisposed An article in the Spring 2020 Journal of Craniomaxillofacial Research described a genetic predisposition to grind, and one study, reported online in the January 2018 Biomedical Reports, suggested that bruxers tend to share traits such as anxiety. Occasionally, an inherited dental misalignment will lead to bruxism. “For these people, the grinding will decrease after we improve the problem with their bite,” says Clemons. Antidepressant users Bruxism is among the rare but possible side effects of some selective serotonin reuptake inhibitor (SSRI) antidepressants, which rank among the most-prescribed drugs in the United States. Diagnosed with Parkinson’s disease or other conditions People with Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, or attention deficit hyperactivity disorder (ADHD) are more likely than the general population to develop a bruxing habit, according to the Mayo Clinic. So, too, are people who face some ongoing mental illnesses.
Signs of BruxismWhen people come to them complaining of headaches, sleep disruption, or pain, dentists search for some characteristic “tells” to confirm bruxism. These include: Damaged teeth or dental work Teeth or dental restorations that show visible signs of wear, flattening, cracks, or chips serve as strong evidence of ongoing grinding. In severe cases, the destruction is so pronounced that teeth are barely visible above the gumline, or the internal structure of the tooth has been exposed. “I’ll see back teeth where the peaks are worn down or have little potholes, or where the body of the tooth has turned yellowish or brownish because of missing enamel, the white ‘candy coating’ of teeth,” says Rao. Extreme, persistent gnashing can also unmoor teeth from their attachments to the jaw. “When the surrounding bone has been broken down, the tooth becomes like a fence post planted in soil that’s too loose,” Rao says. “If you rock it too much, it falls.” Noise For some, the impetus to seek medical help comes from a frustrated sleeping partner who’s sick of the noise. The temporomandibular joint itself (that’s the hinge where the top and bottom jaws meet) can generate popping or snapping sounds. Audio recording devices or applications can help suspected bruxers determine whether they’re making a racket overnight. Sensitivity Teeth may become especially sensitive to pain, cold, heat, or other stimuli. That’s often because of tiny fractures created by the repeated force of the jaws. These breaches allow heat, cold, or bacteria to enter and compromise the body of the tooth, potentially requiring a root canal treatment. Muscle, jaw, and neck pain The jaw muscles may be noticeably tight or overdeveloped, or they may be painful to the touch. The ability to open and close the mouth may be diminished, while the neck can be sore and fatigued. Some bruxers unconsciously create small sores from chewing the insides of their cheeks. Headaches Referred pain that originates in the muscles of mastication (those involved in chewing and controlling the jaw’s movement) can radiate to other portions of the head and face. Bruxers may experience pain or a sense of fullness near the ear, or they may have headaches, particularly upon awakening. “If someone tells me they wake up with a headache or pain and fatigue in their jaw, my brain immediately goes to the possibility of nighttime parafunctional activity,” Uyanik says. “If the pain occurs near the evening, it suggests there’s been daytime grinding or clenching.” Sleep disruption The American Sleep Association notes that bruxism can impair normal sleep cycles, particularly in the earlier sleep stages. That kind of disruption can delay the most restful and deepest sleep phases, leaving the bruxer feeling insufficiently rested the following day. Vertigo and earache By preventing the muscles, bones, and joints associated with the jaw from working together smoothly, bruxism can sometimes lead to dizziness and otalgia, or earache — an argument for ear-nose-throat (ENT) clinicians and dentists to work together.
Treatments for Daytime ClenchingMany daytime bruxers clench their teeth at periods of intense emotion, worry, and concentration – frequently unintentionally. For these folks to stop bruxing, awareness, attention, and practice are essential, hence there are two categories of best practices. Catch yourself bruxing. For many patients, proving to oneself that their bruxism is real constitutes the first therapy milestone. Their dentists will advise them to try to catch themselves bruxing, especially while they're focused or distracted. The following is an idea from Uyanik:
- Set an alarm to chime every 20 minutes, signaling a bruxing check.
- Try one of several smartphone applications that automatically chime, and document your experiences. (See the resources listed below.)
- Maintain a bruxing journal for noting the circumstances that trigger jaw action.
- Keep lips together, teeth apart. “If it feels off or uncomfortable, it’s easier for me to convince people that it’s because they’re accustomed to always clenching their teeth,” Uyanik says.
- Practice pronouncing the letter “N.” “That automatically separates your bottom and top teeth and puts your mouth in a kind of psychological rest position, creating a new habit,” says Uyanik.
- Try small in-ear monitors that detect and warn of a bruxing episode so that the wearer can interrupt and correct it. As described in the December 2020 International Journal of Environmental Research and Public Health, this new approach is based on the discovery that the ear canal tightens during clenching.