Bruxism Causes And Management

Introduction

Do you wake up in the morning with pain in your jaw radiating down your face? Or perhaps you often suffer from headaches early in the day, or maybe you always wake up tired and struggle with poor sleep and fatigue. All these symptoms could indicate teeth grinding or clenching (bruxism), so what is bruxism, and what are the causes and management.

Bruxism can be defined as the involuntary, unconscious, excessive grinding or clenching of teeth, and/or thrusting of the lower jaw (mandible). It can happen during waking hours and it is called awake bruxism, or it can happen during sleep hours and it is called sleep bruxism, and they are considered as different conditions and managed differently.¹

There is a lack of consensus on the true prevalence of bruxism, with current data providing a range of possibilities. It is however not certain if it is predominant in people assigned male at birth or people assigned female at birth, or if it is more prevalent in older or younger people even though some literature suggests it occurs more in young adults and declines with age. More research is being conducted regarding the prevalence and epidemiology of teeth grinding.

Causes of bruxism

The cause of bruxism is not well understood or identified, but there are several risk factors that can increase your chances of developing bruxism, these include the following:²

• Psychological factors: stress, anxiety, depression, and nervousness, have been correlated with a higher incidence of bruxism.
• Personality traits: bruxism affects people with nervous tension such as anger and frustration, and those with  aggressive competitive personality.
• Dental problems: premature contact and occlusal interferences.
• Diet: consuming large amounts of alcohol and caffeine have been associated with teeth grinding.
• Smoking.
• Medications: certain medicines used for the treatment of depression (selective serotonin reuptake inhibitors), attention deficit activity disorders (ADHD), and seizures may increase the risk of having bruxism.
• Sleep-related disorders such as snoring and sleep apnea have been linked to bruxism.

Types of bruxism

• Sleep (nocturnal) bruxism: grinding your teeth during sleeping hours is usually more serious and does more harm than doing that during waking hours because you usually will not be aware of it. Nocturnal bruxism is also associated with sleeping problems like snoring and sleep apnea.³
• Awake or daytime bruxism (diurnal): grinding your teeth during waking hours usually comes with fewer side effects because you are likely aware of this habit and you can manage it by reducing stress and being mindful of your mental health and developing better-coping mechanisms.

Symptoms and signs of teeth grinding (bruxism)

There is a broad spectrum of signs and symptoms linked to bruxism, they include the following:⁴

• Loud grinding or clenching of teeth.
• Wearing of teeth enamel and exposing deep layers which may cause tooth sensitivity and pain.
• Flattened teeth surface (teeth attrition), and fractured or loose teeth.
• Mild headache.
• Pain in jaw muscles, and sometimes inability to open and close your mouth properly.
• Jaw, neck and face pain.
• Earache.
• Sleep disturbance and disruption and fatigue especially in the morning as a consequence of that.

Diagnosis of bruxism

If you experience any signs or symptoms of bruxism you should seek professional opinion from a dentist, oral medicine specialist or orofacial pain specialist. The following are done to reach a definitive diagnosis:⁵

• Medical history: a thorough history is taken to know the pattern of teeth grinding and if it happens during sleep or during the day, the healthcare provider will also take a history of the signs and symptoms you are experiencing and any triggering factors or stressors, and past or current medical conditions and medications.
• Physical examination: teeth and dental restorations are examined for signs of wear or damage. The face and jaw are also inspected for pain and tenderness.
• Polysomnography: it is a complex sleep study used to record and monitor body functions during sleep. It detects sleep-related disorders like sleep apnea, and it assesses if the bruxism occurs during sleep.

Management of bruxism   

Your healthcare provider will tailor a treatment plan for you based on your age, your overall health status and medical history. Your treatment may include one or more than one of the following:^6,7

• Mouthguards and occlusal splints: occlusal splints are worn on the upper or lower teeth. There is not enough evidence on the role of splints in treating bruxism, but they are recommended for the protection of teeth and restorations. Mouth guards can be recommended during the day or during sleep based on your type of bruxism to prevent damage to teeth and aid in behavior change.
• Behaviour changes: you may be taught how to rest your tongue, teeth and lips without clenching your teeth and tightening your jaw. Relaxation training can also be provided to relax the muscles voluntarily.
• Sleep hygiene: following sleep hygiene practices has been proven effective in reducing bruxism like avoiding alcohol, tobacco and caffeine before sleep, limiting stimulants before sleep, and sleeping in a dark quiet room.
• Psychotherapy: awake bruxism has been linked to stress, so counselling can manage stress and tension and create awareness about the habit.
• Physiotherapy: it can be recommended if bruxism is causing severe muscle pain and stiffness.
• Biofeedback: These electronic instruments measure muscle activity of the mouth and the jaw and send you signals when there is hyperactivity. It is effective for daytime bruxism, but the use of biofeedback for sleep bruxism is still underdeveloped.
• Medications: the use of medications should only be limited to severe cases where non-pharmacological treatments are ineffective. Medications used for treating bruxism include anti-anxiety medications, tranquilisers, sedatives and muscle relaxants. In cases where bruxism was caused by medications, a change of medicine after speaking with your physician is recommended.
• Diet: maintaining a balanced diet and eliminating alcohol and caffeine from your diet can go a long way in treating bruxism.

Summary

Bruxism is the involuntary clenching and grinding of your teeth often during sleep, but it can also happen during waking hours. The cause of bruxism is not well known but several risk factors can lead to teeth grinding including psychological causes like stress and anxiety, consuming alcohol and caffeine, smoking, sleeping problems like sleep apnea, and certain medications. Diagnosis of bruxism is based on taking good history and physical examination, and sometimes polysomnography can be used for diagnosis of sleep bruxism.

Successful management of bruxism can be achieved by managing stress and anxiety, using dental splints and mouthguards, following sleep hygiene practices and changing your diet, sometimes medications can be used for severe cases.

Bruxism is a serious condition that can affect your quality of life and cause some harm to your teeth and jaw, so if you are experiencing any signs or symptoms seeking a professional opinion is mandatory to control the condition and prevent the future adverse effects of bruxism.

FAQs

What does bruxism pain feel like?

Tired or fatigued jaw muscles and sometimes locked jaw, headache, sensitivity and pain of teeth, pain and tenderness of face, jaw and neck, pain that feels like earache.

Is bruxism something to worry about?

Sometimes bruxism can be mild and doesn’t require treatment, just patient education and awareness, but severe cases of bruxism can cause constant pain and tiredness of the face and jaw that can progress to TMJ dysfunction.

Does bruxism ever go away?

In most cases, bruxism can be successfully managed after your healthcare provider designs a treatment plan based on your case and your history.