Bruxism (Teeth Grinding)

The most obvious sign of bruxism is the prevalence of teeth grinding, more commonly during the night, which will be reported as the primary complaint of the patient or may be apparent from the history. Occlusal sounds accompany this grinding. It is not imperative that bruxism is only experienced during sleep. It may sometimes even be experienced during the waking hours.

In the absence of a positive history or complaint, the following clinical picture and symptoms may be seen:

• Localised or generalised pain in the dentition due to excessive pressure on the jaw
• Presence of jaw pain
• Pain of the temporomandibular joint (joint formed by the lower jaw and  the skull) or tenderness over the area
• Tenderness or fatigue of the masticatory muscles
• Presence of headache in the temporal region
• Ear pain
• Sensitivity of the tooth to hot, cold, sweet and other food stimuli (Read more: Tooth sensitivity causes)
• Generalised attrition, that is the loss of tooth structure at the incisal or occlusal (chewing) surface of the teeth
• Flattening of the occlusal surfaces of the teeth
• Breakage in dental fillings or fractures
• Presence of tooth mobility, or loosening of the teeth from the socket, due to the destruction of periodontal structures
• Inflammation of the gums or periodontitis causing gingival recession, or receding of the gum line so that the roots of the teeth are visible
• Dental fractures or chipping
• Reduction in the functional movements of the jaw or reduction in the chewing force, which is manifested as difficulty in chewing food
• Changes in the positioning of the teeth due to the tooth movements caused by excessive pressure. This can lead to crowding, overlapping or other tooth relations of orthodontic concerns.
• Malocclusion, that is, mal-alignment of the teeth between two dental arches
• Shift of centric occlusion, that is, deviation of the teeth from the normal centre
• Indentation on the tongue due to the habit of biting
• Bite marks on the area of the oral mucosa of the cheek or the lips
• Disturbance in sleep patterns (Read more: Insomnia causes)
• Reduction in the salivary flow
• Reduction in the mouth opening ability (Read more: Trismus management)

Excessive vertical and horizontal forces on the mandible or the lower jaw is the primary cause of bruxism. While chewing and swallowing of food, the occlusal forces directed at the mandible are usually in a vertical direction and are acceptable by the supportive structures of the teeth. But during bruxism, there is an increase in the magnitude of these forces and they are additionally experienced in a horizontal direction as mandible shifts from side to side. These forces are not tolerated by the periodontal fibres and lead to their loss or destruction causing symptoms like mobility of tooth.

Also during this period, there is a sustained contraction of the masticatory muscles, which reduces blood flow and oxygen to the area. This leads to the manifestation of pain. During clenching, there is also an influence on the protective neuromuscular forces of the jaw due to which their impact on muscular activity is affected and prolonged contraction is seen. These changes may be caused due to the following:

• Acute trauma: This will be in the form of blow or injury to the face or the jaw, which could be caused due to an accident or a fall.
• Chronic trauma: Chronic trauma occurs due to the prolongation of repeated forces on the jaw, due to temporomandibular joint disorders, orthodontic disturbances like an open bite, malocclusion, presence of a premature contact (in which some teeth contact sooner than the rest) or change in the path of the bite.
• Psychological factors: One of the most common causes of sleep bruxism is the presence of emotional stress or trauma. Individuals who are suffering from a phase of anxiety or depression are far more likely to experience bruxism than others.

Risk factors

• Genetic factors: It is believed that some sort of genetic factors have an influence on the habit of bruxism, which implies that positive family history is a definitive risk factor.
• Medications and associated disorders: Some medications and disorders can also lead to the manifestation of bruxism as they affect the activity of muscles. Conditions such as Down syndrome, Parkinson disease, atypical facial pain, torus mandibularis, Rett syndrome and oromandibular dystonia are often associated with this condition. Medications such as dopamine agonists or antagonists, cocaine, selective serotonin uptake inhibitors and tricyclic antidepressants may also increase the risk.
• Other risk factors: Other risk factors for bruxism include excessive alcohol consumption, smoking, consumption of tobacco, increased caffeine intake, sleep disorders and excessive fatigue. In children, behavioural abnormalities, sleep apnoea and disturbances in sleep are the main risk factors.

(Read more: Effects of alcohol on the body)

Bruxism can be prevented by managing risk factors and stress reduction. Here is what you can do to prevent bruxism:

• Get a proper sleep of 7 to 9 hours so that your body is well rested and your masticatory muscles are relaxed.
• Make sure that your bedroom environment is comfortable. Avoid excessive lighting or noise. You may use a dim night lamp.
• Avoid watching television or making the use of electronic devices before you get in bed.
• You can listen to some relaxing music or take a hot shower before bedtime to sleep better. Some hot teas like valerian tea are also likely to help with sleep.
• Stress can be managed with the help of yoga, meditation, massage and other relaxation techniques. Take out some time each day to relax and rejuvenate in order to avoid excessive stress and muscle tension.
• Avoid smoking as it can lead to respiratory and sleep issues, which further cause bruxism.
• If you have any trouble sleeping or suffer from sleep apnoea, seek treatment at the earliest. Respiratory disorders must also be managed correctly.
• Anxiety, depression and other mental health problems must not be ignored. Other than medical help, support groups may also be helpful to manage these conditions.
• In case of dental problems, like an overjet or an overbite, you must consult your dentist immediately. These problems may be visible as protrusion of the upper teeth. Functional problems like difficulty in chewing food due to an open bite or a high dental filling must be managed at the earliest. Any deleterious oral habits like nail biting, chewing on objects or tongue thrusting must also be managed in children.
• If you are on prescription medications, it is important that you take them on time and follow your doctor’s instructions. If you suspect that any of the medications are making you more anxious or causing disturbed sleep, you must talk to your doctor who may then adjust the dosage. You must not stop taking medications by yourself.

Bruxism is mainly diagnosed on the basis of patient history and complaint along with signs and symptoms. Difficulty in sleeping and pain in the jaw or dentition are the common complaints which help to diagnose the condition. A confirmatory diagnosis can be formed on the basis of the oral picture, which may divulge attrition, bite marks, gingival recession or broken fillings or teeth. Your dentist may tap your tooth to check for pain.

Intraoral radiographs and an orthopantomogram or OPG may be required to determine the specific cause of bruxism by having a look at the condition of the jaw bone and the dental arches. This will help with the diagnosis and treatment plan.

Bruxism remains unnoticed for long periods of time due to the unawareness of symptoms. So, if you experience even the slightest of signs like pain in the jaw or unexplained headaches in the morning hours, it is recommended that you seek dental treatment at the earliest. Your dentist will manage the condition with the help of the following therapies:

Occlusal adjustments

Any occlusal disorders leading to the symptoms of bruxism must be managed at the earliest. Coronoplasty will be performed by your dentist in order to relieve premature contact of dentition in a relaxed jaw position.

Intraoral splint devices

Splint devices are most commonly used to manage grinding. These devices are fabricated to be worn over the occlusal surface to minimise the damage to tooth structure. Usually, hard splints are used over soft splints for the management of bruxism. Splint devices are removable and are meant to be used during night time to guide occlusion in place. This would help to reduce tension in the masticatory muscles managing increased muscle tone. They can also be worn during the day to prevent daytime grinding.

Psychotherapy

Since bruxism is most commonly related to stress and anxiety, it is essential that these conditions are effectively managed.

Patient education

Patient education forms a major part of the management of bruxism so that the habits or triggers that lead to the condition are adequately managed. The use of a splint device must be encouraged and the individual must also be introduced to relaxation techniques, which help to relax the associated group of muscles, thereby relieving bruxism symptoms.

Restorative treatment

If the individual presents with fractured teeth or fillings due to the habit of bruxism, restorative treatment is provided ensuring that there are no premature contact points. 

Physical therapy

In case of severe pain or muscle stiffness, physical therapy like massage and relaxation of the joint is performed.

Pharmacological management

Painkillers and anti-inflammatory drugs are often prescribed to manage the symptoms of bruxism. Other than this, anti-anxiety drugs, sedatives, tranquillizers, muscle relaxants and anti-depressants may also be recommended based on the cause of bruxism.

Biofeedback

Biofeedback therapy is used for the management of bruxism, which helps bruxers unlearn the habit with the help of an auditory, visual, tactile or gustatory stimulus. This approach is used for both daytime and nighttime grinding.

If left untreated, bruxism can lead to serious oral problems and conditions like periodontitis and toothache. Fracture of dental fillings or teeth and sensitivity of the teeth can be some other complications. Over time, bruxism will progress to cause jaw pain, orthodontic problems and temporomandibular joint problems.