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Bruxism-Teeth Grinding and Clenching 20-343253 3 Hours Back to Course Index

 

BRUXISM

Teeth Grinding and Clenching

All about Clenching and Grinding Teeth - Dental Wellness Group

 

  

Bruxism is when an individual clenches (tightly hold the top and bottom teeth together) or grind (slide the teeth back and forth over each other) the teeth.

 

 

Causes, Incidence, and Risk Factors  Bruxism2

 

People can clench and grind without being aware of it during both the day and night, although sleep-related bruxism is often the bigger problem because it is harder to control.  It can even occur during short naps.  It is one of the most common sleep disorders.

 

The cause of bruxism is not completely agreed upon, but daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms. Whether or not bruxism causes pain and other problems may be a complicated mix of factors:

 

  • How much stress they are under
  • How long and tightly they clench and grind
  • Whether their teeth are misaligned
  • Posture
  • Ability to relax
  • Diet
  • Sleeping habits

 

 

imagesCAMMOCFDSymptoms And Harmful Effects

 

Bruxism is a habit rather than a reflex chewing activity. Reflex activities happen reliably in response to a stimulus, without involvement of subconscious brain activity.  Chewing and clenching are complex neuromuscular activities that can be controlled either by subconscious processes or by conscious processes within the brain. During sleep, and for some during waking hours while conscious attention is distracted, subconscious processes can run unchecked, allowing bruxism to occur.

 

Some bruxism activity is rhythmic with bite force pulses of tenths of a second (like chewing), and some has a longer bite force pulses of 1 to 30 seconds (clenching).

 

The etiology of problematic bruxism can be quite varied, from allergic reactions or medical ailments, to trauma (such as a car crash) to a period of unusual stress, but once bruxism becomes a habit, the original stimulus can be removed without ending the habit. Certain medical conditions can trigger bruxism, including digestive ailments, anxiety, and hypermyotonia due to consumption of amphetamine and related stimulants.

 

Clenching the teeth puts pressure on the muscles, tissues, and other structures around the jaw. The symptoms can cause or worsen temporomandibular joint problems (TMJ).

 

Grinding can wear down the teeth. It can be noisy enough at night to bother sleeping partners.

 

In some cases, chronic teeth grinding can result in a fracturing, loosening, or loss of teeth. The chronic grinding may wear their teeth down to stumps. When these events happen, bridgescrownsroot canalsimplants, partial dentures, and even complete dentures may be needed.

 

Not only can severe grinding damage teeth and result in tooth loss, it can also affect the jaws, result in hearing loss, and even change the appearance of the face.

 

Symptoms include:

 

  • Depression
  • Earache (due in part because the structures of the temporomandibular joint are very close to the ear canal, and because an individual can feel pain in a different location than its source; this is called referred pain)
  • Eating disorders
  • Headache
  • Hot, cold, or sweet sensitivity in the teeth
  • Insomnia
  • Sore or painful jaw

 

 

Diagnosing Bruxism  bruxism1

 

Bruxism is not the only cause of tooth wear, making it difficult to diagnose by visual evidence alone. Abraded teeth are usually brought to the patient’s attention during a routine dental examination.

 

The most reliable diagnostic technique is measuring EMG (electromyography). These measurements pick up electrical signals from the chewing muscles (masseter and temporalis). This method is commonly used in sleep labs. 

 

“Bedside” EMG units are similar to those used by sleep labs. These units pick up their signals from facial muscles through wires connecting the bedside unit to electrodes that are adhesively attached to the user’s face. TENS electrodes or ECG electrodes may be used.

 

biofeedback headband may be used in silent mode to record the total number of clenching incidents and the total clenching time each night. These two numbers easily distinguish clenching from rhythmic grinding and allow dentists to quantify severity levels. Biofeedback headbands do not require adhesive electrodes or wires attached to the face. They do not record the exact time, duration, and strength of each clenching incident as bedside EMG monitors do.

 

Bedside EMG units and biofeedback headbands can both be used either as a diagnosis measurement or in biofeedback mode as a treatment to help patients break their bruxism habit.

“Disposable” EMG monitors adhesively mount to the side of the face over the masseter muscle. They monitor one night and provide a single-digit measure of bruxism severity.

 

Abfraction2 imagesCAWSF55W

 

 

 

The Dental Professional Should Look For:

 

 

 

 

  • Complaints from patients regarding pain, headaches, insomnia, ear aches, neck aches
  • Canine teeth or eye teeth should be pointy
  • Indentions in the sides of the tongue
  • White horizontal line or irritated skin on the inside of the cheek
  • Abractions or receding gums
  • Abnormally large masseter muscles when teeth are clinched

 

 

Treatment imagesCA9E28KG

 

The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.

 

To help relieve pain, there are many self-care steps an individual can take at home. For example:

 

  • Apply ice or wet heat to sore jaw muscles. Either can have a beneficial effect.
  • Avoid eating hard foods like nuts, candies, steak.
  • Drink plenty of water every day.
  • Get plenty of sleep.
  • Learn physical therapy stretching exercises to help restore a normal balance to the action of the muscles and joints on each side of the head.
  • Massage the muscles of the neck, shoulders, and face. Search carefully for small, painful nodules called trigger points that can cause pain throughout the head and face.
  • Relax the face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
  • Try to reduce your daily stress and learn relaxation techniques.
  • To prevent damage to the teeth, mouth guards or appliances (splints) have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.

 

A splint may also help reduce clenching, but some people find that it makes their clenching worse. In others, the symptoms go away as long as they use the splint, but pain returns when they stop or the splint loses its effectiveness over time.

 

There are many different types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep the jaw in a more relaxed position or provide some other function. If one type doesn’t work, another may.

 

For example, a splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.

 

As a next phase after splint therapy, orthodontic adjustment of the bite pattern may help some people.

Surgery should be considered a last resort.

 

Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching, since nighttime clenching cannot be consciously stopped.

 

In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.

 

As noted above, electromyographic devices can be used to diagnose and also to treat teeth grinding.  When used as a treatment, the device monitors the electromyographic (EMG) activity of the temporalis muscle. When the muscle contracts, the device records the muscle activity and sends out a contingent electrical stimulation (CES) to receptors in the skin. The contingent electrical stimulation is designed to trigger an inhibitory reflex in the brain stem that relaxes the jaw-muscles and inhibits the bruxing event without waking up the user. The function of the device is therefore different from other devices in the market, which wake up the user acoustically to stop the grinding. The device has an electrode with three metal contact pads to record the muscle activity and send out the CES. The electrode is attached to the skin with a disposable gel-pad.

The level of stimulation is set by the user at the same time as the calibration, that must be done by the user in order for the bruxing events to be detected correctly. The stimulation intensity is clearly perceived by the user -but not painful. All user interaction with the device is done via a menu on the display of the device. The device is intended for use during sleep although it may also be used while the user is awake.

 

Botulinum toxin (Botox) can lessen bruxism’s effects. An extremely dilute form of Botox is injected to weaken (partially paralyze) muscles and has been used extensively in cosmetic procedures to ‘relax’ the muscles of the face.

 

Botox was originally developed for use in treating strabismus (misalignment of eyes), during trials of which its effects on wrinkles in the eye area were discovered. It was, and continues to be, used to treat diseases of muscle spasticity such as strabismusblepharospasm (eyelid spasm), and torticollis (wry neck). Bruxism can also be regarded as a disorder of repetitive, unconscious contraction of the masseter muscle (the large muscle that moves the jaw). In the treatment of bruxism, Botox weakens the muscle enough to reduce the effects of grinding and clenching, but not so much as to prevent proper use of the muscle. Botox treatment typically involves five or six injections into the masseter muscles. It takes a few minutes per side, and the patient starts feeling the effects the next day. Occasionally, bruising can occur, but this is quite rare. Injections must be repeated more than once per year.

 

The optimal dose of Botox must be determined for each person as some people have stronger muscles that need more Botox. This is done over a few touch-up visits with the physician. The effects last for about three months. The muscles do atrophy, however, so after a few rounds of treatment, it is usually possible either to decrease the dose or increase the interval between treatments.

 

There is anecdotal evidence that suggests taking certain combinations of dietary supplements may alleviate bruxism; pantothenic acidmagnesium, and calcium are mentioned on dietary supplement websites. Calcium is known to be a treatment for gastric problems, and gastric problems such as acid reflux are known to increase bruxism.

 

The dental approach to treatment will include x-rays and prescribing a mouth guard.  A patient can also be referred out for a massage-based approach. A massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage can help with treatment.

 

 

Expectations

 

Bruxism is not a dangerous disorder. However, as noted, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.

 

  • Complications
  • Depression
  • Eating disorders
  • Insomnia
  • Increased dental or TMJ problems
  • Nightly grinding can awaken roommates and sleeping partners

 

Damaged teeth can be repaired by replacing the worn natural crown of the tooth with prosthetic crowns. Materials used to make crowns vary; some are less prone to breaking than others and can last longer. Porcelain fused to metal crowns may be used in the anterior (front) of the mouth; in the posterior, full gold crowns are preferred. All-porcelain crowns are now becoming more and more common and work well for both anterior and posterior restorations. To protect the new crowns and dental implants, an occlusal guard should be fabricated to wear during sleep.

 

 

Prevention

 

Stress reduction and anxiety management may reduce bruxism in people prone to the condition.

 

Attending counseling for stress, starting an exercise program, seeing a physical therapist, or obtaining a prescription for muscle relaxants are among some of the options that may be offered.

 

Other tips to help someone stop teeth grinding include:

  • Avoid or cut back on foods and drinks that contain caffeine, such as colas, chocolate, and coffee.
  • Avoid alcohol. Grinding tends to intensify after alcohol consumption.
  • Do not chew on pencils or pens or anything that is not food. Avoid chewing gum as it allows the jaw muscles to get more used to clenching and makes someone more likely to grind their teeth.
  • Train self not to clench or grind the teeth. If the patient notice that they are clenching or grinding during the day, they can position the tip of their tongue between their teeth. This practice trains the jaw muscles to relax.
  • Relax the jaw muscles at night by holding a warm washcloth against the cheek in front of the earlobe.

 

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