Symptoms of bruxism
A number of symptoms point clearly to bruxism, or to the possibility of it. The main ones are:
- Tense, painful muscles
- Earache
- Headache
- Sensitive and worn teeth
- Broken-off parts of the crown of a tooth
- Receding gums
- Loose teeth
So if someone has heard you grinding your teeth, if you wake with a tired and aching jaw, if your teeth and gums hurt on waking, if you have headaches, or if you have noticed yourself clenching and grinding during the day, it is worth asking a dentist.
What causes bruxism
The causes of bruxism are still not entirely clear, though we know considerably more about it than we used to. It can have psychological and physical causes, but it is most often linked to stress. That includes long-standing habits (thumb-sucking, nail-biting and so on) as well as cognitive and behavioural factors (stress, anxiety, personality traits).
Bruxism is commonest in people who are perfectionists, anxious, hyperactive or dissatisfied. In most cases an uneven bite decides how much damage is actually done. Higher intake of caffeine, nicotine and alcohol can also bring it on.
What bruxism leads to
The consequences are many, particularly because the teeth take the pressure of clenching combined with the extra pressure of sideways movement. What can happen is:
- Wear facets on the teeth
- A fractured tooth
- Fillings coming out
- Cracks in the enamel
- Loss of the vertical dimension of the bite
- Jaw pain
- Toothache
- Earache
- Headache
- Disturbed sleep
Types of bruxism
Dentists distinguish two kinds: centric bruxism, which happens during the day, and eccentric bruxism, which happens at night.
Daytime bruxism
Daytime, or centric, bruxism often takes the form of hard clenching during heavy physical effort — any physical work, lifting weights or carrying loads that makes us clench.
It can also happen entirely independently of any activity. It may simply be a habit the patient is not aware of at all. As a rule it is involuntary and cannot be controlled.
Night-time bruxism
Night-time, or eccentric, bruxism means cyclical or rhythmic clenching during sleep. It is particularly damaging to the teeth and the jaw muscles, because the protective mechanisms and reflexes do not work during sleep. That means a person can produce a far stronger bite than they ever would consciously in the daytime.
If someone clenched as hard as they could during a night-time episode, the bite would be three to four times stronger than one produced consciously during the day. That much force can seriously damage the chewing system.
How is bruxism diagnosed?
Diagnosing bruxism is complex. It asks for precision and commitment from the dentist, and patience from the patient — particularly when they arrive in severe pain, which makes diagnosis considerably harder.
Because the symptoms are varied and rather general, patients often see other specialists first. The cause of the pain can also be misread, with teeth and gums treated by mistake, which does not improve the symptoms. All of that can be exhausting, and frustrating, for the patient.
The first and most important step is the conversation between dentist and patient. A thorough examination follows. Impressions of the upper and lower jaw are taken and a model of the patient's teeth is made. Then the relationship between the upper and lower teeth is analysed in different positions, using an instrument called an articulator.
Since patients are often unaware that they may have bruxism, people around them can help a great deal with the diagnosis. A partner or friends who notice any of these symptoms or behaviours can point out habits you are not conscious of.
How is bruxism treated?
Treatment happens in two stages. The first relieves whatever pain the patient is in. The second replaces and rebuilds the damage that has been done.
The first and commonest help is a splint. This device is fitted over the teeth of one jaw, usually the upper, to bring every part of the chewing system — teeth, muscles and joint — into an ideal relationship. It prevents grinding and clenching and so relaxes the jaw muscles, which together reduces pain in the teeth, the muscles and the joint.
Depending on the situation, a splint may be worn during the day as well as at night. The dentist decides how long it is worn in each individual case. While it is being worn, regular check-ups matter, to make sure the relationship between the teeth is right — that is the only way the damage from bruxism is put right.
Once the splint has reduced the pain, the dentist moves to the second stage. Its aim is to repair the disturbed relationship between teeth, joint and muscles for good — in short, to put the bite right. This varies from case to case. Sometimes minimal adjustment of the teeth is enough to correct the interference causing the bruxism. In more severe cases a larger reconstruction is needed, using fillings, crowns, bridges, dentures or implants. The point is to replace missing teeth and to get the relationship between the teeth right.
Diagnosing and treating bruxism is by its nature multidisciplinary. The best trained for it are specialists in dental prosthetics. If the dentist judges the pain severe enough, medication may also be prescribed to reduce pain around the jaw joint.
When to see a specialist
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