Bruxism is the term used to describe the habit of clenching and grinding the teeth involuntarily, particularly while sleeping. Most people who suffer from it aren’t even aware they’re doing it, unless they’re disturbing a partner.
Affecting both children and adults, it is estimated that one in three people will experience bruxism at some stage during their lifetime. As many as 10% of these sufferers grind their teeth so badly that they will eventually need reconstructive surgery.
Different theories have emerged over the years to explain the causes of teeth grinding but scientists still can’t pinpoint exactly what triggers it.
It is thought to be associated with jaw misalignment, dental occlusion and psychological causes, such as stress or anxiety. It might even be a pathophysiological abnormality involving the central nervous system.
Overall, bruxism can be classified into two broad categories: daytime bruxism and nocturnal bruxism. Daytime bruxism is thought to be associated with stress, anger, aggression or misalignment between the upper and lower teeth.
It is easier to control than night-time bruxism, since those who grind while awake are more likely to be aware of it and can make a conscious effort to stop. Night-time bruxism, on the other hand, may be related to sleep apnea and is more difficult to treat. The quality of sleep is also inevitably impaired.
This habit seems to be deeply wired in the brain. The grinding action eventually wears the teeth ragged, resulting in unattractive stubs. The jaw muscles may also become stressed, causing temporomandibular joint (TMJ) problems, such as severe headache, buzzing in the ears, hearing loss, neck or severe jaw pain, especially upon waking.
The old fashioned way of treating teeth grinding is to cover the teeth with a night guard to protect them. This night guard fits on the teeth and prevents contact between them, so they are less likely to crack or break over time.
The reasoning behind it is that if the clenching and grinding can’t be prevented, at least we can mitigate the damage. But it is a band aid solution at best that does little to address the underlying issues.
There are several types of night guard on the market, designed to address individual habits. For example, the soft mouth guard made of rubber is made for people who clench more than grind. A hybrid laminate guard is used by those who have a moderate grinding problem and lastly, the firm acrylic guard is designed for those who suffer from severe grinding.
In more severe cases, medical devices – available only from a dentist – may be required. Cerezen is one such device. It consists of two custom-made, 3D-printed hollow inserts that sit in each ear canal, the nearest access point to the temporomandibular joint.
When the devices, which are made from a rigid material, are inserted into the ear canal, they retain the shape of the ear canal in the open-jaw position. This encourages the jaw to return to an ‘open bite’ position, reducing the grinding and resulting pain.
Studies have shown that 25% of those who suffer from sleep apnea grind their teeth while sleeping. When these people are treated for sleep apnea with constant positive airway pressure (CPAP), more than half of them have shown improvement or complete resolution of the teeth grinding problem.
As a result, it is now widely accepted that grinding can be an instinctual response that helps us survive by keeping the airways open while we sleep.
Prescription drugs can also be used to reduce teeth grinding and associated symptoms. Since stress and anxiety are thought to be a possible cause, anxiolytics such as benzodiazepines have been prescribed to reduce nocturnal bruxism and improve the quality of sleep.
Researchers, linking teeth grinding with neurotransmitter abnormality, have discovered that low doses of dopamine receptor agonist may reduce severe clenching and grinding. And botulinum toxin is used to alleviate symptoms in those who experience bruxism induced by causes such as Huntington disease, Autism, Parkinson disease, brain injury and street drug abuse.
Various psychological and relaxation techniques such as self-monitoring, hypnosis, meditation and cognitive behavioral therapy have also been introduced to manage teeth grinding although these have not been scientifically substantiated.
Nonetheless, these techniques have been found to be effective in some patients, especially those who suffer from day-time bruxism. These psychological interventions mainly focus on reducing stress levels and improving self-control.
Other hearsay remedies include restricting alcohol and products containing caffeine. Dentists often prohibit certain habits such as nail biting or chewing hard objects. The aim here is to avoid the jaw muscles becoming accustomed to excessive and unnecessary clenching and grinding movements.
The good news is that in most cases, teeth grinding waxes and wanes and the severity of it varies from one person to another. Those who are mildly affected, for example, may get over it without medical attention. As for children, they often grow out of it once they lose their baby teeth – as with other sleep issues such as sleep talking and sleep walking.
To conclude, there is no one-size-fits-all treatment for teeth grinding. The approach taken by healthcare practitioners is mainly symptom-based treatment tailored to each individual. This is done in the hope of minimising damage, preventing progression of the condition and improving the quality of sleep. Because as we all know, a good night’s sleep is the best cure of all.