Many people recognize that they have the bad habit of clenching or grinding their teeth during sleep. This habit is called bruxism. Bruxism encompasses any types of abnormal use of the jaw muscles during sleep, including side-to-side grinding, back-and-forth grinding, and stationary clenching. Many people are completely unaware that they clench or grind their teeth. They may be informed by a sleeping partner if the habit makes noise and the partner is a light sleeper. In many cases, the dentist is the first person to recognize a concern with bruxism. They may notice it before the patient has any idea that there is a problem.
Do You Really Grind Your Teeth?
When someone clenches or grinds their teeth, there are many signs and symptoms that manifest from the habit. A symptom is defined as any subjective evidence of disease. This means it is something the patient experiences and describes, but cannot be quantitatively measured or verified. An example of a bruxism symptom would be facial muscle pain. A sign is objective evidence of a disease. A sign can be measured or detected by someone other than the patient. Many patients can see signs, but doctors cannot see symptoms.
The Symptoms of Bruxism
Not every patient who clenches and/or grinds his or her teeth will experience these symptoms. In fact, many people do not experience symptoms of bruxism at all, and they are surprised to learn from their dentist that this habit is occurring. There are also many people who do experience symptoms, which can include the following.
- Facial muscle pain – Just like any other muscle in the body, if the masseter or temporalis (the two largest muscles used to close the teeth) are overworked, they can become sore.
- Headaches – Bruxism commonly causes muscle tension headaches in the temples, forehead, and neck.
- Jaw joint (TMJ) pain – Due to high pressure compression of the joint by the large muscles which close the teeth, the joint can become inflamed and tender.
- Facial muscle tightness – Muscle tightness or tension may result from strong flexing of the facial muscles overnight.
- Generalized tooth sensitivity – The heavy forces absorbed by the teeth create a hypersensitivity in the tooth’s nerve, which makes it more sensitive to temperature and pressure.
- Tooth pain – If an individual tooth receives a disproportionate amount of biting force, the excess pressure from bruxism may cause toothache-like symptoms.
The Signs of Bruxism
Signs of bruxism give your dentist evidence that you are clenching or grinding your teeth. You may or may not be aware of them.
- Attrition – Attrition is the gradual wearing away of tooth structure by friction against the opposite tooth. Teeth with severe attrition appear shorter than normal and have areas missing enamel.
- Abfraction – An abfraction is a notching of tooth structure at the gumline of a tooth caused by improper biting forces. Abfraction lesions present as a sharp concavity on the tooth where it enters the gums.
- Cracked teeth – Constant clenching and grinding puts above-average stress on teeth, which can cause fractures.
- Recession – If clenching or grinding cause a tooth to microscopically flex between its root and crown, the gums may retreat from the flexion. This leads to gum recession and exposure of root surface.
- Linea Alba – Latin for “white line”, this is a callous formed on the inner cheek where the teeth meet. Bruxism creates a suction effect inside the mouth, which pulls the cheeks in to rub against the grinding teeth.
- Scalloped Tongue (pie crust tongue) – In the same way a linea alba is formed, the tongue will be pressed to the inside of the teeth and reflect the shape of the outline of the teeth.
- Enlargement of facial muscles – As with the muscle pain mentioned above, muscles that are usedfrequently will grow. While this may be desirable for chest and arm muscles, it is not good to have large facial muscles. You do not want to exert more force on your teeth.
- Clicking or popping in the jaw joint – Bruxism can cause the small cartilage disc in your jaw joint (TMJ) to slip out of its correct position. This can cause sounds during movement of the jaw as the bones move onto and off of the cartilage.
- Locking in the jaw joint – As with joint sounds, a slipped disc can prevent proper movement of the jaws, which is called a “lock”. Jaw locking can occur in an open state, where the patient is unable to close their teeth, or in a closed state, where the patient is unable to open. Either scenario is very uncomfortable.
What Should I Do About Bruxism?
The key is prevention! Many of the signs and symptoms can be lessened or entirely prevented if bruxism is recognized and treated early enough. The way to prevent problems from bruxism is wearing a nightguard. A nightguard is a dental appliance made to protect the teeth, gums, muscles and jaws from the heavy forces produced by bruxism. The mechanism of action is separation of the teeth. By separating the teeth, the amount of force the muscles can create is reduced, and the teeth are not physically contact each other. There are many different types of nightguards available, and this blog will only differentiate between generic over-the-counter nightguards and professional custom nightguards.
OTC Nightguards – An over-the-counter nightguard will have a generic fit and a soft material. The soft material is necessary because it must be heated and molded to the shape of your teeth. The benefit of OTC nightguards is they are very inexpensive. There are several disadvantages, though. Because they are made from a soft material, they wear out quickly. A heavy grinder will make short work of a soft nightguard. The softness also creates a “stress ball” effect. Because the material feels squishy, it can cause people to clench or grind even more. This will not help with muscle tension or pain, headaches or jaw pain. In fact, the only way the OTC nightguard helps is by separating the teeth, . . . until you grind through it, that is.
A professional custom-made nightguard has many advantages over an OTC nightguard. Usually made from a hard acrylic material, they can withstand the heavy forces of bruxism. The rigidity of the appliance also allows it to function as a retainer, keeping the teeth in their current position. The firm separation of the teeth reduces muscle contraction and decreases the muscle force generated. This equals relief of muscle pain and tension, reduced compression of the jaw joint (TMJ), and lowered risk of TMJ dysfunction. The cost for a professional nightguard is higher than an OTC nightguard; however, it is much lower than the cost of one crown in the event that you crack a tooth!