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Bruxism Content Supplied by NHS Choices
Introduction

Bruxism is the medical term for grinding the teeth and clenching the jaw.

People sometimes grind their teeth without it causing any symptoms or problems. But regular, persistent teeth grinding can cause jaw pain and discomfort and wear down your teeth. It can also cause headaches and earache.

Read more about the symptoms of bruxism.

Most cases of teeth grinding (nearly 80%) occur subconsciously during sleep. It's usually associated with contributing factors, such as stress or anxiety.

Bruxism also affects people when they're awake, although this is more likely to be clenching the teeth and jaw, rather than grinding their teeth. Most people do it subconsciously while concentrating or when they're in stressful situations.

Many people with bruxism find it will come and go. It's likely to be worse during stressful periods.

What causes bruxism

Bruxism almost always occurs in association with other factors. About 70% of bruxism cases that occur during sleep are thought be related to stress and anxiety.

There's also an association between bruxism and obstructive sleep apnoea (OSA). OSA is a sleep disorder where your breathing is interrupted during sleep. How bruxism and OSA affect each other isn't currently fully understood.

Teeth grinding can also be caused by taking antipsychotic and antidepressant medication, particularly a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs).

Your lifestyle can also have an effect. For example, regularly drinking alcohol, smoking and using recreational drugs such as ecstasy and cocaine increases your risk of bruxism.

Doctors sometimes refer to teeth grinding caused by an underlying condition as primary bruxism. Teeth grinding associated with a medication, condition or lifestyle factors is often known as secondary bruxism.

Read more about the causes of bruxism.

Treating bruxism

There are a number of possible treatments for teeth grinding, but only a few have been shown to be effective.

Behavioural therapies and the use of mouth guards or mouth splints can be effective in managing the symptoms associated with bruxism.

Mouth guards and mouth splints work in the same way by reducing the sensation of clenching or grinding teeth, and also help prevent any wear on the teeth.

Other treatments, such as muscle-relaxation exercises and sleep hygiene, may also help manage your symptoms.

If you grind your teeth while you're asleep, you may need to wear a mouth guard or mouth splint to protect your teeth from further damage.

If you have an anxiety or stress-related problem, a course of cognitive behavioural therapy (CBT) may be recommended. The aim of CBT is to help you manage your problems by changing the way you think and how you act.

It may be possible to break the habit of teeth grinding using habit-reversal techniques.

Making some simple lifestyle changes, such as giving up smoking (if you smoke), reducing your alcohol consumption and managing stress may also help.

Read more about treating bruxism.


Symptoms of teeth grinding

Teeth grinding (bruxism) can cause different symptoms, including facial pain, headaches and worn-down teeth.

Some of the symptoms of bruxism, such as facial pain, will often disappear when you stop grinding your teeth. Others, such as tooth damage, can be permanent and may need dental treatment.

Possible symptoms of teeth grinding include:

  • headaches
  • facial muscle pain (facial myalgia)
  • earache
  • tightness and stiffness in the shoulders
  • pain and stiffness in the jaw joint and surrounding muscles (known as the temporomandibular joint)
  • sleep disruption (both to you and your partner)

Symptoms that affect the mouth include:

  • worn teeth, which can result in short teeth, increased tooth sensitivity and possible loss of teeth
  • fractured teeth or fillings
  • difficulty opening your mouth

It's important to note tooth wear only occurs in severe cases of bruxism and not everyone who grinds their teeth will have it.

If your teeth become worn through grinding, you may need dental treatment to avoid developing further problems, such as infection or a dental abscess.

When to see a doctor or dentist

You should see your dentist if:

  • your teeth are worn, damaged or sensitive
  • you have pain in your jaw, face or ear
  • your partner complains that you make a grinding sound in your sleep

Tell your dentist if you think you're grinding your teeth. They'll check your teeth and jaw for signs of bruxism, help work out the possible causes, and suggest appropriate treatment.

See your GP if you grind your teeth and you have high stress levels or anxiety. They'll be able to recommend treatment to help manage your stress, which may alleviate your teeth grinding symptoms.

Read more about treating bruxism.


Causes of teeth grinding

The causes of teeth grinding (bruxism) aren't always known, but it's usually linked to other factors, such as stress and anxiety or sleep problems.

Stress and anxiety

Teeth grinding can be associated with mental or psychological problems, such as stress and anxiety.

Studies have shown around 70% of cases of sleep bruxism are caused by stress or anxiety, which affects people subconsciously while they're asleep.

High levels of work-related stress can have a significant adverse affect on your sleep and trigger episodes of sleep bruxism.

Being stressed or anxious may also cause you to clench your jaw or grind your teeth.

Bruxism can also sometimes be caused by taking certain antidepressants used to treat depression and anxiety.

Sleep disorders

Studies have shown people who snore or have a sleep disorder, such as obstructive sleep apnoea (OSA), are more likely to grind their teeth while they're asleep. OSA causes your breathing to be interrupted while you sleep.

The link between bruxism and OSA has only been identified fairly recently, and the exact relationship between the two conditions isn't fully understood.

You're also more likely to grind your teeth if:

  • you talk or mumble while asleep
  • behave violently while asleep, such as kicking out or punching
  • you have sleep paralysis (a temporary inability to move or speak while waking up or falling asleep)
  • you experience hallucinations (seeing or hearing things that aren't real) while you're semi-conscious

Medication

Bruxism can sometimes occur as a side effect of taking certain types of medication. These include some psychotropic medicines that affect your mood, such as antidepressants and antipsychotics.

In particular, bruxism is sometimes linked to a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). Examples of SSRIs include paroxetine, fluoxetine and setraline.

Although there's an increased risk of developing bruxism if you're taking these medications, you may not develop any symptoms.

Lifestyle

Certain lifestyle factors can also increase your chances of developing bruxism. These include:

  • drinking alcohol excessively
  • smoking
  • using recreational drugs, such as ecstasy and cocaine
  • drinking caffeinated drinks, such as tea or coffee (six or more cups a day)

Teeth grinding in children

Around 1 in 5 children up to the age of 11 are reported to have bruxism, although the real figure is probably higher as it's often not noticed by parents.

Teeth grinding often occurs after a child develops their first teeth and again after they develop their permanent teeth. The habit usually stops after the adult teeth are fully formed.

After teething, a child may grind their teeth for the same reasons that adults do. For example, it may occur at stressful times, such as during school exams.


Treating teeth grinding

Recommended treatments for bruxism (teeth grinding) include behavioural therapies and using mouth guards or mouth splints.

Other treatments, such as muscle relaxation exercises and sleep hygiene measures, may also help you manage your symptoms.

Mouth guards and mouth splints

If you grind your teeth while you're asleep, you may need to wear a mouth guard or mouth splint at night.

These even out the pressure across your jaw and create a physical barrier between your upper and lower teeth to protect them from further damage. They can also reduce any grinding noises you make at night.

Mouth guards are similar in appearance to those used in sports such as boxing. They're usually made out of bendy rubber or plastic and can be made by your dentist to fit your mouth. You'll usually have to pay for this type of custom-made dental appliance.

Mouth guards are also available to buy from your local pharmacist. However, it's unlikely to fit as well as one made by your dentist.

A mouth splint (also known as an occlusal splint or bite plate) is made from harder plastic and fits precisely over your upper or lower teeth.

Mouth splints are no more effective than mouth guards in reducing the symptoms of bruxism. They tend to last for years, whereas mouth guards usually last for less than a year. However, mouth splints are more expensive.

Although mouth guards and splints may help reduce muscle activity in your jaw at night, they're only able to control the condition, not cure it.

Treating the underlying cause

Psychological treatments, such as cognitive behavioural therapy (CBT), can be used to treat any underlying psychological problems, such as stress and anxiety, that may be causing you to grind your teeth.

CBT aims to help you manage your problems by changing the way you think and how you act. A specially trained therapist will encourage you to talk about how you think about yourself, the world and other people, and how your actions affect your thoughts and feelings.

If your bruxism is stress related, it's important that you try to relax and get a good night's sleep. There are a number of things you can do to help you wind down before you go to bed. These include:

  • yoga
  • deep breathing
  • massage
  • reading
  • having a bath
  • listening to music

Different things will work for different people. Your GP will also be able to recommend some additional stress management techniques.

Breaking the habit

Habit-reversal techniques are designed to break your teeth grinding habit. However, there's no scientific evidence to suggest that using habit-reversal techniques will cure bruxism.

If you grind your teeth while you're awake, it might be useful to record how often you grind your teeth each day. You can then work out when you're more likely to do it and why - for example, when you're concentrating or stressed.

Being more aware of your habit will make it easier to break. To break the habit, you could train yourself to relax your jaw when you feel yourself grinding or clenching. For example, you could open your jaw slightly or gently place your tongue between your upper and lower teeth.

Habit-reversal techniques may be used by a specially trained therapist, or you can try them yourself using a computer programme or self-help book. Your GP will be able to advise you.

Treating and preventing dental problems

It's important that you have regular dental check-ups and that any problems caused by your teeth grinding are treated as soon as possible to prevent further damage.

For example, if your grinding leads to a cracked tooth and is left untreated, the nerve in your tooth could die and a dental abscess might develop. As a result, you may need to have root canal treatment.

In severe cases, your tooth could actually split in two. If this happens, your dentist won't be able to save the tooth and it will need to be taken out.

Dental problems, such as misaligned, cracked, crooked or missing teeth, can usually be treated with reconstructive dental treatments, such as false teeth, overlays and crowns.

These treatments can sometimes reshape the chewing surface of your teeth and stop you grinding. You'll usually have to pay for this type of dental treatment and it can often be expensive.

Find and choose a dentist.

Medication

Medication isn't usually used to treat bruxism. But non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help relieve any pain or inflammation you have around your jaw as a result of grinding your teeth.

In some cases, your GP may suggest taking a muscle relaxant before you go to bed to help relieve your symptoms.

If you develop bruxism as a side effect of taking antidepressant medication, your GP may suggest changing your medication. But you should never stop taking medication that's been prescribed for you without consulting your GP first.


'It's been a bad habit from an early age'

Matt Leslie has ground his teeth since childhood, but it was only when his dentist told him he was a bruxist that he realised the problems his teeth grinding could cause.

"I remember from an early age my parents telling me to 'stop grinding my teeth', so I suppose it's been a bad habit from an early age. I didn't realise the problems it could cause until I was much older.

"I first noticed a problem with my jaw when I was at university. It began clicking quite regularly when I ate or yawned, so I visited my doctor to see if there was a problem. He asked me lots of questions about whether I had been hit playing sport or if I'd been in a fight, but there wasn't an obvious explanation. He told me to take anti-inflammatories and that there was nothing to worry about. The clicking never went away, but I've got more used to it over the years.

"It was only when my dentist told me I am a bruxist, about eight years ago, that things started to fall into place. My dentist explained that I grind my teeth, and to such an extent that it was causing dental problems. It was the likely cause of my clicking jaw, too.

"During more visits to my dentist it became clear that the lower left side of my jaw was rife with problems. I had ground my back teeth down to a sharp point and had some cracked teeth, too. In short, my nightly grinding was slowly wearing down my teeth.

"Over the last few years I've had to have root canal treatment and crowns put in place, and I've also been fitted with a mouth splint. The mouth splint I have is made out of a fairly stiff clear plastic and is moulded exactly to fit over my lower teeth and correct my bite. I've worn it nearly every night for the last four years and had to replace it once when it cracked. I don't think it has stopped me from grinding my teeth at night, but at least it's protecting my teeth from any further damage.

"Since I've been aware of bruxism and its effects, I've started to realise how it affects me on a daily basis. I can't eat very chewy or crunchy food, such as crusty bread, because it really makes my jaw ache and gives me a headache. Also, very occasionally, I wake up and can't open my jaw because it feels so stiff.

"I mostly grind my teeth at night, but I do catch myself grinding during the day sometimes, especially when I'm concentrating on something. My colleagues have to tell me I'm doing it!

"I'm not sure why I grind my teeth. I don't feel stressed and don't suffer from any sleep disorders. I think, for me, bruxism is a bad habit that started young and is going to be hard to break. It doesn't cause me daily pain, so it's difficult to know what to do about it. I'd like to find some ways I could try to break the habit."

'I started experiencing a really sharp shooting pain'

After finally having a mouth guard fitted, Karen Smith now feels in control of her bruxism.

"I think it was about five years ago that my dentist first told me I was grinding my teeth.

"During a routine check-up he said my teeth were worn down, especially the ones at the back. He then asked if I ever felt any tension in my jaw and asked me to open my mouth wide and close it again.

"I did feel some tension, but my teeth didn't hurt and I wasn't experiencing any other symptoms, so it didn't seem like much of a problem. I went away and didn't think about it much.

"At further check-ups my dentist always mentioned the grinding and told me about the possible risks to my teeth, including the fact that the grinding can weaken them and lead to cracks and loosening. He suggested getting a mouth guard, but as I still wasn't experiencing any symptoms, it didn't seem like a priority.

"I finally did something about it last year. I had wanted to get all my silver fillings replaced with nice white ones for a while and decided to treat myself to the dental work after getting a new job.

"After having the fillings done I started experiencing a really sharp shooting pain on the right-hand side of my jaw. After paying a lot of money for all the dental work to be done I didn't want anything to be wrong, so I went back to my dentist to check that everything was ok.

"My dentist was away, so I saw another dentist who told me the shooting pain was a consequence of an abnormal bite that had been made more prominent after the work on my fillings. It was probably making me grind my teeth more, which was leading to the shooting pain.

"The dentist recommended a mouth guard for my lower teeth, which would correct my bite and hopefully stop me grinding as well. I had a fitting for the mouth guard, which involved having a cast made of my teeth, and I got it a few days later. It was made out of a flexible rubber that absorbs the shock of clenching and grinding, and is also non-abrasive so it doesn't wear your teeth down.

"Wearing the mouth guard took a bit of getting used to. But I wore it every night for three weeks and, sure enough, the shooting pain went away."

 
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