Bruxism (Teeth Grinding): What You Need to Know About Teeth Grinding

"Bruxism" is the term for grinding, gnashing, or clenching your teeth, generally, when you are unaware of it. It is more common when people are awake, but it can also happen when you sleep. Experts estimate that anywhere from 8% to 31% of adults have bruxism, depending on the type of bruxism they have. It tends to happen less often as people age.

If bruxism is severe, it can affect more than your teeth. Here's a look at the types of bruxism, the symptoms, and treatments.

Signs of Awake Bruxism

Awake bruxism and sleep bruxism have similar signs and symptoms. It is easier to become aware of awake bruxism, though both are subconscious behaviors (you do them without effort or awareness). The signs of awake bruxism include:

• Clenching the jaw
• Gnashing or grinding teeth
• Thrusting the jaw forward
• Worn, cracked, or damaged teeth
• Headache
• Jaw, neck, or shoulder pain
• Tooth sensitivity to heat and cold
  

Signs of Sleep Bruxism

Sleep bruxism, also known as nocturnal bruxism, is involuntary and sometimes considered a sleep disorder. People may notice they feel pain in the jaw, neck, or shoulders when they awaken. Sleep bruxism tends to occur during certain phases of sleep when you are sleeping more lightly or transitioning from one phase of sleep to another.

The signs of sleep bruxism include:

• Clenching of the jaw or teeth
• Grinding or gnashing of teeth
• Thrusting the jaw forward
• Worn, cracked, or damaged teeth
• Headache
• Jaw or shoulder pain
• Tooth sensitivity to heat and cold
  

What Causes Bruxism?

Underlying reasons why people grind or gnash their teeth include mood, behaviors, medical conditions, family history, and medications. Experts classify bruxism as primary or secondary, depending on the cause.

Primary Bruxism

Primary bruxism is not related to a medical condition. Causes include:

• Stress or depression
• Tense, angry, aggressive, hurried, or competitive personality
• Family history of bruxism
• Caffeine
• Alcohol
• Smoking

Secondary Bruxism

Secondary bruxism develops in people who have certain medical conditions or take medications that may lead to teeth grinding, including:

• Neurological conditions such as encephalitis (brain inflammation), brain hemorrhage (bleeding in the brain), traumatic brain injury (TBI), or stroke (blockage of blood flow or bleeding in the brain)
• Medications, including the antidepressants Prozac (fluoxetine) and Paxil (paroxetine), anti-seizure medications, and attention deficit hyperactivity disorder (ADHD) medications
• Imbalance in neurotransmitters in the brain (chemicals that facilitate communication between nerve cells)
  
  

What Are the Long-Term Effects of Bruxism?

Over time, bruxism can cause:

• Cracked or broken teeth
• Worn tooth enamel which can lead to gum disease and tooth loss
• Chronic headaches or pain in the jaw, ears, neck, or shoulders
• Migraine headaches
• Bone damage that may require a jaw hinge replacement procedure in severe cases
• Temporomandibular joint disorder (TMD) (involves the joint near your ear that connects the skull and the lower jaw)
  

How Is Bruxism Diagnosed?

Healthcare providers diagnose bruxism with the following methods:

• Dental examination: A dental exam looks for worn teeth or painful areas in the teeth or jaw.
• Medical history: The healthcare provider asks questions about tooth or jaw pain, fatigue, awareness of grinding, and whether your partner has noticed or heard teeth grinding at night. You may be asked about neurological conditions and medications.
• Sleep study: You are observed and monitored during sleep to see if you grind your teeth or have other signs of a sleep disorder.

Your healthcare provider can also rule out other possible causes of jaw, neck, or shoulder pain, such as arthritis, ear infections, injury, or neurological conditions.

How Bruxism is Treated

Treatment depends on whether you experience bruxism when you're awake or asleep bruxism and whether it is primary or secondary.

Mouth Guards and Splints

If you have sleep bruxism, you can be fitted for a splint or mouth guard, which you wear at night to protect your teeth from damage. They come in various designs, but they keep the upper and lower back teeth separated so the grinding doesn't wear them down.

Splints are sometimes used to try to reposition the jaw. However, some experts believe that splints can cause jaw damage, so be aware of the pros and cons.

Sleep Hygiene

Sleep hygiene techniques can help you sleep better, which can reduce sleep bruxism. A study in children showed that it can be effective. These techniques include:

• Sleep in a dark, quiet, and cool room.
• Avoid coffee or alcohol close to bedtime.
• Minimize mental stimulation close to bedtime, including the use of electronic devices.

Pillows are sold that claim to help jaw pain from bruxism, but there is a lack of evidence to support their use. Lying flat without a pillow may help.

Contingent Electrical Stimulation

Contingent electrical stimulation, or CES, uses a device that senses when sleep bruxism occurs. It uses a low level of electrical energy (such as a brief impulse to the muscles) to relax the mouth and jaw muscles during sleep. Two early studies showed some promise using this technique.

Physical Therapy

If you have muscle pain and stiffness from grinding your teeth that affects your face, jaw, neck, or shoulders, a physical therapist can show you exercises that help you stretch the muscles and joints to release tension and relieve pain. You can do the exercises yourself, as needed.

Self-Care

Steps you can take to reduce pain and avoid damage from bruxism include:

• See a dental provider regularly to monitor damage to your teeth and jaw.
• Apply cold packs or warm, damp cloths to ease sore jaw muscles.
• Massage your neck, shoulder, and facial muscles.
• Avoid gum and hard or dense food that requires a lot of chewing.
  

Medication

If stress or depression is causing bruxism, antianxiety medications, sedatives, or muscle relaxers may help. Most are not meant to be used on a long-term basis, so make sure you understand the pros and cons of this approach.

Biofeedback and Alternative Therapies

Some treatments that have not been fully studied for sleep bruxism include biofeedback sessions, in which you view an electromyography (EMG) monitor, which detects when your jaw moves. You receive feedback in the form of a visual or sound cue so that you become aware of the pattern.

It can also be used while you sleep, with a device that sends sensations that wake you up when you begin to grind your teeth. Hypnosis is another path to retrain yourself to avoid bruxism.

Botox Injections

A low-dose Botox (onabotulinumtoxinA) injection to the jaw relaxes the masseter muscles, which you use when you open and close your mouth. Botox can reduce incidences of teeth grinding, the pain it causes, and the force of grinding. The result is temporary, lasting several months.

Treating Underlying Conditions

If you have a neurological condition or injury that may be causing your bruxism, talk to your healthcare provider about how they can address it.

Acid reflux is also associated with bruxism, and both conditions can wear down the teeth. If you have indigestion, talk to your provider about what they recommend to reduce it.

How to Stop Grinding Your Teeth

If you have bruxism, you can take steps to make you less prone to grinding your teeth. One common treatment approach providers use is behavior modification, which reinforces positive actions, not negative ones.

Since bruxism is connected to tension and stress, learning strategies to reduce these factors in your life can help. Options include:

• Relaxation techniques, including meditation and yoga
• Counseling or mental health therapy can help you cope with and reduce anger, stress, or tension
• Noting when you grind your teeth and relax the jaw to help break the habit
  

Summary

Bruxism is grinding or gnashing your teeth while you are awake or asleep. It can damage your teeth and cause jaw pain, headaches, or neck or shoulder pain. It can be caused by stress, anger, tension, medication, or underlying medical conditions.

Treatments include devices to prevent teeth grinding while you sleep and behavioral therapies or counseling to help you break the pattern.