Bruxism

Bruxism is the medical term for the habit of grinding and clenching your teeth.

Most people will do this from time to time, which does not usually cause any harm, but when teeth grinding happens on a regular basis it can permanently damage the teeth. In some people it can also aggravate headaches, earaches and pain and discomfort in the jaw (see Bruxism - symptoms for more information).

Teeth grinding usually occurs subconsciously during sleep. In most people, stress and anxiety are a contributing factor to bruxism.

Types of bruxism

Bruxism is often classified as either:

  • Awake bruxism, which is when you habitually clench your teeth and jaw when awake (but there is not usually any teeth grinding). Most will do this subconsciously while concentrating.
  • Sleep bruxism, which is when you subconsciously grind your teeth and squeeze your jaw muscles in your sleep. Partners may hear the grinding or clenching, which can be noisy. 

Bruxism is then further divided into:

  • primary bruxism, which occurs without any underlying medical condition
  • secondary bruxism, which is caused by another condition such as depression or anxiety, medication such as antidepressants, or recreational drugs such as cocaine and ecstasy

How common is it?

It is not known exactly how many people have bruxism, but up to 8-10% of the population are affected by it at some point in their life.

It can occur in both children and adults, but is most common in adults aged 25-44.

There are some estimates that up to 15-33% of children grind their teeth, although the habit tends to stop when their adult teeth are fully formed. In most children it occurs during growth and has no long-lasting effect.

Stress and anxiety are thought to make teeth grinding in your sleep more likely, or worse. Bruxism is also more prevalent in people who regularly drink alcohol, smoke tobacco or drink caffeine (more than six cups a day).

Outlook

There isn't a cure for bruxism, although it may be possible to break the teeth-grinding habit by trying habit-reversal techniques (see Bruxism - treatment for more information).

For those with a known stress-related problem, cognitive behavioural therapy may help treat any underlying stress or anxiety.

Meanwhile, you may need to wear a mouth guard or mouth splint (sometimes referred to as gumshields or gum splints) at night to protect your teeth from wearing down, and may be advised to make simple lifestyle changes, such as giving up smoking (if you smoke) and managing stress.

If left untreated, bruxism can lead to increased dental problems, such as tooth fractures and inflammation (swelling) as well as pain around the jaw joint.

Generally, medication is not used to treat bruxism.

Who is most at risk?

You are more likely to suffer from bruxism if you:

  • have a stressful lifestyle
  • drink large amounts of alcohol
  • smoke
  • take medication for sleep, depression or anxiety
  • drink six or more cups of tea or coffee a day
  • have sleep apnoea, snore, or talk, kick or punch in your sleep

Teeth grinding (bruxism) can affect people in many different ways. Some of the adverse effects go away when you stop grinding your teeth. But some can be long-lasting or permanent.

Short-term effects

Most people remain unaware of their teeth-grinding habit and have no symptoms.

However, it may cause disrupted sleep for the person with bruxism and their bed partner.

Some people with bruxism may develop headaches, an aching jaw and facial muscles, earache or tightness and stiffness in the shoulders.

Long-term effects

The long-term effects of bruxism include:

  • worn teeth, which, in extreme cases, can shorten the crown of teeth, leading to the need for expensive dental restorations
  • cracked teeth from grinding, which can lead to further problems such as infection and dental abscesses if not treated
  • tooth sensitivity
  • pain and stiffness of the jaw joint (known as temporomandibular joint disorder)

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
  • others complain that you make a grinding sound in your sleep

If you suspect you may be grinding your teeth, talk to your dentist. They can examine your mouth and jaw for signs of bruxism, help you to work out the possible causes, and suggest an appropriate treatment, for example a mouth guard.

If you suffer from stress, make an appointment to speak to your GP (see Bruxism – treatment).

Stress and anxiety

It has been estimated that nearly 70% of bruxism occurs as a result of stress or anxiety that is affecting people subconsciously during sleep. Stress and anxiety can be related to the high demands of a job or difficult life events.

Bruxism can also occur as a result of taking certain antidepressants used to treat depression and anxiety.

Imperfect bite

Bruxism can be related to an abnormal bite. This is when there is a problem with your top and bottom teeth coming together (called an occlusal discrepancy). Having teeth that are missing or crooked can also prompt you to grind your teeth.

In most people, although an abnormal bite can be identified by a dentist, removing the problem is not guaranteed to stop any symptoms. 

Lifestyle factors

Bruxism may be more prevalent in people who indulge in:

  • alcohol
  • tobacco
  • recreational drugs, such as ecstasy and cocaine

Medicines

Bruxism can occur as a side effect of taking certain medications. These include some psychotropic drugs (medicines that affect your mood), such as antidepressants and antipsychotics.

Bruxism may be linked to a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor). Types of SSRI include paroxetine, fluoxetine and setraline. Consult your doctor before you stop taking any medication.

Bruxism in children

Some estimates suggest that 15-33% of children grind their teeth. This usually happens after they develop their first teeth and again after they develop their permanent teeth. The habit usually stops when their adult teeth are fully formed.

After teething, grinding can occur for the same reasons as in adults (for example, because of an imperfect bite, stress or anxiety). Bruxism is thought to be more common around the time of school exams.

Treatment for teeth grinding aims to:

  • Address any underlying cause. For example, it may involve managing stress or anxiety through counselling or other talking therapies, by using relaxation techniques or (in some cases) by taking medication such as a muscle relaxant.
  • Protect your teeth. Your dentist may fit a mouth device called a splint or guard, which will even out your bite (the way your upper and lower teeth meet) and protect your teeth from wearing down at night.
  • Break the habit. Habit-reversal techniques may help you to break the teeth-grinding habit.
  • Treat and prevent any dental problems.

Addressing the underlying cause

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

CBT aims to help you manage your problems by changing how you think and act. For more information, see the Health A-Z pages on CBTtreating stress and treating anxiety.

If your bruxism is brought on by stress it is important to try to relax and get a good night's sleep. You can try a number of measures to wind down before you go to bed, such as:

  • 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 stress-management techniques.

For more information on relaxation, see the Health A-Z page on stress prevention.

Protecting your teeth

Mouth guards and splints

You may need to wear a mouth guard or mouth splint at night. These prevent tooth movement by evening out the pressure in your mouth.

A mouth guard or splint also creates a physical barrier between the teeth to protect them from further damage, and should reduce any grinding noise you make at night.

  • A mouth guard or night guard looks like a sports mouth guard. They are available from your pharmacist or dentist. They are usually made out of a bendy rubber-like plastic and can be made to fit your mouth. Those purchased from a pharmacist are unlikely to fit as well as those made by a dentist. 
  • A mouth splint (also known as an occlusal splint or bite plate) is usually made of a harder plastic and measured specifically to fit over your upper or lower teeth. A splint is usually more expensive than a mouth guard.

Although splints and guards are thought to help reduce muscle activity in your jaw at night, they can only control and will not cure the condition.

Dentists will use mouth guards or splints as the main treatment for bruxism and leave the stress management to doctors or others qualified to treat the condition.

Mandibular advancement devices (MADs)

Mandibular advancement devices (MADs) are usually used for the management of sleep apnoea and snoring, but studies have shown they can be effective for night bruxism as well.

An MAD is worn in the mouth at night to hold the lower jaw forward and closed during sleep. A simple MAD consists of two mouth guards (one for the top teeth and one for the bottom teeth) welded together so that the lower jaw sticks out slightly when it is worn.

Ask your dentist or GP about MADs and where they are available to buy.

Breaking the habit

You could try habit-reversal techniques to attempt to break your teeth-grinding habit.

For example, you could try recording the number of times you grind your teeth every day, and work out when you are more likely to do it and why (for example, when you are stressed or concentrating).

This will make you more aware of your habit, and make it easier for you to break it.

You could attempt to break the habit by training yourself to relax your jaw when you feel yourself grinding or clenching. For example, you could slightly open your jaw or gently place your tongue between your upper and lower teeth.

However, there is no scientific evidence that this approach will cure your bruxism.

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

Treating and preventing dental problems

It is important to go for regular dental check-ups and to get any problems caused by your grinding treated as soon as possible to prevent further damage.

If your grinding leads to a cracked tooth, for example, and this is not treated, the nerve can die and an abscess might grow. You may need to have root canal treatment.

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

In most cases, dental problems such as misaligned, cracked, crooked or missing teeth can be treated with reconstructive dental treatments such as false teeth, overlays and crowns. Sometimes this work can reshape the chewing surface of your teeth and stop you from grinding.

Examples of dental treatments that you may need to treat problems caused by bruxism include:

  • Tooth-coloured fillings. These can be used to reshape the teeth with smaller crown heights if worn teeth have become sensitive.
  • Crowns and root canal treatment. Crowns are used as a last resort for teeth that are damaged by wear or from cracks caused by grinding. A crown fits right over what is left of the tooth, making it strong and giving it the appearance of a natural tooth. If the nerve has been damaged and becomes infected, you may need to have root canal treatment first. This involves removing all infection from the root, cleaning it and filling it to prevent any further infections. For more information, see the Health A-Z topic on root canal treatment.

You will have to pay for dental work, and it can be expensive.

Medication

In general, medication is not used as a treatment for bruxism.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to relieve any pain or inflammation (tissue swelling) around your jaw that occurs as a result of grinding your teeth.

In some cases your doctor 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 an antidepressant medication, your doctor may suggest you change your medication.

Tips to prevent bruxism

  • See your dentist for regular check-ups.
  • Train yourself not to grind your teeth: when you find yourself doing it, position the tip of your tongue between your teeth so your jaw muscles get used to relaxing.
  • Try to be aware of any stress and anxiety you are feeling and how it is affecting you. Find some relaxation techniques that work for you.
  • Cut back on alcohol as it tends to make sleep bruxism worse.
  • Quit smoking. 
  • Avoid recreational drugs such as ecstasy and cocaine.
  • Do not chew pencils, gum or anything that is not food.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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