WHAT IS BRUXISM?
Bruxism is a movement disorder characterised by non-functional grinding of the teeth and clenching of the jaw. Bruxism occurs in both children and adults but occurs most commonly in the 25-44 age group. It is also more prevalent in individuals who regularly use alcohol, tobacco and caffeine (6 cups or more per day) and also in those with a higher educational status.
TYPES OF BRUXISM
Bruxism can be classified into awake bruxism and sleep bruxism. Awake bruxism is found more commonly in females in comparison to males while sleep bruxism shows no such gender difference.
Awake bruxism is characterised by a largely unconscious and involuntary clenching or grinding of the teeth and jaw bracing in reaction to certain stimuli. Awake bruxism can be associated with life stress and anxiety such as family stresses and work stress.
Sleep bruxism is characterised by automatic teeth clenching and/or grinding with rhythmic and sustained jaw muscle contractions. Sleep bruxism is found more frequently in those individuals who have an existing sleep disorder. The rhythmic muscle activity that occurs in sleep bruxism is related to sleep arousals, hence it is important to be assessed by your doctor and your dentist.
SIGNS AND SYMPTOMS
General signs and symptoms:
Rhythmic contractions of the jaw muscles
Grinding sounds while the person is asleep – usually observed by someone who shares the same bedroom with the bruxer
Aching teeth, particularly on waking
Headache, particularly on waking
Jaw joint and/or ear pain – particularly in the morning or on waking
Aching, stiffness and/or tightness of jaw, neck or face
Jaw joint clicking or locking
Aching, stiffness and/or tightness in the jaw while chewing, particularly during breakfast or while eating something particularly chewy like meat
Hypertrophic masseters – larger jaw muscles due to overuse which can cause changes to the appearance of your jaw and face
Tooth indentations on the tongue and/or inside of cheeks (linea alba)
Dental signs and symptoms:
Temperature-sensitive teeth
Crack lines in teeth and/or cracked or chipped tooth enamel
Dental wear facets – teeth have been ground down and flattened due to repeated tooth-on-tooth contact
Abfraction lesions – loss of tooth structure, around the neck of the tooth, due to bending of the tooth with high force during bruxism
Gum recession
Teeth that may be mobile
CAUSES
The cause of one person's bruxism is usually multifactorial and may include the following:
Physical issues such as an uneven bite that interferes with normal movements of the jaw or structural factors causing jaw joint issues
Psychological factors including extreme stress and anxiety
Medical factors including neurological disorders or medications; more commonly antipsychotics and antidepressants
Sleep and airway issues. The rhythmic muscle activity that occurs in sleep bruxism is related to sleep arousals which is commonly due to airways issues such as obstructive sleep apnoea, hence it is important to be assessed by your doctor and your dentist to be properly diagnosed prior to any treatment
Temporomandibular Joint Disorder can also cause or result from bruxism
TREATMENT
As mentioned above, the cause of a person's bruxism is generally multifactorial, hence, it is often difficult to treat. Proper diagnosis is important before making any changes.
Behaviour Modification and Diet
Reducing or eliminating alcohol consumption, smoking habits and intake of food and drink that contain caffeine such as soft drinks, chocolate, coffee and tea can help in improving sleep hygiene, anxiety and overall health.
It is also important to be mindful of how you use your mouth and jaw. Avoid wide mouth opening, avoid chewy foods, very hard or crunchy foods and foods that may encourage long chewing periods eg. chewing gum. Also, avoid biting or chewing anything that is not food, eg. chewing pencils. Awareness of awake bruxism can also be very helpful as you can actively relax your mouth and jaw if you catch yourself clenching and grinding during the day. You should aim not to overuse your mouth and jaw and allow your jaw muscles to rest.
These changes to your diet and lifestyle will in turn give you a better chance at treating your bruxism.
Stress Management
Modifying behaviour can help in not only preventing or treating bruxism but also improving your overall health especially when it comes to stress. It has been found that nearly 70% of bruxism occurs as a result of stress or anxiety, therefore, awareness of your stress triggers, stress management, regular exercise, relaxation techniques and good sleep hygiene can all help reduce your risk of bruxism. If you are finding that your stress and anxiety is affecting your daily activities, it is important to consult your family doctor to discuss ways to manage your stress and mental health.
Occlusal management
Occlusal splint therapy
The most common way to protect the teeth from further damage due to bruxism is occlusal splint therapy. This involves a removable dental appliance (occlusal splint) that is worn during sleep and during times of stress. This occlusal splint may be referred to as a dental night guard, night splint, sleep guard or night mouthguard.
Occlusal splint therapy not only protects your teeth from further damage but can also reduce muscle activity associated with bruxism.
Occlusal rehabilitation
If occlusal rehabilitation is required, your dentist may recommend adjustment of the shape and height of certain teeth to improve the evenness of your bite. This may be done by fillings, crowns or orthodontic movement. It is very important that you are fully aware of the treatment required and alternative options as this is an irreversible technique that may not completely alleviate signs and symptoms.
Treatment of sleep disorder
Sleep hygiene is very important to overall health and preventing and treating bruxism. Smoking, caffeine intake and heavy alcohol consumption are associated factors of bruxism, hence it is important to reduce or eliminate any habits that may be contributing to your poor sleep quality and consequently perpetuating your bruxism. Many recreational and prescription medications also contribute to poor sleep quality and increase risk of sleep arousal. If you are taking medications that are known to cause bruxism, it is important that you speak with your family doctor prior to making any changes to your medication routine.
If you are experiencing ongoing sleep issues, referral to your family doctor is important to assess the nature of the sleep disorder ie. whether it is caused by behavioural factors, psychological factors or medical factors. You may also be referred to a sleep physician for a sleep study. Depending on your diagnosis, you may require treatment including, but not limited to, CPAP, Mandibular Advancement Splints and/or surgery.
Other treatment options
It is important to be assessed by your dentist and family doctor to obtain a proper diagnosis before commencing any treatment. There may be other treatment options available for your specific case such as certain medication, jaw exercises, referral to a jaw specialist or physiotherapist.
Bruxism can have a significant effect on your quality of life and can become a more debilitating condition if it is not addressed. If you are experiencing any of these symptoms, speak to your dentist or family doctor for further information.
Dr Lufi and Dr Leah
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