Unbeknownst to many who suffer with it, the condition of grinding our teeth is actually known as bruxism – during the day, we may unconsciously clench our teeth together, while at night this condition makes us clench and grind them. And while teeth are obviously involved, sleep bruxism is considered a sleep-related movement disorder; in fact, people who clench or grind their teeth during sleep are more likely to suffer from additional sleep disorders such as snoring and pausing during breathing (also known as sleep apnea). Mild cases usually do not require immediate treatment, but in some patients the problem can be frequent and severe enough to yield disorders of the jaw, headaches, damaged teeth and other issues.
It is important to know the signs and symptoms, and to seek professional dental care if you exhibit one or more of them.
Before we delve into the specifics of what causes teeth grinding and the treatments available, including a special mouth guard, let’s first take a look at the stress factor associated with what we’re discussing here. Interestingly, Dr. Sherman of Park Avenue Dental has had the pleasure of speaking with dentists from all over the world, and during some lectures he often asks, “In dental school…what were you taught were the primary causes of bruxism?” Almost always there are one or two dentists who say something to the effect of, “occlusal interferences,” but the vast majority of them often shout out, “STRESS!”
Of course, these dentists were referring to emotional stress, and there is indeed evidence that some patients will grind and clench their teeth episodically because of events in their lives that are stress-inducing. Yet for dentists treating patients with obstructive sleep apnea, they often make a connection between nocturnal (nighttime) bruxism – including clenching and grinding – and an attempt by the patient’s subconscious to protect the airway during sleep. Dr. Sherman has looked at many patients and noted the grooves on their tongues from the tongue attempting to escape the confines of the mouth in order to get out of the airway, thus leading to conclusions about sleep apnea.
While Dr. Sherman and other professionals screen patients for possible sleep apnea-related bruxism, they have also come to the conclusion that many of these patients grind their teeth when they sleep because of stress…the stress of not breathing.
Causes of Bruxism
Most of us grind our teeth from time to time for various reasons. This occasional teeth grinding does not usually cause harm, but when teeth grind on a regular basis they can be damaged, with other oral health complications not far behind. Why do we grind our teeth? Although teeth grinding can be set off by stress (as we focused on above) and/or anxiety, it is more often caused by an abnormal bite during sleep or missing teeth.
While some doctors claim they don’t completely understand what causes bruxism, dentists such as Dr. Sherman of Park Avenue Dental have come to the conclusion that physical or psychological causes may include:
• Emotions, such as anxiety, stress, anger, frustration or tension
• Aggressive, competitive or hyperactive personality types
• Abnormal alignment of upper and lower teeth (malocclusion)
• Other sleep problems such as sleep apnea
• Response to pain from an earache or teething (in children)
• Stomach acid reflux into esophagus
• Uncommon side effect of some psychiatric medications such as phenothiazines or certain antidepressants
• A coping strategy or focusing habit
• A complication resulting from a disorder such as Huntington’s or Parkinson’s Disease
Some RISK FACTORS associated with the problem include:
• Stress – Increased anxiety or stress can yield teeth grinding, as can anger and frustration (touched on above).
• Age – Teeth grinding is common in young children, though it normally disappears by the time teen years arrive.
• Personality Type – Aggressive, competitive or hyperactive personality types, as also documented above, are susceptible to the teeth grinding we’re focusing on here.
• Stimulating Substances – Smoking tobacco, drinking caffeinated beverages or alcohol or taking illegal drugs such as Ecstasy or methamphetamine may increase the risk of teeth grinding at night.
Treatments for Bruxism
Recommended treatments for grinding teeth include behavioral therapies and the utilization of mouth guards or mouth splints. Other treatments, such as muscle relaxation exercises and sleep hygiene measures, may also contribute to managing these symptoms. Let’s take a closer look at some of these…
• Mouth Guards and Mouth Splints
When we grind our teeth as we sleep, a mouth guard or mouth splint worn at night could propose a viable response. These devices even out the pressure across the jaw and create a physical barrier between the upper and lower teeth as to protect them from additional damage. Further, they can also reduce any grinding noises exhibited at night.
Mouth guards are similar to those variants used in sports such as boxing, and are usually crafted from bendable rubber or plastic which is made by a dentist to fit an individual patient’s mouth. While these guards are available at local pharmacies, they are unlikely to fit as well as one made by a dentist such as Dr. Sherman at Park Avenue Dental.
A mouth splint – also referred to as an occlusal splint or bite plate – is made from harder plastic and fits precisely over the upper or lower teeth. In terms of reducing the symptoms of teeth grinding, one approach isn’t more effective, necessarily, than the other; mouth splints tend to last for years whereas mouth guards usually last for less than a year, but mouth splints are more expensive.
• Treating the Underlying Cause via Cognitive Behavioral Therapy (CBT)
Psychological treatments can, of course, be used to treat any underlying psychological problems such as anxiety and stress…and indeed this is useful when talking about bruxism, because these can be what causes the grinding of teeth.
CBT aims to help you manage your issues by changing the way you think and act – a specially-trained therapist will encourage you to talk about how you view yourself, the world and others, as well as how your actions affect your thoughts and feelings. If teeth grinding is stress-related, it is indeed important to relax and get a good night’s sleep.