Bruxism/Teeth Grinding

• Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
• Teeth that are worn down, flattened, fractured or chipped
• Worn tooth enamel, exposing deeper layers of your tooth
• Increased tooth sensitivity
• Jaw pain or tightness in your jaw muscles
• Enlarged jaw muscles
• Earache — because of severe jaw muscle contractions, not a problem with your ear
• Headache
• Chronic facial pain
• Chewed tissue on the inside of your cheek
• Indentations on your tongue

Causes

Doctors don't completely understand the causes of bruxism. Possible physical or psychological causes may include:

• Anxiety, stress or tension
• Suppressed anger or frustration
• Aggressive, competitive or hyperactive personality type
• Abnormal alignment of upper and lower teeth (malocclusion)
• Changes that occur during sleep cycles
• Response to pain from an earache or teething (in children)
• Growth and development of the jaws and teeth (for children)
• Complication resulting from a disorder, such as Huntington's disease or Parkinson's disease
• An uncommon side effect of some psychiatric medications, including certain antidepressants.

Risk factors

These factors increase your risk of bruxism:

• Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration.
• Age. Bruxism is common in young children, but usually goes away by adolescence.

Complications

In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:

• Damage to your teeth (including restorations and crowns) or jaw
• Tension-type headaches
• Facial pain
• Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth

Diagnosis

During regular dental exams, your dentist likely will check for physical signs of bruxism, such as:

• Unusual wear and tear on your teeth
• Continued breakdown of dental restorations, including loss of crowns
• Tooth fractures
• Tooth sensitivity

If you have any of these signs, your dentist will look for changes in your teeth and mouth over the next several visits to see if the process is progressive and to determine whether you need treatment.

If your dentist suspects that you have bruxism, he or she will try to determine its cause by asking questions about:

• Your general dental health
• Your daily medications
• Whether you routinely drink alcohol or caffeinated beverages, especially during the evening
• Your sleep habits, especially about any unusual grinding sounds heard by your roommate or sleeping partner during the night

To evaluate the extent of bruxism, your dentist may check for:

• Tenderness in your jaw muscles
• Obvious dental abnormalities, such as broken or missing teeth or poor tooth alignment
• Damage to your teeth, the underlying bone and the inside of your cheeks, usually with the help of X-rays

A dental examination may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint (TMJ) disorders, other dental disorders or an ear infection. If your dentist suspects a significant psychological component to your teeth grinding or a sleep-related disorder, you may be referred to a therapist, counselor or sleep specialist.

Treatments and drugs

In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't grind or clench their teeth badly enough to require therapy. However, if the problem is severe, treatment options include certain therapies and medications.

Therapies

• Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help your child to talk about his or her fears just before bed or to relax with a warm bath or a favorite book.
• Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.

1. Splints are usually constructed of hard acrylic and fit over your upper or lower teeth. Some dentists may make them right in the office, while others may send them to a laboratory to be made.
2. Mouth guards are available over the counter and from your dentist. Your dentist can make a custom mouth guard to fit your mouth. Mouth guards are less expensive than splints, but they generally don't fit well and can dislodge during teeth grinding.
3. Correcting misaligned teeth may help if your bruxism seems to be associated with dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and though it will correct the wear, it may not stop the bruxism.

• Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses.

During a biofeedback session, electrical sensors are applied to different parts of your body. These sensors monitor your body's physiological responses to stress — such as teeth grinding — and then feed the information back to you via auditory and visual cues. These cues may take the form of a beeping sound or a flashing light. With this feedback, you'll start to associate teeth grinding or clenching with stress and learn to change your behavior. You may also be given a portable biofeedback device that you use at home.

Medications

In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. Botulinum toxin (Botox) injections may help some people with severe bruxism who haven't responded to other treatments.

Lifestyle remedies

These self-care steps may prevent or help treat bruxism:

• Reduce stress. Listening to music, taking a warm bath or exercising can help relax you and may reduce your risk of developing bruxism.
• Talk to your sleep partner. If you have a roommate or bed partner, ask him or her to be aware of any grinding or clicking sounds that you might make while sleeping. Your sleep partner can then let you know if he or she notices any teeth-grinding sounds in the night.
• Schedule regular dental exams. Dental exams are the best way to screen against bruxism, especially if you live alone or don't have a sleep partner who can observe bruxism at night. Your dentist can best spot signs of bruxism in your mouth and jaw with regular visits and examinations.

References:

https://en.wikipedia.org/wiki/Bruxism

http://www.hse.ie/eng/health/az/B/Bruxism/Treating-teeth-grinding.html

http://www.colgate.com/en/us/oc/oral-health/conditions/bruxism

http://www.jawpain.ie/index.php/bruxism-grinding-and-clenching

https://sleepfoundation.org/sleep-disorders-problems/bruxism-and-sleep