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Grinding Teeth (Bruxism)

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Oral Appliances

What is it?

Sleep related bruxism involves the grinding or clenching of teeth during sleep. It is common for the jaw to contract while you sleep. When these contractions are too strong, they produce the sound of tooth grinding. This can cause dental damage by wearing the teeth down. In most severe cases, hundreds of events can occur during the night. In milder cases, the grinding may vary from night to night.

Severe bruxism may briefly disturb your sleep. Only at rare times will it cause you to fully wake up. Loud sounds caused by the grinding of teeth can be very unpleasant. This can also disturb the sleep of a bed partner. It can occur during all stages of sleep. It is most common in stages one and two of non-REM sleep.

The following are signs of bruxism:

  • Tooth pain
  • Jaw muscle pain
  • Mouth and facial pain
  • Limited jaw movement
  • Damaged or worn teeth
  • Sore gums
  • Headaches

Who gets it?

You may not know that you have it unless a family member or bed partner hears the noise. The rate of bruxism seems to be highest in children. About 14% to 17% of children have it. It can begin as soon as a child’s upper and lower teeth have come through the gums. Around one third of children with bruxism will still have it when they are adults. About 8% of young to middle-aged adults have it. The rate continues to decrease with age.

Some people may have it every night for most of their lives. Dentures that are often used in the elderly may dampen the sound of grinding. This can keep the bruxism from being detected. It seems to affect men and women at the same rate. It does tend to occur in families. From 20% to 50% of people with bruxism have at least one family member with a history of grinding his or her teeth.

Your personality type can raise your chance of having bruxism. People who are highly motivated and driven tend to have a higher rate of it. It can also be caused by stress and anxiety. This may be due to a life event or pressure at school or work.

The use of cigarettes or caffeine before sleep may increase tooth grinding.

Secondary sleep related bruxism is often found in children with cerebral palsy and mental retardation.

How do I know if I have it?

1. Do you grind or clench your teeth while you sleep?

2. Do you have one or more of the following signs?

  • Damage or wear to the teeth
  • Jaw discomfort, fatigue, or pain
  • A locked jaw when you wake up

If you answered yes to these questions, then you might have sleep related bruxism.

It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

Do I need to see a sleep specialist?

You should not be alarmed if you only grind your teeth from time to time. But regular tooth grinding can cause serious damage. Talk with a family doctor about your problem. Your doctor or a counselor can help you find ways to deal with the stress that may be causing the bruxism. You may also need to see a dentist if your tooth grinding is severe.

What will the doctor need to know?

First, the doctor will need to know when your bruxism started. He or she will also want to know what else has been going on in your life. Share with your doctor about any sources of stress that you are dealing with. The doctor will need to know your complete medical history. Be sure to inform him or her of any past or present drug and medication use. Also tell your doctor if you have ever had any other sleep disorder.

Keep a sleep diary for two weeks. The sleep diary will help the doctor see your sleeping patterns. This information gives the doctor clues about what is causing your problem and how to correct it.

Will I need to take any tests?

Your doctor may have you do an overnight sleep study, but this is rarely needed to detect bruxism alone. This study is called a polysomnogram. The polysomnogram charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. This will show if there are other disorders, such as sleep apnea, that are causing your sleep problems.

The best sleep study will also record your sleep on video. This will help show if you grind your teeth or do anything unusual during the study.

How is it treated?

An oral appliance can be used to protect your teeth while you sleep. It is usually made of soft plastic and fits over your teeth like a mouth guard. Some are made so you can mold them at home to fit your mouth. You simply boil the device and then bite down to shape it to your mouth. Most of the time, however, you will need to go to a dentist for a proper fitting.

Stress often causes bruxism or makes it worse. You can make efforts to reduce or manage the stress in your life. This can help prevent bruxism and reduce the jaw pain that results from it.

There are many ways to handle stress. Self-help strategies are common. Relaxation training and biofeedback may also be helpful. These are types of cognitive behavioral therapy. A counselor or therapist may also be able to help you.

Reviewed by Donald R. Townsend, PhD
Updated May 16, 2006


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