Tag Archives: bruxing

Bruxism? Sounds Uncomfortable – and Is

We’ve talked about bruxing before – habitual tooth grinding and clenching. It’s an unconscious act that can happen day or night, during sleep or waking hours. It sounds uncomfortable – and is, often leading to pain in the jaw, neck and shoulders. But even while awake, bruxers are usually oblivious to the noise that can sometimes put others on edge (and even keep bed partners from getting a good night’s sleep).

But why would someone brux anyway? Until fairly recently, there was a popular school of thought that poor bite alignment, known as malocclusion, was to blame. Yet while that idea has fallen into disfavor, there’s still no consensus on what makes people brux. Several triggers – including stress and medication side effects – have been identified.

tmj_painA study published last year in the Journal of Oral Rehabilitation verified what many dentists have long suspected: bruxism is related to temporomandibular disorders (TMD) and, by extension, depression. Although non-bruxers with painful TMD proved at higher risk for “moderate/severe depression and non-specific physical symptoms,” bruxers with TMJ problems were even more at risk. The authors couldn’t say that any one condition caused the others, only that they tend to occur together.

A slightly later study, published in Pain, likewise found an association between TMD and depression and anxiety, which the authors said should thus be considered risk factors for TMD pain.

Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination.

TMJ pain and its related problems aren’t the only trouble to come from bruxing. The constant grinding can cause physical damage to your teeth, too. It can wear them down and even fracture them. (Take a look at this gallery of suffering teeth.) Obviously, this has potential for financial pain, as well – but it needn’t come to that, not if we identify and address the issue early on.

A quick visit to the dentist could be the first step to relief. We have many options for pinpointing problems and assisting in treatment. If you’re experiencing pain associated with bruxing, controlling or stopping the behavior usually alleviates the symptoms, but the associated pain can be treated independently, as well.

For most people, a combination of behavior modification and splint therapy with a night guard or other appliance does the trick. Dr. E can steer you to the one that is most comfortable and best suited for your specific needs.

Most people get used to their night guards very quickly. But don’t get too attached. Many patients find that, in time, the need for their mouthpiece disappears.

As with devices for sleep apnea, there are over-the-counter night guards available. And just as with the apnea devices, they’re rarely effective. Most who use them experience no improvement and end up going to a dentist to get a custom splint, properly fitted and suited to their problem.

A helpful hint: Just skip that extra step and talk with your dentist first. It’s your quickest way to a solution.

Image by reallyboring, via Flickr

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What’s Bite Got to Do with It?

“Bruxism” is the dental term for the habitual, involuntary clenching and grinding of teeth, often during sleep. It’s also pretty common.

Physical and psychological stress are often the main culprits, but a variety of other factors have been suggested, too, including sleep disorders, SSRIs and other drugs, even parasitic infection. Many have thought bruxism can result when a person’s teeth don’t come together (occlude) properly – an attempt to self-correct the problem, even if it means wearing down the teeth for a more comfortable bite.

But according to a meta-analysis published earlier this year in the Journal of Oral Rehabilitation, the bite may actually have little to do with it. Having reviewed 46 relevant published papers, the authors say they found “no evidence whatsoever for a causal relationship between bruxism and the bite.”

Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism.

What’s more, malocclusion (“bad bite”) may not even play a “mediating” role between the grinding and the damage it does.

Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date.

Of course, malocclusion and bruxing can and do occur together. It’s just that there may not be a causal relationship between them.

For the individual who grinds, though, that may make little difference. What they know is how it affects them – the headaches; the face, neck and shoulder pain; the damaged teeth; the receding gums and tooth sensitivity; and so on. Usually, it’s the pain that leads people to seek help.

One of the most common and conservative measures for bringing relief is splint therapy, in which a special appliance is used to cushion the forces of bruxing. Since most grinding occurs during sleep, they’re often called “night guards.” Unfortunately, the mass market ones you can buy in a store are often of little help to serious bruxers. They grind right through them pretty quickly. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint provided by your dentist will fit your mouth precisely and normally last much longer.

Here’s what one of our patients had to say after just his first week of using a specific type of night guard called an NTI device:


Learn about other causes of jaw, face, head and neck pain


Image by Dr Parveen Chopra, via Flickr

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Natural Ways to Deal with Stress-Induced Teeth Grinding


Ever since the economic meltdown, the news has been peppered with stories about dentists seeing more patients who clench their teeth, grind and brux. According to a Chicago Dental Society poll, “Nearly 75 percent of dentists surveyed said their patients reported increased stress in their lives. And 65 percent of dentists said they have seen an increase in jaw clenching and teeth grinding amongst their patients.” As recovery from the recession appears to be slow-going, it’s no great leap to presume that these habits may become chronic.

There are several reasons for concern, not the least of which is the pain that can result – headaches and pain throughout the jaw, face and neck, even into the shoulders and upper back. Chronic clenching and grinding also damage the teeth over time, wearing down the biting surfaces or even chipping the teeth. Occulsion – how the teeth come together in a bite – also may be thrown out of alignment, which can further contribute to pain.

Moreover, the psychological stress itself may contribute to other dental problems. Research published last year in the International Journal of Dental Hygiene demonstrated that elevated stress increases the levels of inflammatory markers in the gingival crevicular fluid and of cortisol in saliva. Study subjects also had inflamed gums and more dental biofilm (plaque) on their teeth – conditions that pave the way for increased caries (cavities) and gum disease. Compounding these problems are the fact that, as research published in the Journal of Periodontology has shown, more than half of us neglect regular brushing and flossing when stressed.

Times like now, when national and global problems can contribute so much to our stress load – problems that we can’t do much about individually – it becomes more important than ever to do what we can to manage our stress and not let it get the best of us.

Some ways of managing stress can also help you reduce grinding and the damage it can do:

  • Eat well.
    Eating a nutritionally dense diet based on whole foods, including plenty of fruits and vegetables, can minimize inflammation while giving your body the nutrients it needs for good health. Avoid processed foods that are high in sugars and refined carbohydrates, as well as caffeine, which just adds to muscle tension when you’re under stress.
  • Get a massage.
    Therapeutic massage or other body work can help by both soothing the pain and loosening the muscles, working the tension out of the body. You can even massage your neck and jaw yourself to do this. If you choose to use a therapist, consider finding one who’s qualified to provide craniosacral manipulation, as it can be particularly helpful for releasing tension and easing pain in the face, neck and upper body.
  • Get some acupuncture done.
    Acupuncture can be used for general relaxation or for dealing with pain. In fact, more and more studies are showing the real benefits of acupuncture for reducing pain, including that associated with clenching and grinding, as well as TM joint disorders (TMD). Though many of us flinch at the thought of needles, when performed by a well-trained and qualified acupuncturist, the procedure is not at all painful or uncomfortable.
  • Take supplements before sleep.
    Most people who grind do so at night, so taking supplements to help relax both body and mind can help reduce the amount of nighttime grinding. Magnesium and calcium supplements taken together are wonderful for relaxing the muscles. Valerian root and chamomile are excellent calming herbs. Most bedtime teas include one or the other in addition to other calming herbs such as passionflower, lemon balm, mugwort, St. John’s wort and lavender.
  • Exercise.
    Exercise is well-known to reduce stress and anxiety, thanks in part to the release of endorphins: opiate-like neurochemicals that reduce pain and give the sense commonly known as a “runner’s high.” Also, moderate exercise keeps your body – including your immune system – strong and healthy, more resilient to stress. Activities such as yoga and tai chi may be especially helpful in that they combine both mental and physical processes, releasing stress.
  • Meditate.
    Taking a mental and physical time-out to slow down, breathe deep and focus beyond immediate problems and stressors can also provide for greater calmness and mindfulness – states that make us better able to deal with stress and problems in our daily lives. Some people choose prayer, while others choose zen-style meditation, and yet others may do guided visualization or any other sort of meditative activity. The key is to find the meditative style that works best for you.

Your dentist, of course, can also help. Typically, the first step is to provide you with a molded plastic mouthguard fitted to your teeth to help cushion and absorb the pressure from grinding. Using such a “night guard” – so called because it’s worn during sleep, when most grinding tends to occur – can often reduce the strength and frequency of headaches and other pain resulting from these behaviors.

To learn more about this topic and other treatment options, see “Why Your Jaw, Face, Head and Neck Might Hurt – and What We Can Do to Help” at drerwin.com.


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