In this article:
- Bruxism refers to the excessive or involuntary clenching/grinding of the teeth during the day or at night.
- Teeth grinding is particularly common during childhood, but it can also affect adults irrespective of their age.
- Bruxism is caused by both physical and emotional/psychological factors, with misaligned teeth, stress, pent-up anger, and frustration being some of the prime culprits.
- Bruxism may not present any symptoms. Some people only become aware of the problem when they experience unexplained facial pain, toothache, or headache triggered by the repeated dental stress.
The involuntary tendency to grind, clench, or gnash your teeth, often without even realizing it, is medically referred to as bruxism. This condition is fairly common and can affect people of all ages.
The spasmodic jaw contractions exert recurrent pressure on the periodontal framework, which includes the teeth, muscles, tissues, and other areas around the jaw.
These contractions are similar to putting a weight of nearly 1,200 pounds on your teeth and underlying structures at frequent intervals.
The uncontrolled tightening of the jaw muscles causes your teeth to clamp together, which paves the way for considerable dental damage over time.
Types of Bruxism
Bruxism can affect you during the waking hours or when you are asleep, virtually at any time of the day.
Depending upon the time of occurrence, this condition is broadly classified into daily bruxism and nightly or nocturnal bruxism. Both these forms of bruxism are etiologically different and are recognized as two separate clinical entities.
Daily bruxism, or bruxomania, refers to the unintentional teeth clenching/grinding that you experience when you are fully conscious during the day.
Nocturnal bruxism is much more imperceptible as it occurs when you are in a state of slumber. (1)
It is especially common for the jaw to clench tightly during sleep, which may be accompanied by involuntary teeth grinding. This nighttime exacerbation of bruxism can interfere with your sleep and trigger other health problems. (2)
Bruxism in Children
According to a 2014 review the incidence of sleep bruxism in children of 0-12 years of age varies from 5.9% to 49.6%. (4)
Children usually go through a temporary phase of bruxing as their baby teeth or adult teeth begin to surface. They usually grow out of it by the time they enter their adolescence.
This kind of childhood bruxism is brought on by the rapid development of the teeth and jaw frame that occurs during the early years, which is part of the growing up process.
It can start as early as before age one or when the baby teeth first appear. (3)
The teeth grinding tends to progressively decline once the permanent teeth become fully mature, usually after the age of 14 years.
Moreover, children who show signs of increased anxiety, personality, or attention deficit/hyperactivity disorder (ADHD), and other parafunctional habits are more likely to grind their teeth than those who do not.
Bruxism mostly affects children during their sleep, but anxiety or nervousness can trigger this tendency during their waking hours.
Bruxism in children is typically asymptomatic, but it can become a cause of concern if it becomes a frequent occurrence.
Excessive teeth grinding throughout the day can result in tooth damage or jaw discomfort, and nightly aggravation of this condition can lead to major sleep disturbances.
Even though most children eventually stop grinding their teeth without any treatment, you may have to refer to your pediatrician if the condition becomes too severe or distressing for your child.
Associated myth: Bruxism only affects children and is an incurable condition.
Fact: Bruxism affects children the most, but this condition is not limited to them alone.
Adult men and women can develop this tendency at any age, but unlike children, they do not outgrow it naturally. Bruxism in adults is a clinically significant concern that requires proper treatment.
The teeth grinding that occurs in childhood is merely a developmental tendency that resolves on its own after the adult teeth become fully formed.
In other words, kids generally outgrow bruxism by the time they enter their teens, whereas adults require treatment for it.
What Causes Bruxism?
Teeth grinding can be a result of one or more of the following factors:
- People with misaligned teeth or abnormal jaw alignment are increasingly prone to bruxism.
- Excessive or incorrect dental restorations can also contribute to the development of bruxism.
- Certain other local factors that can pave the way for bruxism include occlusal trauma or periodontal injury, the buildup of periodontal calculus, deformed lips, loose teeth, and gingival overgrowth around the teeth (gingival hyperplasia).
Neurological and systemic factors:
- Drinking more than 6 cups of caffeinated beverages in a day since excessive intake can increase your likelihood of developing bruxism. (8)
- Unhealthy habits, including smoking, excessive alcohol consumption, and the use of recreational drugs, such as ecstasy and cocaine, are all recognized as contributing factors to the onset of bruxism.
- Neurological disorders that are characterized by sudden and involuntary tics or motor movements, such as Parkinson’s disease and epilepsy, can give rise to bruxism.
- People with down syndrome or those who suffer from parasitosis, brain damage, mental retardation or central paralysis are also more prone to developing this condition.
- Certain antianxiety drugs and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and some types of selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), have been associated with an increased incidence of sleep bruxism.
- Nocturnal bruxism often affects people who snore or have a sleep disorder, such as obstructive sleep apnea (OSA).
- Bruxism is a common occurrence in people who are prone to stress, nervous tension, frustration, or situational anxiety, as well as those who struggle with anger, pain, or overly-competitive tendencies.
- Bruxism has been linked with certain other systemic factors as well, such as allergies, gastrointestinal problems, unchecked enzymatic digestion, and nutritional deficiencies.
In such cases, your doctor will most probably switch your medication to a more suitable alternative or reduce your dosage. However, these changes do not guarantee a considerable improvement in your condition. (6)(7)(9)(10)
The following factors can also make you susceptible to bruxism:
- Insufficient intake of calcium, magnesium, and vital vitamins
- Chronic and parasitic colon diseases
- Breathing through the mouth
- Consistent and recurrent urinary dysfunction
- Hormonal changes during puberty (5)
Associated myth: Bruxism only stems from physical causes.
Fact: People generally associate bruxism with structural defects such as misaligned or missing teeth, an overbite, and other evident factors such as sleep disorders or the use of certain medications.
While all these contributing factors often play major roles in the development of bruxism, this condition can also be traced back to deeper psychological causes.
Emotional and mental dispositions have bearings on the development of such involuntary physical tendencies. People who are prone to stress and anxiety or suffer from mood disorders are more likely to develop bruxism.
Signs and Symptoms
Excessive clenching, grinding, or gnashing of teeth can chip away the tooth enamel and can lead to the following physical signs and symptoms:
- Grinding sound in your sleep
- Toothache, which tends to be particularly intense in the morning after you wake up
- Pain and stiffness in the facial muscles and around the temples soon after waking up
- Generalized tooth sensitivity, especially to extreme temperatures
- Soreness and pain in the jaw upon waking up in the morning or while chewing
- Ear pain
- Stiffness in the neck, which can result in neck pain
- Swollen or raised tissue on the inner lining of the cheek due to involuntary biting
- Teeth marks on the tongue
- Loose teeth
- Cracks and chips on the teeth, in extreme cases
Some other signs include spontaneous or repeated breaking or fracturing of existing restorative work in the patient’s mouth, which includes crowns, veneers, and fillings.
People with bruxism also usually struggle with the following emotional problems:
- Situational anxiety
- Eating disorders
Bruxism can also occur without any noticeable symptoms. In such asymptomatic cases, the patients remain oblivious of their condition until a family member hears them grind their teeth in their sleep.
If you experience radiating facial pain that stems from your teeth and extends up to your ear, accompanied by headaches and soreness in the jaw without any apparent reason, bruxism can be a possible cause.
In order to reach a conclusive diagnosis, your doctor will conduct a quick physical exam of your oral cavity to check for chipped or cracked teeth, teeth indentations on the tongue, or bite marks on the inside of the cheek.
The doctor may also order x-rays to assess the severity of the problem properly. Dental x-rays can reveal the extent of the dental and skeletal damage caused by repeated trauma.
While a general dentist can be a first contact for diagnosing bruxism, there are specialists such as oral medicine dentists, oral surgeons, or orthodontists who can make definitive diagnoses and render specialized treatment.
In rare cases that the bruxism has caused damage to the temporomandibular joint, surgical intervention is needed.
A serious case of bruxism can induce progressive dental damage, which can make your teeth structurally weakened, worn out, and extremely sensitive.
Moreover, excessive teeth grinding can leave your jaw painfully sore such that you are unable to chew properly without experiencing a great deal of discomfort.
People with such complaints are usually referred to a dentist to undo the tooth damage. The repair usually includes reshaping the chewing surfaces of the teeth or insertion of dental crowns to mend the damage.
The commonly prescribed medications for bruxism include:
- Muscle relaxants: Your doctor may recommend short-term use of muscle relaxants, usually to be taken before bedtime to reduce excessive muscle activity and spasticity during sleep.
- Medication for anxiety or stress: Your doctor may put you on a short course of antidepressants or anti-anxiety medications to manage stress or other emotional triggers that may be responsible for your bruxism.
Biofeedback is a noninvasive alternative therapy that uses an electronic instrument to monitor different physiological functions, (11)
The readings are used to modify or regulate the problem behaviors that may trigger involuntary or excessive muscle activity responsible for daytime bruxism. (12)
In severe cases of bruxism, when the patient does not respond to any other treatment, Botox injections may be administered to relax the masseter muscle, which is responsible for jaw movement.
The injection contains botulinum toxin, which can help control the involuntary grinding of the teeth and clenching of the jaw by weakening the underlying muscle.
Associated myth: Bruxism is untreatable.
Fact: Bruxism is a parafunctional habit that you do not have much control over. However, multiple treatment strategies can be used to resolve this condition.
There is no set etiology for bruxism, and treatment may vary depending upon the underlying cause and severity of the problem, as well as the age of the patient.
Your dentist will take into account all the relevant factors and outline an appropriate treatment plan accordingly.
How to Manage Bruxism
While little can be done to prevent bruxism in children who are sprouting new teeth, there are several tips and therapies that can help manage stress-related teeth grinding, both in children and adults
1. Self-Care Tips
- Avoid eating hard or dense foods such as nuts, candies, and steak.
- Avoid chewing gum as it can further stress your jaw muscles.
- Give up smoking.
- Minimize or completely avoid caffeine and alcohol during the evening to reduce teeth grinding during sleep.
- Maintain optimal fluid intake by drinking at least 7-8 glasses of water every day.
- You may also try physical therapy stretching exercises to relax the muscles and joints on each side of your head.
- Make concerted efforts to manage your daily stress, preferably by practicing relaxation therapies such as meditation, yoga, and deep breathing exercises.
- You can seek professional counseling if your bruxism is stress-related or to improve your sleep hygiene to avoid nighttime teeth grinding.
- Share your stress, anxieties, and frustration with your friends and family to unload the mental baggage.
- Try to identify stress triggers and avoid them as best as you possibly can.
- Use moist heat therapy to soothe the orofacial pain caused by bruxism. When you apply steam or a damp warm compress on the jaw area, the heat penetrates to the underlying muscles and helps them loosen up.
- Limit physically or mentally stimulating activities too close to bedtime.
Teeth grinding is usually more evident during sleep, and calming your mind before bedtime is one of the most effective ways to reduce the incidence or intensity of nocturnal bruxism.
The following bedtime measures can help you relax at night:
- Avoid any source of sensory stimulation too close to sleep time by switching off the television and other electronics several hours before you go to bed.
- Listen to calming music to put your mind at ease before you call it a night.
- A warm shower or bath before bedtime can help relax your body and induce peaceful sleep.
- Reading in bed is also an effective stress-buster as it takes your mind off the worldly tensions just before you fall asleep.
- Deep breathing exercises an hour before going to bed can help de-stress your mind and relax your tired muscles.
2. Splint Therapy
Your dentist may recommend splint therapy, which involves wearing a customized mouthguard or occlusal splint, as the first-line treatment for primary sleep bruxism.
Since its mostly worn during the night, the occlusal splint is often referred to as a nightguard.
This orthotic device comes in different designs, and your doctor will help you choose the one that is best for you.
The different types of mouthguards serve different purposes. Some are worn to reduce dental damage. Others are designed to prevent contact between the maxillary and mandibular teeth.
The occlusal splint covers both the upper and lower sets of teeth and keeps them from grinding against each other by acting as a buffer between them.
The use of an occlusal splint is well tolerated by most patients with bruxism as it helps to reduce the dental grinding noise and tooth damage associated with nocturnal bruxism without causing any undue side effects. (13)
People with obstructive sleep apnea (OSA) might experience increased respiratory distress while sleeping if they wear occlusal splints, and therefore are advised extra-precaution. (22)
Note: Although there are over the counter mouth guards available in the market, most dentists do not recommend wearing them as they are not customized to the patient’s teeth and can therefore cause further dental damage.
Massage therapy can work well as an adjunctive tool to release the tension in your masticatory muscles.
Besides helping your jaw muscles unclench, this kind of topical stimulation also has a pain-relieving effect as it activates the parasympathetic activity to thwart the transmission of pain signals to the central nervous system.
However, massage only works for bruxism if it is done right and in conjunction with other doctor-prescribed treatments such as wearing a mouthguard. (15)
Use gentle pressure and circular hand motions to massage the muscles of the neck, shoulders, and face for a few minutes daily, preferably before bedtime.
This kind of pre-sleep ritual can help reduce the frequency and intensity of teeth grinding during the night when used as part of a well-designed treatment strategy.
This was corroborated by a 2015 randomized clinical trial conducted on 60 subjects suffering from nocturnal bruxism. (15)
4. Muscle Stretching Exercise
Physical therapy for bruxism involves certain muscle stretching exercises that are specifically designed to: (16)
- Ease stiff or tense jaw muscles
- Improve muscle flexibility, structure, and/or function
- Reduce bruxism-induced pain
These exercises not only alleviate the discomfort associated with excessive teeth grinding or jaw clenching, but they also prevent frequent recurrence of bruxism.
While you exercise the muscle fibers, the adjoining structures such as the tendons, fascia, and nerves are stretched as well, making the entire jaw area more limber and comfortable.
One of the simplest single-step stretching exercises that can help relax your chewing muscles is a jaw exercise.
To do this, touch the frontal surface of your teeth with your tongue while opening your mouth as wide as comfortably possible.
It is also important to maintain a gap between your upper and lower teeth to avoid unnecessary clenching or grinding, except when chewing.
To that end, practicing mindful teeth placement can help you hold your mouth in a favorable resting position.
Simply roll your tongue to say the letter “n” such that the tip touches the roof of the mouth, and consciously maintain this kind of teeth placement to avoid clenching.
Note: Proper technique is important when performing these jaw stretching exercises to avoid any trauma. The risk of injury is relatively greater when you are stretching the masticatory muscles as opposed to the limb/trunk muscles, as they have smaller fibers that can rupture easily.
5. Herbs to Promote Good Sleep and Reduce Stress
The following herbs have no direct impact on the involuntary tendency of teeth grinding. However, they can help you relax, and they promote good sleep. People who sleep better are less likely to experience nighttime bruxism.
Valerian works as a muscle relaxant that can help de-stress your body and induce sound sleep when taken close to bedtime. (17)
Lavender is another herb that can be used as a mild sedative to promote deep uninterrupted sleep. It contains bioactive constituents that engender a calming effect on the nervous system and, thereby, put your body at ease. (18)
Teeth grinding during sleep is aggravated by nervous tension, anxiety, or stress. You can drink a cup of warm herbal tea before bedtime to prepare yourself for better sleep.
Therapeutic beverages such as green tea and chamomile tea can help relax your mind and body to reduce the incidence of sleep bruxism. You can use tea leaves or packaged tea bags to prepare the tea at home. (19)(20)
These herbs do not bring relief to bruxism directly but promote sleep and thus counter nocturnal teeth grinding. This kind of adjunctive therapy should be used along with other treatment option such as braces or clear aligner therapy like Invisalign, primarily to fix badly aligned teeth that can prove to be a big risk factor for bruxism.
How Long Does Bruxism Last?
Bruxism in kids rarely requires treatment, as it is mostly a reaction to newly emerging teeth. The problem ceases once the baby teeth are replaced by fully formed adult teeth.
Even though most children stop grinding their teeth by the time they enter their teens, some continue to brux well into adolescence.
Stress is also a common trigger for bruxism, both in children and adults. This type of teeth grinding is likely to last for as long as the stress persists.
How to Stop Semi-Voluntary Bruxism During the Day?
Daytime bruxism can be a habitual response to daily stressors, and it is usually semi-voluntary in nature.
The best way to manage stress-related teeth grinding or jaw clenching while awake is to practice relaxation techniques such as deep breathing, yoga, and meditation daily.
Bruxism is unlikely to pose any major health risk if treated timely, but long-term teeth grinding can give rise to some serious consequences, such as:
- Permanent damage to the teeth, periodontium, and oral lining
- Jaw or face pain
- Damage to the masticatory or chewing muscles
- Cervical pain
Extreme complications include:
- More severe cases of teeth grinding can lead to temporomandibular joint and muscle disorder (TMJ) as well as hearing disorders.
- Prolonged dental damage caused by untreated bruxism can eventually lead to complete tooth loss.
- Chronic stress-related bruxism is associated with an increased incidence of mood disorders such as depression and anxiety. (21)
When to See a Doctor
Early treatment is the best way to prevent any serious damage caused by excessive teeth grinding. So, if you notice any potential symptom of bruxism, visit your dentist for a thorough checkup.
The dentist will review your symptoms, examine your teeth and jaw for signs of teeth grinding, and recommend the proper treatment for your case.
What you may ask your doctor:
- What is the best way to reduce the grinding noise associated with bruxism?
- Should I worry about bruxism damaging my child’s baby teeth?
- Can the dental wear caused by teeth grinding affect my child’s appetite?
- How long will this problem last?
- Can teeth grinding be a side effect of any medication?
- What routine measures should I take to reduce teeth grinding?
- Is aligning my teeth an option for me to reduce or eliminate my grinding?
- Should I see a specialist for my teeth grinding?
What your doctor may ask you:
- Have you or your family members ever noticed your grinding sounds?
- Are you under any kind of personal or professional stress that may be responsible for your condition?
- How long have you been suffering from this condition?
- Do you have frequent headaches or jaw pain in the morning immediately upon waking up?