Overview
Many people can find themselves clenching their jaw or grinding their teeth especially if they are feeling a strong emotion such as feeling angry, afraid or stressed. It’s an involuntary response but they are aware that they are doing it and it only happens when they are awake.
Bruxism is a condition where a person can either clench their jaw or grind their teeth during their sleep, or sometimes less commonly whilst they are awake. Whist anyone can develop the condition generally it occurs most often in childhood, adolescence or in young adults. There are two types of bruxism, primary when the condition occurs on its own, or secondary, when it is caused by another condition or medication.
People who have bruxism whilst they are awake don’t always need treatment, as if they are aware that they are doing it, and it is stress or anxiety related, they can learn ways to manage and reduce their stress or anxiety. For people who only have symptoms when they sleep, it can be harder as they are not always aware that they are doing it and they are more likely to need treatment. This is because the longer it goes undiagnosed the more problems it can cause.
Causes and risk factors of bruxism
Dentists and doctors do not fully understand what causes a person to develop the condition, but it is believed that a number of factors are responsible and that these can vary dependant on the type of bruxism a person has. Whether it’s primary bruxism that occurs on its own or secondary bruxism that occurs because of another underlying health condition. These factors can be genetic, physical or psychological as well as being due to a person’s lifestyle choices.
Causes for both types of bruxism can include:
· Drinking alcohol and smoking which can make you twice as likely to develop the condition
· Having a high caffeine intake, so drinking more than six to eight cups of coffee a day
· Using non prescriptive or recreational drugs
· Certain prescribed medications including SSRI’s (selective serotonin reuptake inhibitors) and other types of antidepressants and antipsychotic medications
· If you are a heavy snorer
· Your personality type can also be a factor, if you are very competitive person, hyperactive or aggressive you could be at greater risk
· Having a misaligned bite, crooked or missing teeth or other cause of irritation in the mouth
· If you suffer from mental health conditions such as anxiety, stress, depression or emotions such as anger or frustration, all of which have been shown to have a significant association with the condition
· Neurological conditions such as Parkinson’s and Huntingdon’s disease can cause sleep movements and disturbances which can result in bruxism
· Sleep apnea, a condition that causes the breathing to drop or stop frequently, but temporarily during sleep which results in a poor sleep cycle, also increases your chances of developing the condition.
· Young children are forty percent more likely to have bruxism whilst their teeth are developing. This is because during childhood the teeth and jaw grow quickly. This doesn’t usually cause any lasting damage and resolves itself over time.
Symptoms of bruxism
Symptoms can vary amongst individuals both in severity and duration. The most common of these include:
· Damage to your teeth including wear to fillings or teeth, broken teeth or tooth loss
· An increase to already existing tooth pain or sensitivity
· Grinding of the teeth or clenching of the jaw
· Damage to the inside of your mouth where you have bitten or chewed your cheeks or lips, which can result in scarring or injury to the tongue
· Pain in the ear that feels like earache but is caused by bruxism rather than an infection
· Face, neck, shoulder and jaw pain
· Headaches and ringing in the ears known as tinnitus
· Muscle tightness and tiredness in the jaw
· Difficulty opening and closing your mouth, pain or discomfort when eating
· Sleep disturbances
· Inflammation or bleeding of the gums
· Noises in your jaw, like popping, clicking or grinding
Associated conditions or risks
Whilst milder forms of bruxism may not even require treatment and generally the condition doesn’t result in serious problems, severe cases can result in:
· Disorders that occur in the temporomandibular joints which are located in front of your ears, commonly referred to as TMJ’s or TMJ syndrome. This can cause both pain and clicking or popping noises when you either open or close your mouth
· A condition called lock jaw where you are unable to either fully open or close the jaw
· The jaw to dislocate
Diagnosis and treatment for bruxism
Generally people initially become aware of the fact that they grind their teeth or clench their jaw because either their partner tells them, or their dentist notices early signs of the condition during their dental check-ups.
If they see signs that the condition is progressing they might ask you questions about your general health, sleep habits, daily routines or about any medications you take. They will also need to rule out any other medical or dental disorders that could be responsible including TMJ disorders. If they believe that the condition may be related to your mental or physical health they can suggest you see your doctor, your treatment will depend on the underlying cause of your bruxism.
Dental treatments
Your dentist could suggest that you might benefit from using either a mouthguard or mouth splint. They help by evening out the pressure across the jaw and protecting the teeth from further damage and wear. They can also help to reduce the noise that you make when grinding your teeth. They are tailor made by your dentist to fit your teeth either your bottom or top depending on whether you have a guard or splint. Your dentist will discuss which option they think will work best for you. You can by sports guards, but it’s not recommended you use these for bruxism as they are not designed for that purposes, so are likely to be uncomfortable and could cause further damage.
If your bruxism has caused extreme damage to your teeth your dentist may need to repair the damage by using crowns or replacing missing teeth.
Medical treatments
Your doctor can diagnose any underlying mental or physical cause for your bruxism and suggest a suitable treatment plan.
If they think you might have sleep apnea, they can refer you to a sleep clinic where they can perform tests by monitoring your breathing when you sleep. By doing this they can see if you require a continuous positive airway pressure machine also known as a CPAP machine. This will help to reduce your breathing disruptions whilst sleeping which can help improve your bruxism.
If you are suffering with anxiety, stress or depression your doctor can prescribe medicine to help with this, as well as ensuring that you are not already taking prescriptive medications that might be causing your bruxism.
The condition gastroesophageal reflux disease known as GERD can also cause bruxism so diagnosing and treating this condition can help to reduce bruxism symptoms.
In extreme cases it has been known for doctors to prescribe Botulinum toxin injections more commonly referred to as Botox. These can help by temporarily relaxing your jaw muscles, which can also help relieve pain. In order to maintain these results you will need to have treatment every three or four months.
Psychotherapy and CBT (cognitive behavioural therapy)
You could also try therapy to help with bruxism especially if it is related to conditions such as anxiety, stress, depression or sleep problems. Talking therapies and CBT can help you to identify the underlying reasons for all of these conditions as well as identifying negative thoughts and behaviours. They can also help you to change negative reinforcements and replace them with positive ones.
Lifestyle changes to help manage your bruxism
Other than following your doctors’ advice and treatment, there are several ways that you can help yourself to manage or reduce your symptoms, these can include:
· Avoid chewing gum as this encourages you to clench your jaw and grind your teeth. Also avoid habits like chewing things like pencils
· If you don’t sleep alone, ask your partner if they are aware of issues such as snoring, or any noises you make in your sleep like clicking or grinding that you may not be aware of
· Try to cut back on your alcohol, tobacco and recreational drug use, as well as the amount of caffeine, chocolate and soft drinks that you consume
· Try to reduce your stress levels, you can do this by listening to music, practicing mindfulness or yoga, exercising regularly or taking a warm bath before bed.
· You could also hold something warm against your cheek or earlobe to help try and relax your jaw muscles before you go to sleep, or try facial relaxation techniques or massaging the face neck and head
· Develop a good sleep routine by going to bed and getting up at the same time, ensure your room is dark and that there is nothing to interrupt your sleep. Avoid caffeinated drinks or alcohol late at night
Make sure you see your dentist on a regular basis as they are often the first people to spot signs of bruxism and to make a diagnosis of the condition as well as being able to suggest treatment or monitor ongoing treatments. Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.