The Daily Grind

Chances are you’ve unknowingly done it at one time or another in your life.  And for a small percentage of the population, bruxism (grinding one’s teeth) is a chronic problem — but one with solutions.

Bruxism, the medical term for the subconscious, habitual, nonfunctional grinding and gnashing of teeth, is a condition that many adults experience at some point in their lives.  However, according to the Canadian Sleep Society, it’s only chronic in about eight percent of adults and teens, three percent of seniors and 14 percent of children.  And, according to Dr. Victor Kutcher, ODA President-Elect and a periodontist practising in Burlington, while “grinding is common in children and is viewed as normal, in adults it’s pathological, meaning it may be indicative of a more serious disease.”

Some people grind their teeth during the day, but the majority of bruxers grind while sleeping, which is known as nocturnal or sleep bruxism.  And, adds Dr. Jerry Smith, ODA President and a dentist in Thunder Bay, “the great majority of people don’t know they’re grinding their teeth at night or even when they’re grinding.”

What happens during bruxism

“The forces that occur during bruxism are not vertical in nature, they are horizontal; the jaw shifts and slides from side to side,” explains Dr. Smith.   “And it’s these horizontal forces, mixed with the amount of time the teeth are together, that increase the likelihood of significant damage to the teeth and the supportive structures.”  For example, with normal chewing and swallowing, teeth come together for up to 20 minutes per day, with natural teeth exerting up to 44 pounds of pressure per square inch (psi).  But during bruxing, that pressure can soar to nearly 1,000 psi, and teeth can be together for hours, sometimes up to 40 minutes for every hour of sleep. Talk about the power for potential destruction!

Signs and symptoms

Because so many people grind while sleeping, it’s not uncommon for someone in the same room or bed to be the one who often hears the other person grinding and alerts the bruxer, states Dr. Smith.  Other tell-tale signs of a grinder?  Frequent headaches (especially in the morning) or earaches; sore jaws; jaw-clicking; frequent toothaches; sensitive teeth; facial pain; worn, broken or cracked teeth and/or fillings; (accelerated) gum recession; loose teeth; and indentations on the lateral borders of the tongue.

And, adds Dr. Kutcher, the damage from bruxism he sees in his clinic is “cumulative; it’s a time-dependent process, so if there is more wear on the teeth than one would expect for someone at a particular age, then assessing the issue may be necessary.”  What’s interesting to note, however, he says, is “many people seem to grind happily away and have no issues, while others will experience pain in teeth or muscles or joints.”

During bruxing, teeth may exert up to nearly 1,000 pounds of pressure per square inch (psi), which is the equivalent to the bite force of a lion.

lion

Causes and complications

The exact cause of bruxism is still a medical mystery. But, “it’s thought that physical or psychological issues are involved, and some of the suggested causes include: anxiety and stress, frustration or anger, type A personality, dental malocclusion [abnormal alignment of upper and lower teeth], response to pain and sleep issues,” says Dr. Kutcher.

Dr. Smith says some studies suggest there might be a genetic link to bruxism. As well, “some drugs may be associated with bruxism or thought to increase bruxism, including dopamine-related drugs, antidepressant drugs, sedative and anxiolytic drugs and drugs of abuse,” says Dr. Smith, though he cautions that “the literature is still controversial on this and is based mostly on anecdotal case reports.” The world-renowned Mayo Clinic adds that “smoking tobacco, drinking caffeinated beverages or alcohol and taking illegal drugs, such as methamphetamine or ecstasy, can increase the risk of bruxism.”  The clinic cites other potential physical and psychological causes may include stomach acid reflux into the esophagus, uncommon side-effects of some psychiatric medications, such as phenothiazines, and complications resulting from disorders such as Huntington’s disease or Parkinson’s disease.

Treatments

Nocturnal bruxism is thought to be a “central nervous system function,” says Dr. Kutcher.  And while many of us grind away and have no issues, so far there is no known cure “because we just don’t have a good handle on the exact triggers for bruxing in each person,” he says, adding, “so from a dentist’s perspective, the most effective method of dealing with bruxism is to interfere with the damage that is occurring to the teeth, and facial and mouth structures.”

If you do show evidence of bruxism and are experiencing signs or symptoms associated with bruxing, there are several treatment options you may want to discuss with your dentist.  “The best treatment is usually conservative in nature,” says Dr. Smith.  “In addition to repairing any damaged teeth and/or correcting obvious occlusion [bite] irregularities, a night guard (or splint) is fabricated for the patient, which may reduce bruxism, but will certainly prevent further tooth wear and damage,” he stresses.  The custom-made appliance is fabricated out of acrylic and must be worn every night, fitting over the upper or lower teeth.

“In some cases, medications for pain and muscle spasm are prescribed for the short term,” clarifies Dr. Smith.  As well, according to the Mayo Clinic, “Botox injections may help some people with severe bruxism who don’t respond to other treatments.”  The Canadian Sleep Society recommends physiotherapy, avoiding noise (TV or computers) in the bedroom and avoiding sleeping on your back (supine position) to help manage bruxism.
Self-care techniques may also be effective for coping with bruxism.  The Mayo Clinic suggests reducing stress and anxiety [yoga or meditation, for example], avoiding stimulating substances in the evening (caffeinated coffee or tea, alcohol and smoking) as they may worsen bruxism, practising good sleep habits (which may include treatment for sleep problems) and scheduling regular dental exams.

Bottom line? Don’t ignore bruxism.  It can cause significant damage if left untreated, warns Dr. Smith. And, he adds, remember that “only your dentist can diagnose bruxism, repair the damage and provide treatment that can aid in preventing further damage.”

Written by Jennifer D. Foster.  Reprinted with permission of the Ontario Dental Association and YourOralHealth.ca Magazine, 2014.

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