By Michael Heffernan

Bruxism (Tooth Grinding) and Dental Health

Most people show some amount of chewing or clenching movements when they are asleep, but the difference with Bruxism, also known as tooth grinding, is that the frequency and the forces are far greater, leading to problems in dental health.

So, what is Bruxism, how can we treat it, and how exactly does it impact our dental health? 

In sleep, we lose the conscious awareness of the pressure we are placing on our teeth, and this can mean the maximum voluntary biting force achieved during the day can be easily doubled at night, and with no protective feedback mechanism, this biting force can cause muscle pain (facial myalgia), Temporomandibular joint (TMJ) pain (leading to TMD), cracked tooth syndrome and even worn, loose teeth or damaged crowns, fillings, and implants. TMD may mean that a person suffers from clicking jaw joints or limitation in how far they can open their mouth without locking or pain. 

Because the majority of sleep bruxism occurs early in the sleep cycle, it could be that bed partners do not notice the grinding and clenching effects, so sufferers may be unaware of bruxism until their dentist picks up on the tooth damage. 

Bruxism is often associated with high levels of stress and anxiety. Therefore treatment of bruxism can be challenging as it is not always easy to remove or manage stress in our lives. 

The great attritional forces from bruxism can compound the damage done to teeth if there is acid in the mouth from either pre-sleeping alcohol or from acid reflux in the form of GORD/GERD. This softens the outer enamel and with teeth-grinding the softened enamel chips away leading to tooth sensitivity and compromised teeth. Therefore although bruxism can not easily be stopped, methods to ameliorate the damage caused is key. 

The most straightforward approach is to use either a soft or hard mouthguard. These can be bought over-the-counter or fabricated by your dentist. The soft ones are less expensive and a good starting point. They help to relieve the pressure on the jaw joint (TMJ) and protect the teeth. However the soft appliances can cause people to want to chew on them more aggravating muscle pain and prevent sleep. Some bruxers will chew through the soft appliances too! 

Hard occlusal guards come in the form of “Michigan” splints or “Tanner” appliances and these are custom made by dentists. They are more rigid and tend to control the bite more favorably. They also help prevent changes in the bite that can happen with soft appliances and are more easy to clean. 

Alternatively medications can be provided in the form of antidepressants or muscle relaxants (benzodiazepines like “diazepam” or “temazepam”) can help sleep and reduce muscle tone. Low doses of “amitriptyline” (tricyclic antidepressants) have been prescribed to help but a study in 2008 by Alkan et al found that a hard splint was more effective in the treatment of bruxism and avoiding medication avoids the unwanted side effects of any medication use. 

More recently bruxism has been treated with botox and this has the benefit of reduction in muscle pressures as well as reduction in muscle mass; when patients have been clenching for many years they can end up with large prominent cheek muscles that some patients do not like the appearance of and botox decreases this masseter muscle prominence “hypertrophy."

So, you see, there are many ways your dentist can help relieve the damage of Bruxism, as well as other sleep disturbances.

Dr. Heff's can help as well...

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They are ideal for people that suffer from dry mouth as they help to stimulate saliva and the mint leaves the mouth feeling fresh and clean. They are scientifically tested by international dental schools, recommended by dentists, and endorsed by Toothfriendly International. 

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Take care,

Dr. Mike Heffernan and Team Heff