Bruxism

 

   
 
 
by Beverly Presley-Nelson, D.D.S.
 

Bruxism—Clenching and Grinding

  
 
Do you clench or grind your teeth? Many patients can answer that question with a resounding "Yes!" Others are unsure but suspect that they may do so unconsciously and/or in their sleep.
  
 

So what? So what if grinding or clenching of the teeth occur?

  
  The answer to that question is damage. Bruxism can damage the teeth, the supporting structure of the teeth (the periodontium) and the Temporo-Mandibular-Joint (TMJ), which is the "hinge" between your upper and lower jaw.  
 

How can one tell if they are bruxing? If you clench or grind while sleeping, someone may report hearing or seeing you do it. If not, signs that you are bruxing in your sleep are tired jaw muscles upon waking, TMJ pain or very sensitive teeth. Sometimes headache in the temporal area may be a clue. "Catching yourself" clenching or grinding during waking hours is possible once you know that it is a harmful habit. Teeth were only meant to touch during chewing. The rest of the time, the jaws should be at rest with the teeth slightly apart (2-4 mm). This is called "Freeway Space" and is what our anatomy was designed for.

Our teeth are encased in bony crypts or sockets that are lined with many tiny suspension cords (like rubber bands). This system is called a periodontal ligament (PDL). The PDL allows movement and provides cushioning for the teeth. If you keep clenched together, the teeth are always jammed down hard into their sockets and damage can occur. Let those teeth rest and float on their suspension systems except for when chewing food. Amazingly, that adds up to only about 10-15 minutes of socket compression a day. If that's all the system was build to bear, imagine the destruction that can come from the overload of constant tooth contact. Not only can the PDL, gum tissue, and bone support be broken down, but the teeth themselves can wear down. Flattened and worn areas occur on teeth as well as chipping and thinning, or even cracking. Enamel rods can be "plucked" out of cuspal areas, leaving holes. Enamel rods may "ping" away at the neck of the teeth, leaving those deep "cuts" in the dentin near the gum line that dentists call abstractions. Imagine also, the effect on a joint that doesn't have rest and healing time. The TMJ can suffer also.

People respond differently to bruxism and the forces applied vary. Some patients will suffer with joint problems, others will instead have tooth or periodontal damage. Long term, untreated bruxism can result in a combination of probems in the three areas.

  
  What can be done about it? If you clench or grind consciously, make efforts to stop. If you brux at night, get a night guard and wear it as soon as you can. It is a retainer-like device that is easily tolerated and protects your teeth from wear. It keeps the jaws apart a few millimeters so you can't compress your jaw joint completely. It helps to even out a bad bite. In some cases, it can help interrupt the habit. Other people may just grind against the guard, at least sparing the teeth and keeping the joint uncompressed. Relief from many symptoms can be had from a properly made night guard that is custom fitted to even out bite problems and ramp forces along stronger teeth. Some people wear a "night" guard while on the computer or commuting to work. A softer homemade sports guard may help short term in an emergency, but is not as therapeutic as a well-made professional one.  
 

What causes clenching and grinding? The cause of bruxism is explained in theories only, due to the difficulty of controlling the variables for formal study. Stress may be a factor. A kind of neurological "tic" may be suspected. Unconscious attempts to even out a bad bite may be a culprit. The irritating sensation of sinus pressure (especially in children whose sinuses are convoluted and poorly drained) has been suspected. Even skeletal misalignment and psychological issues from abuse have been proffered as a cause. If a simple night guard does not abate the problems, referral to a specialist or a "bruxism" clinic at the dental school may be necessary. There, an MRI or special x-rays may offer valuable joint information. Biofeedback, counseling, and/or an orthotic device to reposition the jaw may be needed.

Bruxism is a serious dental and head and neck problem and should not be ignored. Please tell us if you may be clenching or grinding.