Teeth grinding (Bruxism)
At least one in two people express their worries and stress at night through grinding and straining of the teeth. This involves either teeth being clenched together, or chewing motions being repeated between upper and lower jaw. The chewing surfaces of the teeth count amongst the victims of this action. The first steps to take to remedy this issue include using mouth guards (bite guards) and mouth splints.
We tend to think over our problems and concerns in the night time. These psychological stresses and process often lead to tension in our body’s muscles.
That is how the chewing muscles, normally responsible for breaking up food working with the teeth in the jaw, become tensed and teeth are ground against each other.
The patient generally doesn’t even know this is happening. Usually, it is the partner that is disturbed and woken up by loud grinding sounds produced by the teeth during sleep. A diagnosis can be established by the dentist during a routine check-up appointment e.g. based on the cusp profile of the teeth surfaces, to know whether any given case involves bruxism.
Bruxism: a parafunction like lip-biting or nail-chewing
Bruxism, or grinding of the teeth, is classified by dentists as a “parafunction”. “Para” tends to mean something like “incorrect” or “contrary”. Thus, parafunction refers to a malfunction of the chewing apparatus. This parafunction is multifactorial, i.e. there are many different variables which may contribute to causing it. Causes include poor contacting, over-active chewing muscles, and jaw bone differences between the right and left jaw joints. A common cause comes down to psychological factors. Inner tension, stress from work or in your private life. These habits also serve as a kind of emotional pressure relief valve. Habits also fall under the category of parafunctions. Habits include actions like thumb-sucking in children at later ages, nail-biting, chewing the inside of your cheeks, or lip-biting.
Where only the mucosa layers of the skin are affected by lip-biting or chewing of the inner cheek, in the case of grinding of the teeth, the chewing surfaces themselves are actually worn away. Tooth enamel, which is actually meant to protect the dental nerve from exterior influences, such as the cold, is worn away more and more. This is particularly easy to see in the front teeth and the canines.
These natural humps and bumps are ground down by a forward and backward motion of the upper and lower jaws, just like a slide. Many people not only grind their teeth at night, but also clench their teeth together with tremendous force. The chewing muscles are trained over an entire lifetime and develop immense strength. Even the robust design of the tooth cannot, however, oppose this great strength. Cracks form in the enamel, and teeth even become bent. Due to this bending force applied to the tooth, some parts of the tooth may break away at the thinnest and weakest points. This is in the neck of the tooth, or the “dental cervix”. These become thinner and thinner and eventually can no longer protect the tooth from outside influences such as the cold, and this leads to pain.
Unconscious grinding of the teeth is not only damaging to the chewing surfaces of the teeth, and the tooth neck, but also the periodontium. The periodontium forms the structures that surround and support the tooth. This is where the tooth is fixed into both the jaw and the gums. As a result of clenching and grinding of the teeth, the periodontium is exposed to excessive forces, which can lead to loosening or inflammation. Many patients who experience night-time grinding of the teeth also report muscle pain in the morning in the affected area. This can also lead to the chewing muscles becoming tense, causing patients to experience head and neck pain.
“We meet patients on a daily basis in our practice who report tenseness, stress, headaches and psychological strains. As dentists, we can diagnose these problems quickly and we are delighted to be able to help to alleviate patients’ teeth-clenching problems using made-to-measure plastic mouth guards.
Dr. Sarah Kästle, Dentist at the Dr. Hager Dental Practice
Night-time chewing activity can have many different causes. Doctors refer to multifactorial causes in this instance. Even the expression “the daily grind” can give a hint of the problem we are faced with here: something repeated, tiresome, something that wears you down! Crooked teeth, uneven jaw joints, or poorly positioned fillings are just a few examples. Results from various studies show that women between the ages of 30 and 50 years are particularly affected. They are often under a great deal of pressure. Over a longer period of time, a poor bite can result. Night-time tooth grinding, where a great deal of force is applied to the jaw by the chewing muscles, is accompanied by particularly unpleasant consequences. This is where patients can truly fall into a vicious cycle, where first symptoms such as headaches and pains in other muscles groups such as the neck can be followed by acute pains over the entire body, even causing sleep apnoea syndrome. Unconscious teeth grinding, mostly during the night-time, is particularly evident on individual teeth with polished (worn down) chewing surfaces.
Causes of bruxism can include:
- Excessive stress
- Problems at work
- Issues in your private life
- Financial problems
- Addictive substances, such as nicotine or coffee
Initial treatment of patients with bruxism is generally with a mouth guard. This mouth guard treatment is a completely symptomatic treatment. The mouth guards used in bruxism treatments have many different names within the dentistry field. As such, they may also be referred to as bite guards, mouth splints, night guards, stress guards, teeth guards etc.
They are made from plastic and have the functional purpose of dissipating the tension created by the chewing muscles of the affected person, whilst at the same time preventing the grinding of tooth on tooth. In this way, mouth guards represent two different treatment approaches.
On the one hand, chewing muscles are relaxed. Muscle groups in the head and neck area are overloaded by the chronic tooth grinding. This begins with sore muscles the day after, and with repeated long-term stressing of muscles due to bruxism, the fibres of the chewing muscles can become altered, causing hardening and inflammation in the region of the muscles. This over-stressing leads to inflammation of the jaw joint moved by these muscles, and finally inflammation of the muscles themselves. Occasionally cracking sounds can be made made in the jaw joint due to this action. Mouth guards prevent the complete contraction of the chewing muscles by maintaining a distance between the two sets of teeth. Chewing muscles are only able to generate their powerful forces through complete contraction. The mouth guard has a thickness of up to 2 mm which prevents this maximum tension being achieved in the night-time.
Protection against chipping of healthy teeth
On the other hand, the main function of mouth guards is to protect the natural tooth edges against wearing of the tooth surfaces. Often, just with the grinding movements of the teeth across the front teeth and canines, the teeth can be reduced to such as extent that it may no longer by considered aesthetically pleasing. In order to halt this process, a mouth guard will help in the first instance. If the patient is also looking for an aesthetic solution, the patient can look into veneers or crowns. Where the side teeth are affected, ceramic inlays or crowns may help.
How mouth guards are manufactured
Mouth guards are quite similar to braces. In the case of mouth guards, only the tooth chewing surfaces are covered. The gums are not affected. For this reason, speech is not affected. The PMMA plastic used by dentists when creating this treatment solution means the mouth guards are very hard wearing. The mouth guard is often created for the upper jaw. Once a diagnosis has been confirmed, the first treatment appointment involves taking impressions of the teeth. Following this, heated PMMA plastic plates are pressed onto the impressions using a vacuum pressing machine in the dental laboratory.
The mouth guards are then cut and formed from the plastic plates. The mouth guards are then finished by the dental laboratory technicians using polishers, to then be fitted for you by a dentist in a second appointment. The patient will experience noticeable improvements in their jaw and muscles over the course of the following days.
In exceptional cases, mouth guards can also be sent to patients by post.
Frequently asked questions
Can night-time tooth grinding lead to headaches?
Yes, and headaches aren’t the only symptoms. Patients can also suffer from muscular tension in the area of the entire head and even in the shoulders. It may also cause pain in the teeth. These are usually short, sharp pains due to the exposed tooth necks.
How can I notice whether I grind my teeth at night or not?
When a person grinds their teeth or clench them together, we call this bruxism. There is, however, a difference between grinding and clenching. During grinding of the teeth (which may occur in the day or in the night-time), the two sets of teeth rub back and forth against each other, i.e. the lower jaw is moved around in all directions with contact of the tops of the teeth. This leads to the tops of teeth being worn away, and leaves clear visual signs as a result which your dentist can identify. In cases of clenching, however, those affected bite down with their teeth with all their strength, with one jaw clamping down onto the other, but without moving the jaw around. This causes the muscles to be severely over-stressed and this is what you notice the following morning. Symptoms include “day-after” muscle pains, exposed tooth necks (with increased sensitivity) and starkly increased tension in the area of the mouth. Tension in the back and neck along with headaches are also possible symptoms which may affect patients. One possible treatment for this is the use of mouth guards.
Is cracking of the jaw joint dangerous?
Studies have shown that over 70% of people that have issues with audible cracking of the jaw joint show no symptoms. Cracking of the joint means that it is put under more stress which might lead to more problems developing later in life. It is interesting to note that it is not the bone itself, but rather the fluid in the joint that creates the cracking noise due to pressure differences created when moving the joint socket.
What will happen if I do nothing about my night-time tooth grinding?
It is at night that people process their mental stresses and worries in their sleep. Unfortunately, for some people the “daily grind” doesn’t stop in the workplace. One consequence of not having treatment is that tooth replacement treatments may be required due to massive loss of chewing surfaces in the mouth. Jaw joint issues arise, the bite becomes lowered, and teeth are lost. These symptoms occur most notably in people in living in the Western World.
Is grinding problematic in the case of children?
No, many adults think that grinding of the milk teeth is pathological (i.e. harmful to health), but actually this isn’t the case. Grinding is actually even a positive thing for milk teeth. This process allows children to adjust to a correct position and direction of growth of the lower jaw in relation to the upper jaw. As such, grinding is necessary for the successful development of a healthy (normally functioning) bite with the subsequently emerging “real teeth”. For this reason, bruxism is not a term that can be used in the case of children.