Dr. Shnall's Dental Blog
Have you ever been told by your spouse or partner that they can hear you grinding your teeth while you sleep at night?
Do you ever find yourself clenching your teeth together during the day when you are stressed?
These habits can often lead to symptoms that bring people in to see their doctor or dentist, for grinding and/or clenching your teeth can lead to sore jaws, headaches and/or sore teeth.
In this article we will discuss the causes of clenching and grinding of teeth, which is otherwise known as bruxism and what remedies are available.
Bruxism is the repetitive clenching or grinding of teeth, either while awake (awake bruxism) or while sleeping (sleep bruxism).
Research has determined that awake bruxism usually involves jaw clenching and is a reaction to stress, worry or anxiety.
Sleep bruxism can occur in people who don’t feel stressed or worried and is has been found to occur due to brain activity as they fall from stages of deeper sleep to lighter sleep.
Awake and sleep bruxism are considered:
Primary if they are not thought to be caused by any other medical condition or
Secondary if they are thought to be caused by another health issue or a side effect to a medication
Approximately 8% of adults are affected by sleep bruxism and this number decreases with age.
Awake bruxism affects approximately 20% of the population and is more common in females.
Significance of Bruxism
Bruxism can cause significant wearing of the teeth as very strong biting forces can be applied to the teeth when people sleep.
The strong and repetitive chewing forces that a bruxer can apply during sleep can lead to the development of cracks in the teeth, which can lead to eventual breakage of teeth and/or breakage or chipping of dental work (i.e. chipping of porcelain crowns or veneers.)
Hours of clenching or grinding while asleep or awake can also cause headaches as many of the muscles that open and close our jaw are located on our temples and overlie the top of our head.
These muscles can get sore and fatigued and cause a headache the same way that your legs may get sore if you went out for a seven hour run.
Patients who suffer from sleep or awake bruxism may develop one or more sore teeth. If a particular tooth gets heavy amount of biting or clenching pressure in a bruxer the tooth may become sore to biting and/or sore to cold drinks. This can occur when people are under an unusually high amount of stress i.e. during school exams, a personal crisis or severe work stress. Often a simple bite adjustment can help resolve the pain in the overloaded tooth.
Treating Awake Bruxism
Since awake bruxism is caused by stress and/or anxiety, counselling or therapy to help with stress management can be helpful. Your family doctor would be a good resource person to speak with to get a referral for counselling.
Management of Sleep Bruxism
Research has shown the following strategies can help manage sleep bruxism:
1. First, try to improve the quality of your sleep.
Because sleep bruxism occurs when you transition from deeper stages of sleep to lighter stages of sleep, the more time you stay in deeper, more restful stages of sleep the less time you will spend in lighter stages of sleep where bruxism occurs. The following tips may improve your sleep quality:
- quit smoking (again, your family doctor would be a good resource to help with this)
- don’t drink coffee or alcohol at night
Research has shown sleep bruxism to be more common in people who use alcohol, tobacco and coffee.
- don’t exercise too close to bedtime
- don’t read or watch any on television that gets you too engaged right before bed
- try to ensure you sleep in a room that is quiet and dark.
Dental Appliances to help manage Sleep Bruxism
Your dentist can make you a custom fitting dental appliance called a Night Guard to help prevent tooth damage and reduce headaches caused by sleep grinding and clenching.
A Night Guard is also known as an occlusal splint. It is similar to a sports mouth guard worn by hockey, football and basketball players. It covers either the entire upper or lower set of teeth and is put in right before bed.
The Night Guard likely won’t reduce clenching or grinding but it will prevent teeth from wearing down or developing cracks as it prevents hard tooth against tooth contact.
A Night Guard can reduce the amount of the biting force which can help reduce or eliminate headaches caused by sleep bruxism.
Snoring, Obstructive Sleep Apnea (OSA) and Sleep Bruxism
Do you snore loudly or have you been diagnosed with obstructive sleep apnea? Research has shown that patients who suffer from OSA are more likely to have sleep bruxism. If you are a sleep bruxer you should rule out OSA before making a simple dental appliance for grinding, as it would be more effective to treat the OSA first. For an article I wrote on OSA click here.
Is there a Medication to treat Sleep Bruxism?
Currently there are no medications that have been proven to help sleep bruxism on a long term basis.
Bruxism and Neurologic Disorders
If you suddenly start a habit of severe tooth grinding while awake that you don’t have any control over consult your doctor, as it could indicate a neurologic disorder.
Bruxism as a Side-Effect of Medications
There are reports of sleep bruxism being caused or made worse by certain medications.
- This has been found to affect women more than men.
- Sleep Bruxism has been shown to start a few weeks after starting certain medications
- it can improve or worsen depending on whether the dose of the drug is decreased or increased
- sleep bruxism will often stop after the drug has been discontinued.
Some of the reported medications to cause or worsen sleep bruxism are:
- certain SSRI antidepressants (i.e. Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
-some Serotonin/Dopamine and noradrenaline reuptake inhibitors
- some antipsychotic medications
Sleep and awake bruxism is a fairly common condition that every dentist sees in their practise. It can be a chronic condition that can be managed with the many strategies discussed in this article.
If you have any questions or comments, please feel free to contact our office.
Dr. Jeff Shnall
Note: An article used as a reference for this article was:
Guaita, M. & Högl, B. Curr Treat Options Neurol (2016) 18: 10. doi:10.1007/s11940-016-0396-3
Dr. Jeff Shnall