According to statistics, 5-10% of adults suffer from bruxism to some extent. This term refers to the involuntary spasm of the jaw muscles, causing a person to clench their jaws tightly and grind their teeth. Most often, episodes occur during sleep when conscious control over the body is weakened. Specialists at the AESTHETE dental clinic explain what bruxism is, what causes it, and how it can be treated.
Bruxism – What Is It?
This condition manifests as a spasm of the masticatory muscles, during which the jaws are tightly clenched. It is often accompanied by the characteristic grinding of teeth. A person cannot control this spasm, and in most cases, the condition occurs during sleep.
There are two types:
- Sleep bruxism – more common;
- Awake bruxism – less common.
Often, a person is unaware that they grind their teeth during sleep; relatives inform them about it. Initially, there may be one episode lasting 10-15 seconds during the night, but as the condition progresses, the frequency of episodes increases.
In the early stages of the disease, a person may feel tired in the morning, have headaches, and experience tension in the neck and jaw muscles. Gradually, due to constant high stress, the teeth begin to deteriorate.
Symptoms of Bruxism
The main sign indicating the condition is the grinding or clenching of teeth during sleep. More often, the patient themselves does not notice it; it is reported by their relatives. The grinding may be accompanied by an increase in heart rate and elevated blood pressure. However, the person does not remember this because they do not wake up during an episode, although overall their sleep is light, restless, and not sufficiently long.
Regular episodes lead to increased strain on the temporomandibular joint (TMJ). As a result, dysfunction develops, and pain arises in this area. The discomfort becomes more noticeable when the person moves their jaw, such as while eating or talking. Gradually, the pain may spread to the neck and shoulders.
Indirect signs that manifest during the day include:
- Fatigue of the masticatory muscles;
- Headaches;
- Dizziness;
- Drowsiness and quick fatigue;
- Chips in fillings, crowns, and damage to dental prostheses.
With prolonged duration of the condition, enamel wears away, and cracks and chips appear. Teeth become sensitive to temperature stimuli as well as sweet, sour, and salty foods. If inflammation of the surrounding soft tissues begins, the teeth may become loose and even fall out. Due to bite misalignment, nasolabial folds become deeper.
Possible damage to the oral mucosa may occur.
Causes of the Condition
Bruxism can occur at any age, but in children, it is typically associated with teething and the formation of the bite. In adult patients, teeth grinding arises for many reasons, which is why modern medicine has several theories explaining the onset of this condition.
Neurological
Proponents of this theory believe that the pathology arises due to damage to the central or peripheral nervous system. This is supported by the fact that organic damage to the trigeminal nerve is often found during diagnosis. It is noted that the condition is frequently accompanied by headaches, insomnia, and observed episodes of sleep apnea—brief interruptions in breathing. If the condition is left untreated for a long time, it may lead to nocturnal enuresis, epilepsy, and muscle tremors, which are involuntary contractions of body muscles.
Psychological
In this case, psycho-emotional issues are identified as the primary cause. Emotional instability, stress, fatigue, and even strong positive emotions can trigger involuntary spasms of the masticatory muscles. Statistics show that among adult patients, individuals with heightened hostility are often found. In children, the likelihood of the condition increases if the child exhibits restless behavior. Therefore, psychological factors play a significant role.
Genetic
Estimates suggest that the number of people whose relatives also grind their teeth in their sleep ranges from 20% to 50%. Genes involved in stress regulation are also related to the development of the condition.
Dental
According to supporters of this theory, bruxism occurs due to pathologies of the dental and jaw apparatus. An improper bite, dental and gum diseases, and prolonged wear of poorly fitted crowns, prostheses, and orthodontic appliances can manifest as involuntary spasms of the masticatory muscles, not necessarily immediately.
Osteopathic
Doctors have found that individuals suffering from bruxism often develop osteochondrosis of the cervical spine. This condition frequently develops in children after complicated births and is accompanied by weakness in the skull bones. Therefore, it is possible that involuntary spasms of the masticatory muscles are a manifestation of the body’s protective response.
Nasal Breathing Disorders
There is a suggestion that people with a deviated septum are more likely to suffer from bruxism. Adenoids and frequent colds accompanied by nasal congestion, as well as difficulties in airflow through the nasal passages, may also be factors contributing to the onset of this condition.
Pathogenesis of Bruxism
Modern medicine has not yet found a definitive answer to the question of how the disease arises and how the episodes occur from a physiological perspective. It may be related to the necessity of neutralizing stress states.
Initially, the sympathetic nervous system becomes activated in the patient. This speeds up heart function and intensifies metabolic processes.
At the same time, the activity of the parasympathetic nervous system decreases.
The heart rate increases, and breathing becomes more frequent. The tone of the suprahyoid muscles rises. As a consequence, the masticatory muscles are involuntarily activated—this is the episode of bruxism.
Classification
There are several parafunctions of the masticatory muscles:
- Tooth clenching – a habitual action performed at will by the individual;
- Non-food chewing – a small-amplitude movement of the lower jaw that occurs with closed lips and resembles grinding, often seen in elderly individuals with poorly fixed upper dentures;
- Bruxism – an involuntary spasm of the masticatory muscles.
In children, three forms of the disease are identified: daytime, nighttime, and a combination of both daytime and nighttime forms. The daytime form is characterized by tooth clenching, while the nighttime form involves grinding.
In adults, clenching, grinding, and tapping can be signs of both daytime and nighttime forms of the disease. However, at night, they are often accompanied by non-food chewing.
Another classification of the disease in adults considers three forms:
- Acute – sudden episodes of tooth clenching accompanied by pain;
- Initial or compensated – impaired function of the masticatory muscles without morphological changes, so the patient has no cause for complaints;
- Chronic – characterized by complications due to increased wear of dental enamel, with the transition from the initial stage to chronic potentially occurring over many years.
Degrees of Severity of Bruxism
In this case, the main criterion is the extent of tooth wear.
- First degree – enamel of the cusps and incisal edges is worn minimally.
- Second degree – enamel of the cusps and incisal edges is worn to the extent that dentin is exposed.
- Third degree – enamel and dentin are worn down to the level of the tooth cavity.
Complications
Bruxism can lead to two serious conditions: dysfunction of the temporomandibular joint (TMJ) and increased tooth wear.
Consequences that may arise from TMJ dysfunction include:
- Headaches;
- Pain and discomfort in the ears and neck;
- Inflammation of the parotid salivary glands;
- Subluxation or dislocation of the jaw.
Increased tooth wear leads to heightened sensitivity, causing painful reactions to hot, cold, sweet, salty, and sour stimuli. Additionally, accelerated wear of dental enamel results in:
- Damage to teeth and fillings – chips and cracks;
- Reduced lifespan of fillings, bridges, and crowns;
- Inflammation of the periodontium – the complex of tissues surrounding the tooth roots and holding them in the jawbone;
- Mobility and loss of teeth;
- "Aging face" – decrease in the height of the lower third of the face.
Diagnosis
A precise diagnosis of bruxism is not always possible. This is why statistics vary widely—5-10% of the adult population is reported to grind their teeth at night, while some doctors suggest the condition may affect up to 80% of people. Measuring this objectively is challenging, so researchers often rely on surveys, which are subjective and do not provide sufficient accuracy.
Diagnosis typically begins with the use of bruxism checkers. These are plastic mouthguards that the patient wears at night. In the morning, they remove the guards and give them to the doctor, who takes impressions for further analysis. This allows determination of:
- Which teeth are under increased stress;
- The extent to which the condition is related to bite and tooth alignment.
Electromyographic analysis is also used to assess the state of the muscles at rest and during movement. This helps identify ill-fitting or improperly placed dental prosthetics.
If necessary, neurologists, otolaryngologists, maxillofacial surgeons, and psychotherapists may be involved in the diagnostic process. Accurate diagnosis of bruxism should be comprehensive. An examination will only yield results if it is thorough.
Treatment
Bruxism is treated using various methods. It is important to identify the factors that contributed to its onset and development to eliminate them, which helps reduce the risk of recurrence.
Three methods are particularly commonly used to relieve patients of bruxism and its consequences. These methods are often combined, as a comprehensive approach ensures higher effectiveness.
Behavioral Therapy
This treatment approach aims to eliminate or alleviate the psychological issues that cause teeth grinding. Even lifestyle changes can improve the situation. It is essential to normalize sleep and reduce stress. Patients may not always be able to achieve this on their own, so to help them relax and calm down, the following methods are used:
- Massage
- Hypnosis
- Psychoanalysis sessions
Patients learn to respond appropriately to situations in which they feel uncomfortable, reducing the negative impact of stress. Techniques such as self-suggestion, meditative practices, and breathing exercises help lower the tone of the jaw muscles.
Pharmacological Treatment
Medication is also utilized. The doctor prescribes medications that help manage depression and improve sleep quality. In some cases, a calming herbal remedy may suffice, while other situations require more effective medications.
Patients should not self-prescribe antidepressants; this should be done by an experienced psychiatrist or psychotherapist. Some antidepressants may not only fail to alleviate bruxism but may actually contribute to its onset and progression. Treatment should be managed by a physician who can fully assess the clinical situation and consider all circumstances related to the condition.
In treating bruxism, type A botulinum toxin injections are administered into the temporal and masseter muscles. Botox paralyzes the muscles, preventing involuntary spasms.
Restoring Bite Height
First, it is necessary to eliminate bruxism, and then address its consequences. Due to increased wear of the enamel, teeth become damaged, and bite height changes. To restore it to a normal level, crowns are used, made from various materials such as ceramics, metal-ceramics, or zirconium dioxide.
If the bite has changed significantly, extensive remodeling of the chewing muscles may be required. Otherwise, crowns and bridge structures can crack and break. To resolve this issue, the doctor may recommend the installation of orthodontic appliances—splints and aligners of different sizes that need to be changed periodically.
At night, patients should wear relaxation splints made of soft plastic. These protect tooth surfaces from wear during involuntary muscle spasms.
It is important to understand that restoring bite height treats not the bruxism itself but its consequences. Orthopedic treatment is also conducted to prevent other diseases that may arise due to the reduction in height of the crown portions of the teeth.
Risks of Teeth Grinding During Sleep
Bruxism reduces the quality of life. It leads to enamel wear, causing teeth to deteriorate and become particularly sensitive to various irritants. Enamel damage can result in cavities. Over time, tooth roots may loosen, and gums can become inflamed, increasing the risk of tooth loss.
The presence of damaged or missing teeth affects the aesthetics of one’s smile. Individuals may feel embarrassed to open their mouths, talk less, and laugh infrequently. This can create difficulties in social interactions and lead to psychological issues.
Additionally:
- Pain may occur in the neck and joints, especially the temporomandibular joint (TMJ).
- There may be hypertrophy of the jaw muscles.
- Jaw movement can become restricted.
- Conditions such as gingivitis and stomatitis may develop.
- Painful ulcers can appear on the tongue.
Constant teeth grinding at night increases fatigue, contributes to sleep deprivation, and worsens stress resilience. This can lead to memory problems, daytime drowsiness, difficulty concentrating on tasks, and depression.
Bruxism is a contraindication for most prosthetic methods, particularly preventing the installation of veneers.
Prognosis
If treatment is initiated in a timely manner, the prognosis is favorable. However, achieving a complete resolution of the condition may take several months.
For pediatric patients, continuous monitoring is essential. In children, both daytime and nighttime teeth grinding often resolves on its own without additional medical intervention.
Prevention
Although modern medicine can treat bruxism, it's best to prevent the disease from developing in the first place. Here are some preventive measures to consider:
- Oral Hygiene: Brush your teeth twice a day, using not only a toothbrush and toothpaste but also mouthwash, dental floss, and an irrigator.
- Avoid Stress: Try to minimize stress and nervous tension. Activities such as outdoor walks, sports, and socializing with friends can help maintain a stable emotional state.
- Monitor Diet: Reduce the intake of carbohydrate-rich foods. Include more meat, fish, fruits, and vegetables in your diet. If possible, replace caffeinated beverages like coffee and tea with herbal infusions and vitamin-mineral complexes containing magnesium, calcium, and B vitamins—though it's advisable to discuss this with your doctor first.
- Sleep and Activity Regulation: Ensure you get enough quality sleep, spend time outdoors, and engage in moderate physical activity. Avoid heavy meals before bedtime and prioritize rest.
- Jaw Monitoring: Be aware of your jaw position and check if your teeth are clenched.
- Regular Dental Visits: It's recommended to see a dentist for preventive check-ups twice a year. The dentist may notice signs of the condition that you haven't yet recognized.
AESTHETE Dental Clinic is located in Dubai (UAE), Bluewaters Island. Our highly qualified doctors have extensive experience helping individuals suffering from bruxism. We will diagnose the condition, propose a treatment plan, and monitor your progress.
Clinic administrators are ready to answer any questions. They can assist in scheduling an appointment and explain how to register for a consultation.
Questions & Answers
Which doctor should I see?
Bruxism and its consequences are usually treated by a dental prosthetist, who may involve other specialists as needed. Generally, you should first consult a therapist, who will listen to your complaints, collect a medical history, and refer you to the appropriate specialist.
Why do adults grind their teeth at night?
During the day, it’s easier for a person to maintain control. At night, this control weakens, which is why nighttime bruxism occurs significantly more often than daytime bruxism. The condition usually arises due to nervous disorders and harmful habits, such as nail-biting, excessive alcohol consumption, or overuse of coffee and energy drinks.