Bruxism is when you clench or grind your teeth. The term clenching means you tightly clamp your top and bottom teeth together, especially the back teeth. The stressful force of clenching causes pressure on the muscles, tissues, and other structures around your jaw. This can lead to jaw joint disorders, jaw pain and soreness, headaches, earaches, damaged teeth, and other problems. These symptoms are often collectively referred to as “TMJ” or temperomandibular joint problems.
Many people who clench also grind their teeth. Grinding is when you slide your teeth over each other, generally in a sideways, back-and-forth movement. This action may wear down your teeth and be noisy enough at night to bother sleeping partners. Like clenching, grinding can lead to jaw pain and other problems.
Causes, incidence, and risk factors
People can clench and grind subconsciously during both the day and night, although sleep-related bruxism is often the bigger problem because it is harder to control.
The cause of bruxism is not completely agreed upon, but daily stress may be the trigger in many people. Some people probably clench and never feel symptoms. Whether or not bruxism causes pain and other problems may be a complicated mix of factors - how much stress you are under, how long and tightly you clench and grind, whether your teeth are misaligned, your posture, ability to relax, diet, sleeping habits, and other factors. Each person is probably different.
- Teeth grinding, which may be loud enough to annoy sleeping partners
- Sore or painful jaw
- Earache (partly because the structures of the temperomandibular joint are very close to the ear canal, and partly because of referred muscle pain - pain that is perceived in a location different from its actual source)
- Anxiety, stress, and tension
- Insomnia, depression, eating disorders
Signs and tests
An examination can rule out other disorders that may cause similar jaw pain or ear pain, including ear disorders such as ear infections, problems with the temporomandibular joint (TMJ) itself, and dental disorders. The person may have a history of significant stress and tension.
The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching behaviors as much as possible.
To help relieve pain, there are may self-care steps you can take at home. For example:
- Relax your facial and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
- Massage the muscles of the neck, shoulders, and face. Search carefully for small, painful nodules called trigger points that can refer pain throughout the head and face. An excellent resource is The Trigger Point Therapy Workbook by Claire Davies.
- Learn physical therapy stretching exercises to help the restore a normal balance to the action of the muscles and joint on each side of the head. An excellent resource is Taking Control of TMJ by Robert Uppgaard.
- Apply ice or wet heat to sore jaw muscles. Either can have a beneficial effect.
- Avoid eating hard foods like nuts, candies, steak.
- Drink plenty of water every day.
- Try to reduce your daily stress and learn relaxation techniques.
- Get plenty of sleep.
To prevent damage to the teeth, mouth guards or appliances (splints) have been used since the 1930’s to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching. It may also actually help reduce clenching behaviors, but some people find that it makes their clenching worse. In others, the symptoms go away as long as they use the splint, but pain returns when they stop or the splint loses its effectiveness over time.
There are many different types of splints. Some fit over the top of the teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn’t work, another may.
For example, a splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.
As a next phase after splint therapy, orthodontic adjustment of the bite pattern may be beneficial for some people. Surgery should be considered a last resort.
Finally, there have been numerous approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching, since nighttime clenching is cannot be consciously stopped. In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include various biofeedback devices, self hypnosis, and other alternative therapies.
Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.
If clenching leads to jaw pain, this in turn can lead to insomnia, depression, and eating disorders. Clenching and grinding can worsen existing dental or TMJ problems. Nightly grinding can awaken roommates and sleeping partners.
Calling your health care provider
See a TMJ specialist immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Therefore, see a TMJ specialist for a full evaluation if self-care measures do not help within several weeks.
Grinding and clenching does not fall clearly into one medical discipline, and TMJ specialists have a variety of treatment approaches. For a massage-based approach, look for a massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage, particularly as it applies to TMJ disorders.
Dentists who specialize in evaluating and treating TMJ disorders will typically perform x-ray exams and prescribe a mouth guard. Surgery is now considered a last resort by the vast majority of TMJ experts.
Stress reduction and anxiety management may reduce bruxism in persons prone to the condition.
by Levon Ter-Markosyan, D.M.D.