Bruxism (Teeth Grinding): What Is It and Causes

Do you wake up with a sore jaw or notice your teeth feeling worn down? You might be experiencing bruxism, a condition where you grind or clench your teeth, especially during sleep.

This article explores the symptoms and causes of teeth grinding at night, shedding light on how stress and anxiety can contribute. Understanding bruxism can help you manage and prevent further damage to your teeth and jaw, improving your dental health.

The Definition of Bruxism

Bruxism is the involuntary clenching or grinding of the upper and lower teeth, occurring without food in the mouth. It represents a harmful non-physiological movement of the stomatognathic system, characterized by the clenching or grinding of teeth resulting from the contraction of various jaw muscles, including the masseter and temporal muscles.

Prevalence of Sleep-Related Bruxism

Sleep-related bruxism affects 15-40% of children and 8-10% of adults, as indicated by cross-sectional survey studies and self-reports. In children, bruxism typically emerges after the eruption of front teeth. Awake bruxism is more common in females than males, but sleep bruxism does not show a gender preference. As individuals age, the prevalence of bruxism tends to decrease. For adults over 65, some studies suggest an incidence of about 3%.

Related content:

What It Means When Toddlers Grind Their Teeth

Classification of Bruxism

Bruxism is classified into two categories based on age: children and adults. It is also categorized by the time of occurrence, distinguishing between awake bruxism and sleep bruxism.

Furthermore, bruxism exhibits distinct characteristics, including clenching, grinding, and a mixed mode involving both clenching and grinding.

Causes of Bruxism

The causes of bruxism include stress, anxiety, lifestyle factors, medical conditions, and psychological factors. Teeth grinding, especially at night, can be triggered by stress and anxiety during the day. Lifestyle choices like high caffeine intake, alcohol use, and smoking can also contribute to bruxism.

The causes of bruxism are complex, involving various factors:

1. Heredity and Neurologic Factors:
   • A combination of heredity, neurologic factors, and dysfunction in the stomatognathic system contribute to bruxism.
   • Studies on family members and gene analysis suggest the role of both environmental and genetic factors in Sleep Bruxism (SB).
2. Occlusal Factors:
   • Long-term malocclusion can lead to occlusal disorders and bruxism.
3. Local Stimulation Factors:
   • Periodontitis patients may experience bruxism (50% incidence), and symptoms may improve during periodontitis treatment.
4. Neurotransmitter Imbalance:
   • Bruxism may be linked to an imbalance in centrally acting neurotransmitters like dopamine and serotonin.
   • Neurological and psychiatric diseases (e.g., epilepsy, Parkinson’s, schizophrenia) and certain medications may also induce bruxism.
5. Somatic Diseases and Blood Pressure:
   • Variations in blood pressure, blood glucose, blood calcium concentration, and diseases such as gastrointestinal disorders, sleep apnea, and intestinal parasitic infections can contribute to bruxism.
6. Psychosocial Factors:
   • Psychosocial factors, including anxiety, depression, stress, and maladaptive coping strategies, elevate the risk of Sleep Bruxism (SB).
   • Teeth clenching may occur in students during exams, females during menstruation, and individuals facing extreme work stress or suppressed emotions.
7. Lifestyle Factors:
   • Smoking, alcohol consumption, and caffeine intake are additional lifestyle factors that can increase the risk of SB.

Psychological Factors in Bruxism

If you experience teeth grinding at night, psychological factors can play a significant role in exacerbating this condition. Here are some key points to consider regarding the relationship between sleep bruxism and psychological factors:

1. Symptoms of Sleep Bruxism: Symptoms like tight jaw muscles, facial pain, and headaches can be exacerbated by psychological factors such as stress and anxiety.
2. Possible Causes: Psychological factors like stress and anxiety can trigger teeth grinding during sleep, leading to increased severity of bruxism symptoms.
3. Impact on Bruxism: Understanding the psychological aspects of bruxism is crucial as managing stress and anxiety can help alleviate symptoms and improve overall oral health.

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Medical Factors Contributing to Bruxism

Consider how medical factors can influence bruxism, affecting your dental health and overall well-being. Medical conditions like GERD, epilepsy, and sleep-related disorders can contribute to teeth grinding during sleep.

Symptoms such as flattened, chipped, or loose teeth, worn enamel, and jaw pain may indicate bruxism related to these medical factors. Diagnosis involves dental exams and symptom inquiries, leading to treatments like stress management, dental splints, and behavioral therapies.

In severe cases, a multidisciplinary approach may be necessary for effective treatment. Regular dental care is crucial in monitoring and managing bruxism stemming from medical factors.

Signs and Symptoms of Bruxism

When experiencing bruxism, you may notice symptoms such as flattened, chipped, or loose teeth. These signs and symptoms can indicate that you’re grinding or clenching your teeth, especially at night.

Here are three common indicators of bruxism:

1. Worn tooth enamel: You may observe that the enamel on your teeth is wearing down due to the grinding action.
2. Tooth pain or sensitivity: Increased sensitivity or unexplained tooth pain can be a result of the pressure exerted on your teeth.
3. Tight jaw muscles: Feeling tension or tightness in your jaw muscles, particularly upon waking up, could be a sign of bruxism impacting your muscles.

Effects of Teeth Grinding

When teeth grinding occurs, it can lead to various adverse effects on your oral health and overall well-being. Grinding your teeth during sleep can result in fracturing, loosening, or loss of teeth, wearing teeth down to stumps, and the need for bridges, crowns, root canals, implants, or dentures. Additionally, the impact on the jaws and temporomandibular joint (TMD/TMJ) can cause changes in facial appearance. To address these issues, identifying the cause of teeth grinding and seeking treatments such as mouth guards, dental corrections, stress reduction techniques, and proper sleep hygiene practices are crucial. Regular monitoring by a dentist is essential for managing the effects of teeth grinding effectively.

1. Masticatory Muscle Hypertrophy: Bruxism may lead to an increase in the size and tension of the muscles involved in chewing.
2. Tooth Surface Loss: The constant grinding can result in the wearing down of tooth surfaces.
3. Fracture of Restorations: Dental restorations may be prone to fractures due to the persistent force applied during bruxism.
4. Hypersensitive or Painful Teeth: Bruxism can contribute to tooth sensitivity or pain.
5. Loss of Periodontal Support: Continuous grinding may impact the support structures of the teeth, potentially leading to periodontal issues.

Can bruxism change your face?

Chronic bruxism can lead to changes in facial structure over time due to the constant pressure on the teeth and jaw muscles.

Dr. Dan Rifkin

MD, MPH, FAASM Sleep Medicine Expert Physician & Neurologist

Bruxism Diagnosed

The most reliable diagnostic evidence for sleep-related bruxism comes from a history of teeth grinding during sleep, corroborated by parents, caregivers, or bed partners. In cases of uncertain diagnosis, bruxers’ reports, clinical interviews, clinical examination, intraoral appliances, or recording of muscle activity can aid in diagnosing sleep bruxism.

Formal Criteria according to ICSD-3

• Regular or frequent tooth-grinding sounds during sleep.
• Clinical signs such as abnormal tooth wear are consistent with reported tooth grinding during sleep.
• Morning jaw muscle pain, fatigue, temporal headache, or jaw locking upon awakening.

Physicians should ask bruxers about risk and exacerbating factors, including signs of poor sleep quality, symptoms of obstructive sleep apnea (e.g., loud snoring, witnessed pauses in breathing), and excessive caffeine or alcohol intake. Evaluating the medication list for potential contributors, including antipsychotic and serotonergic drugs, is also essential.

Dentist’s Examination

During regular dental exams, dentists may check for signs of bruxism, including tenderness in jaw muscles and dental abnormalities like broken or missing teeth. 

Auxiliary Examinations

• Oral Devices with Radio Transmitter: Records prolonged upper and lower teeth contact time.
• Maxillofacial Electromyography Examination: Records elevated muscle potential in bruxers during sleep, along with increased frequency of rhythmic masticatory muscle activity.
• Polysomnography: An insightful test to determine comorbid sleep disorders that may exacerbate bruxism episodes, based on clinical history.

Understanding these diagnostic methods is crucial for comprehensive assessment and effective management of sleep-related bruxism.

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Treatment for Sleep Bruxism

Many individuals with sleep-related bruxism may not require specific treatment, as occasional bruxism is common, especially during childhood, and often asymptomatic. However, for those with frequent or symptomatic bruxism, various therapies are available. To address bruxism effectively, consider utilizing mouth guards, dental corrections, stress reduction techniques, and proper sleep hygiene practices as part of the treatment options. Here are some strategies to help reduce bruxism:

1. Psychological and Behavioral Therapy:
      – Addressing the effects of behavioral and psychological factors.
      – Pre-bedtime treatments to reduce brain excitement, including relaxation techniques, appropriate exercises, avoiding stimulating foods and smoking, and improving the sleep environment.
2. Muscle Relaxation:
      – Physical therapy, masticatory muscle topical spray, muscle pain-point-blockade biofeedback therapy, muscle relaxants, and other approaches to relax local muscles and alleviate tension.
3. Biofeedback Therapy:
      – Using biofeedback to detect arousal during sleep and interrupt teeth grinding through auditory or electrical signals, such as taste biofeedback.
4. Dental Care:
      – Bruxers with sleep-related issues should receive routine dental care to monitor tooth wear.
      – The use of occlusal splints, a common technique to address bruxism.
5. Medication:
      – For drug-induced sleep-related bruxism, symptoms may improve by adjusting the dose, changing medication, or temporarily discontinuing medication.

The primary goal of treatment is to eliminate bruxism symptoms, reduce muscle tension, and safeguard the function of the stomatognathic system. Tailoring the approach to each individual’s needs and considering various therapeutic options can lead to effective management of sleep-related bruxism.

Prevention Techniques for Bruxism

Utilize preventive measures to manage bruxism by incorporating stress reduction techniques and maintaining proper sleep hygiene practices.

Recognize symptoms like flattened or chipped teeth, worn enamel, and jaw tightness as indicators of teeth grinding. Address causes such as stress, anxiety, and lifestyle factors by practicing stress management techniques like deep breathing or listening to ShutEye® App.

Implement prevention techniques such as using a custom mouthguard at night to protect teeth from grinding during sleep. Prioritize relaxation methods before bedtime to reduce nighttime grinding, including warm cloth application to relax jaw muscles.

Ensure children practice good dental habits and stress-relief activities to prevent teeth grinding. Regular dental check-ups and consultations can aid in monitoring and managing bruxism effectively.

Risk Factors for Bruxism

Regularly, you may experience teeth grinding at night due to various risk factors associated with bruxism. These risk factors include:

1. Stress and Anxiety: High levels of stress, anxiety, anger, or frustration can increase the likelihood of teeth grinding during sleep.
2. Personality Traits: Traits like aggressiveness or hyperactivity can raise the risk of bruxism.
3. Medications and Habits: Certain medications, smoking, alcohol consumption, and a family history of bruxism can also contribute to the condition.

Understanding these risk factors can help in identifying potential causes of teeth grinding and may guide you toward seeking appropriate interventions to manage bruxism effectively.

Complications of Bruxism

Complications of bruxism can include severe tooth, jaw, or restoration damage. When left untreated, the symptoms of teeth grinding, such as flattened or chipped teeth, worn enamel, and jaw pain, can worsen, leading to long-term issues.

Constant grinding can cause tension-type headaches, facial pain, and even temporomandibular joint disorders, characterized by clicking sounds in the jaw. Over time, the continuous pressure on teeth and jaw muscles from bruxism can result in fractures, loose teeth, or the need for extensive dental work like bridges, crowns, or implants.

Monitoring and addressing teeth grinding promptly can help prevent these complications and preserve your dental health and overall well-being.

Can Bruxism cause headaches? What does a bruxism headache feel like?

Bruxism can cause headaches, typically characterized by a dull, persistent pain in the temples or jaw area, often upon waking or during periods of teeth grinding.

Dr. June Seliber-Klein

MD DABPN, Sleep Board Certified, Chief Medical Officer Ognomy Sleep

Conclusion

In conclusion, understanding the causes and symptoms of bruxism is crucial in managing this common dental issue.

By addressing psychological and medical factors, seeking appropriate treatment, and implementing preventive measures, you can protect your teeth and jaw from the damaging effects of teeth grinding at night.

Taking steps to reduce stress, anxiety, and other risk factors can help you improve your overall dental health and prevent complications associated with bruxism.

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