Bruxism is the medical term for teeth grinding. It refers to grinding, clenching, or gnashing your teeth. Bruxism can occur both while you’re awake and while you’re asleep. It usually happens subconsciously (you are not aware when you grind your teeth).

Grinding teeth is most common in children, adolescents, and young adults, but can occur at any age. Occasional bruxism is not harmful, but chronic and severe bruxism can lead to jaw pain, headaches, dental damage, and other health issues.

Note: Many people have some mouth movements during sleep, such as occasional chewing motions. These are called rhythmic masticatory muscle activities (RMMA). However, in people with sleep bruxism, these mouth movements are more frequent and more forceful.

Distinction Between Sleep Bruxism and Awake Bruxism

	Sleep Bruxism (Grinding Teeth in Sleep)	Awake Bruxism (Teeth Grinding While Awake)
Occurrence	During sleep, usually in the early stages of sleep	During the day
Prevalence	More common in children and affects 15-40% of children and 8-10% of adults	Affects 22-31% of the population
Causes	Sleep-related chewing activity mediated by the central nervous system and associated with micro-arousals from sleep	Emotions such as anger, frustration, stress, anxiety, or tension or concentrating hard on something
Treatment	Treating sleep bruxism is often necessary due to bruxism symptoms such as morning headaches, jaw pain, and severe wear and tear of the teeth	Treatment may not be required if you can reduce stress and find ways to become aware of and stop teeth-grinding

The prevalence of bruxism can vary by age group and population:

Children: One study in Iran showed the prevalence of bruxism in children is about 26%, beginning at an average age of around 5 years old. Grinding teeth was 2.6 times more common in children who had a family history of teeth grinding. Almost 9 out of 10 children with bruxism had a history of distressing events in their life.
Teens and Young Adults: A study in Spain was done on university students before, during, and after the COVID-19 pandemic. The results showed that awake bruxism (grinding teeth during the daytime) had a prevalence rate of 39% pre-pandemic, 16% mid-pandemic, and 37% post-pandemic. Sleep bruxism (teeth grinding in sleep) had a prevalence rate of 18% pre-pandemic, 47% mid-pandemic, and 30% post-pandemic.
Adults: A study in The Netherlands assessed the prevalence of bruxism in the adult population and found 5% of adults had awake bruxism and 16.5% of adults had sleep bruxism.
Bruxism Awareness: A study in Thailand found self-reported awake bruxism in 35% of the respondents, sleep related bruxism in 37% of the respondents, and both awake and sleep bruxism in 19% of the respondents. Awareness of bruxism (knowing that they grind their teeth) was higher among dentists and dental students compared to patients.

What is the Main Cause of Bruxism?

Psychological Factors

People experiencing stress or those with mental health conditions such as generalized anxiety disorder or major depressive disorder are more likely to have bruxism.

Personality Type

There is some evidence that aggressive, hyperactive, and competitive personality types are risk factors for bruxism.

Genetic Predisposition

Sleep bruxism may run in families. People who have close family members with teeth grinding in sleep are more likely to do so themselves.

Malocclusion (Bite Issues)

Some people develop bruxism because of a misaligned bite. Irritation in the mouth due to crooked, missing, or loose teeth can also contribute to teeth grinding and clenching.

Sleep-Related Disorders

Research suggests there is a link between sleep bruxism episodes (grinding teeth in sleep) and obstructive sleep apnea (OSA). Both conditions are present together in many people. But we don’t know if teeth grinding in sleep causes sleep apnea or if sleep apnea causes sleep-related bruxism. In other words, more research is needed to understand the connections between teeth grinding and obstructive sleep apnea, and other sleep disorders.

Note: Sleep bruxism (grinding teeth in sleep) is considered a sleep-related movement disorder because it involves repetitive and forceful jaw muscle contractions and tooth grinding during sleep.

Other Medical Conditions

Bruxism may occur in association with certain medical conditions ,including:

Night terrors
Gastroesophageal reflux disease (GERD)
Attention deficit hyperactivity disorder (ADHD)
Seizure disorders
Dementia
Parkinson's disease

Lifestyle Factors

Smoking, alcohol consumption, and excessive caffeine consumption (more than 6 cups of coffee a day) can lead to tooth grinding. The use of recreational drugs such as heroin, methamphetamine, and MDMA (ecstasy) has also been linked to increased teeth grinding.

Medication Side Effects

A group of medications called selective serotonin reuptake inhibitors (SSRIs) can cause teeth grinding (bruxism) and jaw clenching as side effects. These drugs are used to treat anxiety and depression. Examples include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Other medications linked to drug-induced bruxism include anticonvulsants such as barbiturates and medications used to treat attention deficit hyperactivity disorder (ADHD).

Symptoms of Bruxism

If you grind your teeth, you may experience:

Soreness of the jaw muscles due to repeated jaw clenching
Morning jaw pain (if you have teeth grinding in sleep)
Morning headaches (if you have sleep bruxism)
Facial pain
Earache
Tinnitus (ringing in the ears)
Pain with chewing
Difficulty opening and closing your mouth due to tight or fatigued jaw muscles as a result of repetitive jaw muscle activity

What Does A Bruxism Headache Feel Like?

A bruxism headache typically feels like a dull ache or steady pressure on both sides of the head in the temple region. Teeth grinding or clenching can also cause neck pain and soreness in the shoulder muscles, along with a morning headache. Bruxism headaches are a type of tension headache that occurs due to repeated contractions of the jaw muscles.

Impact on Oral Health

Tooth damage, including flattening, chipping, and fracturing of the upper or lower teeth.
Wear and tear of the tooth enamel due to excessive teeth grinding, leading to exposure of the deeper layers of dentin.
Tooth pain and hot/cold sensitivity due to the above.

Effects on Quality of Life

Nocturnal bruxism (teeth grinding in sleep) can cause sleep arousal and sleep disruptions in the affected person. The noise from the clenching and grinding of teeth during sleep can also disturb a sleep partner.

Diagnosis of Bruxism

You should seek medical care if you have any symptoms of bruxism. Whether it is a temporary problem, such as bruxism related to a stressful life event, or a more long-term problem, there are effective ways to treat bruxism. The important thing is to have bruxism treated. Untreated bruxism can lead to chronic facial pain, tooth damage, sleep disorders, and temporomandibular joint disorders (TMJ).

Dentists and other healthcare providers can diagnose bruxism based on your symptoms, medical history, and physical exam.

Role of Sleep Studies

It can be hard for people to be aware of sleep bruxism unless their sleeping partner notices it. If your healthcare provider suspects sleep bruxism based on your symptoms, they may order a polysomnogram (sleep study). This test involves staying overnight in a sleep clinic and being monitored with sensors and observed by a sleep technician.

Polysomnography is the only way to make a definitive diagnosis of sleep bruxism (teeth grinding in sleep). A sleep study can also be used to diagnose sleep apnea, a sleep-related breathing disorder that has been linked to bruxism.

Bruxism Treatment and Management

How Do You Permanently Stop Bruxism?

Primary bruxism is teeth grinding and clenching that occurs on its own without an underlying cause. Secondary bruxism is teeth grinding and clenching that occurs as a result of another medical condition. Secondary bruxism may be permanently cured by treating the underlying condition. For example, if a gastroesophageal reflux disorder is causing bruxism, treatment with acid-reducing medications can help to reduce bruxism symptoms. You may be able to permanently stop bruxism by treating the underlying cause and/or wearing a mouth guard.

Can Chewing Gum Reduce Bruxism?

It’s controversial whether chewing gum can reduce bruxism symptoms. Some experts say that when you chew gum, it helps to relax the jaw muscles and serves as a distraction. Others believe chewing gum is like adding fuel to the fire and is best avoided. Talk to your dentist about chewing gum for relief if you have a teeth-grinding habit.

Custom Mouthguards: The Most Effective Treatment For Bruxism

Mouth guards are considered the most effective teeth-grinding treatment for people with bruxism. They are also called occlusal splints, night guards, bite guards, and dental guards.

Your dentist can order a custom-built mouth guard or night guard for you to wear over your teeth at times when teeth grinding is most likely. This device can improve sleep bruxism and awake bruxism, protect your upper and lower teeth from damage, and place your jaw in better alignment to lower the risk of temporomandibular disorders (TMJ disorders).

Relaxation Techniques and Psychotherapy

Stress is a common cause of secondary bruxism. Stress reduction techniques such as meditation, deep breathing exercises, and progressive muscle relaxation can help to reduce bruxism symptoms. Talk therapy, for example, cognitive behavioral therapy (CBT), can help you learn to manage stress and anxiety if these are the cause of your bruxism symptoms.

Lifestyle Changes

Reducing caffeine intake, limiting alcohol consumption, and stopping smoking may help to reduce teeth grinding if these lifestyle factors are the underlying cause.

Medications and Therapies

Taking a muscle relaxant at bedtime can help relax the jaw muscles and reduce sleep bruxism. However, this is a temporary solution—it may be used if bruxism is secondary to a short-term stressful event and is affecting sleep quality.

Botulinum toxin (Botox) injections can be done to temporarily relax the jaw muscles. This injection treatment needs to be repeated every 3-4 months.

Preventive Measures: Dietary and Lifestyle Adjustments

Here are some tips to lower your risk of developing bruxism:

Practice self-care and stress management techniques to prevent bruxism related to psychosocial factors like stress and anxiety.
Maintain healthy sleep habits and practice good sleep hygiene.
Limit the use of caffeine and alcohol. Avoid using recreational drugs. Stop smoking if you smoke.
Get regular dental checkups so that any tooth wear and tear can be detected early and bruxism treatment can be started. Read next: How to Manage Fear of the Dentist.

Giltuss Bucalsep

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