Bruxism: Managing the Symptoms, Treating the Causes

Definition

Even a slight discrepancy in the balance of your bite can trigger clenching and grinding inside your mouth. This condition is known as 'bruxism', and is characterized by chronic, forceful, unconscious biting down at non-mealtimes. Bruxism can also be triggered by high-pressure situations or chronic stress. Considering these risk factors—bite discrepancies and chronic stress-- it's understandable that bruxism is found in about 95% of the population, causing extreme problems for at least a third of those people, and affecting women more severely than men.

Sometimes, bruxism can be related to something as simple as poor stress management. In fact, bruxers may be those personality types who react to stress with anger, pain, frustration, or aggressively and competitively. In other cases, the clenching is a conscious attempt to force the upper and lower teeth to touch at all times. Occasionally, people with bruxism have other 'biting' habits as well: such as biting fingernails, pencils, lips, or the insides of their cheeks.

Whatever the cause, bruxism is a serious and harmful habit that can lead to serious dental problems. Not only does the clenching and grinding wear down tooth surfaces and cause a misaligned bite, but this unbalanced bite can then trigger further problems. Why? Because the jaw is designed to operate most efficiently when the bite is in balance; when it's not, the jaw and temple muscles work to reinstate the proper status quo. As these incredibly strong muscles tug and pull against each other, a tremendous amount of stress may be put on all of the surrounding structures, particularly your jaw joint. Left unchecked, this sequence of events can create a situation of perpetual pain: including fractured and worn teeth, TMJ, facial pain, headaches, and even inner ear pain or stuffiness.

Recognition

Because bruxers are often entirely unaware of their habit, Dr. Goldberg will generally do an automatic check for such a problem. Typically, he’ll look for the following warning signs indicating that you need help with bruxism: broken or fractured teeth, excessive wear or flatness on teeth, worn enamel, unexplained sensitivity in teeth and gums, jaw pain, temporomandibular joint (TMJ) pain, popping and clicking jaws, tense muscles, headaches, partially exposed and sensitive tooth interior (dentin), and/or tongue indentations. In severe cases, frequent clenching and grinding may cause the entire jaw to move out of balance. Dentistry typically acknowledges that the activity responsible for these symptoms is bruxism.

Assessment & Treatment

The current standard treatment for bruxism is typically a hard acrylic nightguard, or physiological bite appliance. This device is made from an impression of your mouth and carefully adjusted to fit comfortably day or night. The guard works in two ways: first, it provides a substitute biting surface for the teeth on which to clench, protecting the teeth and underlying jawbone from further trauma. By covering the teeth and eliminating the bite discrepancy, we hope to suppress the clenching and grinding trigger. If this is successful, then we have the best-case scenario: the bruxing habit is eliminated.

If the clenching and grinding continues despite the guard, we have at least protected the teeth from further damage by allowing the hard acrylic biting surface to take the brunt of the bruxing, rather than the opposing teeth. Further, the guard now serves as a diagnostic tool for Dr. Goldberg, from which he can assess the connection between the occlusal problem and the bruxing habit, investigating possible related joint physiology abnormalities as well.

This diagnostic process also assists Dr. Goldberg in creating a long-term treatment plan or cure. For example, if the guard eliminates the pain and other bruxism-related symptoms, then no further action is needed other than long-term protective wear and occasional re-alignment of the splint as it wears down. If the symptoms are NOT eliminated, then the habit may be unrelated to the bite, necessitating further examination of underlying pathology…the correction of which may require more extensive treatment beyond the nightguard.

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