What is bruxism?

Bruxism is the clenching or grinding of teeth. It's the repeated jaw-muscle activity of the facial or chewing muscles. With bruxism, you grind or clench your teeth, or you may brace or thrust your jawbone (mandible). It's typically not done on purpose.

You may clench and grind your teeth during the day (wakeful bruxism), but it's more common to do it at night while you sleep (sleep-related bruxism). It most often occurs in the early part of sleep. It may or may not be something you can hear. Bruxism can be mild, or it may occur more often and with more force. Even during sleep, a person may clench their teeth with a force of up to 250 pounds. You may not even realize you have this condition.

What causes bruxism?

Experts don’t know what causes bruxism. Oral health specialists often point to too much stress and certain personality types as causes of bruxism. It often affects people with nervous tension, such as anger, pain, or frustration. It also affects people who are aggressive, hurried, or very competitive. There is some proof that in some people, bruxism is caused by an imbalance in brain neurotransmitters. Also, some medicines, such as the antidepressants fluoxetine, sertraline, and paroxetine, can cause bruxism.

Who is at risk for bruxism?

 A risk factor is anything that may increase your chance of having a disease. Some risk factors may not be in your control, Others may be things you can change. Risk factors for bruxism may include: 

• Having certain sleep disorders such as obstructive sleep apnea, and sleep talking or sleepwalking (called parasomnias)

• Side effects of taking certain psychiatric medicines

• Psychosocial factors such as stress, anxiety, and competitive personality traits

• Having certain neurological disorders such as Rett syndrome

• Having certain conditions such as GERD (gastroesophageal reflux disease) or TMD (temporomandibular dysfunction)

• Smoking tobacco, heavy alcohol use, caffeinated drinks

• Using drugs such as cocaine and amphetamines

• Talk with your dentist or healthcare provider about your risk factors for bruxism and what you can do about them.

What are the symptoms of bruxism?

Symptoms vary, and can include:

• Clenching, grinding, or gritting teeth

• Chipped or cracked teeth

• Morning muscle stiffness or facial pain

• Very sensitive teeth

• Tense facial and jaw muscles

• Headaches

• Dislocation of the jaw

• Locking of the jaw

• Wearing away of the tooth enamel, exposing the inside of the tooth (the dentin layer)

• A popping or clicking in the temporomandibular joint (TMJ)

• Tongue indentations

• Damage to the inside of the cheek

• Flat, smooth areas created on the biting surfaces of the teeth as they are rubbed together repeatedly (called wear facets)

The symptoms of bruxism may look like other conditions or health problems. See a dentist or your healthcare provider for a diagnosis and treatment.

How is bruxism diagnosed?

The first sign of a problem may be found during a regular dental visit. Your dentist notices the wear and tear on your teeth.

If your dentist or healthcare provider thinks you may have bruxism, you may be asked about your family history, your health history, symptoms, and risk factors. The provider will ask about your sleep quality and if you have morning jaw pain or severe tiredness (fatigue), headaches, or jaw locking. You’ll be asked about any medicines you take, and your caffeine and alcohol intake. You’ll be asked if you have conditions such as GERD or a sleep disorder called obstructive sleep apnea.

If you have a sleep partner, they may be asked if you snore. They may be asked if they have heard you clench or grind your teeth during sleep.

During regular dental visits, your dentist will check your teeth for signs of bruxism, such as flattened tips of the teeth. There are other causes of tooth wear and tear, or jaw pain. If you have bruxism symptoms, your dentist or other healthcare provider may watch the condition over the next few visits before treatment is started.

How is bruxism treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

In most cases, bruxism can be successfully treated. Treatment may include:

• Behavior changes. You may be taught how to rest your tongue, teeth, and lips correctly. You may also learn how to rest the tongue upward to ease mild pain on the jaw while keeping the teeth apart and lips closed.

• Mouth guard. You may be fitted for a plastic mouth guard that you can wear at night to absorb the force of biting. It can be worn during the day if you grind your teeth while awake. This mouth guard may help prevent future damage to the teeth and help in changing behavior.

• Biofeedback. Biofeedback uses an electronic tool that measures the amount of muscle activity in the mouth and jaw. It then signals you when there is too much muscle activity so you can take steps to change that behavior. This is especially helpful for daytime bruxism. More research is needed to create a treatment program for those who clench during the night.

• Medicine. Some medicines may be helpful in controlling the neurotransmitters. Changing medicines may be needed if antidepressant medicines are found to be the cause of bruxism.

• Botulinum toxin shots (injections). This may be offered to some people with severe bruxism who don’t respond to other treatments.

What are possible complications of bruxism?

Bruxism may lead to cracks or fractures of the teeth. Tooth enamel may wear away. This exposes the dentin layer underneath. Teeth then become sensitive to temperature changes and pressure. Bruxism may also cause damage to the temporomandibular joint (TMJ). This is the joint on each side of the mouth that attaches the lower jawbone to the skull.

If bruxism goes untreated, it may lead to jaw muscle and joint problems. These are known as TMJ problems or TMD (temporomandibular disorder). You could even lose your teeth.

How do I manage bruxism?

Not everyone needs treatment. It's important to have regular dental checkups to identify bruxism in the early stages so that you can receive treatment, if needed.

If you have sleep-related bruxism, good sleep hygiene may help. Sleep hygiene is a set of habits that can help you to have and maintain better quality sleep. These habits include:

• Go to bed at the same time and wake up at the same time.

• Don’t take naps.

• Don’t try to sleep unless you feel sleepy.

• Exercise regularly, several hours before bedtime, if possible.

• Don’t drink anything that has caffeine after lunch.

• Don’t drink alcohol close to your bedtime.

• Don’t smoke.

• Don’t watch TV in bed.

• Have a quiet, peaceful bedroom.

• Don’t use smartphones, laptops, or other electronic devices for at least 1 hour before bedtime.

Other home care tips include:

• Avoid hard or chewy foods.

• Don't chew gum.

• Reduce stress and learn relaxation techniques.

• Pay attention to any tension in your facial muscles throughout the day

Talk with your dentist or healthcare provider about other ways to manage bruxism.