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Teeth Grinding / Bruxism

Definition:
Bruxism is the medical term for grinding, gnashing or clenching your teeth. The condition affects both children and adults.

Some people with bruxism unconsciously clench their teeth together during the day, often when they feel anxious or tense. This is different from tooth grinding or clenching that occurs at night, which is called sleep bruxism. Most children who are bruxers do so at night, while adults are either daytime or nighttime bruxers.

Bruxism may be mild and may not even require treatment. However, it can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems. Unfortunately, people with sleep bruxism usually aren't aware of the habit, so they aren't diagnosed with the condition until complications occur. That's why it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Causes:

Doctors don't completely understand the causes of bruxism. For daytime bruxism, it has been thought that abnormal alignment of upper and lower teeth (malocclusion) may contribute to the problem, though this hasn't been confirmed in research studies. Sleep bruxism is believed to be related to changes that occur during sleep cycles in some individuals, and this is an active area of current research.

In adults, psychological factors seem to be associated with bruxism, including:
  • Anxiety, stress or tension
  • Suppressed anger or frustration
  • Aggressive, competitive or hyperactive personality type
In children, bruxism may be related to growth and development of the jaws and teeth. Some researchers think children brux because their top and bottom teeth don't fit together comfortably as they are erupting.  Others believe that children grind their teeth because of tension, anger, or as a response to pain from an earache or teething. While bruxism has been reported to occur in up to 30 percent of children, often in children under the age of 5, most children outgrow bruxism before they get their adult teeth.

In some cases, bruxism isn't caused by stress or dental problems. It can be a complication of another disorder, such as Huntington's disease or Parkinson's disease. It can also be an uncommon side effect of some psychiatric medications including certain antidepressants.

Risk Factor:
These factors increase your risk of bruxism:
  • Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration.
  • Age. Bruxism is common in young children, but usually goes away by adolescence.
When to seek medical advice:
Bruxism often goes unnoticed. See your doctor or dentist if you have worn teeth or pain in your jaw, face or ear. Also consult your doctor or dentist if your bed partner complains that you make a grinding noise while you sleep.

If you notice that your child is grinding his or her teeth — or has other signs or symptoms of this condition — be sure to mention it at your child's next dentist appointment.

Symptoms:
The signs and symptoms of bruxism may include:
  • Teeth grinding or clenching, which may be loud enough to wake your sleep partner
  • Teeth that are worn down, flattened or chipped
  • Worn tooth enamel, exposing the inside of your tooth
  • Increased tooth sensitivity
  • Jaw pain or tightness in your jaw muscles
  • Earache — because of severe jaw muscle contractions, not a problem with your ear
  • Headache
  • Chronic facial pain
  • Chewed tissue on the inside of your cheek
Dignosis:
During regular dental exams, your dentist likely will check for physical signs of bruxism, such as unusual wear and tear on your teeth, broken dental restorations and tooth sensitivity. Continued breakdown of dental restorations, loss of crowns and fracture of teeth are frequent problems associated with the tooth grinding and clenching associated with bruxism. If you have any of these signs, your dentist will look for changes in your teeth and mouth over the next several visits to see if the process is progressive and to determine whether you need treatment. You may also be asked to return for additional exams.

If your dentist suspects that you have bruxism, he or she will try to determine its cause by asking questions about your stress level, your general dental health, your daily medications, and whether you routinely drink alcohol or caffeinated beverages, especially during the evening. If you share your bedroom, your dentist may also ask your roommate or bed partner about your sleep habits, especially about any unusual grinding sounds heard during the night.

To evaluate the extent of bruxism, your dentist will examine your mouth and jaw, checking for tenderness in your jaw muscles and any obvious dental abnormalities, such as broken or missing teeth or poor tooth alignment. Your dentist will also inspect your teeth, the underlying bone and the inside of your cheeks for damage caused by bruxism. He or she may make a series of X-rays of your mouth and jaw.

A dental examination may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint disorders or other dental disorders. If your dentist suspects that you have an ear infection (otitis media), he or she will probably refer you to your primary care provider for further examination and treatment. If your dentist suspects a significant psychological component to your teeth grinding or a sleep-related disorder, you may be referred to a therapist, counselor or sleep specialist.

Complications:
In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:
  • Damage to your teeth (including restorations and crowns) or jaw
  • Tension-type headaches
  • Facial pain
  • Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth
Treatment:
In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't brux badly enough to require therapy. However, if the problem is severe, treatment options include :
  • Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help your child to talk about his or her fears just before bed or to relax with a warm bath or a favorite book.
  • Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth. Your dentist can make a custom mouth guard to fit your mouth. Over-the-counter mouth guards are available and they're less expensive than custom guards, but they generally don't fit well and can dislodge during bruxing.

    If your bruxism seems to be associated with dental problems, your dentist may also correct misaligned teeth. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and though it will correct the wear, it may not stop the bruxism.

  • Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses.

    During a biofeedback session, a therapist applies electrical sensors to different parts of your body. These sensors monitor your body's physiological responses to stress — such as teeth grinding — and then feed the information back to you via auditory and visual cues. These cues may take the form of a beeping sound or a flashing light. With this feedback, you'll start to associate teeth grinding or clenching with stress and learn to change your behavior. You may also be given a portable biofeedback device that you use at home. Your therapist will explain how it works.

  • Medications. In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. Botulinum toxin (Botox) injections may help some people with severe bruxism that hasn't responded to other treatments.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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