Bruxism: Causes, Signs and Treatment

Bruxism: Causes, Signs and Treatment

Bruxism is involuntary grinding or clenching of the teeth, and it comes in two distinct forms. Sleep bruxism happens during sleep and you are unaware of it; awake bruxism is daytime clenching, usually while concentrating or under stress, and it is a separate habit with a separate solution. Both wear teeth, but they are not treated the same way.

Causes

Sleep bruxism is now understood as a centrally driven sleep phenomenon rather than a simple problem of bite. The main associations:

• Stress and anxiety, the most commonly reported factor
• Sleep-disordered breathing, including snoring and sleep apnoea - the association most often missed, and the most important, because treating the breathing improves the grinding
• Medication, particularly some antidepressants
• Stimulants: caffeine, nicotine, alcohol and recreational drugs
• Bite factors, which can contribute but are rarely the whole story

A patient who grinds, snores, wakes unrefreshed and is sleepy during the day should have the sleep investigated, not only the teeth protected. That is the single most useful sentence on this page.

Signs and Clinical Findings

• Jaw ache or tightness on waking, easing through the morning
• Headaches at the temples, present when you wake
• Flattened, shortened or chipped teeth - the canines usually first
• Teeth sensitive to cold with no decay to explain it
• Restorations that keep fracturing or debonding
• A partner who hears the grinding
• Scalloped edges on the tongue and a ridge along the inside of the cheek
• Enlargement of the masseter muscles, broadening the lower face

How It Is Diagnosed

By examination rather than by a test: the wear facets are assessed and photographed, the chewing muscles are palpated for tenderness, the jaw joint is checked for clicking and restricted opening, and the bite is examined. Photographs and models allow the wear to be measured against itself over time, which is what distinguishes active grinding from historical wear that has stopped.

Where sleep-disordered breathing is suspected, that is referred for proper investigation rather than guessed at.

Treatment

A night guard is the first step in almost every case. It does not stop the grinding - be sceptical of anyone who says otherwise - but it puts a replaceable layer of acrylic between the teeth so the wear happens to the guard, and it unloads the muscles and the joint. Hard acrylic is the default; soft guards can increase muscle activity in heavy grinders, and shop-bought boil-and-bite devices can shift the bite over months.

Botulinum toxin in the masseter reduces the force itself rather than protecting against it, and it is added where muscular pain persists despite a well-made guard, or where the muscle bulk is itself the complaint. It lasts three to six months. It is an addition to the guard, not a replacement - injections alone leave the teeth unprotected as the effect fades.

Restorative and prosthetic correction comes after protection, not before. Rebuilding worn teeth in a patient who is still grinding unprotected is how expensive work fails within two years. Where an individual restoration is high, adjusting it is quick and worthwhile; what is not supported by evidence is extensive irreversible grinding of tooth surfaces to "balance" the bite.

Behavioural measures carry more weight than they are given credit for: addressing sleep quality, reducing caffeine and alcohol in the evening, managing stress in whatever way actually works for you, awareness training for daytime clenching, and physiotherapy for the muscles. Reviewing medication with the prescriber matters where a drug is implicated.

What Happens If It Is Left

Enamel wears, and it does not grow back. Teeth shorten and the face loses vertical height. Sensitivity increases as dentine is exposed. Restorations fracture repeatedly. Cracks develop, and a vertical root fracture cannot be repaired at any price. The chewing muscles and the jaw joint become painful, and morning headaches become routine.

None of that happens quickly, which is exactly why it is ignored - the change over a year is small, and the change over fifteen is not reversible.

If You Are Having Aesthetic Work Done

This deserves stating plainly for anyone planning veneers, crowns or implants abroad. Unprotected grinding is one of the main reasons such work fails early, and a clinic that plans a full smile makeover without asking about grinding, examining the wear facets and including a guard is not planning for the years after you fly home. If you grind, the guard is part of the treatment, not an upsell.

The information in this article is general and does not replace a clinical examination. Whether you grind, and what treatment is appropriate, can only be determined after examination.

Written by Tuğçe Arslan Founder – Dentist · Beyaz Oral and Dental Health Clinic

She sees patients at our clinic in Kuşadası and writes and regularly reviews the medical content on this site. The information here is for general guidance only and does not replace an examination.