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Bruxism (Teeth Grinding)

What Is It?

Bruxism is clenching or grinding your teeth, often without being aware that your are doing it. In the United States, bruxism affects an estimated 30 to 40 million children and adults.

Some people grind their teeth only during sleep; this condition is called "nocturnal bruxism" or "sleep-related bruxism." Others grind their teeth during the daytime as well, most often during situations that make them feel tense or anxious. People with severe bruxism can fracture dental fillings or cause other types of tooth damage. Severe bruxism has also been blamed for some cases of temporomandibular joint dysfunction (TMD), mysterious morning headaches and unexplained facial pain.

Bruxism can have a variety of psychological and physical causes. In many cases, it has been linked to stress, but it can also simply be the body's reaction to the teeth being aligned wrong or a poor bite (the way the teeth come together). Bruxism can sometimes occur as a complication of severe brain injury, or a symptom of certain rare neuromuscular diseases involving the face. Bruxism also can be an uncommon side effect of some psychiatric medications, including antidepressant medications, including fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).

Symptoms

Symptoms of bruxism include:

  • Rhythmic contractions of the jaw muscles
  • A grinding sound at night, which may disturb the sleep of someone who shares a bedroom with a "bruxer"
  • A dull morning headache
  • Jaw muscles that are tight or painful, especially in the morning
  • Chronic facial pain
  • Damaged teeth, fractured dental fillings and injured gums

Diagnosis

Your dentist will ask about your current life stresses, your general dental health and your daily medications. He or she also will want to know whether you routinely drink beverages containing alcohol or caffeine, because both of these chemicals seem to increase the tendency to grind your teeth.

If you share your bedroom, the dentist also may want to ask that person about your sleep habits, especially about any unusual grinding sounds heard during the night.

Your dentist will examine you, paying special attention to your mouth and jaw. During this exam, your dentist will check for tenderness in your jaw muscles, as well as for any obvious dental abnormalities, such as broken teeth, missing teeth or poor tooth alignment. If your dentist suspects that you have bruxism that is related to dental problems, he or she may conduct a more detailed assessment. In addition to checking your "bite," the dentist will examine your teeth and gums for damage caused by bruxism. The dentist will also take a series of mouth X-rays.

If your child grinds or clenches his or her teeth, discuss the problem with your family dentist. Although many children eventually outgrow bruxism, even short-term tooth grinding can cause damage to your child's permanent teeth.

Expected Duration

Of all children who brux between the ages of 3 and 10, more than half will stop spontaneously by age 13.

In teenagers and adults, how long bruxism lasts depends on its cause. For example, bruxism can last for many years if it is related to a stressful life situation that doesn't go away. However, if bruxism is being caused by a dental problem, it should stop when the teeth are repaired and realigned — often within a few dental visits.

Prevention

If your bruxism is related to stress, you may be able to prevent the problem by seeking professional counseling or by using strategies to help you learn to relax. Also, try cutting down on stimulants such as tobacco and caffeine.

In both children and adults, tooth damage related to bruxism can be prevented by wearing a night bite plate or a bite splint (a dental appliance worn at night to stop teeth grinding).

Treatment

The treatment of bruxism varies depending on its cause:

  • Stress — If you have bruxism that is stress-related, your dentist or physician may recommend professional counseling, psychotherapy, biofeedback exercises or other strategies to help you relax. Your dentist or physician also may prescribe muscle relaxant medications to temporarily ease the spasm in your clenched and overworked jaw. If conventional therapy does not help, your dentist may refer you to an oral surgeon who may inject botulinum toxin directly into your jaw muscles (to temporarily interfere with muscle contractions).
  • Dental problems — If your bruxism is related to tooth problems, your dentist will probably treat it with occlusal therapy (to correct tooth alignment). In severe cases, your dentist may need to use onlays or crowns to entirely reshape the biting surfaces of your teeth.
  • Brain injury or neuromuscular illness — Your bruxism may be especially hard to treat if you have these medical problems. Your oral surgeon may give you injections of botulinum toxin if more conservative treatments fail.
  • Medication — If you develop bruxism as a side effect of antidepressant medications, your doctor either can switch you to a different drug or give you another medication to counteract your bruxism.

When To Call A Professional

Call your physician or dentist if you have symptoms of bruxism, or if you are told that you grind your teeth while you sleep.

Also, make a dental appointment immediately if you fracture a tooth, lose a filling, or notice that your teeth are becoming abnormally loose in their sockets.

Prognosis

Even without special treatment, more than half of young children with bruxism stop grinding their teeth by age 13. Until your child stops bruxing on his or her own, your dentist can fit your child with a night bite plate to prevent excessive tooth wear. This device is effective in almost all children who use it as directed.

In teenagers and adults, the outlook is excellent if bruxism is treated properly. Even if all other therapies fail, injections of botulinum toxin can temporarily stop bruxism in most patients.

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