Bruxism is a sleep-related movement disorder characterized by nighttime teeth grinding. The name derives from the Greek word brychein which means gnashing of the teeth – and it is precisely what this condition is. It can cause disrupted sleep, along with teeth damage. This disorder is involuntary, and movement during sleep is unconscious, just like all other sleep-related movement disorders. The condition is primarily connected to rhythmic masticatory muscle activity (RMMA).
People tend to grind their teeth while they are awake, but this disorder causes a much more significant health issue than occasional daytime teeth grinding. Since it is involuntary, individuals are not aware if they are grinding their teeth or not. People in most cases discover it when the condition is observed and reported by their sleep partners. Self-reports are very rare, and they have a high false-negative rate. If left untreated, the condition can last for years, causing your teeth to wear down, loosen or break, cause jaw pain, headaches, and in some cases temporomandibular joint (TMJ) disorder. The biggest problem with this condition is that it interferes with sleep quality. Teeth grinding tenses the muscle, preventing the body to relax and fall into a deep and restful slumber.
There are two main types of bruxism – sleep bruxism or nocturnal bruxism that happens during sleep and awake bruxism or diurnal bruxism that happens during wakefulness. Both types cause similar dental damage, but sleep bruxism tends to interfere with sleep, get worse in the morning and aggravates as the day advances, while awake bruxism appears only during the day and doesn’t worsen from morning to night.
The term bruxism was introduced in 1938 to define repetitive teeth grinding that was also known as bruxomania. Back then, there was no differentiation between sleep bruxism and diurnal bruxism. After reviewing both conditions, researchers agreed that bruxism is best defined as a repetitive jaw-muscle activity with grinding or clenching of the teeth and that it should be separated from diurnal bruxism.
Bruxism can display a variety of symptoms like tooth pain, unexplained facial pain, headaches, jaw pain, and earaches. Apart from these, people suffering from this condition can also experience swelling and pain in the jaw, flattened or fractured teeth, changes in teeth shape, increased tooth pain or sensitivity, damage from chewing on the inside of your cheek, and broken or chipped teeth, crowns or fillings.
People with sleep bruxism often have excessive tooth wear, especially attrition that is responsible for the flattening of the occlusal (biting) surface. Apart from that, other types of tooth wear, failure of dental restorations, and tooth fractures are also common. Abfraction is also common, with notches that appear at the gum line of the teeth, and around their neck. Inflammation of the teeth’s periodontal ligament can also happen, making them hurt or sore on the touch or bite.
Hypersensitive teeth are also a common symptom, which occurs when teeth wand their insulating layers dentin and enamel are worn off. Dental pain is in that case experienced when eating or drinking something warm or cold, depending on the level of tooth damage. Cheek biting, pain or fatigue of the muscles, burning sensations of the tongue, restricted mouth opening, lip biting, and hypertrophy of the muscles can also manifest with teeth grinding. Lastly, during sleep, you will produce grinding noise which may get noticed by your sleep partner or roommate, if you have one.
It is estimated that around forty million Americans have problems with teeth grinding at day and night. Approximately ten percent of them experience severe consequences such as teeth, crown, and filings damage.
Young adults with less than thirty years have more issues with teeth grinding than other age groups. Adults over sixty years rarely have this issue. Bruxism is most common during childhood. Almost a third of children grind their teeth, but fortunately, most of them grow out of it when the permanent teeth start showing up. As for genders, bot males and females are equal in the number of sleep bruxism, but awake bruxism is more prevalent in women.
The cause of bruxism is not yet known and probably involves different factors. What is certain is that awake bruxism and sleep bruxism have different causes, and treatments as well. The condition is often the result of anxiety or stress, with bruxism as a coping mechanism. Adults that are emotional and have hyperactive or aggressive personalities are more prone to teeth grinding. Individuals that have sleep-related breathing disorders have a higher chance of developing bruxism if they do not treat their conditions properly. Disorders like sleep apnea, REM behavior disorder or sleep talking put people at risk of sleep bruxism, as well as nicotine, alcohol, drugs, and caffeine.
One of the causes of sleep bruxism can be sleep arousal – with the rising activity of the cardiac and respiratory systems. The arousals happen up to 15 minutes in one hour of sleep, and they can appear with increased muscle activity. These arousals are more frequent with individuals that have other sleep-related breathing disorders, especially sleep apnea. With sleep apnea, teeth grinding can be an unconscious response where jaw muscles prevent the restrictions of airflow. Many physical conditions can also cause bruxism, such as an abnormal alignment of the upper and lower teeth or acid reflux.
Many risk factors can increase your chances of having sleep bruxism. The primary risk factor is stress. Increased levels of stress or even anxiety have been known to lead to teeth grinding. The same goes for frustration or anger. Individuals with a competitive, hyperactive or even aggressive personality are more likely to develop this condition. Age is also a significant contributor to teeth grinding. Like we mentioned before, it is most common in young children, but it disappears by adulthood in most cases.
Consuming particular medication or other substances can also lead to sleep bruxism. Psychiatric drugs and certain antidepressants can cause teeth grinding, which can lead to sleep bruxism, both the awake and sleep one. Consummation and abuse of nicotine, tobacco, caffeine, alcohol, or drugs is a significant risk factor for bruxism.
Genetics are also a risk factor for teeth grinding. Because it tends to happen in families, if anyone from your family has bruxism or has a history of it, chances are you might also have it. And some medical and mental health disorders like dementia, epilepsy, Parkinson’s disease, gastroesophageal reflux disorder (GERD), night terrors, Attention Deficit Hyperactivity Disorder (ADHD) and other sleep-related disorders also increase your risks.
Sleep Bruxism in Children
Around thirty percent of five-year-olds have shown signs of bruxism. It can develop as a coping strategy for their teething or earaches, but fortunately, in most cases, it goes away just like sleepwalking, night terrors, and bedwetting. By the age of 13 more than half get rid of their sleep bruxism.
Diagnosing sleep bruxism is done by checking your oral healthcare. Having a dental checkup every six months is a good way to find early signs of bruxism. Diagnosing sleep bruxism early is difficult, but also advantageous because it can prevent further teeth damage and the detrimental effect on the quality of your sleep.
When diagnosing sleep bruxism, it is vital to exclude any temporomandibular disorders, dental diseases, seizure disorders, and rhythmic jaw movements. This exclusion is done with a dental examination and electroencephalography for seizure disorders. The diagnosis is made clinically. The clinical study is based on the person’s history with reports of grinding noises, sleep disruptions and any other indicators and symptoms. For those who live with other people, the diagnosis is very easy – just by the sound. Individuals that live alone can try using a sound-activated tape recorder, Bruxcore, or Brux Checker.
After all other disorders have been excluded, a sleep study should be done. The study monitors any increased activity in the body during sleep with electrocardiography, airflow monitoring, electromyography, audio-video recording, and electroencephalography.
There is no cure for bruxism. You can only reduce its symptoms and prevent further damage it can cause. With a combination of therapies, you can also improve your sleep quality.
The first thing you need to do is to improve your sleep hygiene and reduce stress. You need to maintain a regular sleep/wake schedule and incorporate stress management and relaxation techniques into your bedtime routine. Reducing stress can be done through yoga, meditation, and deep breathing exercises. Warm baths, facial massages, along with avoiding chewing gum and hard foods, as well as eliminating or just reducing alcohol, caffeine, and nicotine are great ways to relieve both the symptoms of stress and sleep bruxism. Going through CBT to practice proper jaw and mouth positions can also contribute to stopping your teeth grinding. Combining cognitive behavioral therapy with occlusal splints (nighttime teeth grinding mouthguards) can also be an effective treatment for sleep bruxism. There are also some medications – muscle relaxants, which can reduce jaw muscle tension when taken before sleep.
It’s important to know that mouthguards and splints are recommended for controlling bruxism, but they do not cure it. Your dentist can either make a mandibular advancement device (MADs) or you can get a tongue retaining device. The devices do not stop the grinding, but they protect your teeth and prevent future damage. MADs and TRDs, apart from alleviating bruxism, can also be used to treat sleep apnea. However, for sleep apnea, using a continuous positive airway pressure (CPAP) device is the best therapy.