What is bruxism?
In bruxism the teeth are repeatedly clenched or ground against each other. Common complaints are headaches and shoulder pain, migraine, muscle tension or difficulty swallowing; women are affected more often than men. The tricky part is that many people have no symptoms. Tooth substance is worn away unnoticed over years – leading to decay, aesthetic problems, loss of bite height and pain from overloaded jaw joints.
Most people grind their teeth at some point, usually temporarily under stress. About 20 percent develop craniomandibular dysfunction (TMD). If you suspect it, an early assessment is worthwhile: early treatment relieves symptoms and prevents further dysfunction.
Dr. Nina van Sprundel has published on the subject, including on the three-surface posterior veneer for tooth damage in bruxism patients and on radiological imaging of the jaw joint.
Causes
The causes have been little researched. Surveys show, however, that everyday stress plays a major role. A faulty bite is also common: if the upper and lower teeth do not meet at the same time and evenly, premature contacts occur – for example through crowns, fillings or bridges that are too high, untreated gaps, ill-fitting dentures, poorly adjusted implants or orthodontic misalignment.
- genetic factors, emotional tension, anxiety disorders and depression
- sleep disorders, breathing disorders at night, restless legs syndrome
- excessive chewing gum, poor posture
- imbalances of messenger substances in the brain, reflux disease
- heavy use of alcohol, caffeine or drugs; certain medications such as antidepressants
Effects and diagnosis
Bruxism can cause sensitive teeth, toothache up to inflammation of the nerve, worn chewing surfaces, cracks in the enamel, loose, shortened or brittle teeth, and damage to veneers, crowns and bridges.
Typical signs are tender chewing muscles, tooth imprints on the tongue and cheeks, polished chewing surfaces, chipping of enamel, tooth necks and incisal edges, shortened teeth, canines without tips and receding gums. We assess bruxism through a conversation and an examination of the teeth, supporting tissues, chewing muscles and bite. TMD shows as pain when the muscles are palpated and when the jaw moves, sideways deviation on opening and restricted mouth opening. Electromyographic measurements also help; the most important method for judging severity is polysomnography.
Treatment
Grinding itself cannot be cured, but it can be reduced considerably. Treatment depends on the cause, and a combination of approaches works best.
- Splint: the occlusal splint is the standard therapy. It fits over the upper or, less often, the lower teeth, protects against wear and relaxes the jaw in most people. It should be worn consistently at night; if symptoms ease quickly, therapy can end after a few weeks. Adjustable splints such as the Michigan splint can correct a faulty bite in the long term. A relaxation splint guides the lower jaw into a relaxed position, a centric splint specifically targets jaw joint problems.
- Relaxation: enough time to unwind, a balanced work-life balance, relaxation techniques, physiotherapy and exercise such as Nordic walking, moderate jogging, walks, Pilates or yoga reduce stress.
- Psychotherapy: it helps identify psychological causes such as stress, anxiety or depression – for example with behavioural therapy, biofeedback, hypnotherapy or relaxation methods such as progressive muscle relaxation and breathing exercises.
- Cutting down substances: we rarely use medication. It is more effective to reduce sleeping or caffeine tablets, alcohol, coffee, energy drinks and black tea.
- Botulinum toxin: injections into the chewing muscles can be useful for bruxism.
Rebuilding the teeth
Worn teeth can be rebuilt with composite or ceramic. First we analyse the occlusion – how the teeth meet when the jaw closes – and address the causes of grinding. A bite raise restores the normal bite; after that, a complete aesthetic restoration with veneers, crowns and bridges is possible. We plan your new smile digitally on screen beforehand.
Grinding in children
Many young children grind their teeth at night. In milk teeth this is not unusual: bone and muscles grow in spurts, teeth temporarily meet unfavourably and are worn down. Once the permanent teeth come through, grinding should stop – sometimes as early as the fourth year of life. Passive smoking is a risk factor for bruxism in children.