Do you wake up with headaches, neck pain or sore teeth? You could have bruxism and be unconsciously clenching teeth while you sleep. Paul R. Johnson, DDS, explains this common women’s health problem, how to recognize it, and how to stop teeth grinding for good…
If you’re like more than 50% of women, you probably have a nighttime habit you may not even know about: gnashing, grinding or clenching teeth while you sleep. And for about 10% of you, this could be causing serious problems. It’s a condition known as bruxism. We, dentists, refer to it as “the nightly grind.”Here’s how to tell if you’re doing it: Take your thumb or finger and feel along the edges of your upper and lower front teeth.
- Do they feel ragged?
- Any little chips along the edges?
- Any fractures?
- Now, go to the bathroom mirror and really look at them.
- Are they flat or worn down?
- Are there sharp ends?
Then ask yourself these questions:
- Do you ever have a slight morning headache or neck ache?
- Do your teeth feel sore in the morning?
- Have ringing in your ears?
- How about an ache in your jaw, at the point where you open and close your mouth, on one or both sides?
That’s your temporomandibular joint (TMJ), which allows your jaw (known as the mandible) to hinge up and down. It can be pretty sore after a night of grinding and clenching teeth. In my experience, few patients are aware that they’re teeth clenching at night. They’re usually surprised when I demonstrate the destructive results to them, using a large patient’s mirror. What causes bruxism – and, more important, how can you stop the damage? Read on to find out.
A Hard Grind
When you grind your teeth while you sleep, you’re putting an incredible amount of force on them – the equivalent of hundreds of pounds, and many times more than you would tolerate if you were doing it during daylight hours.
The damage it causes can range from minor to severe. Some people just clench teeth at night, but they’re still likely to move the jaw slightly from side to side or front to back – and end up wearing those teeth down. As the teeth grind down and become flat, they can begin to look unsightly. The back teeth may start hitting each other as the front ones shrink. Teeth get shorter, chip easily, become loose – and a once-beautiful, youthful smile could be lost. That jaw joint really takes a beating with bruxism too. Ligaments in and around the TMJ can be damaged as the surrounding area becomes inflamed. The result is pain – sometimes acute. You can even get earaches from the tremendous pressure placed upon this delicate area. The inner ear is separated from the TMJ by mere millimeters – so if the area is inflamed and sore, the inner ear can become painful too. In fact, some dentists and ear, nose, and throat (ENT) specialists believe teeth clenching may cause tinnitus or ringing in the ears.
So why do people grind their teeth at night? The short answer is “nobody knows.”Some noteworthy dentists have suggested a variety of possible reasons for teeth clenching: improperly aligned teeth, major stress or just a habit formed over many years. On some level, there must be something satisfying about it. Dentists who specialize in treating children (called pedodontists) have reported that a majority of kids under the age of 6 grind their front baby teeth. (And it seems unlikely that most 5-year-olds suffer from stress, doesn’t it?)Maybe some adults simply retained this habit from their youth? Whatever the reason, if you’re grinding your teeth, you need help to stop doing it.
Before doing anything else, you should learn a simple technique: “Lips together and teeth apart.”This is the optimal posture for keeping your jaw relaxed.
When your mouth is closed, your upper and lower teeth should be apart, with your tongue slightly forward between them. This will prevent you from clenching teeth during the day – and, with luck, will ease the habit while you’re asleep as well. Everyone should know and use this technique, whether or not they grind their teeth. But you’ll still need professional help. There are differing schools of thought on bruxism treatments, so be careful in choosing someone to help you. Start by talking to your dentist. Ask first about their training or expertise with bruxism treatments. (If you know you’re clenching teeth, yet your dentist or hygienist has never brought it to your attention, maybe they’re not the right people to handle it.)If you’re satisfied, make an appointment for a consultation. If not, call a local periodontist (gum disease specialist) or ask friends and neighbors to recommend one. The treatment should be appropriate for your level of symptoms.
For example, if you just have some slightly worn or chipped front teeth, there’s no need to get a CT scan of your TMJ, which is sometimes done to rule out serious issues.
Most Common Bruxism Treatments
Your dentist will probably recommend a custom-fitted dental night guard, a hard, plastic appliance that fits over the upper teeth.It usually has a flat, smooth surface in the back so that there are no “play areas” to grind on – all your teeth should hit it evenly. Less frequently, the dentist may suggest a type of mouthguard that only allows the front teeth to come together, with back teeth remaining separate – or, in severe cases, dual appliances for both upper and lower teeth. Your dentist will make impressions of your teeth, but the dental night guard itself is usually made in a laboratory. It should fit comfortably and will last 2-4 years. The appliance will keep you from wearing down teeth. But will it stop you from clenching and grinding (on the plastic surface)?
Probably. A properly made dental night guard actually reprograms muscles and nerve pathways. Don’t bother with cheap appliances you can buy at a drugstore or online – they aren’t as effective. If you have acute symptoms, a soft diet may be recommended for a period of time. The dentist may also suggest applying a cold or heat pack to the jaw. Some dentists may want to use an electrical stimulus machine on your facial muscles, called a TENS device – but this is unproven and highly controversial. In severe cases, some patients have had Botox injected into the “chewing” muscles to weaken their ability to clench. But this is expensive and has to be repeated every six months or so – and there’s little scientific evidence supporting it. Sometimes, medications are prescribed: muscle relaxants, pain relievers, anti-inflammatories or sleeping pills. Some dentists also may want to even out your bite by reshaping the tooth enamel, which can be very tricky. They had better be very well trained.
This should be done if agreed upon by all before the dental night guard is made. Your dentist may make models of your teeth to study or send you for a consultation with an orthodontist. As a last resort, they may suggest major dental work to even out the stresses on your bite. This may include crowns in the back, and/or caps (porcelain crowns or veneers, which only cover the visible half of the tooth) in the front to re-establish your proper smile. Before committing to this expensive, permanent treatment – which requires shaving teeth down – you can usually test out “fake” work beforehand, using plastic to lengthen your front teeth. And last, but still important, you should learn these lifestyle habits:
- Eat a nutritious, low-calorie diet
- Engage in regular sports and aerobic exercise
- Maintain low consumption of alcohol
- Don’t smoke
- Avoid recreational drugs
- Have loving friends, and give to others on a regular basis
- Get plenty of good sleep