Teeth grinding (bruxism)

Bruxism is clenching the teeth and rubbing them against each other without meaning to. It happens most often during sleep, which is why the person does not hear it or remember it. The muscles that close the jaw are very powerful, and in one night they can do to the teeth what ordinary chewing does not manage in years. The good news is that teeth can be protected from it, and the way it is done is simple.

How people find out that they grind their teeth

Almost nobody works it out alone. It usually comes to light in one of four ways.

• Whoever sleeps beside you says so. The sound of night-time grinding is loud and very distinctive, and in most cases it is the partner who sends the person to the dentist.
• The dentist notices. A check-up shows what you cannot see yourself: the cusps of the back teeth worn flat as though filed down, chips along the edges of the front teeth, cracks in the enamel, broken fillings or fillings that keep coming out, smooth patches where there should be relief.
• The way mornings feel. The jaw is tight on waking, as though you had been chewing all night; the muscles near the angles of the jaw and the temples ache; your head aches from the moment you wake and eases after an hour or two; sometimes the ear nags although there is nothing wrong with the ear.
• The teeth become sensitive to cold, heat and anything sour, in the places where the enamel has worn away.

There are smaller clues too: tooth marks along the edges of the tongue and on the inside of the cheeks, clicking in the jaw joint, noticeably bulkier muscles at the sides of the face.

Two different habits are worth telling apart. The night-time one is grinding proper: the person does not know about it and cannot stop it by will. The daytime one is more often silent clenching, with no sound at all — at work, in traffic, over the phone. That one can be caught and unlearned, and it is where to start.

Where it comes from

The exact cause cannot always be named, but the range is known.

• Stress, anxiety, tension — the commonest by far. Bruxism clearly increases in difficult stretches and settles in calm ones, and many people spot that link themselves.
• Snoring and pauses in breathing during sleep. This gets its own section below: it is the one cause where the thing to treat is not the teeth.
• Medicines. Grinding can be a side effect of some antidepressants, chiefly those in the group of selective serotonin reuptake inhibitors, and of drugs with a stimulant effect. If it began around the time a medicine was started, tell the doctor who prescribed it. Medicines like these are not stopped on your own initiative.
• Caffeine, alcohol, nicotine and stimulant recreational drugs. Coffee and energy drinks in the second half of the day, and alcohol before bed, make sleep worse and increase grinding that same night.
• Reflux and other things that make sleep shallow.

In children bruxism is common, particularly during the years when teeth are coming through and being replaced. Night-time grinding in a child is usually not a sign of illness and usually goes away on its own, with no treatment at all, as the adult bite forms. It is worth taking a child to the dentist if the teeth are visibly worn or chipped, if the child complains of jaw or head pain, and also if they snore loudly and sleep with the mouth open.

Snoring and pauses in breathing: the cause that is looked for separately

Teeth grinding often goes along with pauses in breathing during sleep, that is, with sleep apnoea. This matters not for the sake of completeness but because it changes the whole plan: while someone stops breathing ten times an hour, no splint between the teeth will fix the underlying problem, and treating the apnoea often reduces the grinding by itself.

Tell your doctor about the grinding if you have any of these:

• loud snoring with pauses in breathing on top of it, gasping, the feeling of having choked in your sleep;
• you sleep your usual hours and still wake unrefreshed;
• you nod off during the day — at the wheel, in a meeting, in front of the television;
• a headache and a dry mouth on waking;
• you get up to pass urine several times a night;
• your blood pressure is high and hard to bring down.

With that picture the doctor will suggest a sleep study. It is not an emergency, but it is not something to leave for a few years either.

What gets damaged, and when the dentist is not put off

The consequences of bruxism build up quietly. Enamel wears away, teeth get shorter and more sensitive, chips and cracks appear along the edges, fillings and crowns loosen and come out, the gum edge recedes, and the jaw joint starts to click and ache. The constant work of the muscles produces a headache of its own: dull, in the temples and at the sides of the forehead, first thing in the morning.

Do not put off seeing a dentist if:

• a tooth is chipped, cracked or broken, or a filling has come out;
• your teeth have become noticeably shorter, or sensitive to cold and heat;
• the jaw or face hurts enough to make eating difficult;
• the jaw has locked and you cannot open or close your mouth fully;
• the joint clicks and the click comes with pain;
• you have been told you grind at night, even if nothing is troubling you yet.

And separately: if severe throbbing pain in a tooth appears, with swelling of the cheek or gum and a temperature, that is no longer bruxism but an infection, and it needs attention the same day.

A protective splint: the thing that genuinely helps

The main measure in bruxism is a protective splint, or mouth guard, made by a dentist from an impression of your teeth. It is worn at night. It is worth being clear about what it does: it does not break the habit and does not treat the cause, it takes the load itself, spreads it out and stops the teeth wearing down and breaking. That is exactly why it works — while the cause is being looked for and dealt with, the teeth stay intact.

A splint like this is fitted in the mouth and then checked and adjusted from time to time, because it wears out and because the bite changes over the years. Ready-made guards, the sort softened in hot water and bitten into at home, fit less well, can shift the bite and irritate the gum, so in this situation it makes more sense to go to the dentist once. Do not file or alter the splint yourself.

Besides the splint, the dentist looks at what has already suffered: rebuilds worn and chipped teeth, checks whether the teeth meet evenly, deals with pain in the jaw joint and, if your account suggests apnoea, sends you to have your sleep looked into. Treating the bruxism itself is not always needed: where it is mild, with no symptoms and no wear, a doctor may simply keep an eye on it.

What you can do yourself

None of this replaces the splint, but it helps noticeably, especially with daytime clenching.

• Catch yourself during the day. Check several times a day: teeth apart, lips together, tongue resting quietly, jaw loose. At rest the teeth should not be touching. Reminders help — a note on the monitor, an alert on your phone.
• Take away the jaw's exercise: chewing gum, biting nails, pens and seeds, very hard or chewy food. Do not always chew on the same side.
• Cut down on caffeine, especially after midday, and do not drink alcohol before bed.
• Sort out your sleep: go to bed at the same time, dim the lights and put the screens away an hour beforehand, sleep in a dark, cool room.
• Let the tension out in whatever way suits you: a walk, regular exercise, breathing exercises, a calm evening routine. If anxiety is clearly getting in the way of your life, tell your doctor — it is dealt with in its own right, and that helps the teeth too.
• Relax the muscles: a warm compress on the jaw area before bed eases the tension; if the jaw is swollen and sharply painful, cold wrapped in a towel is better instead. For pain you can take one of the usual over-the-counter painkillers, paracetamol or ibuprofen, at the dose on the packet. Aspirin is not given to children or teenagers.
• Go for regular dental check-ups. Wear shows up at an examination before you notice it yourself.

Online consultation

The splint is made by a dentist, but much of this subject is settled in conversation. An Oladoctor doctor will help you work out whether your morning jaw and temple pain really is connected with grinding, check whether sleep apnoea is sitting behind it, and say which sleep study makes sense. They will go through your list of medicines — sometimes the cause is precisely there — and explain how to raise it with the doctor who prescribed them, without stopping anything on your own. They will tell you who to see in your situation: only a dentist for the splint, or also someone about your sleep, your anxiety or the pain in the jaw joint. And if what you describe suggests the teeth are already suffering, you will be told that the dental appointment is better not postponed.

This material is for information only and does not replace medical advice.