Do you frequently wake up with pain in your jaw? If you do, maybe you suffer from bruxism, a disorder in which grinding of teeth occurs at night during sleep. Bruxism is more common than we think. This condition usually brings about another series of symptoms, such as intense and mild headaches, dizziness and even a buzzing in the ears.
It is normal that at certain times of the day we clench our jaw without noticing, but when this situation continues throughout the night, the effects are felt the next day due to the tension to which the muscles of the jaw have been exposed to while dreaming.
“Tooth grinding is an activity of significance to the dental specialist because of breakage of dental restorations, tooth damage, induction of temporal headache and temporomandibular disorders.
Bruxism, which can be considered as an umbrella term for clenching and grinding of teeth, is the commonest of the many parafunctional activities of the stomatognathic system. The term Bruxism originates from the Greek word brychein, which means to grind. It was later adopted as ‘Bruxism’ to describe gnashing and grinding of the teeth occurring without a functional purpose. Bruxism can occur during wakefulness or during sleep. The American Academy of Sleeping Disorders proposed the terms Sleep and Awake Bruxism. Bruxism during daytime is commonly a semi voluntary ‘clenching’ activity and is also known as ‘Awake Bruxism’ (AB) or Diurnal Bruxism (DB). Bruxism during sleep either during daytime or during night is termed as ‘Sleep Bruxism’ (SB).
Awake bruxism is linked to life stress caused by familial responsibility or work pressure. Sleep Bruxism is an oromandibular behavior that is defined as a stereotyped movement disorder occurring during sleep and characterized by tooth grinding and/or clenching. Sleep bruxism was recently classified as sleep related movement disorder according to recent classification of Sleep Disorders. Prevalence rate of Awake and Sleep Bruxism is about 20% and 8–16% respectively in adult population. Awake bruxism occurs predominantly among females while no gender difference is seen for sleep bruxism. Onset of Sleep Bruxism is about 1 year of age soon after the eruption of deciduous incisors. The disorder appears more frequently in the younger population. The prevalence in children is between 14 to 20%.”1
Classification of Bruxism
“Bruxism is one of the most prevalent, complex and destructive dental functional disorders. Thus, bruxism can be classified according to the degree of severity, as moderate, severe and extreme, where there are evidences of lesions on the stomatognathic system structures.
It can also be classified as centric and eccentric. Centric bruxism consists in a continuous clenching of teeth, for a given period, with destruction of their supporting structures, but also conditions involving masticatory muscles and temporomandibular joint. In eccentric bruxism, there are isotonic muscle contractions and wear of the incisal edges of the teeth, particularly in the anterior arch. However, not all cases with wear of incisal edges result from this parafunctional activity, it may be associated with other habits such as nail biting, biting objects, among others.
Bruxism is also classified as chronic, acute and sub-acute. Literature states that an occlusal disharmony interferes in bruxism when the patient exhibits signs and/or muscular symptoms. This occurs in centric relation and/or in functional lateral and protrusive phases.
Some authors classify bruxism as diurnal and nocturnal, each one having different causes. In other words, bruxism that occurs during the day (DB) and bruxism that occurs during sleep (SB) are different clinical entities that arise in different states of consciousness and have different etiological factors. Therefore, they should be distinguished, requiring different treatment plans.
DB and SB are classified as primary when no clear medical cause, systemic or psychiatric, is present. Secondary bruxism comes associated with a clinical disorder, neurological or psychiatric, connected to iatrogenic factors or any other sleep disorders.”2
Among the causes behind this problem are a combination of physical, psychological and genetic factors.
Causes of Bruxism
“Bruxism is said to have multiple causes. They include central factors, psychosocial factors and peripheral factors.
Central factors: The physiology of sleep has been studied extensively especially the ‘arousal response’, as bruxism usually occurs during sleep. Arousal response is a sudden change in the depth of the sleep during which the individual either arrives in the lighter sleep stage or actually wakes up. And such a response occurs along with body movements, increased heart rate, respiratory changes and increased muscle activity. […] Hence proving a close association of arousal response with bruxism activity. It is hypothesized that the direct and indirect pathways of the basal ganglion, a group of five subcortical nuclei that are involved in the coordination of movements is disturbed in bruxism patients. An imbalance between both the pathways, results in movement disorder like Parkinson’s disease and this imbalance occurs with the disturbances in the dopamine mediated transmission of action potential. In case of bruxism there may be an imbalance in both the pathways. Acute use of dopamine precursors like L-dopa inhibits bruxism activity and chronic long term use of L-dopa results in increased bruxism activity.
Psychosocial factors A multifactorial large scale population study of sleep bruxism concluded highly stressful life as a significant risk factor. Inability to express emotions such as anxiety, rage, hate, aggression, etc., can also be a cause for bruxism. Awake bruxism or diurnal bruxism can be associated with stress due to familial responsibility or work pressure.
Peripheral factors Bruxism is commonly considered to be related to deviations in dental occlusion and articulation. […] Recent literature studies on this aspect agrees that there is hardly any relationship between bruxism and occlusal factors.”3
However, the most common ones are anxiety, stress and sleep disorders such as insomnia and others. Some risk factors are:
- Age: it is more common in children and by the adulthood, the problem usually goes away
- Medications: some antidepressants may present bruxism as a side effect
- Tobacco smoke
- Other disorders such as Parkinson’s disease, dementia and attention-deficit/hyperactivity disorder (ADHD)
If we do not treat this problem on time, it may give rise to other consequences such as tooth erosion or fracture, chronic headache, deviation of the jaw (some severe cases may lock it, so it won’t open or close completely), tooth pain or sensitivity, neurological problems and digestive disorders of all kinds.
Treatment of Bruxism
“Treatment of occlusal related disorders is often a challenge for both the dentist and the patient. As the presenting symptoms of these conditions are, usually, variable, they are difficult to diagnose. Currently, no specific treatment exists that can stop sleep bruxism. But, treatments based on behavior modification such as a habit awareness, habit reversal therapy, relaxation techniques, and biofeedback massed therapy, may eliminate awake bruxism. To reduce the deleterious effects of bruxism, various methods have been proposed. The most common method is by use of different interocclusal appliances such as occlusal splints, night guards, etc., Recent reviews have concluded that interocclusal appliances are useful adjuncts in the management of sleep bruxism but do not offer a definitive or curative treatment of bruxism or signs and symptoms of temporomandibular disorders.”4
Tips that will help alleviate bruxism
- Move the lower jaw slowly from side to side. Hold the position for 10 seconds and move it to the opposite side. Repeat 10 times.
- Open your mouth and keep it open for 5 seconds. Close it for another 5 seconds and repeat again, up to 10 more times.
- Stretch the cervical vertebrae by slowly bringing your chin to the chest. Repeat 15 times.
Tips to prevent bruxism
- Each night, prepare a delicious and relaxing tea infusion before going to bed. You can add lime, honey, chamomile, lemon balm and / or valerian. It will help calm your nerves and sleep better.
- Prioritize tasks.
- Practice yoga or meditation, it will change your life!
- Increase the consumption of foods rich in calcium, magnesium and Vitamin C. These are essential to combat tooth erosion.
“The management of bruxism associated with neurological disorders focuses on improvement of chewing, speaking, swallowing, and feeding, which are severely compromised, and to relieve orofacial pain symptoms. However, no general rules can be applied because placebo-controlled studies are lacking, so a case-by-case approach is suggested. Conservative measures such as occlusal splints and the use of drugs for treating the underlying disease may help the patient to control his bruxism; for example, a single case report in a patient with multiple system atrophy and constant awake teeth grinding claimed a marked improvement 1 week after starting levodopa-carbidopa, while similar results were documented after using galantamine in a patient with Alzheimer disease and awake bruxism.
Injections of botulinum toxin in the masticatory muscles have been used in two case series of patients with severe bruxism associated with cranial dystonia and other movement disorders. In these studies, the therapy rendered the patients free of bruxism for up to 1–5 months and markedly improved pain reports and mandibular functions. Botulinum toxin was also effective in the resolution of bruxism that appeared during the recovering from coma in four patients with anoxic or traumatic brain injury. Finally, surgical treatment of temporal lobe epilepsy resolved the occurrence of ictal bruxism in two reported cases. It should be mentioned that intraoral devices should be used with caution in epilepsy patients as splints can break during seizures and obstruct the airway.”5
If you put these exercises and remedies into practice, you will notice a great improvement of your symptoms. Remember, always consult your dentist or specialist if you have any concerns or major issues.
(1) Swaminathan, A. A. (2014). A REVIEW OF CURRENT CONCEPTS IN BRUXISM–DIAGNOSIS AND MANAGEMENT. Nitte University Journal of Health Science, 4(4). Available online at http://nitte.edu.in/journal/December%202014/131.pdf
(2) Veiga, N., Ângelo, T., Ribeiro, O., & Baptista, A. (2015). Bruxism–literature review. Int J Dent Oral Health, 1(5), 1-5. Available online at https://pdfs.semanticscholar.org/c569/63eb2da3783fb8344df5cd4abf90f38e7f73.pdf
(3) Kanathila, H., Pangi, A., Poojary, B., & Doddamani, M. (2018). Diagnosis and treatment of bruxism: Concepts from past to present. Available online at http://www.oraljournal.com/pdf/2018/vol4issue1/PartE/4-1-44-680.pdf
(4) Reddy, S. V., Kumar, M. P., Sravanthi, D., Mohsin, A. H. B., & Anuhya, V. (2014). Bruxism: a literature review. Journal of international oral health: JIOH, 6(6), 105. Available online at https://www.researchgate.net/publication/271599036_Bruxism_A_Literature_Review
(5) Guaita, M., & Högl, B. (2016). Current treatments of bruxism. Current treatment options in neurology, 18(2), 10. Available online at https://www.researchgate.net/publication/295398549_Current_Treatments_of_Bruxism