What is bruxism?
Article written by Dr Jaime Guinovart
Bruxism is known as the habit as the habit of grinding the teeth together involuntarily and with excessive frequency and force.
It occurs at any age, regardless of gender or race. Most surprisingly it has a very high incidence: 70% of the population suffers from it.
Unfortunately, our current pace of life causes such a high percentage. In fact, dentists are seeing fewer patients every day who come to the dentist for the common cavity and more who do for bruxism.
When do we grind our teeth?
As we have said, bruxism is an involuntary habit. Most habitually, people grind their teeth at night while they sleep. Although it often goes unnoticed, some people are able to recognise when they wake up if they have been scratching their teeth during the night.
On the other hand and although less common, daytime bruxism also exists and occurs in the day, as the name suggests. According to a study published in the Journal of Orofacial Pain 2009, daytime bruxism is directly related to situations of tension or psychological stress.
Some examples of daytime bruxism occur when driving, working in front of a computer or even watching television.
What causes bruxism?
There doesn’t exist only one cause of bruxism. Bruxism is a multifactorial disease, i.e. several factors influence the onset of bruxism, according to a research article published by the Louisiana State University School of Dentistry.
Even so, all of the studies agree that stress is the principal cause of this pathology. All of us have been faced with a stressful situation and tensing your teeth or jaw is one of the ways that the body has found to relieve this accumulated tension. If this stressful situation becomes chronic, probably you will suffer from bruxism.
Other than stress, other factors that also result in bruxism are: low sleep quality and quantity, an excessive development of the chewing muscles, a poor tooth alignment, missing teeth, muscular-articular pain or pathological habits such as biting on pens, nails, chewing gum, etc.
How do I know if I suffer from it?
Despite being involuntary, many people are conscious of this habit. There are certain signs and symptoms that help us to detect if we have this habit. Amongst the most common we highlight:
- Muscular pain on waking
- Tension in the cheeks, neck and temple
Even though a decisive diagnosis should be made by a dentist, you can also look out for the signs of bruxism:
- Wear and tear of the teeth
- Indentations on the sides of the tongue
- Dental sensitivity
- Dental fractures
- Small teeth
- Sores at the corners of the mouth
It is important to highlight that none of these factors are completely exclusive to bruxism. For this reason, the diagnosis should be carried out by a dentist. It is common that a patient with bruxism goes for a consultation for another problem that has in turn aggravated the bruxism, for example, missing teeth, dry mouth, dental caries or infections.
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Bruxism in adults
There are two different types of wearing of teeth. Physiological attrition and pathological attrition. Physiological attrition is a natural process and where there exists normal tooth wear down. This depends on factors such as the age of the patient.
On the other hand, pathological attrition is that which is not commensurate with the patient's age and demonstrates excessive activity of the masticatory muscles.
According whether the dental wear-down is physiological or pathological, the dentist will approach treatment in a preventive or restorative manner.
Bruxism in children
Bruxism in children usually starts during adolescence, in between 17 and 20 years old, and is similar for boys and girls. As with bruxism in adults, the principal cause of bruxism in children is stress.
It is important to diagnose and prevent bruxism at an early stage, as excessive wear and tear at an early age can greatly compromise quality of life later in life.
Treatments for bruxism
Depending on the extent of the attrition and the age of the patient, the treatment of bruxism will adopt either a preventative approach (to avoid future wear and to strengthen the teeth) or a restorative approach (to achieve a table bite and to reconstruct the worn teeth).
Further on we will explain the different existing treatments for bruxism, for each approach:
Preventative treatments for bruxism
Dental Night Guard:
The most well-known of the treatments. A dental night guard is a dental device similar to a sports mouth guard that is used at night, made of hard resin that is wear-resistant and fits perfectly to your teeth, as it is custom-made. It serves as a barrier so that the upper and lower teeth do not rub against each other.
In addition, it can help to relax the muscles, ligaments and joints, alleviating the force that we unconsciously exert.
These mouth guards are only made in dental clinics by dentists and require an initial casting session and a second delivery and fitting session.
Even though Botox is known as an aesthetic facial treatment used to reduce and prevent the appearance of wrinkles, it is also used in dentistry to treat bruxism.
Botulinum toxin is a neurotoxin made by a bacterium called Clostridium botulinum which is used to "anaesthetise" the muscles so that they do not respond when we ask them to move. In facial aesthetics botulinum toxin is injected to prevent the patient from gestating excessively, thus avoiding the appearance of wrinkles.
Of course, the botulinum toxin is not permanent. After a certain period of time (usually 3-4 months) our body breaks the toxin down, returning to the previous amount of muscular activity.
In dentistry, we use botulinum toxin to tune the chewing muscles and to reduce excessive biting force. This procedure is developed over the course of 3 and 4 sessions until the muscle has reduced to the correct size and recuperates a normal function. This treatment is very effective in extreme cases of bruxism and it can be used in parallel with others.
A physiotherapist specialised in mouth joints, called temporomandibular joints or TMJs, helps you to correct bad bruxing habits (grinding of the teeth) and to learn exercises for the relaxation of masticatory muscles.
Not all dental clinics have an ATM specialised physiotherapist in their team, but it is a fundamental tool in bite correction and complex oral treatments.
This is especially relevant in daytime bruxism. Learning to be aware of when you grind your teeth and what situations act as triggers to start clenching our teeth will help to prevent this ailment. There are some exercises that help us to relax our muscles in these moments, especially with regard to daytime bruxism.
It is important to know that these treatments are all personalised to each individual and their different needs. The treatments are complementary, they can be carried out together.
Restorative treatments for bruxism
As we mentioned before, one of the factors that results in bruxism is bad tooth alignment. Teeth that are crowded and overlapped need to use more force to move freely, accustoming the brain to use intense force for simple movements. Our orthodontists make sure that the teeth fit properly together, equally distributing the chewing forces and reducing the need to exert more force than normal.
Dental reconstruction is an easily visualised treatment as it simply consists of restoring your teeth to their original shape. With this technique, tooth sensitivity is diminished, tooth alignment is improved, and most importantly future wear is prevented due to the use of more resistant materials (composite or ceramic).
This technique also includes replacing missing teeth, because with fewer teeth in the mouth the remaining teeth become overloaded and wear down more quickly. There are different alternatives for replacing missing teeth, but each case is different, and a dentist should recommend the ideal treatment for your case.
In conclusion, bruxism is very common and usually goes unnoticed in its initial development. Prevention and treatment are vital to be able to maintain a good quality of life in the later stage of your life, where it is needed most.
The best way to evaluate and control the wear down of your teeth and of many other pathologies is to see your dentist regularly. This will minimise the risk of development of problems in your mouth through early diagnosis.