Teeth grinding (bruxism)

The medical term for teeth grinding is bruxism (BRUK-siz-um), a condition in which you squeeze or rub your teeth together, also called clenching or grinding. Bruxism is common and can happen during the day or night. If you have awake bruxism, you clench or grind your teeth when you're awake without being aware that you're doing it. If you have sleep bruxism, you clench or grind your teeth during sleep. Sleep bruxism is a sleep-related movement disorder.

People who clench or grind their teeth during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing called sleep apnea. Some people may not know they have sleep bruxism until they have tooth or jaw problems because of it.

In some people, bruxism can be a problem and happen often enough to lead to jaw pain, headaches, damaged teeth and other problems. The grinding sound can disrupt a bed partner's sleep. Learn the symptoms of bruxism and get regular dental care to check your teeth.

Symptoms of bruxism may include:

• Teeth grinding or clenching, which may be loud enough to wake up your sleep partner.
• Teeth that are flattened, fractured, chipped or loose.
• Worn tooth enamel. This can expose the inner layers of your teeth.
• Tooth pain or sensitivity.
• Tired or tight jaw muscles, or a locked jaw that won't open or close all the way. Your jaw may pop and click.
• Jaw, neck or face pain or soreness.
• Jaw muscles that are larger than expected.
• Pain that feels like an earache, though it's not really a problem with your ear.
• Dull headache starting at your temples — the sides of your head between your forehead and ears.
• Sleep problems.

When to see a doctor

See your dentist or other healthcare professional if you have symptoms that could be caused by grinding or clenching your teeth or if you have other concerns about your teeth or jaws.

If you notice that your child has symptoms of teeth grinding, be sure to mention it at your child's next dental appointment.

Exactly what causes bruxism isn't completely understood. It may be due to a mix of physical, mental health and genetic factors.

• Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration or tension. Bruxism also may be a coping strategy or a habit when you're thinking deeply or concentrating.
• Sleep bruxism may be a sleep-related chewing activity linked with brief disturbances during sleep.

These factors can raise your risk of bruxism:

• Stress. Having extra anxiety or stress can lead to teeth grinding and clenching. So can anger and frustration.
• Age. Bruxism is common in young children, but it usually goes away by adulthood.
• Personality type. Having a personality type that's aggressive, competitive or hyperactive can raise your risk of bruxism.
• Awake time mouth habits. Mouth habits, such as lip, tongue or cheek biting and chewing gum for long periods of time, can increase the risk of awake bruxism.
• Medicines and other substances. Smoking tobacco or drinking caffeinated beverages or alcohol can raise your risk of bruxism. So can using recreational drugs or taking medicines that aren't approved by your healthcare professional. It's not common, but bruxism can be a side effect of mental health medicines such as some antidepressants and medicines to treat seizures and attention-deficit/hyperactivity disorder (ADHD).
• Family members with bruxism. Sleep bruxism tends to occur in families. If you have bruxism, other members of your family also may have bruxism or a history of it.
• Other conditions. Bruxism can be linked with some mental health and medical conditions. These may include Parkinson's disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea and ADHD.

For most people bruxism doesn't cause serious complications. But severe bruxism may lead to:

• Damage to your teeth or jaws and to fillings, crowns or other dental repairs.
• Tension-type headaches.
• Severe facial or jaw pain.
• Conditions that occur in the temporomandibular joints (TMJs). These are jaw joints just in front of your ears. TMJ problems can cause pain and may sound like clicking when you open and close your mouth.

During regular dental exams, your dentist checks for signs of bruxism.

Evaluation

If you have any signs of bruxism, your dentist looks for changes in your teeth and mouth. This may be watched over the next several visits. The dentist can see if the changes are getting worse and if you need treatment.

Your dentist also checks for:

• Tenderness in your jaw muscles or jaw joints.
• Stiffness or pain when moving your jaws.
• Dental changes, such as flattened, broken or missing teeth.
• Damage to your teeth, the underlying bone and the insides of your cheeks. You may need X-rays of your teeth and jaw.

Determining the cause

If your dentist finds that you have bruxism, your dentist talks with you to help figure out its cause. You may be asked questions about your dental health, medicines, daily routines and sleep habits.

A dental exam may find other conditions that can cause jaw or ear pain, such as temporomandibular joint (TMJ) disorders, other dental problems or health conditions such as sleep apnea.

Referral to a specialist

If your bruxism is likely caused by major sleep problems, your healthcare professional may recommend that you see a sleep medicine specialist. A sleep medicine specialist can do tests such as a sleep study that checks for teeth grinding during sleep. The test also checks for sleep apnea or other sleep disorders.

If your bruxism is likely caused by anxiety or other mental health conditions, you may be referred to a mental health professional such as a licensed therapist or counselor.

In many cases, treatment isn't needed. Many children outgrow bruxism without treatment. And many adults don't grind or clench their teeth badly enough to need treatment.

If bruxism is severe, options include certain dental treatments, therapies and medicines. These can help to prevent more tooth damage and relieve jaw pain or discomfort. If bruxism is caused by a mental health or medical condition, treating that condition may stop or lessen grinding and clenching.

Talk with your dentist or other healthcare professional about which plan may work best for you.

Dental treatments

Your dentist may suggest one of these methods to prevent or correct the wear to your teeth, though they may not stop bruxism:

• Splints and mouth guards. These keep the top and bottom teeth separated while sleeping. This can stop the damage caused by clenching and grinding. Splints and guards can be made of hard plastic or soft materials that fit over your upper or lower teeth.
• Dental correction. If severe tooth wear has led to sensitivity, or you can't chew properly, you may need dental correction. Your dentist reshapes the chewing surfaces of your teeth or uses crowns to repair the damage.

Therapies

One or more of these methods may help lessen or get rid of bruxism:

• Stress or anxiety management. If you grind your teeth because of stress or anxiety, you may be able to prevent the problem by learning tips for relaxation, such as meditation, yoga and exercise. Advice from a mental health professional may help.
• Behavior change. Once you know that you grind and clench your teeth during the day, you may be able to change the behavior by practicing proper mouth and jaw position. Ask your dentist to show you the best position. Create reminders for yourself throughout the day to check your mouth and jaw position. You also may practice controlling mouth habits such as lip, tongue or cheek biting and chewing gum for long periods of time.
• Jaw relaxation. If you're having a hard time changing the habit of clenching and grinding during the day, jaw relaxation exercises or biofeedback may help. Biofeedback uses monitoring equipment to teach you to control muscle activity in your jaw.

Medicines

In general, medicines are not very effective for treating bruxism. More research is needed to decide if they're effective. Examples of medicines that may be used for bruxism include:

• Muscle relaxants. In some cases, and for a short period of time, your healthcare professional may suggest taking a muscle relaxant before bedtime.
• Botox injections. Botox injections are shots that use a toxin to prevent a muscle from moving for a limited time. These injections relax the jaw muscles. This may help some people with severe bruxism who don't get better with other treatments.
• Medicine for anxiety or stress. Your healthcare professional may suggest short-term use of antidepressants or anti-anxiety medicines to help you cope with stress or other emotional concerns that may be causing your bruxism.

Treating other conditions that can cause bruxism

Treatment for these conditions may help:

• Medicine side effects. If you have bruxism as a side effect of a medicine, your healthcare professional may change your medicine dose or suggest a different medicine.
• Sleep-related disorders. Getting treatment for sleep-related disorders such as sleep apnea may help sleep bruxism get better.
• Medical conditions. If another medical condition, such as Parkinson's disease, is causing bruxism, treating that condition may get rid of or lessen clenching and grinding.

These self-care steps may keep bruxism from happening or help treat it:

• Reduce stress. For example, try meditation, music, a warm bath, yoga or exercise. These can help you relax and may lessen your risk of clenching and grinding.
• Don't drink stimulating beverages in the evening. Don't drink caffeinated coffee or caffeinated tea after dinner and don't drink alcohol during the evening. These may worsen clenching and grinding.
• Don't smoke. If you smoke, talk to your healthcare professional about ways to help you quit.
• Practice good sleep habits. Getting a good night's sleep, which may include treatment for sleep problems, may help lessen bruxism.
• Talk to your sleep partner. If you have a sleep partner, ask your partner if you make any grinding or clicking sounds while sleeping. You can then report this to your dentist or other healthcare professional.
• Schedule regular dental exams. Dental exams are the best way to find out if you have bruxism. Your dentist can spot signs of bruxism in your mouth and jaws during regular visits and exams.

You may start by seeing your dentist or your primary healthcare professional. You also may be referred to a sleep medicine specialist.

What you can do

Get ready for your appointment by making a list of:

• Any symptoms you have, including any that may not seem related to the reason for the appointment. If you have mouth, jaw or head pain, make a note of when it happens, such as when you wake up or at the end of the day.
• Your medical history, such as past bruxism and treatments and any medical conditions.
• Key personal information, including any major stresses or recent life changes.
• All medicines, including nonprescription medicines, vitamins, herbs or other supplements, you're taking and the doses. Be sure to include anything you've taken to help you sleep.
• Questions to ask your dentist or other healthcare professional.

Questions to ask may include:

• What's likely causing my symptoms?
• Are there other possible causes?
• What kinds of tests do I need?
• Is my condition likely temporary or long term?
• What's the best treatment?
• What are other treatment options?
• I have other health conditions. How can I best manage them together?
• Should I see a specialist?
• Is there a generic option to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Some questions your dentist or other healthcare professional may ask include:

• When did you first begin having symptoms?
• Do you have symptoms all the time or do they come and go?
• How severe are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to make your symptoms worse?

Be ready to answer questions so you have time to talk about what's most important to you.