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Bruxism: Avoiding the Nightly Grind
For: Jaws, the Sequel, June 2002

Do you grind your teeth while you sleep? It's thought that perhaps one in 10 adults do, though obviously this can only be a guess. Unless your bedmate tells you, you may be unaware of it—until your dentist notices signs of ground-down teeth and informs you that you have bruxism (the technical term for tooth grinding). Symptoms you may notice include morning headaches, jaw pain, a clicking sound in your jaw, sensitive teeth, and damaged teeth or crowns. Nearly anybody can have occasional episodes of nighttime grinding, but only a small percentage of people grind so much that they damage their teeth and jaws.

Tooth grinding can adversely affect the quality of your sleep. Some experts believe chronic, heavy grinding can lead to TMD (temporomandibular disorder, an umbrella term for painful conditions affecting the jaw and facial muscles, which we will discuss in an upcoming issue). Over time, bruxism can worsen perio-dontal disease, harming gums and teeth.

What makes you grind

There's still argument about the probable causes and appropriate treatments of bruxism.

Emotional stress is a likely villain. People who grind their teeth often report that they are undergoing marital or financial difficulties, worrying about exams, fearful of losing their jobs, or otherwise under pressure. Studies have not agreed on whether one particular "personality type" is associated with bruxism. One small study found that shy, unhappy people tend to grind more, but other studies have suggested that hard-driving perfectionists do. Ironically, antidepressants can sometimes promote, rather than prevent, grinding. Tell your dentist if you are taking these drugs.

Other possible causes: a family history of bruxism; smoking; heavy drinking; and facial abnormalities.

Grinding can also be the body's reaction to poorly aligned teeth—that is, crooked or missing teeth or an uneven bite. Your dentist should also check for signs of malocclusion and, of course, should repair any damage to your teeth or crowns and bridges. Smokers seem to have more tooth-grinding episodes than nonsmokers.

What to do about it

If you are under severe stress, certain steps may alleviate it. Try relaxation techniques, even something as simple as a warm bath before sleeping. Talk to a friend or a qualified counselor about your problems. Cut down on alcohol consumption if you drink, and don't drink before bedtime.

And then there are mouth guards

Your dentist can create an individually fitted mouth guard or splint made of soft or hard acrylic. Usually worn at night, mouth guards do not prevent grinding, but they do redistribute the forces exerted while grinding and thus help protect teeth. They can cost $300 or more. You'll need a checkup every four to six months to make sure the mouth guard still fits.

As a first step, you can try a simple athletic mouth guard, sold at sporting-goods stores for around $5. If it fits properly, it should spread the clenching pressure evenly across your mouth. It won't be as comfortable as a custom-made device and will certainly be bulkier and more visible. Discuss this option with your dentist.

Any mouth guard must be kept clean on a daily basis—you can use toothpaste, mouthwash, or even denture cleaner.

UC Berkeley Wellness Letter, March 2002