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Bruxism: Why it’s Nothing to Smile About

Brusxism

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
Bruxism Defined  |  Causes  |  Signs and Symptoms  |  Risk Factors  |  Diagnosis  | Treatment

 

Overview

Parasomnias refer to a group of sleep disorders characterized by abnormal behaviors, which occur during sleep. Bruxism is considered one of the most critical forms of parasomnias as it can worsen a patient’s physical and mental health. 

Please keep reading to find out more about bruxism; its causes, risk factors, and the diagnosis and treatment of this condition. 

 

What is a Parasomnia?

Bruxism is one of the parasomnias. The term parasomnia refers to a group of sleep disorders marked by abnormal movements and behaviors occurring while the patient is sleeping.[1] [2] These disorders are accompanied by strange perceptions, intense emotions, and bizarre dreams.[3]Bruxism is a significant cause of concern because, if not managed properly, it can increase your risks of several physical and mental health issues. Other types of parasomnias include:

SCOFA Bruxism

 

What is Bruxism?

Bruxism is characterized by involuntary movements of the teeth during sleep. Sometimes called teeth grinding, bruxism causes wear and tear of the tissues of the teeth and jaw. 

Bruxism occurs in an involuntary, repetitive, and aimless manner. It is a stereotyped oral activity accompanied by the clenching of teeth.[4]

Sleep bruxism occurs during all sleep stages, though it tends to be more intense during light sleep. The powerful forces exerted on your teeth, jaw muscles, and other facial tissues due to bruxism could cause long-term severe damage and destruction. 

Patients who suffer from bruxism during sleep may also tend to grind their teeth while awake. Wakeful bruxism can lead to a wide range of oro-dental, psychological, and neurological conditions. 

 

Causes

Bruxism usually occurs due to a combination of psychological, physical, and genetic factors. 

While you are awake, bruxism may occur due to intense emotions such as stress, anxiety, frustration, and anger. It becomes a habit to grind teeth in some patients, especially when they are working on tasks with deep concentration. 

Bruxism could also occur due to the lack of sound sleep due to stress and crowding of thoughts. Some people may have a tendency to ruminate or over-think upcoming tasks while they are trying to sleep. This can keep the brain engaged and trigger physical movements like the grinding of teeth.[5]

Delayed sleep onset latency is also a common cause of sleep bruxism. In other words, if you take a longer time to fall asleep after going to bed, you are more likely to develop bruxism. 

 

Signs and Symptoms

  • Sleep disruptions
  • Grinding and clenching of teeth, which is sometimes so loud that it can wake up your sleep partner
  • Flattening and chipping of the teeth 
  • Worn out tooth enamel, causing exposure of the deeper layers of the tooth
  • Loose and fractured teeth 
  • Recurrent toothache 
  • Increased tooth sensitivity
  • Tiredness and tightness of the jaw muscles
  • Pain and stiffness in the jaw, neck, and face 
  • Damage to the inside of your cheeks from chewing 
  • Recurrent headaches that usually start in the temples

 

Risk Factors

  • Age: Bruxism is more common in young children than in adults.[6]
  • A-Type Personalities: People having aggressive, hyperactive, and competitive personalities are more likely to develop bruxism.
  • Poor Emotional Health: Increased anxiety, stress, anger, and frustration can increase the risk of bruxism.
  • Medications: Bruxism could be a side effect of psychiatric medications like antidepressants. 
  • Lifestyle Habits: The risk of bruxism is higher in smokers and those using recreational drugs. Excessive intake of caffeinated beverages and alcohol can also increase the risk of this condition.[7]
  • Genetics: Sleep bruxism tends to run in families. It is more common in patients having a family member suffering from it.[8]
  • Pre-existing Disorders: The risk of bruxism is associated with Parkinson’s disease, gastroesophageal reflux disorder, epilepsy, dementia, attention-deficit/hyperactivity disorder (ADHD), night terrors, and sleep-related disorders like sleep apnea.[9]

 

Diagnosis

Your dentist might check for the signs of bruxism during a regular dental examination. The goal of diagnosis is to identify the cause of the teeth grinding.

Your dentist will start his diagnosis by asking questions about your dental health, daily routines, medications, and sleep habits. He may also examine you for tenderness in your jaw muscles and other dental abnormalities, like missing or broken teeth.

Bruxism can lead to wear on tooth enamel, causing your dentist to refer you to a psychiatrist or a sleep specialist for further evaluation and treatment. Alternately, a sleep medicine specialist can conduct a sleep study to assess the episodes of teeth grinding and detect bruxism’s underlying causes, including sleep apnea.

 

Treatments

Dental Approaches

Mouthguards and splints designed to fit over your teeth and keep your teeth separated can prevent damage by grinding and clenching.[10]

Suppose the wearing away of the tooth enamel has led to the increased sensitivity and the inability to chew. In this case, your dentist may recommend reshaping the chewing surfaces of teeth and use crowns to avoid further damage.

Stress Management

Suppose your overall health assessment reveals severe mental stress as one of the possible causes of bruxism. In that case, your doctor may recommend strategies like meditation to promote mental and physical relaxation. 

Behavior changes aimed at maintaining the correct position of the mouth and jaw would also help minimize bruxism symptoms.[11] Your doctor may also recommend biofeedback that uses advanced monitoring equipment and procedures to teach you to control the muscles’ activities in your jaw.[12]

 

Medications for Bruxism 

Muscle relaxants before bedtime might help you avoid teeth grinding during sleep. If you have severe bruxism, your doctor may advise you to take Botox injections to relax the jaw muscles. 

Medications for anxiety or stress would help you deal with stress or avoid other emotional issues responsible for triggering bruxism. If your bruxism is linked to sleep apnea, appropriate treatment, such as using a CPAP device, may be needed. 

 

Conclusion

If you have a habit of grinding your teeth, whether in sleep or while you are awake, it is best to consult your doctor to find the possible triggers and seek appropriate treatment. Timely diagnosis and treatment of bruxism are essential for preventing the adverse effects of loss of sound sleep on your physical and mental health. 

 

References:

  1. Lapierre, O., & Montplaisir, J. (1992). Les parasomnies [Parasomnia]. L’Encephale, 18(4), 353–360.
  2. Howell M. J. (2012). Parasomnias: an updated review. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 9(4), 753–775. https://doi.org/10.1007/s13311-012-0143-8 
  3. Fleetham, J. A., & Fleming, J. A. (2014). Parasomnias. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(8), E273–E280. https://doi.org/10.1503/cmaj.120808
  4. Shetty, S., Pitti, V., Satish Babu, C. L., Surendra Kumar, G. P., & Deepthi, B. C. (2010). Bruxism: a literature review. Journal of Indian Prosthodontic Society, 10(3), 141–148. https://doi.org/10.1007/s13191-011-0041-5
  5. Ohayon, M. M., Li, K. K., & Guilleminault, C. (2001). Risk factors for sleep bruxism in the general population. Chest, 119(1), 53–61. https://doi.org/10.1378/chest.119.1.53
  6. Laberge, L., Tremblay, R. E., Vitaro, F., & Montplaisir, J. (2000). Development of parasomnias from childhood to early adolescence. Pediatrics, 106(1 Pt 1), 67–74. https://doi.org/10.1542/peds.106.1.67
  7. Lee-Chiong T. L., Jr (2005). Parasomnias and other sleep-related movement disorders. Primary care, 32(2), 415–434. https://doi.org/10.1016/j.pop.2005.02.001
  8. Hublin, C., Kaprio, J., Partinen, M., & Koskenvu, M. (2001). Parasomnias: co-occurrence and genetics. Psychiatric genetics, 11(2), 65–70. https://doi.org/10.1097/00041444-200106000-00002
  9. Martynowicz, H., Smardz, J., Wieczorek, T., Mazur, G., Poreba, R., Skomro, R., Zietek, M., Wojakowska, A., Michalek, M., & Wieckiewicz, M. (2018). The Co-Occurrence of Sexsomnia, Sleep Bruxism and Other Sleep Disorders. Journal of clinical medicine, 7(9), 233. https://doi.org/10.3390/jcm7090233
  10. Shetty, S., Pitti, V., Satish Babu, C. L., Surendra Kumar, G. P., & Deepthi, B. C. (2010). Bruxism: a literature review. Journal of Indian Prosthodontic Society, 10(3), 141–148. https://doi.org/10.1007/s13191-011-0041-5
  11. Lal SJ, Weber KK. Bruxism Management. [Updated 2020 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482466/
  12. Kardachi, B. J., & Clarke, N. G. (1977). The use of biofeedback to control bruxism. Journal of periodontology, 48(10), 639–642. https://doi.org/10.1902/jop.1977.48.10.639
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