Teeth grinding and clenching
Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.
People can clench and grind without being aware of it. It can happen during the day and night. Bruxism during sleep is often a bigger problem because it is harder to control.
There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms.
Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:
- How much stress you have
How long and how tightly you clench and grind your teeth
Whether your teeth are misaligned
Your ability to relax
Your sleeping habits
Clenching your teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).
Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners.
Symptoms of bruxism include:
- Anxiety, stress, and tension
- Earache (partly because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
- Eating disorders
- Muscle tenderness, especially in the morning
- Hot, cold, or sweet sensitivity in the teeth
- Sore or painful jaw
Exams and Tests
An exam can rule out other disorders that may cause similar jaw pain or ear pain, including:
- Dental disorders
- Ear disorders, such as ear infections
- Problems with the temporomandibular joint (TMJ)
You may have a history of a high stress level and tension.
The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.
These self-care tips may help relieve pain:
- Apply ice or wet heat to sore jaw muscles. Either can help.
- Avoid eating hard or dense foods like nuts, candies, and steak.
- Do not chew gum.
- Drink plenty of water every day.
- Get plenty of sleep.
- Learn physical therapy stretching exercises to help the muscles and joints on each side of your head get back to normal.
- Massage the muscles of your neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout your head and face.
- Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
- Try to reduce your daily stress and learn relaxation techniques.
To prevent damage to your teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect your teeth from the pressure of clenching.
A well-fitting splint should help reduce clenching. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.
There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If 1 type doesn't work, another may.
A splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated. This is based on the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.
After splint therapy, orthodontic adjustment of the bite pattern may help some people. Surgery should be considered a last resort.
Finally, many approaches try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.
In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.
Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.
Bruxism may cause:
Increased dental or TMJ problems
Nightly grinding can awaken roommates or sleeping partners.
When to Contact a Medical Professional
See a dentist right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions, from arthritis to whiplash injuries, can cause TMJ symptoms. Therefore, see your dentist for a full evaluation if self-care measures do not help within several weeks.
Grinding and clenching does not fall clearly into one medical discipline. There is no recognized TMJ specialty in dentistry. For a massage-based approach, look for a massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage.
Dentists who have more experience with TMJ disorders will typically take x-rays and prescribe a mouth guard. Surgery is now considered a last resort for TMJ.
Stress reduction and anxiety management may reduce bruxism in people who are prone to the condition.
Bope ET, Kellerman RD. Diseases of the head and neck. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2016. Philadelphia, PA: Elsevier; 2016:chap 5.
Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 102.