Clenching and grinding of the teeth, or bruxism, is a fairly common problem that many people are reluctant to treat, or of which they are altogether unaware. Usually occurring at night, it can certainly be elusive, but the long term effects can have permanent consequences. However, with the help of a dental professional, bruxism can be diagnosed, treated and most existing damage corrected.
Tooth on tooth contact may seem like a natural and therefore harmless occurrence; after all, the jaw muscles’ main function is to open and close our mouths repeatedly, whether our friends and family like it or not! But on a daily basis, the occlusal surfaces (used for biting and chewing) actually make relatively little contact with each other. In fact, when the jaw is relaxed, the upper and lower teeth rest about two to three millimeters apart and don’t usually come into direct contact for more than a minute or so every day, mostly when swallowing. Even while chewing, the teeth are slightly separated by food.
Just one night of severe bruxism can be the equivalent of a lifetime of normal wear and tear on the teeth, and the extra contact can cause a number of problems. Many common symptoms can seem sporadic, such as occasional jaw pain near the ear, headaches, tooth sensitivity or muscle spasms. Other problems can be permanent and/or visible, but their onset so gradual that many fail to notice them in their early stages, such as the wearing down of teeth, the cracking and fracturing of enamel, receding gums, etc.
Often the first symptom to be noticed, the jaw pain caused by bruxism is a result of giving your jaw muscles too much of a workout at night. Constantly clenching can cause muscle spasms, strain, fatigue and even headaches. The extra force exerted on the temperomandibular joint (TMJ) can also cause pain, popping, clicking and damage that can lead to chronic TMJ problems, such as temperomandibular disorder (TMD).
Tooth sensitivity to touch, hot and cold can be a result of the loss of protective enamel by wearing it away.
Abfraction is a lesser known term for the cracking of enamel at the gum line. Repeated pressure on a tooth can cause it to flex slightly, and the strong but brittle outer layer of enamel can eventually break away. This can leave the softer, yellower dentin exposed, which is aesthetically unpleasing and decreases a tooth’s resistance to damage and decay.
Severe bruxism, or even moderate bruxism over many years, can wear down the occlusal surfaces of teeth enough to reduce their vertical dimension. This is called attrition and can make front teeth appear flat or square. It can also cause the lower jaw to move closer to the upper jaw when swallowing and chewing, which contributes to an older appearance with a sunken jaw and deeper wrinkles in the skin around the mouth.
How can bruxism be treated? For many, clenching and grinding are unintentional manifestations of stress, and in some cases just relieving the source of that stress is enough to stop bruxism.
For others, intervention may be necessary in the form of a custom night guard or other appliance. A custom night guard can maintain enough distance between the upper and lower teeth to keep the jaw muscles at rest and protect the teeth from the wear and tear of grinding. A more advanced type of mouth guard will allow only the two lower front teeth to be in contact with the mouth guard, this will prevent the person from clenching.
If bruxism has gone unchecked for long enough, the damage to the teeth can be repaired. For example, teeth that have lost protective enamel on the occlusal surfaces may be treated with crowns, and the significant loss of vertical dimension can often only be restored with crowns. Such treatments can be expensive, and some may be considered cosmetic and will not be covered by insurance plans.
If a patient has jaw pain or tooth sensitivity, or their spouse has heard the sounds of their teeth grinding at night, it should be assessed by a dental professional as soon as possible. A good dentist will keep an eye out for the telltale signs of bruxism by locating wear facets, recognizing the symptoms of joint damage and assessing incidences of abfraction and enamel loss. Early treatment is the key to avoiding pain, long term damage and costly treatments.