Is it normal to clench or grind my teeth? [Bruxism and grinding teeth]

Is it normal to clench or grind my teeth?

You might be surprised to discover this is actually an age old question. Even as far back as a couple of millenia, you will find references to the ‘grinding and gnashing’ of teeth in the bible.

So we’re aware it’s been happening in humans for thousands of years. But just because it’s common, doesn’t mean it’s normal or healthy.

Another name for the clenching and grinding of the teeth is bruxism. It’s a condition which has been the subject of studies for decades and it appears to affect anywhere from ten to 30 percent of the population on average.

Although there are more complex definitions of bruxism, for the purposes of this blog, we’re keeping it simple. Bruxism or teeth grinding that occurs during sleep is called sleep bruxism, while teeth grinding that occurs during wakefulness is called awake bruxism.

Why is teeth grinding a problem?

Well, consider it this way. Preferably, you only place the teeth together when chewing food, swallowing, speaking or to support/brace your jaw, for example, if you’re jumping. This means there is less wear and tear on teeth and the jaw joint.

In short, it’s not normal to clench or grind your teeth, unless of course you are eating or bracing your jaw consciously for a particular physical activity.

In reality, nearly everybody exhibits bruxism (grinds or clenches their teeth unconsciously when awake or sleeping) at some point in their life, so you’re certainly not alone if you’ve been bruxing. However, it is an issue if it occurs long term and affects your teeth and health.

How do I know if I’ve been bruxing or grinding my teeth?

It’s a good question. We might have an inkling if we’re awake, but what if we brux in our sleep?

Maybe your parent or partner has told you they can hear you grinding your teeth in your sleep, or perhaps they’ve observed you bruxing. If that’s the case there is indisputable evidence because someone has seen you do it.

Alternatively, perhaps your dentist has told you it looks like you grind your teeth. You might wonder, ‘How do they know?’

As a Gold Coast dentist with over 25 years experience, the most common, and easiest way to see evidence of teeth grinding is when teeth are worn down in a pattern that can be reproduced. If I ask the patient to put their teeth together and then slide into a particular position they meet like a ‘jig-saw puzzle’, it’s a fairly clear sign they’ve been bruxing.

But that’s certainly not the only way. Teeth don’t always wear down. Here are some other signs you may be bruxing or grinding your teeth:

• Headache, especially on waking in the morning

• Pain in the jaw joint. Note that the technical term for the jaw joint is temporomandibular joint or TMJ. Pain in the TMJ and the group of things that may cause, promote and lead to pain in the jaw joint is temporomandibular joint dysfunction (TMD)

• Pain in the ear, which may be due to the same nerve that travels to both the ear and TMJ

• Aching or stiffness in the jaws or face while eating

• Sensitive teeth

• Chipped or cracked teeth

• Loose teeth

• Indentations on the side of the tongue which line up with the teeth, which are due to pushing the tongue onto the teeth

• A ridge on the inside of the cheek which lines up with the teeth, which is due to biting the cheek.

So, you have signs you may be grinding your teeth without knowing about it. But why? What causes us to grind our teeth?

What causes bruxism?

Awake Bruxism is typically related to stress or anxiety.

The group of muscles which control the movement of the jaw and joint are called the muscles of mastication. Science has shown that the nerves controlling these muscles travel through the emotional centre of the brain and so emotional stress can stimulate these muscles.

Just think back to a time that you may have been angry, anxious or concentrating on something. Did you clench your teeth without trying?

Of course, stress isn’t the only cause.

Sleep bruxism in particular has been studied for a long time and is proven to be complex. There are many factors which are considered to promote it and it’s still not completely understood. While there are too many factors to list here, some common reasons are:

• Occlusion (or bite) – If there are discrepancies or ‘interferences’ in the way the teeth meet together when biting

• Psychosocial factors, particularly a stressful lifestyle

• Genetic factors – Perhaps other family members like your parents grind their teeth

• Medications – Stimulant and recreational drugs have been linked to teeth grinding.

Some risk factors which may promote tooth grinding in addition to stress and anxiety are:

• Caffeine

• Smoking

• Alcohol

• Snoring and obstructive sleep apnoea (OSA), which we’ll cover in another blog

• Drugs – Both prescription medication, such as antidepressants, and recreational or illicit drugs, such as amphetamines.

A quick note about children grinding their teeth

As a parent who has witnessed – both heard and watched – my children grind their teeth while sleeping and awake, I understand it can be distressing. Not only from the perspective that it feels like running your nails down a chalkboard, but also because of the concern about damage caused to teeth.

There is good news!

For the most part, children commonly outgrow the habit as they age and it’s usually not damaging enough to warrant intervention. Their teeth and jaws are changing and growing so quickly treatment is rarely required.

As well as the same risk factors mentioned above for adults, some others include pain from adult teeth erupting into the mouth and medical conditions such as attention deficit hyperactivity disorder (ADHD).

A dentist or oral health therapist is best positioned to make a full assessment of each individual child’s situation.

What do I do if I am grinding my teeth? Treatment for teeth grinding or bruxism

If you think you grind your teeth, the best thing to do is to come in and speak with one of our dentists. We’ll examine your mouth and teeth prior to talking about possible treatment options.

Like we’ve already mentioned here, there is not a single cause for bruxism, which means there is no ‘silver bullet’ treatment to stop bruxing. The aim is to treat any symptoms and manage the cause.

The first line of management is fabrication of a special mouthguard, also known as an occlusal splint or night-guard which is worn at night (or during the day). When worn, it protects the teeth from damage and helps with the symptoms. There are many different designs, for example, upper or lower, hard or soft, full arch or partial. The point is, it must be custom made especially for your mouth and your situation.

In addition to an occlusal splint there are many other management strategies which include:

• Repairing, restoring or rehabilitating damaged and worn teeth

• Managing other factors that can contribute to the wear of the teeth, like acidity in the diet which promotes ‘softening’ of the teeth and erosion.

• Assessing other risk factors like sleep disordered breathing

• Physiotherapy to help with symptoms

• Stress management therapy

• Relaxation techniques

• Good sleep hygiene

• Exercise

A surprising additional form of treatment is the ‘off-label’ use of Botulinum Toxin (Botox). Although this is not a treatment option in its own right, it is kept as a management tool in combination with an occlusal splint.

A final word on bruxism

Bruxism is relatively common and the contact of the teeth it causes can lead to their wear and tear as well as pain in the jaw joint (TMJ) or headaches among other symptoms. It is managed using a variety of techniques and tools and there is not one treatment option to fix all cases. Rather, it involves assessment by your dentist and the customisation of an appliance (splint) in conjunction with treatment modalities to suit the individual’s specific symptoms and needs.

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