When things are stressful, our bodies can manifest this stress into physical symptoms. We’re talking sleepless nights and sore jaws — a result of bruxism, also known as teeth grinding, clenching, or gnashing. This behavior can happen unconsciously while you're awake (awake bruxism, which affects 22-31% of adults), asleep (sleep bruxism, which affects 9.3-15.9% of adults), or both. So if you’ve been facing anxiety over lockdowns, job loss, illness, or other new stressors, bruxism may sound more like an answer than a surprise.
In fact, a September 2020 national poll of American dentists found a 53% increase in bruxism, symptoms of temporomandibular disorders (TMD), and chipped and cracked teeth. “When people are stressed out, they do tend to clench and grind more throughout the day and at night,” says Dr. George Tsougranis, a Massachusetts-based dentist who reports seeing an increase in damaged teeth in his practice.
And it’s not just Americans who are feeling the stress. You should also know that teeth grinding and TMD symptoms are happening in other countries as well.
An October 2020 study of 1,792 people in Poland and Israel — two countries selected by researchers because they are “culturally different” from each other — found that fears over the pandemic have caused an “intensification” in their bruxism and TMD symptoms.
Read on to learn more about bruxism and how to manage this behavior.
What Is Bruxism?
Though often cited together, bruxism and TMD are different. Bruxism is a behavior (grinding, clenching, and gnashing of teeth), whereas TMD is a group of temporomandibular disorders and a condition that affects the joints and muscles involved with chewing and other movements.
Odontologists are still trying to understand TMD and bruxism, and whether sleep bruxism carries over into awake bruxism, and vice versa. For this reason, terms like TMD, bruxism (both sleep and awake forms)/teeth grinding, and temporomandibular joint (TMJ) syndrome are mistakenly used interchangeably.
But it’s worth noting that bruxism can make TMD symptoms more painful.
What Causes Bruxism?
To date, the exact causes for both sleep and awake bruxism are unknown.
The factors that may increase your risk for bruxism include cigarette smoking, alcohol use, anti-depressants, and caffeine intake.
Other factors include age (it’s often seen in young children), genetics (family members with bruxism), and other disorders, such as sleep apnea, depression, night terrors, and epilepsy.
Why Does Teeth Grinding Happen at Night?
Dr. Gary D. Klasser, DMD, who specializes in orofacial pain at Louisiana State University Health Sciences Center School of Dentistry in New Orleans, says there are three prevailing theories. One could be the disruption of “airway patency,” which is a person’s ability to breathe. “That's why there's been a lot written [about] the association between obstructive sleep apnea and sleep bruxism,” Klasser says.
Another theory: Since we don’t make a lot of saliva while sleeping, Klasser suggests that sleep bruxism is a person’s “wake-up call” to produce more saliva while sleeping.
The last theory is that sleep bruxism is “an adaptive response to psychological impairment and stress.” According to Klasser, sleep bruxism is our version of “wiping the hard drive”: a way to clear out negative feelings to make way for incoming stressors — a physical manifestation of how we cope with psychological issues like depression, anxiety, worry, anger, and loneliness.
Sylvia Kreibig, psychophysiologist and emotion and sleep researcher at Stanford University, further explains this theory. “Our emotional control center disengages during sleep, and lingering emotional activation may lead to the clenching and grinding observed during sleep in sleep bruxism,” she says, suggesting that the grinding takes place to dissolve the rest of those troubling emotions. “That’s the basic idea, but we are still a long way from understanding all involved processes and exact relationships.”
Though sleep bruxism is less common than awake bruxism, it is more complex to tackle, since we may not know it’s happening. That said, it’s possible to experience both, and both are damaging to your physical health.
What Does Bruxism Feel Like and How Do You Know If You Have Sleep Bruxism?
“Take your teeth and clench together, and then move your jaw side to side,” says Klasser. This feeling, which, if you do while awake, can also occur while you’re asleep. If you share a bed at night, ask your sleep partner whether they’ve heard a grating, grinding, or gnashing sound.
Other signs and symptoms of bruxism include:
- headaches around your temples
- sore, tight, or tired jaw muscles
- locked jaw
- cheek chewing or damage from chewing
- chipped or cracked teeth
- worn-down enamel
- tooth pain or sensitivity
- sleep disturbances
If you wake up with these side effects and/or symptoms, it’s likely due to the unconscious clenching and grinding of your teeth, which, when we’re sleeping, can exert up to 250 pounds of force. “If you find yourself clenching your jaw throughout the day, there is a good chance you are doing it at night as well,” adds Tsougranis.
How Is Bruxism Diagnosed?
The official way to get a diagnosis, and help, for clenched teeth and the pain that comes with it is to see a doctor or a dentist. A dentist will inspect your teeth for damage and check your jaw muscles for tension or tenderness.
How to Stop Clenching and Grinding Your Teeth at Night
1. The professional route: a fitted mouthguard
A professionally fitted night guard or mouthguard, worn while you sleep or otherwise grind your teeth, can absorb the impact your jaw or enamel would incur. Although a custom-fit oral appliance may cost more, Klasser says it could save you money in the long run and help keep your teeth intact. “If you fracture a piece of plastic, I can easily replace the plastic. If you fracture a tooth catastrophically, you may lose that tooth.”
Klasser recommends trying a custom-fit mouthguard to help absorb the powerful force you routinely exert on your teeth, protecting your teeth and the rest of your mouth.
“You cannot replace the natural tooth substance that you grind away,” Klasser points out. Check with your dentist or dental insurance company, as some night guards are covered.
Though over-the-counter night guards do not offer the same durability and customization as a custom-fit appliance, they are affordable alternatives and great for travel, particularly for anyone prone to forgetfulness. The Bruxor Dental Guard is a boil-and-bite appliance designed to last for six months and improve sleep issues related to night bruxism, including grinding and clenching. Dental Duty is another over-the-counter option, and can also also be used as an athletic mouthguard or a teeth whitening tray.
2. The medical route: Botox injections and medications
Botox injections to the jaw can relax the muscles in the area and reduce the force with which you grind teeth. This treatment will last anywhere from three to four months.
Talk to your doctor before trying to book appointments or get prescriptions. If you are already taking medications for other conditions, you’ll want to make sure they don’t contradict each other.
3. The lifestyle route: stress reduction
Since stress keeps our body in tension, incorporating a relaxation routine may help eliminate your body’s need to clench your jaw or grind your teeth.
Put aside time throughout the week, especially just before bedtime, to focus on managing stress through meditation, as well as yoga, journaling, relaxation techniques, or cognitive behavioral therapy (CBT). Kreibig says through meditation, “we can create a physiology in our body that is less conducive to teeth grinding at night.” Don’t rely on alcohol or recreational drugs to relax, as these are known risk factors for increasing bruxism.
How to Address Bruxism and Its Side Effects During Daytime
Train your teeth: If you have awake bruxism, Klasser says people can reverse the habit by relaxing those muscles through mindfulness and training. “Try placing your tongue passively on the floor of your mouth and leaving your lips ever so slightly in contact with each other,” he explains. This keeps your teeth apart and your jaw slack to avoid tension.
Meditate or breathe: If you find your entire body tensing from jaw to toe, try taking a break. A five-minute meditation or breathing technique, like box breathing, can help activate the parasympathetic nervous system, which helps us de-stress and relax. Practicing yoga and listening to calming music can also help.
Try facial relaxation or massage: To massage your jaw at home, you can create a fist and hold it gently under your chin. Open your mouth and lightly press against your fist for 10 seconds. Repeat for another 10 seconds on both sides of your jaw. To relieve tension, research indicates you should do this four times a day for 30 seconds total.
Think positive: Take time in the morning or during a break in the day to journal affirmations or positive moments in your life. In that way, you’re “allowing yourself to spend more time in a positive emotional state than in a negative emotional state,” Kreibig explains. Seeing the silver lining among a sea of dark moments can also put you in a better position to handle future challenges.
Though bruxism can be painful and damaging, the silver lining is that it’s the body’s way of trying to send a literal cue to stop focusing on the grind and to prioritize self-care (and the importance of sleep!) instead.
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