Bruxism, a condition characterized by teeth grinding or clenching, is a common dental problem that often goes unnoticed. It is usually detected by dentist on dental visits and sometimes when one seeks attention for constant pain in head and neck area with no other obvious reasons. Bruxism is frequently seen to occur during sleep, although, daytime bruxism is also a common finding, especially in individuals experiencing stress.

Based on the time of occurrence, two types of bruxism have been described; Sleep bruxism, which is characterized by rhythmic chewing muscle activity and occasional grinding; and awake bruxism, characterized only by a clenching or bracing-type activity.¹

Sleep bruxism is usually associated with other sleep related issues like sleep apnea and snoring. While day grinding may indicate psychological stress issues, disturbed upper and lower jaw or teeth relation, and increased muscle contractibility.

Bruxism can be understood as "an anxiety response to environmental stress". These responses can be in the form of anxiety, fear or frustration. Behavioral tendencies causing teeth grinding can cause hysterical symptoms, anxiety, depression as well as stress sensitivity, varying from one person to another.²

Doctors are still unsure of the exact cause of teeth grinding and suggest that it can be an outcome of multiple factors. Bruxism is often caused by a combination of factors, including stress, anxiety, disrupted sleep, and changes in how we use our teeth. Stress, in particular, is a common issue in today's world and can significantly contribute to this condition.

In today's world, stress is no new entity and the younger generation is even more prone to experiencing stress in their life; be it work related or in a relationship. Competitive environment, with its fast-paced lifestyle and constant pressures, has significantly increased the stress levels.

Studies show that stress-induced hormones can trigger neurological pathways which in turn can increase the frequency of involuntary muscle contractions, including those in the jaw. This can lead to bruxism, as the jaw muscles clench and grind teeth together.

Bruxism is known to be more common in females as compared to males, affecting those around 18-35 years of age in greater frequency.²

As innocent as it may seem, clenching, grinding and gnashing teeth together frequently can have severe consequences on dental health, sleep quality and overall well-being.

Bruxism may present itself in the form of :

Tooth Wear: The constant grinding and clenching can cause teeth to clash with each other directly impacting the enamel of teeth of both the jaws, leading to sensitivity and even fractures.

Gum Recession: Excessive force on the teeth can put undue stress on the gums, shifting them away from their natural position. It can later expose the roots and making the teeth more susceptible to decay and infection.

Temporomandibular Joint Disorder (TMJ): The force of clenching teeth can exceed up to 414 N, which is several times more than normal biting force. Bruxism can strain the muscles and joints involved in chewing, leading to pain and discomfort in the jaw, face, and neck. This can also cause clicking, crackling and pain of the jaw joint.³

Dental Fractures: In severe cases, the pressure from bruxism can exceed to the levels that can damage the outer brittle shell, i.e., enamel of the teeth. These undue forces can also lead to crack lines propagating beyond enamel and through the tooth leading to fracture of the teeth.

MPDS (Myofascial Pain Distress Syndrome): Is a chronic pain disorder and is often very disturbing and crippling. It is caused due to fatigue and cramps in the tensed muscles that are responsible for chewing. A series of sleepless nights due to sore muscles might be a symptom of underlying health issues that need to be addressed immediately.

Most commonly the gnashing of teeth happen during sleep and is a subconscious phenomena. The signs that one might have bruxism include:

• Teeth grinding or clenching, that may be loud enough to wake up your partner

• Teeth that with worn out and flattened structure.

• Fractured, chipped, loose teeth that feel tender on biting

• Worn out biting surfaces of tooth enamel, exposing deeper layers of the tooth

• Increased sensitivity for cold and hot food or beverages

• Sharp lightening pain in tooth often felt on biting or releasing the bite

• Fatigued, sore, tight jaw muscles, especially when you wake up

• Pain or soreness around jaw, neck or temple

• Pain may sometimes feel like an earache in the absence of ear infection

• Dull headache in the temple area and spreading through the lower jaw and sometimes back of the head and neck

• Frequent cheek biting may or may not cause traumatic ulcers

• Disturbed sleep cycle

If you suspect of having some of these signs of bruxism, it is important to consult a dentist for appropriate treatment options.

Treatment of bruxism goes beyond just the symptomatic relief and may include multidisciplinary approach for long term relief. The treatment protocols include:

• Nightguards: are mouth-guards that cover the teeth to protect them from the damage caused by bruxism during sleep. These are different from the mouth-guards used in sports and are worn at night during sleeping.

• Counselling and Therapy: The latest treatment modalities for bruxism now focus on central factors issues rather that the peripheral factors. Dealing with anxiety, stress, depression and psychological issues that underlie the condition is now an important part of treatment plan.

• Stress Management Techniques: Practicing relaxation techniques such as meditation, deep breathing, and yoga can help reduce stress and alleviate bruxism.

• Dental Adjustments: In some cases, adjustments to dental restorations or bite alignment can help reduce the strain on the teeth and jaw.

• Restoring teeth structure: Teeth that have lost significant loss of structure may need restorations or crowns to restore the structure and normal functioning of the teeth.

• Oral Rehabilitation: In severe cases with loss of structure in all teeth and TMJ pain, a full mouth rehabilitation may be needed, requiring crowns on many or all teeth.

• Need for Root Canal Treatment: Some teeth may need root canal treatment due to deep fracture lines or infection.

References

1. Pavlou, Ioannis A., Demetrios A. Spandidos, Vassilis Zoumpourlis, and Veronica K. Papakosta. "Neurobiology of bruxism: The impact of stress." Biomedical Reports 20, no. 4 (2024): 1-10.

2. Khoury, Samar, Maria Clotilde Carra, Nelly Huynh, Jacques Montplaisir, and Gilles J. Lavigne. "Sleep bruxism-tooth grinding prevalence, characteristics and familial aggregation: a large cross-sectional survey and polysomnographic validation." Sleep 39, no. 11 (2016): 2049-2056.

3. Thomas, Davis C., Daniele Manfredini, Jaimin Patel, Aaron George, Bindu Chanamolu, Priyanka Kodaganallur Pitchumani, and Linda Sangalli. "Sleep bruxism: The past, the present, and the future—evolution of a concept." The Journal of the American Dental Association (2024).

(Input from various source)

(Rehash/Dr. Abhilasha Manker/MSM)