Bruxism (Teeth Grinding and Clenching)

Types of bruxism

Bruxism is not always harmful. Experts now see it as a behavior that becomes a problem when it causes pain, damage or sleep disruption.

Signs and symptoms

• grinding sounds at night, noticed by a partner or parent
• worn, flattened, chipped or cracked teeth
• tooth sensitivity to hot and cold
• jaw muscle aching or tiredness, especially on waking
• dull headaches in the temples on waking; see tension headache
• ear pain without an ear problem
• clicking, popping or locking of the jaw joint
• enlarged chewing muscles, giving a square jaw
• scalloped tongue edges and a ridge on the inner cheeks
• broken fillings and crowns

Causes and risk factors

• Stress and anxiety: the strongest link, especially for awake bruxism; see anxiety.
• Sleep disorders: obstructive sleep apnea, snoring and frequent arousals.
• Lifestyle: caffeine, alcohol, smoking and recreational drugs, especially stimulants such as cocaine and MDMA.
• Medicines: SSRIs and SNRIs (such as sertraline, fluoxetine and venlafaxine), some antipsychotics and ADHD stimulants.
• Personality and behavior: competitive, hurried or highly conscientious personality traits.
• Neurological conditions: Parkinson's disease, Huntington's disease, dementia, cerebral palsy.
• GERD: acid reflux at night is associated with sleep bruxism.
• Genetics: sleep bruxism often runs in families.

Misaligned teeth or bite are no longer considered a major cause.

Bruxism in children

Grinding is common in children, especially while baby teeth and adult teeth change. It often stops by adolescence and rarely needs treatment, though enlarged tonsils and sleep-disordered breathing should be considered if a child snores.

Complications

• tooth wear, fractures and loss of fillings or crowns; see cracked tooth syndrome
• temporomandibular joint disorder, with jaw pain and clicking
• chronic facial pain and headaches
• gum recession and tooth mobility
• disturbed sleep for the person and their partner

Diagnosis

A dentist usually diagnoses bruxism from the history and examination: tooth wear patterns, chipped edges, jaw muscle tenderness and cheek and tongue marks. They may compare tooth wear over successive visits. If sleep apnea is suspected, a sleep study (polysomnography) can confirm both apnea and bruxism episodes. Wearable devices that record jaw muscle activity are increasingly used.

Treatment

There is no single cure. Treatment protects the teeth and reduces triggers.

Protecting the teeth

• Custom-fitted night guard (occlusal splint): a hard acrylic guard made by a dentist that spreads forces and protects teeth. It does not stop grinding but prevents damage. Over-the-counter soft guards are cheaper but may wear through quickly and sometimes increase clenching.
• Dental repair of worn or broken teeth once the grinding is controlled.

Reducing the habit

• Awareness training: for awake bruxism, remind yourself through the day: "lips together, teeth apart, jaw relaxed." Phone reminders and sticky notes help.
• Stress management: exercise, relaxation techniques, mindfulness and cognitive behavioral therapy.
• Sleep hygiene: regular sleep times; limit caffeine after midday and alcohol in the evening; stop smoking.
• Treat sleep apnea: CPAP or a mandibular advancement device can reduce grinding.
• Review medicines with your doctor if grinding started after a new antidepressant; changing the dose or medicine, or adding another, can help.

For jaw pain

• warm compresses and gentle jaw stretching
• a soft diet during flare-ups
• avoiding gum chewing and nail biting
• OTC pain relievers such as ibuprofen, following the label dose
• physical therapy for jaw muscles

Botulinum toxin

Injections into the jaw muscles can reduce clenching force and pain in some people with severe bruxism. Evidence is promising but limited, and effects wear off after a few months.

Frequently asked questions

What causes teeth grinding at night?

Night-time grinding is linked to stress and anxiety, sleep disorders such as sleep apnea and snoring, caffeine, alcohol, smoking, recreational drugs and some antidepressants. It also tends to run in families. In children it is common and often outgrown.

How do I know if I grind my teeth?

Clues include a partner hearing grinding, waking with an aching jaw or headache, sensitive or worn-down teeth, chipped edges and a tender jaw. A dentist can often see characteristic wear patterns during a routine checkup.

Does a night guard stop bruxism?

A night guard does not usually stop the grinding itself, but it protects your teeth from wear and fractures and can ease jaw strain. A custom guard made by a dentist fits better and lasts longer than over-the-counter options.

Can bruxism cause headaches and ear pain?

Yes. Clenching and grinding overwork the jaw and temple muscles, causing morning headaches in the temples and aching that can be felt in or around the ear. The jaw joint sits just in front of the ear, so jaw problems are often mistaken for ear problems.

Can stress cause jaw clenching?

Yes. Stress and anxiety are the most common triggers for awake bruxism, which is mainly clenching during the day. Becoming aware of the habit, keeping teeth apart, and stress-reduction strategies such as exercise and relaxation techniques help.