Tooth Grinding (Bruxism)

Types of bruxism

Signs and symptoms

• grinding or tapping sounds during sleep
• jaw muscle ache, fatigue or tightness, especially on waking
• headache at the temples in the morning
• flattened, worn, chipped or cracked teeth
• tooth sensitivity to hot or cold from worn enamel
• broken fillings or crowns
• enlarged jaw muscles (masseter)
• scalloped tongue edges or cheek ridges
• earache-like pain from the jaw joint
• disrupted sleep for you or a partner

Causes and risk factors

• stress and anxiety, the most common trigger for awake bruxism
• sleep apnea and snoring: grinding often occurs with breathing-related arousals. See sleep apnea
• caffeine, alcohol and smoking
• recreational drugs: cocaine, ecstasy (MDMA) and amphetamines
• medicines: SSRI and SNRI antidepressants, some antipsychotics and ADHD medicines
• family history
• neurological conditions: Parkinson's disease, dementia, brain injury
• acid reflux during sleep, linked to sleep bruxism
• children: common and often outgrown, sometimes linked to enlarged tonsils or adenoids

Complications

• tooth damage: worn enamel, fractures and cracked tooth syndrome
• jaw disorders: pain and dysfunction of the jaw joint and muscles (temporomandibular joint disorder)
• headaches, including tension headaches
• damage to dental work, implants and crowns
• gum recession in some cases

Diagnosis

• dental examination: wear patterns, cracks, muscle tenderness, and jaw joint function
• history from you and your sleep partner
• sleep study (polysomnography) if sleep apnea is suspected or for research-level confirmation
• portable devices that record jaw muscle activity at night in some clinics

Treatment

There is no cure that stops bruxism completely, but treatment protects the teeth and reduces symptoms.

Protect the teeth

• custom-fitted night guard (occlusal splint): made by a dentist, worn during sleep. It does not stop grinding but prevents tooth damage and often eases jaw pain. Over-the-counter boil-and-bite guards are less durable and may not fit as well.
• dental repairs for damaged teeth.

Reduce triggers

• stress management: relaxation techniques, exercise, mindfulness, and cognitive behavioral therapy
• cut back on caffeine and alcohol, especially in the evening, and stop smoking
• good sleep habits
• review medicines with your doctor if grinding started after a new drug

Habit awareness for awake bruxism

• notice when you clench and follow the rule "lips together, teeth apart, tongue resting on the roof of the mouth"
• set phone reminders or stickers as cues
• avoid chewing gum and biting pens

Medical treatments

• treat sleep apnea, for example with CPAP, which can reduce grinding
• botulinum toxin injections into the jaw muscles reduce clenching force and pain in some people
• physical therapy and jaw exercises for TMJ symptoms
• muscle relaxants occasionally, short-term

Children

Most children outgrow bruxism. A dentist will check for tooth damage. If a child also snores or breathes through the mouth, ask about the tonsils and adenoids and sleep-disordered breathing.

Frequently asked questions

What causes teeth grinding?

Common causes include stress and anxiety, sleep apnea, caffeine, alcohol, smoking, recreational stimulants and certain medicines such as SSRI antidepressants. It also runs in families and is common in children, who often outgrow it.

How do I know if I grind my teeth at night?

Clues include a partner hearing grinding, waking with jaw ache or a headache at the temples, worn or chipped teeth, and tooth sensitivity. A dentist can often see wear patterns that confirm it.

How can I stop grinding my teeth?

A custom night guard protects your teeth. Reducing stress, caffeine and alcohol, improving sleep, treating sleep apnea and reviewing medicines can reduce grinding. During the day, practice keeping your teeth apart and jaw relaxed.

Can teeth grinding cause headaches?

Yes. Clenching and grinding overwork the jaw and temple muscles, causing morning headaches, often at the temples, and tension-type headaches. Treating bruxism often improves these headaches.

Is teeth grinding linked to sleep apnea?

Often, yes. Grinding can happen during brief arousals from breathing pauses. If you grind and also snore loudly, stop breathing at night, or feel very sleepy in the day, ask your doctor about a sleep study.