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Dec 27, 2016

Teeth clenching

Bruxism (BRUK-siz-um) is a condition that involves grinding and forcing teeth together during the day or night. It affects many people, and while some people are aware of the damaging effects, many remain in the dark about the kind of damage this may cause to teeth.  

Excessive grinding can lead to the following unpleasant side effects:

  • Pain in the back, spine, head, ears and muscles
  • Soreness in the teeth and jaw joints
  • Decreased ability to open or close the mouth and/or a locked jaw
  • Gum retraction leading to an exposed root surface of the teeth
  • Increased wear and sensitivity of the dentition hence greater risk for broken fillings, which could eventually lead to bone loss around the teeth

While signs of overload from bruxism are often significant and obvious, most symptoms cannot be seen by patients. Our dentists are trained to spot the early signs of bruxism and can support their findings by performing some simple muscle and ligament tests.

It is unclear why people grind their teeth. The masticatory system, including the mouth and jaws, is a complicated system that is influenced by several external and internal factors. Some trigger factors could be a poorly adjusted bite, loss of teeth leading to an imperfect bite, or damaged jaw joints. The CNS (Central Nervous System) that coordinates the masticatory system could be affected by stress or other diseases in the body, which could also be a trigger for bruxism.

Dental wear can collapse your entire bite, often without you noticing before its gone to far.
Types of Bruxism
There are two main types of bruxism: One that occurs during the day while the patient is awake, also known as awake bruxism; and one that occurs while one is asleep and unaware, or sleep bruxism. In some cases, bruxism persists throughout the day.
Abnormal Teeth Positions
The abrasive surfaces of the teeth are often in positions unrecognisable to the patient. This is likely to be a sign of grinding, especially at night, when patients are more likely to be unaware of the problem.

This patient (23 years old) thinks this is the normal relation between the upper and lower jaw.

When the dentist slowly help the patient to guide the lower jaw forward it feels unfamiliar to the patient.

When moving the lower jaw the dentist finds 6 “natural” slides where the upper and lower jaw “fits” to each other. This is a very common finding although the patients is not aware of the excessive wear on the teeth. We call this kind of wear attrition. Another kind of common problem that can worsen the wear is called Erosion and usually comes from digesting carbonated beverages, citrus fruits, tart candy, or stomach acid (bulimia; gastric reflux). The case on the top is such a case with chemical wear.

Another patient with exposed cervical part of a tooth (tooth neck). The gum has receded due to overload. The root surface is darker/yellow and consists of dentine but no protecting enamel.

Long term damage to teeth
Every tooth consists of a tough layer of enamel on the outside. Underneath the enamel, there is a softer layer of dentine. When teeth grind against each other the enamel wears off, eventually leaving the dentine exposed. This speeds up damage to teeth as the softer dentine wears out much quicker than enamel. Since the enamel erosion is gradual, patients often do not register any problems until the teeth get much worse.

With time, the bite height decreases due to the gradual shortening of the teeth. This makes re-establishing a normal bite more challenging for dentists. This is why it is important to have regular check-ups to ensure good dental health.

Subsequent tension in the facial region can lead to other painful conditions such as chronic headaches and aches in the neck and shoulders. Some also believe it can lead to migraines.

Front teeth side aspect. The lower front teeth slide on the backside of the upper front teeth. Over time the enamel is abraded and eventually missing, exposing the softer underlying dentine. The picture to the right shows an advanced stage with reduced height of the teeth causing possible problems for the TMJ (the jaw joints), muscles and ligaments.

This patient (34 years old) has never had any symptoms, but has recently become aware of shorter front teeth. The cause is probably a combination of Bruxism (grinding) and Erosion (chemical wear) On the picture to the right is the same patient after treatment with bonded minimal invasive ceramics. It would have been much cheaper to treat and protect the teeth 10 years ago when it probably started.

The etiology is often unknown
We don’t know for sure why people grind their teeth. The face, masticatory system and the mouth is a complicated system which is affected by several factors. Trigger factors could be a poorly adjusted bite, loss of teeth leading to disharmony in the occlusion or damaged jaw joints. The CNS (Central Nervous System) which coordinates the masticatory system could be affected by stress or other diseases in the body.

There is no cure for bruxism and treatments are mostly preventive in nature. Often, a night guard is prescribed to protect a patient’s teeth from further wear. Along with a night guard, the dentist will work with the patient to resolve the triggering factors and prevent further damage.

A night guard has two functions. It protects the teeth from wear and it usually makes you grind less or not at all. Many patients sleep much better and cant be without it when sleeping. Others only use it when they get symptoms from the muscles, ligament and jaw joints (TMJ problem).