Dealing with the Nightly Grind

Do you grind your teeth at night? If your answer is an emphatic no, you may want to get another opinion from your partner. While many of us are unaware that we are, in fact, grinding our teeth while sleeping, most dentists can see obvious signs of clenching and grinding by looking for flat spots, perforations in enamel, and cracks in a patient’s teeth. 

 The dental term for clenching and grinding our teeth is bruxism. We clench our teeth when we contract our jaw muscles and aggressively contact our teeth together. Grinding often increases during times of stress and is more prevalent among Type-A personalities. Depending on the study, figures range from 8 to 31 percent of people who exhibit some form of bruxism. Since bruxism usually causes minimal symptoms, many people may not be aware of it. Many people have symptoms like hypersensitive teeth, aching jaw muscles, and headaches when they grind their teeth. While nighttime bruxism affects both males and females equally, females tend to grind more during the day than males. Bruxism also can increase a patient’s chances for headache and jaw disorders − often called TMJ disorder.

The challenge for a dentist is to recognize the signs of bruxism.

  • A patient is continually cracking teeth or dental restorations.
  • Holes get worn in the hard external enamel covering of the tooth.
  • Teeth like canines (eye teeth) that used to be pointed when the patient was young are now shorter and flatter.
  • All the front teeth appear sanded down flat and are the same size. (In the long run this can make a patient’s smile look old years before its time.)
  • Finding these signs early on can dramatically change the dental history of a patient.

Because of the amazing properties of today’s dental materials, we can usually get many years of service from crowns, bridges, and fillings. However people who are grinders can easily cut the lifetime of the restorations down as much as 50 percent by placing these wonderful materials in a very challenging environment.

When reviewing a patient’s medical history, a dentist should inquire about grinding if the patient is on an antidepressant. Medications such as Prozac can significantly increase both the pressure and duration of bruxism. Often just a change in antidepressant prescription is enough to eliminate medically induced bruxism.

Treatment for bruxism generally involves use of a grinding guard. The guard is a hard plastic that acts as a shock absorber between the teeth. A patient will wear out the softer plastic of the guard instead of the teeth. In the past these guards were made of a rigid plastic that was uncomfortable for patients. Today's guards can be made of thermally active plastics that are much more comfortable and adaptable. 

One thing to avoid is over-the-counter grinding guards. They can be much more destructive than wearing no guard at all. In fact they are generally chewy and become nighttime "chew toys" that can actually result in increasing the pressure on the teeth when the guard is removed. Essentially the patient chews the guard for eight hours during sleep and strengthens the muscles used for grinding. Generally guards should be hard, not chewy.

Finally, there have been numerous approaches to help people unlearn clenching behaviors. Daytime habits can more easily be corrected since nighttime clenching cannot be consciously stopped. Fore some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism.