Understanding Bruxism: Do I Clench or Grind My Teeth?

Now, most people may clench and/or grind their teeth to some extent. Clenching means pressing your teeth together, and grinding refers to rubbing your teeth together. Here we’re talking about excessive clenching and/or grinding, which is known as bruxism. Normally, your teeth do clench and grind – after all, they need to close together and rub against each other so you can eat! But in excessive amounts, it can cause some harm. In this post, we’ll talk about bruxism – why it happens, how you can find out if it applies to you, and what to do to protect your teeth.

So, what is Bruxism?

As we’ve discussed, bruxism refers to excessive clenching and/or grinding of the teeth. It falls under habits that are parafunctional – these habits are considered to be outside the normal range of function. Often, we find that this parafunctional habit of bruxism occurs at nighttime. In some cases, people have reported that they can hear their partner grinding their teeth at night!

Generally, bruxism can be separated into 2 categories – awake bruxism and sleep bruxism. These are self-explanatory, as awake bruxism involves clenching or grinding during the day and is most often related to stress and/or anxiety. Sleep bruxism is an unconscious habit and has a few different potential causes (which we will explore!). And as a further point, the American Academy of Sleep Medicine does recognize bruxism as a sleep related movement disorder.

A Quick Clarification

In this post, we will be talking about the Temporomandibular Joint (TMJ). If the TMJ has activity beyond a normal range and causes someone issues, that is Temporomandibular joint Disorder (TMD). So, if you hear the phrase “I have TMJ”, well...technically everyone has that! The correct phrase would be “I have TMD”.

How Common is Bruxism?

According to the Sleep Foundation, Bruxism affects about 8-10% of the adult population. Additionally, about 50% of adults will have experienced some form of clenching and/or grinding at some point in their life. Children can often clench or grind as well, especially under the age of 6 – but they often grow out of this phase as adult teeth start to come in.

One major point is that bruxism often goes undiagnosed! So, if you’re ever suspecting that you may have bruxism, it might be time to check in with your dentist – ignoring it may cause trouble in the long run! Many individuals may wonder, "Do I clench and/or grind my teeth?" If you're experiencing symptoms related to bruxism, it's essential to identify the signs and seek effective solutions.

Why Am I Clenching and/or Grinding?

Stress and/or Anxiety

• This is the most common trigger for bruxism. Whether it’s a big move, a change in life circumstances, pesky final exams, or something else big in life – big things can cause an increase in your stress levels.

• This increase in stress levels is often directly linked to increased muscle activity in the jaw joint – leading to more clenching and grinding.

• So, if you’re experiencing some new jaw soreness and it happens to coincide with some big changes in your life, it may be beneficial to consider managing stress levels to reduce clenching and grinding.

Sleep disorders

• Bruxism is very common in people with sleep apnea, snoring, or disrupted sleeping cycles. If you experience symptoms such as daytime sleepiness and jaw soreness, it may be worth checking in with your physician to consider a sleep study!

Misaligned teeth and/or bite problems

• Your teeth may be positioned in a way where a shift occurs when you bite together. This may be problematic when sleeping, as your teeth will continually shift against each other, possibly causing wear into teeth.

Medications and Substances

• SSRIs (e.g. sertraline), stimulants, alcohol, caffeine, and tobacco may all increase grinding risk – the stimulant nature of these may result in increased muscle activity.

Lifestyle Factors

• Things like poor sleep hygiene and excessive exercise before bed can lead to having more energy at bedtime – this can translate to more jaw muscle activity at night, meaning a higher grinding risk!

How Do I Know if I’m Grinding and/or Clenching at Night?

Here are some signs that may point to nighttime clenching and/or grinding:

• Jaw pain or tightness in the morning – this may be on one or both sides

• Dull headaches, especially in the temple areas

• Worn down teeth that look or feel “flatter” - this can be the front or back teeth!

  • Side note: sometimes acidity can wear down your teeth, and this looks different from the wear you’d see from grinding – this makes it more important to have a dentist diagnose bruxism. In some cases, people can have worn down teeth (from acid) and not grind at all!

• Sensitive teeth or receding gums – if a whole area of teeth are sensitive (ie you can’t pinpoint a single tooth), it may be related to clenching/grinding. If you can point to a single tooth, it may not be related to bruxism – it is important to check in with your dentist to be sure!

• Clicking or popping of the jaw joint – many patients exhibit this with no other symptoms, in which case it is totally normal. However, if clicking and/or popping of the joint is new, and is accompanied by soreness, it may be a sign of bruxism.

• Difficulty fully opening the mouth – if your muscles have been overactive at night, they may be sore during the day – making it tough to open fully!

• Your partner hears your grinding at night.

Please note that this list is not exhaustive – you may have bruxism and not experience any of these symptoms – regular dental check-ups can help catch it early and help you avoid any longer-term consequences of bruxism. “What are these consequences?”, you may ask? Well, let’s find out!

What Are the Consequences of Bruxism?

Here is yet another list. Once again, it is not exhaustive – everyone is unique, and as a result, consequences can vary from person to person.

• Tooth Damage: because bruxism is defined as clenching and/or grinding beyond the normal amount, teeth may chip or crack as they are being subjected to higher than typical forces. The same applies to any fillings, crowns, or other restorative work you have had done.

• Jaw Strain: straining of the muscles and ligaments in the jaw joint (the TMJ) can lead to temporomandibular disorders (TMD) - this can mean things like continuous jaw pain, reduced opening, and joint inflammation

• Gum Recession: as a disclaimer, the research is not settled on this, but bruxism may contribute to receding gums, as excessive forces on teeth can cause gum tissue to move away from teeth. Recession has many different causes, and if you notice receding gums, it is worth checking in with your dental team to see why it may be occurring for you!

• Sleep disruption: if your grinding is excessive and loud, it can disrupt your and/or your partner’s sleep!

How Do We Diagnose Bruxism?

Now that we know what bruxism is and why it’s a problem, how do we determine if someone has it? That is done in a few different ways, but primarily it is diagnosed at your dentist’s office. Your dentist will look for signs like tooth wear, jaw muscle tenderness/soreness, and any issues with your temporomandibular joint (TMJ). Remember, everyone grinds their teeth to some extent. Bruxism refers to an amount of grinding that is greater than what is seen in normal functioning. Another valuable tool is self-reports from patients and/or their partners. Often if patients or their partners notice grinding at home, then something is going on! Lastly, in cases where sleep apnea may be suspected, sleep studies or even electromyography (EMG) can be used to aid in a diagnosis.

How Do We Treat Bruxism?

Now that we know what bruxism looks like and how we can diagnose it, we can look at some ways to treat it. A quick disclaimer – there are many methods to deal with bruxism, but there is no “one size fits all” fix. Much like the knee and shoulder, the TMJ is a highly complex joint, and because of that there can be various causes of bruxism. Without further ado, here are some ways to treat bruxism (please note: this list is not exhaustive – we recommend speaking with your dentist to determine the best course of action for yourself!):

Custom Night Guard

• This is often the “first line” treatment when it comes to bruxism. This is a plastic appliance that fits over your teeth, that you wear at night. It works in two ways – 1) it serves as a layer of protection over your teeth, and 2) it is meant to put your jaw in a position that promotes reduced muscle activity.

Orthodontic treatment (braces or Invisalign)

• If your teeth are misaligned, and grinding presents an especially high risk to cause damage (e.g. if your “front teeth” close together very tightly), it may be worth considering having your teeth moved into a better position to reduce the likelihood of damage. Depending on how severe the misalignment is, this can be done by a general dentist, or an orthodontist.

Stress Management

• Research has shown that stress and anxiety are very closely linked with daytime bruxism.

  • A 2010 study by Winocur et al. (Journal of Oral Rehabilitation) found that individuals reporting high stress and anxiety were 2-3X more likely to experience daytime bruxism.

  • Stress and nighttime bruxism show a moderate link based on research (as more factors can cause nighttime bruxism).

• If this applies to your situation, stress management techniques have been shown to help

  • Mindfulness meditation, breathing exercises, yoga.

  • Cognitive Behavioural Therapy (CBT)

• If you are experiencing significant levels of stress and/or anxiety, we recommend checking in with your family physician or other medical professional for assistance.

Physiotherapy

• If you are experiencing significant muscle soreness due to bruxism and have explored other treatment options (such as a nightguard) to no avail, a physiotherapist with a focus in TMD management is a good option to consider.

  • The PT can provide exercises and massage techniques specific to your situation.

  • If larger issues such as neck and shoulder pain are present as well (which can potentially be related), the PT can assess those as well!

Lifestyle Changes

• Avoiding alcohol or caffeine later in the day may be beneficial, as both can potentially increase heart and muscle activity, resulting in poorer sleep and potentially bruxism.

• Limiting screen time and creating a bedtime wind-down routine can help improve sleep and reduce bruxism

Addressing Underlying Sleep Issues

• We’re sure you’ve noticed that sleep and bruxism have come up a fair bit together in this post. Poor sleep and bruxism often occur together – therefore identifying and addressing poor sleep issues can often improve bruxism.

  • If sleep apnea is suspected, referral to a physician or referral for a sleep study is recommended.

Botox (for severe cases)

• If other avenues such as stress management and a night guard have been attempted and still haven’t reduced muscle activity, botox can be considered (and done by a dentist!) to address bruxism.

  • It is administered to your chewing muscles (masseter, temporalis) to temporarily weaken them, therefore reducing their activity.

  • Typically wears off after about 3 months, so it needs reapplying. As a result, it is often an expensive form of treatment.

Final Thoughts – I Think I Might Have Bruxism, So What Do I Do?

Excessive clenching and grinding may seem minor, but in the long run damage can be caused as teeth wear away at each other. If you suspect you clench or grind your teeth, consult your dentist for a comprehensive evaluation and personalized treatment plan. As always, “an ounce of prevention is worth a pound of cure” - treating bruxism early can save your teeth (and your wallet!) from significant damage later.

If you’re in our neighbourhood or area, and feel you may be grinding your teeth, don’t wait for a broken tooth or jaw pain to tell you something’s wrong. Give us a call today at 780-440-4800 or visit the online booking portal on our website, and let’s work together to protect your smile!