What is bruxism and how does it happen?
It is customary to distinguish between two different conditions with a common name. Night bruxism is the rhythmic activity of the masticatory muscles during sleep, most often in the superficial stages, with short-term micro-awakenings. It is accompanied by that characteristic grinding noise that others hear. Daytime bruxism works differently: it is not grinding, but prolonged silent clenching of teeth during the day - at the computer, in a traffic jam, during concentrated work, during a tense conversation. There is no sound, and the person, as a rule, is not even aware of his habit until he begins to notice fatigue in the jaw.
It is important to understand the scale of the load. During wakefulness, the force of compression is limited by reflexes and the pain threshold: when it becomes unpleasant, the person unclenches his jaw. During sleep, these restraints do not work, and the clenching episode can last several seconds with a force significantly greater than normal chewing. There are many such episodes during the night, and the total time of stress on the teeth and joints turns out to be incomparably greater than when eating. Hence the consequences: abrasion of enamel, cracks, chips, destruction of restorations, overload of the temporomandibular joint and chronic muscle tension.
- Nocturnal bruxism - grinding in a dream, a person is not aware of it, others hear it
- Daytime bruxism is silent clenching of teeth during the day, more often with tension and concentration.
- Normally, the teeth of the upper and lower jaws contact only a short time per day - during eating and swallowing
- With bruxism, the contact time increases many times, and the force of compression during sleep is not limited by reflexes
- Occurs at any age, often in children and usually goes away on its own
- It may be an independent phenomenon, or it may be a manifestation of another disorder - primarily sleep breathing disorder
The myth about worms and where it came from
The belief that grinding teeth in a dream indicates worms exists in almost every culture, and it is extremely tenacious. It was tested many times: they looked for a connection between the presence of parasites and the frequency of bruxism, and observed children before and after antiparasitic treatment. It was not possible to find a convincing connection, and the grinding does not stop after treatment for helminths. A mechanism that would explain such a connection has also not been described.
- Both phenomena are more often noticed in children - this creates the appearance of a connection
- Grinding in children often goes away on its own, and if it coincides with treatment, the effect is attributed to the treatment
- Nocturnal grinding is noticeable to others, so they have traditionally sought a vivid everyday explanation for it.
- Antiparasitic drugs are not harmless drugs; they should not be taken “just in case”
- Examination for parasites makes sense for its own indications, and not because of grinding
- While the cause is being looked for in the wrong place, teeth continue to wear away - this is the main harm of the myth
Real reasons
The modern understanding of bruxism assigns the main role not to the teeth, but to the nervous system and the quality of sleep. For a long time it was believed that the reason was “bad bite” and that it was enough to grind down the interfering tubercles. This approach has not justified itself: selective grinding of teeth for the treatment of bruxism is now not recommended, because it does not give an effect, but irreversibly changes the teeth. The real factors are grouped into several categories.
- Psycho-emotional stress, anxiety, high workload - the most common and most studied factor, especially for daytime clenching
- Breathing disorders during sleep: snoring and breathing pauses. Episodes of compression often follow micro-awakening when breathing is restored
- Smoking and nicotine in any form
- Caffeine in large quantities, especially in the afternoon
- Alcohol impairs sleep patterns
- Some medications, primarily a number of antidepressants and stimulants, may cause the grinding sensation to appear soon after you start taking it
- Stimulants and drugs
- Neurological diseases and disorders associated with sleep movements
- Hereditary predisposition - bruxism often occurs in relatives
The connection with sleep apnea deserves special attention because it changes treatment tactics completely. If episodes of teeth clenching occur as a reaction to the cessation of breathing, then the main problem is not the jaw muscles, but the airways. Getting a mouth guard in this situation will protect your teeth, but will not solve the underlying problem, and some types of mouth guards can even make breathing worse during sleep. Therefore, when grinding is combined with loud snoring, pauses in breathing, night awakenings and severe daytime sleepiness, the right path is first a sleep examination, and only then dental solutions.
How to understand that bruxism exists
The main difficulty is that the person himself does not hear his own grinding. Most often, the problem is reported by a partner or a family member, and if a person lives alone, the diagnosis is often first made by a dentist based on characteristic changes in the teeth. Therefore, it makes sense to know the indirect signs - they are quite recognizable.
- Fatigue, stiffness or dull pain in the masticatory muscles in the morning, a feeling of a “worked” jaw
- Headache in the morning in the temples and forehead, less often pain in the ears without signs of ear disease
- Clicking or crunching in the jaw joint, limited mouth opening after sleep
- Smooth, shiny abrasion areas on the cutting edges and cusps of the teeth, shortening of the front teeth
- Chips of enamel, vertical cracks, regularly falling out fillings and chipped crowns
- Increased sensitivity of teeth to cold without caries
- Imprints of teeth along the edges of the tongue and a white horizontal line on the mucous membrane of the cheeks along the closure line
- Noticeable increase and density of masticatory muscles in the area of the angles of the lower jaw
- Partner hears scratching at night
Simple self-control is useful for daytime bruxism. For several days, several times a day, pay attention to the position of the jaw: at rest, the teeth of the upper and lower rows should not touch each other, the lips are closed, the tongue is relaxed and lies at the roof of the mouth. If you find yourself clenching your teeth every time, you have a habit. It lends itself well to correction precisely due to awareness: reminders on the phone, stickers on the monitor and in the car, conscious relaxation of the jaw work better than any devices, because daytime clenching is under the control of consciousness, unlike nighttime clenching.
Consequences: not only worn teeth
The damage from bruxism accumulates over years and is distributed across multiple systems. The teeth are the first to suffer: the enamel wears away, softer dentin is exposed, the teeth shorten and become sensitive. The wear is uneven, and over time the height of the bite changes, and with it the position of the lower jaw and the proportions of the lower third of the face. It is possible to restore lost height, but this is one of the most difficult, time-consuming and expensive tasks in dentistry, and it is better not to go through with it.
- Enamel wear, tooth shortening, dentin exposure and increased sensitivity
- Cracks and chips of teeth, destruction of fillings, crowns and veneers, increased risk of root fracture
- Overload of the temporomandibular joint: clicking, pain, limited mouth opening
- Chronic tension and enlargement of the masticatory muscles, pain when pressed
- Tension headaches, temple pain, pain and tinnitus
- Gum recession and wedge-shaped defects at the necks of teeth from excessive lateral load
- Complications during implantation and prosthetics - structures last less
- Deterioration in sleep quality and, as a result, daytime fatigue
Treatment: mouthguard, cause and what to do with them
The basis of dental protection remains an individual mouth guard, made from an impression in a dental laboratory. It is put on at night and takes the load on itself: the teeth do not touch, the enamel does not wear off, the restorations do not chip, and the load on the joint is distributed more evenly. But it is important to understand honestly: a mouthguard is protection, not treatment. It does not eliminate the cause and does not stop the muscle activity itself. The person continues to clench his jaw, but the damage is not caused to the teeth, but to the replaceable plastic structure.
- Изготовление индивидуальной капы у стоматолога с последующей коррекцией по прикусу. Готовые аптечные варианты подходят хуже и при неправильной форме способны усугубить нагрузку на сустав.
- Оценка ситуации со сном: при храпе, паузах дыхания и дневной сонливости — обследование до изготовления капы, поскольку тактика может измениться.
- Работа с психоэмоциональным напряжением: режим сна, физическая активность, техники расслабления, при необходимости консультация психотерапевта.
- Пересмотр стимуляторов: сокращение кофеина во второй половине дня, отказ от никотина, уменьшение алкоголя, особенно перед сном.
- Проверка принимаемых лекарств вместе с назначившим их врачом, если скрежет появился после начала приёма. Самостоятельно отменять препараты нельзя.
- Для дневного бруксизма — тренировка осознавания: напоминания в течение дня и сознательное расслабление челюсти, упражнения на мышцы и щадящий режим для челюсти.
- Восстановление зубов при уже произошедшем стирании — после того как активность мышц взята под контроль, иначе новые реставрации разрушатся так же.
It is worth mentioning separately what not to do. Grinding teeth “for proper closure” as a method of treating bruxism is not recommended: the effect has not been proven, and changes in the enamel are irreversible. Injections of drugs that relax the masticatory muscles are used in some difficult cases at the discretion of the doctor, but are not a routine solution and require repetition. Orthodontic treatment corrects the bite when necessary, but is not a cure for bruxism. And most importantly, the mouth guard needs to be brought in regularly for examination: by how and where it is washed, the doctor sees what is happening at night and evaluates whether the chosen tactics are working.