Sleep Bruxism

Definition

Bruxism comes from the Greek word “brychein” for “gnashing of the teeth.” This sleep-related movement disorder involves nighttime teeth grinding. Like other sleep-related movement disorders, bruxism is characterized by involuntary, unconscious movement during sleep.

What is Bruxism?

Bruxism comes from the Greek word “brychein” for “gnashing of the teeth.” This sleep-related movement disorder involves nighttime teeth grinding. Like other sleep-related movement disorders, bruxism is characterized by involuntary, unconscious movement during sleep.

While people also grind their teeth while awake, sleep bruxism is generally a bigger health concern. People with sleep bruxism may not know they’re grinding their teeth, so the behavior can continue for years. Left untreated, sleep bruxism can break, loosen, or wear down teeth, enamel, crowns, and fillings. It can also cause headaches, jaw pain, and temporomandibular joint (TMJ) disorder.

Sleep bruxism also interferes with sleep quality. The body needs to relax during sleep, and tooth grinding involves tensing the muscles, inhibiting the body’s ability to relax into a deep, restful sleep.

Symptoms of Bruxism

People with bruxism may not be aware of the condition. Here are symptoms of nighttime tooth grinding:

  • Tooth pain, jaw pain, unexplained facial pain, earaches, and headaches
  • Pain and swelling in the jaw
  • Broken or chipped teeth, crowns or fillings
  • Changes in the shape of teeth
  • Complaints of grinding or gnashing sounds at night from bed partners

How Common is Bruxism?

Experts estimate that 40 million Americans grind their teeth during the day or night, and up to 10 percent of those do it intensely enough to significantly damage their teeth, dental fillings, and crowns.

Rates of bruxism decrease with age. Prevalence in adults under age 30 is estimated at 13 percent, while rates for those over 60 drops to 3 percent.

Bruxism is common in early childhood; researchers estimate that around a third of young children grind their teeth during sleep. This condition is usually outgrown by the time the permanent teeth start to erupt, around age 5 or 6.

What Causes Bruxism?

Doctors still don’t know what causes bruxism. However, several risk factors increase the risk of bruxism, including genetics, stress, other sleep disorders such as sleep apnea, and regular alcohol, drug, or tobacco use.

Bruxism often stems from stress or anxiety; 70 percent of bruxism cases are related to anxiety and stress, and bruxism occurs at a higher rate in adults who are prone to intense emotions and have aggressive or hyperactive personalities. People may develop bruxism as a coping strategy similar to biting their cheeks, lips, or nails.

People with sleep-related breathing disorders like obstructive sleep apnea have a higher risk of bruxism.

Besides OSA, other sleep-related risk factors for sleep bruxism include sleep talking and REM behavior disorder (where an individual physically acts out their dreams).

Using nicotine, caffeine, alcohol and psychoactive drugs increase the risk of bruxism.

Sleep Bruxism in Children

At age 5, around 30 percent of kids show signs of bruxism. Some children develop bruxism as a coping strategy for the pain from earaches or teething, or as a response to anxiety.

Fortunately, like bedwetting, night terrors, and sleepwalking, bruxism goes away for many children as they age out of childhood. More than half of children with sleep bruxism naturally stop by age 13. By adulthood, only 5 to 10 percent still grind their teeth.

Diagnosis

Dentists are trained in all aspects of oral healthcare, which includes identifying early signs of bruxism. One of the best ways to diagnose sleep bruxism early and prevent long-term damage is with a twice-annual dental checkup.

Treatment

Bruxism has no cure. However, symptoms of bruxism and damage to the teeth can be reduced or eliminated through a combination of therapies.

Lifestyle modifications can help reduce symptoms and improve sleep quality for people experiencing bruxism. These include improving sleep hygiene and reducing stress.

  • Maintaining a consistent bedtime and wake-up time.
  • Meditation, yoga and deep breathing exercises can reduce stress.
  • Warm baths, warm compresses and facial massage can alleviate jaw tension.
  • Avoiding hard foods and chewing gum can keep jaw muscles more relaxed.
  • Reducing or eliminating caffeine, alcohol, and nicotine.

When lifestyle modifications don’t provide enough relief, dental devices or other therapies can help alleviate bruxism. Occlusal splints, occlusal bite guards, night guards, bite plates, and bruxism appliances are all custom fitted by a dentist.

A dentist takes an impression of the teeth, which is used to fit a device worn during sleep. These devices do not actually stop grinding, but they can prevent further damage by separating and protecting teeth and reducing grinding noise.

Mandibular Advancement Devices (MADs) are appliances fitted by a dentist, designed for overnight wear. These devices treat both OSA and sleep bruxism: they prevent tooth grinding while keeping the tongue forward, so it can’t collapse back into the airways and obstruct breathing.

When bruxism is connected to another sleep disorder, treating the underlying condition can bring relief. If bruxism is caused by OSA, treating the sleep apnea with a continuous positive airway pressure (CPAP) device eliminated the related sleep bruxism.

If the bruxism is a side effect of an anxiety disorder, treating underlying anxiety can eliminate bruxism symptoms. For example, combining cognitive behavioral therapy (CBT) with occlusal splints has proven more effective for treating sleep bruxism than occlusal splints alone, further reinforcing the connection between bruxism and stress and anxiety.

Additional Resources