Sleep Bruxism

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Bruxism comes from the Greek word “brychein” for “gnashing of the teeth” – put sleep in front of it, and you have the fancy term for grinding your teeth during sleep.

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.

Sleep bruxism is of particular concern because the damage caused to the teeth is much more severe than daytime bruxism, it’s more challenging to treat, and worst of all, individuals may not even realize they’re doing it.

What is sleep bruxism?

Bruxism describes unconscious and rhythmic grinding, gnashing, or clenching of teeth. Awake bruxism happens during the daytime, while sleep bruxism happens during the night.

Sleep bruxism can break, loosen, or wear down your teeth, enamel, crowns, and fillings. It can also cause headaches, jaw pain, and temporomandibular joint (TMJ) disorder.

Over time, grinding your teeth while you sleep can completely destroy your teeth, but it also interferes with your quality of sleep. Your body needs to relax while you sleep, and tensing the muscles to grind your teeth interferes with your ability to achieve truly restful deep sleep. This is why sleep bruxism is categorized as a sleep-related movement disorder, along the likes of restless leg syndrome and periodic limb movement disorder. These disorders are characterized by uncontrollable physical movement during sleep – in the case of sleep bruxism, the movement is caused by the jaw muscles.

How do you know if you have sleep bruxism? Here are the biggest warning signs:

  • You experience tooth pain, jaw pain, unexplained facial pain, earaches, or headaches
  • Your partner wakes up to sounds of you grinding your teeth at night
  • You experience occasional swelling in your lower jaws
  • Your teeth look flatter or ground down

effects of sleep bruxism

What causes sleep bruxism?

Doctors still don’t know what causes bruxism, but they’ve identified several risk factors, namely stress, other sleep disorders such as sleep apnea, and regular alcohol, drug, or tobacco use.

1. Stress

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.

2. Obstructive sleep apnea

Sleep bruxism is linked to sleep-disordered breathing like obstructive sleep apnea (OSA) and snoring. OSA develops when the individual’s tongue or muscles at the back of their throat collapse, blocking the airways and literally stopping breath while sleep. Researchers hypothesize the bruxism may be an unconscious response to the apneic episode.

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).

3. Smoking, alcohol, and drug use

Episodes of sleep bruxism tend to correspond with increased activity in the cardiac and respiratory symptoms during sleep, leading doctors to believe it may be an arousal response. Lending credence to this theory is evidence that sleep bruxism often occurs during transitions between the different sleep stages, when brain waves, breathing, heart rate, and muscle movements change.

The use of psychoactive substances like drugs, alcohol, nicotine, and caffeine can all increase arousal during sleep and thus induce bruxism. Amphetamine use and certain SSRIs are also linked to bruxism.

Sleep bruxism in children

At age 5, around 30 percent of kids grind their teeth. 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, and by the time they reach adulthood, only 5 to 10 percent still grind their teeth.

Figuring out you have bruxism as an adult is tricky, because you’re often unconscious when it’s happening, but diagnosing it in your child can be even trickier. You might consider checking in on your child occasionally during sleep to note any sounds of grinding, or ask a sibling who shares their bedroom. Pay attention if your child complains of pain while chewing, or any mouth, facial, or ear pain that’s not from an actual earache. Remember that stress or anxiety can also contribute. Regular dental checkups can also catch symptoms early on.

Treatment options for sleep bruxism

Currently there’s no way to permanently “cure” bruxism, although various treatment options exist for significantly alleviating symptoms and reducing the damage done to your teeth.

Regular dental checkups

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

If your dentist recognizes symptoms of sleep bruxism, they may outfit you with an occlusal mouth guard or mandibular advancement device, both described below. Alternately, they may even out your bite by adding new fillings, crows, or otherwise adjusting your bite so your teeth fit better together and are less likely to grind down from bruxism.

Occlusal mouth guards

Occlusal splints, occlusal bite guards, night guards, bite plates, and bruxism appliances are all custom fitted by a dentist to your teeth. A mold is taken by your dentist, and then formed into a plastic designed for you to wear while you sleep. These do not actually stop bruxism from happening, but they stop further damage by separating your teeth while you sleep. Occlusal mouth guards protect your teeth during bruxism episodes and silence the associated sounds of bruxism that may rouse anyone you share the bed with.

Mandibular Advancement Devices (MADs)

Like occlusal splints and bit guards, MADs are also fitted by a dentist, designed for you to wear at night. However, these devices make you physically unable to grind your teeth, preventing both the results and the actual occurrence of sleep bruxism. These are commonly used in cases of comorbid sleep apnea and sleep bruxism, since they also treat OSA by keeping the tongue forward, so it can’t collapse back into the airways.

In cases of OSA-induced sleep bruxism, treating the sleep apnea with a continuous positive airway pressure (CPAP) device eliminated the related sleep bruxism.

Reducing stress and anxiety

If the bruxism is a side effect of an anxiety disorder, treating the root cause often makes the bruxism go away. 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.

CBT is a form of psychotherapy that helps individuals better manage stress, anxiety, and related sleep problems like insomnia. Patients learn to recognize problematic behaviors and negative thought patterns, and how to replace them with healthy, positive ones instead..

Meditation, relaxation and deep breathing exercises are all effective strategies for dealing with stress, as is a regular yoga practice. Certain yoga poses in particular can relieve the muscles associated with teeth grinding, such as Warrior 2, Camel, and Bridge.

A relaxing bedtime routine that includes reading, taking a warm bath, or listening to soothing music can also calm the mind and stave off bruxism.

Other options

If you know you have sleep bruxism, make things easier on your teeth whenever possible. Avoid eating hard foods and chewing gum. Actively take time to relax your face and jaw muscles during the day.

You might apply a warm washcloth to your face to relieve sore jaw muscles. Muscle relaxants are sometimes prescribed to ease the pain and muscle tension in the jaw. Multiple studies are currently exploring Botox injections in the jaw muscle as another treatment for severe cases of sleep bruxism.

Additional resources

  • The American Dental Association runs MouthHealthy.org, an educational website dedicated to dental health topics, including bruxism. The site helps you diagnose various oral care issues and offers a local provider directory.
  • The Bruxism Association is a UK-based organization that shares detailed information on bruxism symptoms, causes, and treatments, and sells various anti-bruxism devices in its online shop.
  • The New York Times Bruxism topic page curates editorial pieces on the latest bruxism research and articles on related topics such as TMJ disorders.
  • The Mayo Clinic provides an in-depth overview of bruxism, recognizing symptoms, and finding treatment options.
  • The Bruxism Forum on Topix connects fellow teeth grinders with one another. Concerned individuals, sleeping partners, and parents can also ask dentists and dental hygienists directly for help on the Dentistry subreddit.
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