Bruxism

What is Bruxism (Teeth Grinding)?

Bruxism (teeth grinding) is a parafunction, a harmful habit, in which a person clenches, grinds or presses their teeth together. Contrary to popular belief, teeth grinding can occur not only at night, but also during the day when doing a stressful job, focusing or lost in thought. While a normal individual rubs their teeth together an average of 260 times in 8 hours, this number can go up to 1200 times during sleep in individuals with a teeth grinding habit (bruxomaniac individuals).

What Causes Teeth Grinding? What Are the Causes?

Teeth grinding is a problem seen in almost 1 in 3 people today. Especially after the COVID-19 outbreak, the number of teeth grinding cases has increased. This has proven to us once again the connection between teeth grinding and psychology. Before this, we knew that teeth grinding increases in cases of stress, anxiety and nervousness due to high blood pressure, hyperthyroidism or psychological reasons, and even the effects of professional groups on teeth grinding habits in people. For example, the amount of teeth grinding is high in athletes, in occupations that depend on physical strength such as construction and transportation, in occupations with high stress levels such as soldiers and police, or in occupations that require high precision such as microsurgery doctors who need to do fine work. If we list these and other reasons:

Dental factors: Recent dental treatments, incompatible fillings or dentures, irregularities in the alignment of teeth, etc.

Psychosocial factors: Anxiety, stress, tension, repressed emotions, aggressive or hyperactive personalities

Neurological factors: Brain trauma or some neurological diseases

Central nervous system disorders: Parkinson's Disease, Huntington's Disease, Tourette Syndrome, etc.

Drugs or substances used: Use of substances such as cigarettes, alcohol, tobacco, caffeine, cocaine and addictions, some antidepressants (selective serotonin reuptake inhibitor drugs) Calcium channel blockers

Genetic Predisposition Factors

General systemic disorders: Intestinal flora, eating disorders, allergies, endocrine diseases

What Are the Symptoms of Teeth Grinding and How Is It Diagnosed?

Abrasions on teeth

Pain, sound and locking in the jaw joint

Pain in the chewing muscles (especially increasing when waking up in the morning and decreasing during the day)

Fractures in teeth and fillings, sensitivity due to cracks in the teeth

Loose teeth and gum recession

Headache

Neck and back pain

Since teeth grinding is not a conscious habit, it is usually diagnosed by dentists. Dentists can diagnose bruxism in patients with symptoms such as growth in the chewing muscles, the shape of the wear on the teeth, vertical decreases due to wear, the amount of fractures and cracks in the teeth, sounds caused by deterioration in the jaw joint, locking, and abnormal movements of the jaw during mouth opening. In addition, physiotherapists and doctors who go with complaints of headaches or neck and back pain may suspect teeth grinding and refer patients to dentists when there is persistent pain despite treatment.

What are the harms of teeth grinding?

Clenching teeth has harmful effects on teeth and surrounding tissues. Because the extra loads on teeth with bruxism can cause deterioration in the entire chewing system and even in general body health. We can understand these extra loads better as follows: according to research, during normal chewing, teeth touch each other for 0.3 seconds and an average load of 80 kg is placed on the teeth. However, during teeth clenching, the contact time of the teeth increases to 7 seconds and the load increases to 140 kg. This reveals a very striking result.

Does Teeth Clenching Age the Face?

With so much load on the teeth and the hard surfaces rubbing against each other, the upper and lower teeth act like a rasp, causing the chewing surfaces of the teeth to wear down. Due to the wear, the distance between the tip of the nose and the tip of the chin, which we call the lower face height, begins to shorten. As a result, the lips collapse inward, and wrinkles, which we call the Chinese moustache, form on the chin. All of these cause the person to look older. The reduced lower face height causes the muscles to work harder while chewing, thus causing the face to widen horizontally along with the growth of the chewing muscles.

Does Teeth Clenching Cause Face, Head, or Neck Pain?

In addition to aesthetic deterioration not only in the teeth but also in the entire face, bruxism causes pain in the muscles and joint diseases. Trigger points, commonly known as crunches, occur in overused muscles and are felt as pain and fatigue by the person. This situation, which is mostly experienced in the chewing muscles, causes the surrounding muscles to become more active and causes similar problems. For example, teeth clenching may be the cause of persistent pain in the neck and back.

Does Clenching Teeth Cause Sensitivity?

The teeth are constantly exposed to trauma due to the friction of hard tissues. Just like the trauma caused by suddenly biting a stone that comes out of the food, during bruxism, the teeth are constantly affected by the trauma caused by the friction force. As a result of this excessive force, cracks form in the teeth and sensitivity begins. The risk of tooth fracture increases, especially in older individuals, as the enamel tissue wears away and the dentin is exposed. Because just as the skin loses its flexibility and wrinkles with age, our teeth also age and lose their flexibility. This leads to fractures in the teeth.

Does Teeth Grinding Cause Gum Recession and Tooth Loss?

The high forces coming to the tooth try to be balanced by the gums and jawbone surrounding the tooth. However, due to excessive forces, the surrounding tissues may not be able to tolerate this. As a result, gum recession, melting of the jawbone and consequently loosening and loss of teeth begin. This causes tooth loss even if there is no decay.

Teeth Grinding Treatment: What Are the Treatment Options for Bruxism?

One of the most frequently asked questions is, “I grind my teeth while I sleep. Will all my problems go away with teeth grinding botox?” or “Is using a night guard enough for teeth grinding?” Unfortunately, NO.

The first important step in the treatment of a disease is to diagnose the cause of the disease and treat it accordingly. Bruxism (teeth grinding) is a complex disease that needs to be treated from many perspectives. The most common cause of teeth grinding is psychological and oral reasons. Treatment should first begin with a dental examination. If there are any problems detected during this examination (e.g. missing teeth, ill-fitting/high fillings and dentures, crowding and inappropriate tooth contacts, one-sided chewing habits), these are determined. If abrasion and crack examination and treatment are necessary for sensitivity caused by teeth grinding, they should be performed with a microscope and the patient should be reassured. Because microcracks caused by teeth grinding may not be visible to the naked eye and may require the use of a microscope. After the intraoral tooth relationships are brought to ideal, other treatment options should be evaluated and should mostly be supported by psychotherapy.

Using antidepressants, muscle relaxants, relaxing organic oils, botox applications, and making intraoral splints/plates are not a treatment on their own, but they are sweeping the existing problem under the rug. As dentists, we use botox and night plate applications to protect our patients' teeth and surrounding tissues from the harmful effects of teeth grinding throughout their treatment. Trying to find a solution to teeth grinding with these alone is like a cancer patient using painkillers to relieve their pain. It does not solve the problem.