Bruxism (clenching) is a parafunction, that is, a harmful habit in which a person clenches, grinds or presses their teeth together. Contrary to popular belief, teeth clenching can be experienced not only at night but also during the day while doing a stressful job, while focused or immersed. While a normal individual touches his/her teeth an average of 260 times in 8 hours, this number can increase up to 1200 in individuals with clenching habits (bruxomania) during sleep.

WHY DOES TEETH CLENCHING OCCUR AND WHAT ARE THE CAUSES?

Teeth clenching is a problem seen in almost 1 out of every 3 people today. Especially after the COVID-19 pandemic, cases of clenching have increased. This has once again proved to us the connection between clenching and psychology. Prior to this, we knew that clenching increased in cases of high blood pressure, hyperthyroidism or stress, anxiety and nervousness due to psychological reasons, and even the effects of occupational groups on the clenching habit in people. For example, the amount of clenching is higher in athletes, in occupational groups that depend on physical strength such as construction and transportation, in occupational groups with high stress levels such as soldiers and police, or in occupational groups that work with 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 prostheses, malalignment of the dentition, etc.

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

Neurological factors: Brain trauma or certain neurological diseases

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

Drugs or substances used: Smoking, alcohol, tobacco, caffeine, cocaine and addictions, some antidepressants (selective serotonin reuptake inhibitors) Calcium channel blockers

Genetic predisposing factors

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

WHAT ARE THE SYMPTOMS OF TEETH GRINDING? HOW IS IT DIAGNOSED?

Abrasions on teeth

Pain, noise and locking in the jaw joint

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

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

Loose teeth and gum recession

Headache

Neck and lower back pain

Since clenching is not a conscious habit, it is mostly diagnosed by dentists. Dentists can diagnose bruxism with symptoms such as growths in the chewing muscles, the shape of the abrasion on the teeth, vertical drops due to abrasion, the amount of fractures and cracks in the teeth, sounds due to deterioration in the jaw joint, locking, abnormal movements of the jaw during mouth opening. In addition, physiotherapists and doctors who are visited with headaches or neck and back pain complaints may suspect tooth clenching and refer the patient to dentists when there is pain that does not go away despite treatment.

WHAT ARE THE HARMS OF CLENCHING?

Teeth clenching has harmful effects on teeth and surrounding tissues. Because the extra loads on the teeth with bruxism can cause deterioration in the entire chewing system and even in general body health. We can better understand these extra loads as follows: According to researches, in a normal chewing, the teeth contact each other for 0.3 seconds and an average load of 80 kg is placed on the teeth. However, during 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 mutually act like a rasp, causing the chewing surfaces of the teeth to wear down. Due to abrasion, the distance between the tip of the nose and the tip of the chin, which we call the lower face height, begins to shorten. Accordingly, the lips collapse inward and wrinkles, which we call the Chinese mustache appearance, form on the chin. All these cause the person to look old. Decreased lower facial height causes the muscles to work harder while chewing, thus causing the face to expand horizontally with the growth of the chewing muscles.

DOES TEETH GRINDING CAUSE FACE, HEAD AND NECK PAIN?

In addition to aesthetic deterioration not only in the teeth but also in the whole face, bruxism causes muscle pain and joint diseases. In overused muscles, trigger points are formed, which are popularly called earaches, and the person feels pain and fatigue. This condition, which is mostly experienced in the chewing muscles, leads to increased activity of the surrounding muscles and similar problems. For example, clenching teeth may be the cause of persistent pain in the neck and back.

DOES TEETH GRINDING CAUSE SENSITIVITY?

Teeth are constantly exposed to trauma when hard tissues rub against each other. Like the trauma caused by the sudden biting of a stone coming out of the meal, the teeth are constantly affected by the trauma caused by the friction force during bruxism. As a result of this excessive force, cracks form in the teeth and sensitivity begins. The risk of tooth fracture increases, especially in elderly individuals, as the enamel tissue is eroded and dentin is exposed. Because just as the skin loses its elasticity and wrinkles with age, our teeth also age and lose their elasticity. This leads to tooth fractures.

DOES TOOTH CLENCHING CAUSE GINGIVAL RECESSION AND TOOTH LOSS?

The gum and jawbone surrounding the tooth try to balance the high forces on the tooth. However, as a result of 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 leads to the loss of teeth even if there is no decay.

TREATMENT OF BRUXISM: WHAT ARE THE TREATMENT OPTIONS FOR BRUXISM?

One of the most common questions is “I clench my teeth while sleeping. Will all my problems go away with clenching botox?” or “Is it enough to use a night plate for clenching?”. Unfortunately, NO.

The first important step in the treatment of a disease is the diagnosis of the cause of the disease and treatment for the cause. Bruxism (clenching) is a complex disease that needs to be treated in many ways. The most common causes of clenching are psychological and intraoral reasons. Treatment should start with a dental examination. If there are any problems detected in this examination (for example, tooth deficiencies, incompatible / high fillings and prostheses, crowding and inappropriate tooth contact, one-sided chewing habits), these are detected. If necessary, abrasion and crack examination and treatment for sensitivity caused by clenching should be performed with a microscope and the patient should be relieved. Because microcracks caused by clenching may not be visible with the naked eye and may require the use of a microscope. Other treatment options should be evaluated after the intraoral dental relations are optimized and should be supported by psychotherapy.

The use of antidepressants for clenching, muscle relaxants, the use of relaxing organic oils, botox applications, intraoral splint/plate making is not a treatment in itself, but it is sweeping the existing problem under the carpet. As dentists, we use Botox and night plate applications to protect our patient’s teeth and surrounding tissues from the harmful effects of clenching throughout the treatment. Trying to find a solution to clenching with these alone is similar to a cancer patient using painkillers to relieve pain. It does not solve the problem.