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Bruxism

Teeth grinding; Clenching

Bruxism is when you grind your teeth (slide your teeth back and forth over each other).

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Causes

People can clench and grind without being aware of it. It can happen during the day and night. Bruxism during sleep is often a bigger problem because it is harder to control.

There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench or grind their teeth and never feel symptoms.

Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:

• How much stress you have
• How long and how tightly you clench and grind your teeth
• Whether your teeth are misaligned
• Your posture
• Your ability to relax
• Your diet
• Your sleeping habits

Symptoms

Grinding your teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).

Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners.

Symptoms of bruxism include:

• Anxiety, stress, and tension
• Depression
• Earache (partly because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
• Eating disorders
• Headache
• Muscle tenderness, especially in the morning
• Hot, cold, or sweet sensitivity in the teeth
• Insomnia
• Sore or painful jaw

Exams and Tests

An exam can rule out other disorders that may cause similar jaw pain or ear pain, including:

• Dental disorders
• Ear disorders, such as ear infections
• Problems with the temporomandibular joint (TMJ)

You may have a history of a high stress level and tension.

Treatment

The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.

These self-care tips may help relieve pain:

• Apply ice or wet heat to sore jaw muscles. Either can help.
• Avoid eating hard or dense foods like nuts, candies, and steak.
• Do not chew gum.
• Drink plenty of water every day.
• Get plenty of sleep.
• Learn physical therapy stretching exercises to help the muscles and joints on each side of your head get back to normal.
• Massage the muscles of your neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout your head and face.
• Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
• Try to reduce your daily stress and learn relaxation techniques.

To prevent damage to your teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect your teeth from the pressure of grinding.

A well-fitting splint should help minimize the effects of grinding. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.

There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn't work, another may. Botox injections into the jaw muscles have also shown some success in controlling clenching and grinding.

After splint therapy, adjustment of the bite pattern may help some people.

Finally, many approaches try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.

In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.

Outlook (Prognosis)

Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.

Possible Complications

Bruxism may cause:

• Depression
• Eating disorders
• Insomnia
• Increased dental or TMJ problems
• Fractured teeth
• Receding gums

Nightly grinding can awaken roommates or sleeping partners.

When to Contact a Medical Professional

See a dentist right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions, from arthritis to whiplash injuries, can cause TMJ symptoms. Therefore, see your dentist for a full evaluation if self-care measures do not help within several weeks.

Grinding and clenching does not fall clearly into one medical discipline. There is no recognized TMJ specialty in dentistry. For a massage-based approach, look for a massage therapist trained in trigger point therapy, neuromuscular therapy, or clinical massage.

Dentists who have more experience with TMJ disorders will typically take x-rays and prescribe a mouth guard. Surgery is now considered a last resort for TMJ.

Prevention

Stress reduction and anxiety management may reduce bruxism in people who are prone to the condition.

Related Information

TMJ disorders

References

Indresano AT, Park CM. Nonsurgical management of temporomandibular joint disorders. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery. 3rd ed. St Louis, MO: Elsevier; 2018:chap 39.

Lee E, Crowder HR, Tummala N, Goodman JF, Abbott J, Zapanta PE. Temporomandibular disorder treatment algorithm for otolaryngologists. Am J Otolaryngol. 2021;42(6):103155. PMID: 34214714 pubmed.ncbi.nlm.nih.gov/34214714/.

Ryan CA, Walter HJ, DeMaso DR. Motor disorders and habits. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 37.

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Review Date: 1/24/2022  

Reviewed By: Michael Kapner, DDS, General Dentistry, Norwalk Medical Center, Norwalk CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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