Bruxism – Grinding or Clenching
Bruxism is excessive clenching or grinding of teeth that is not part of the normal chewing movements. It can lead to excessive wear and cause permanent damage to the teeth and jaw joints. It often happens during sleep, but daytime habits occur also. Sometimes it is a temporary problem, but in many people, it becomes a significant, long term problem and needs to be managed by your dentist.
Causes of bruxism – the exact cause is unknown, but the following factors are thought to contribute:
- psychological stress
- physical stress
- heavy alcohol consumption
- certain antidepressant drugs
- illegal drugs/stimulant drugs
- sleep disorders
Signs and symptoms of bruxism – vary depending on the nature, frequency, duration and strength of the excessive clenching and grinding. They include:
- pain in the teeth including sensitivity to temperature
- chronic facial pain with tension headaches
- noise during sleep – this can wake or disturb partners or relatives
- flattened/worn teeth
- fractured/cracked teeth or restorations
- loose teeth
- stiffness and pain in the TMJ
People who clench only, may have more muscular pain without damage to the teeth, whereas people who grind, will usually have damaged teeth and muscular problems.
Your dentist will conduct a thorough examination, including medical history and clinical examination. Signs and symptoms will be assessed, and your treatment options outlined.
Why is grinding and clenching worth treating?
If the habit continues, irreversible damage to the teeth can occur with fracture, loosening or tooth wear, and damage to your temperomandibular joint (TMJ).
How is bruxism treated?
Sleep bruxism that is clearly established usually requires a physical barrier to prevent tooth contact. This barrier is called an occlusal splint, and the most common design involves a high strength acrylic which sits over the biting surfaces of either the upper or lower teeth. It is worn only while sleeping.
TMD or TMJ
Your TMJ, or temperomandibular joint allows the jaw to open and close. It plays an important role in talking, chewing and yawning. It is one of the most complicated joints in the body, and problems on one or both sides can cause pain and limit function. When there is a problem with the TMJ, it may be called TMD – short for temperomandibular dysfunction. Your dentist will examine the joint, the muscles around it, your teeth, and movement of the jaw on opening. They will then discuss the best way to manage your issues.
Disorders of the TMJ can be caused by:
- grinding (bruxism) or clenching teeth
- missing teeth
- stress and tension in the muscles
- injuries such as fractures
- degenerative diseases such as arthritis
- occlusal (biting) problems
- limited jaw movement
- difficulty opening/locked jaw
- clicking or popping noises
- pain on chewing
- face/neck/shoulder pain
- uncomfortable bite
- clenching or grinding of teeth
Treatment is usually conservative. Quite often the first place to visit is not the dentist, but a physiotherapist.
The main treatments are:
- physiotherapy exercises
- modified diet
- avoiding extreme movements
- warm or cold packs
- relaxation and stress management
- oral appliances
- specialist management
- surgery – this is a last resort
SNORING AND SLEEP APNOEA
Millions of Australian adults snore. While for many it causes no significant medical problems, for some it may indicate a more serious condition called Obstructive Sleep Apnoea. This can lead to heart disease, increased blood pressure, or even stroke or heart attack.
Obstructive Sleep Apnoea (OSA) is caused when the soft tissues at the back of the throat relax too much, or collapse and obstruct the airways. These interruptions to breathing may occur many times a night, with each episode lasting from seconds to minutes.
Signs and symptoms of OSA:
- tiredness on waking
- excessive daytime sleepiness
- choking/gasping during sleep
- sore, dry throat on waking
- morning headache
- poor concentration
- memory deterioration
- irritability and personality changes
- decrease in job performance
- anxiety or depression
Diagnosis and assessment of OSA
This is important so the most effective treatment can be offered. People who snore should be assessed by a sleep physician, who can determine the severity of their snoring or OSA. In cases of simple snoring or mild to moderate OSA, a dental appliance may be recommended. In severe OSA, a patient will require more complex treatment, including the use of CPAP (Continuous Positive Airway Pressure).
Here at MSD, we are trained in oral appliance therapy which can treat sleeping and mild to moderate sleep apnoea.
Worn during sleep, the appliance holds the airway open by bringing the lower jaw forward. These devices have been found to help 95% of patients with snoring, and 80% of patients with OSA.
While these success rates are exciting, there can be complications. These include:
- discomfort around the teeth
- Discomfort in the temperomandibular joint (TMJ)
- excessive salivation, or alternately dry mouth
- irritation to the soft tissues of the mouth
- changes to the bite – these are usually minor, but can be significant.