Bruxism

Bruxism is grinding of the teeth. The verb is “to brux”.

This is an oral para-functional habit observed in a large number of people occasionally and, in a smaller number, habitually. The mechanism of causation is tension and spasm of the muscles used for mastication. The term also refers to clenching of the teeth, which causes similar problems.

Often, it occurs during sleep; even a short nap may induce it. In a typical case, the canines and incisors are commonly moved against each other laterally, i.e. with a side to side action. This erodes tooth enamel, removing the sharp biting surfaces and flattening the edges of the teeth. Sometimes, there is a tendency to grind the molars together, which can be loud enough to wake a sleeping partner.

Over time, bruxing shortens and blunts the teeth being ground, and may lead to pain in the joint of the jaw, the temporomandibular joint, or headache. Teeth hollowed by previous decay (caries) may collapse; the pressure exerted by bruxism on the teeth is extraordinarily high.

The cause, or causes, of bruxism remains unclear. Some dentists believe it is due to a lack of symmetry in the teeth; others, that it reflects anxiety, digestive problems or a disturbed sleep pattern.

Until now, dentists could not reliably diagnose bruxism until damage appeared on the teeth or if a bed partner or parent heard grinding noises. In short, unless a patient complained of pain or damage appeared on the teeth, it went undiagnosed. Adding to the problem, many patients are in denial when given the news they might be bruxing. They simply don’t believe it.

A new FDA-approved device called the BiteStrip enables at-home overnight testing for Sleep Bruxism. The device is a miniature electromyograph machine that senses jaw muscle activity while the patient sleeps.

In the morning, the patient removes the device, waits 60 minutes for the electro-chemical display to develop and then removes a green sticker to see the results. BiteStrip scores on a scale of 0 through 3 with a 3 meaning a severe condition. For the first time, a dentist can see evidence of the condition before damage to the teeth. Further, the device enables the dentist to establish the severity level, which helps determine an appropriate treatment plan. The display further reduces a patient’s denial of their condition.

The effects of the condition may be quite advanced before sufferers are aware they brux. Eroded teeth may be brought to the patient’s attention during a routine dental examination. If enough enamel is eroded, the softer dentine will be exposed, and erosion will accelerate. This opens the possibility of dental decay and tooth fracture, and in some people, gum recession. Early intervention by a dentist is advisable.

Some drugs are known to cause bruxism as a side-effect, e.g. MDMA and others of the amphetamine-based family.

Treatment of bruxism

Unfortunately, there is no accepted cure as yet; mainly as we have no accepted model of causation for the condition. Ongoing management of bruxism is based on prevention of the abrasion of tooth surfaces by the wearing of an acrylic dental guard, created to the shape of the individual’s upper teeth from a bite mould.

This requires trips to the dentist for measuring and fitting. Alongside this full width guard, smaller and alternative shapes can be obtained, some with proprietary names. It is worth noting that some clinicians advise against the fitting of fitted guards as a long term treatment.

If a tense jaw is experienced during wakefulness, some sufferers find it helpful to gently press their jaws open with fingertip pressure, to relax the affected muscles much as one would treat a leg cramp, but in this case, it is important to take care not to overextend the jaw joint.

Though, presently, there is no cure available for bruxers, it may be found beneficial to work at reducing stress and anxiety before bedtime, by a winding-down activity such as massage, meditation or reading, and eating early enough to ensure a fairly empty stomach at bedtime may also help.

Damaged teeth can be repaired by replacing the worn natural crown of the tooth with an artificial crown. Materials used to make crowns vary; some are less prone to breaking than others, and can last longer. Porcelain fused to metal crowns may be used in the anterior (front) of the mouth, and in the posterior (back) gold is the preferred material. To protect the new crowns, an occlusional guard may be fabricated to wear at night.

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