Bruxism is not simply a physiological problem

As spring gathers momentum, there is more sunshine in our lives, which makes us feel like smiling. However, sometimes those smiles need a little help… Now that the days are longer and summer is just around the corner, the time is perfect for us to take better care of ourselves and get rid of the harmful and disconcerting elements in our lives which disturb the harmonious functioning of our bodies. Therefore, today we invite you to learn more about bruxism, a disorder that involves the involuntary grinding of one’s teeth, and its treatment. Dentist Rokas Perevicius has kindly agreed to share his insights and advice with us. He urges those suffering from bruxism to act without further delay – in order to be healthier, more energetic and responsible for creating new smiles.

Those who have not encountered the science of dentistry might think that bruxism – or involuntary teeth grinding – is not that serious of a problem. Well, perhaps there is some danger of waking up someone sleeping nearby… Yet what is this condition really like? What kind of health dangers await those with this disorder?

People experience both short and long-term consequences of bruxism. The short-term effects disappear together with the bruxism; while the long-term ones do not or become irreversible. Short-term consequences involve headaches, pain of the facial or chewing muscles, jaw pain (which spreads to the ear area), pain and stiffness of the neck or shoulder girdle (muscle), limitations or difficulties in opening the mouth, sleep disorders (which can affect both the person suffering from bruxism and the people sleeping nearby), loose teeth, gingivitis (gum inflammation) or receding gums. Long-term effects include temporomandibular joint dysfunction (which covers a whole spectrum of unpleasant symptoms) and tooth wear (cracked or broken teeth).

If your loved ones keep these symptoms to themselves, what other signs may suggest that they are suffering from bruxism?

The main symptoms of sleep bruxism are headaches in the morning or in the first half of the day, facial and neck muscle pain, and an unexplained feeling of their tiredness or stiffness. Teeth grinding or jaw clenching may also happen during the day, but then the person is able to feel or notice it.

What causes bruxism – peculiar features of the human anatomy? Or acquired bad habits and an unhealthy lifestyle?

It is a common opinion that bruxism is related to changes in or an incorrect dental occlusion, although there is a lack of credible scientific data to back up this hypothesis. It has been found that bruxism is caused by a variety of factors that are directly related to a person’s nervous system, including: stress, emotional tension, or the use of various chemical substances (pharmaceuticals, drugs). Sporadic data also points to some inherited risks of bruxism.

Nowadays, it is popular to talk about the influence of stress on the overall condition of our bodies and the increased frequency of anxiety disorders. Do chronic stress and anxiety lead to bruxism?

Certainly. As per its definition, bruxism is a parafunctional habit. This means that it is in no way related to the normal functions of the human body, like speaking or eating. It is often compared with such habits as cheek biting, chewing the fingernails, and biting the ends of pens and pencils. Usually, we are required to exert our will to perform these actions, but people also do them involuntarily. It is believed that these cases are the result of chronic stress and anxiety. According to scientific data, children who suffer from bruxism have higher levels of anxiety than those who do not. People over the age of 50 who have bruxism are statistically more often lonely and better educated, which indirectly suggests that they also suffer from higher levels of stress. Occupational stress, working night shifts or an irregular work schedule may also have a serious impact. Supposedly, feelings of contained and suppressed anger or despair can also contribute to the development of bruxism. Tense times, such as exam periods, crises in family relationships, a divorce or moving house may also provoke the disorder. Additionally, smokers suffer from bruxism twice as often as non-smokers.

What are the most effective contemporary dentistry techniques for treating bruxism? How much depends on the efforts of the dentist and how much depends on a patient’s efforts?

The treatment or management of bruxism is a complicated and multifaceted process, which requires close cooperation between the patient and the dentist. First of all, the patient or the specialist must acknowledge the problem. I have already mentioned the list of symptoms which can help to determine the disorder. During a dental visit, tooth damage (chipped teeth, damage to the tooth necks), as well as pathological wear (lower dental occlusion than usual), broken dentures, tension in the chewing muscles and hypertrophy (increased volume) are the most visible signs. Next, the treatment consists of a rectification of the current tooth damage (if possible), the prevention of further damage and management of the symptoms. Upon finishing the treatment, a dentist usually suggests that a patient should use a mouth guard (a medical device which is made according to the patient’s personal dental mould and is used to protect the teeth by placing the guard over them). The guard does not treat the bruxism on its own, but it protects the teeth from the consequences of this disorder – tooth or denture wear, as well as tooth chipping or breaking. However, many people do not tolerate a mouth guard – they may salivate more, feel there is a foreign object in their mouth, and sometimes experience pain in their temporomandibular joint, or in the facial and neck muscles. This may happen because using a mouth guard makes the patient’s dental occlusion higher, which may cause some discomfort. Additionally, soft mouth guards may even exacerbate and encourage a teeth grinding habit because they are elastic and shock absorbing, which encourages people to bite into them. The other treatments available could be classified as follows:

  1. Prescription medications such as nervous system inhibitors, anxiety and tension reliefs – various sedatives, sleeping pills and antidepressants. These have very strict instructions, warnings and precautions, and will often result in unpleasant side effects such as drowsiness, dizziness or impaired motion coordination.
  2. Psychosocial interventions may be prescribed instead, in the form of psychotherapy, hypnosis or biofeedback. The aim is to decrease the level of stress, to help a person manage their anxiety, and to teach them to understand their body and its processes. These types of treatments can aid a person to learn how to notice when they are clenching their jaw or grinding their teeth, and to develop control mechanisms for these habits. However, these activities are time-consuming and require a lot of effort.
  3. Botulinum toxin injections into the chewing muscles may also be recommended.

Botox is an interesting and unexpected type of treatment for bruxism. However, this is perhaps due to its persistent connection with beauty procedures. Please tell us more about the circumstances where the use of botulinum is beneficial for treating bruxism and the reasons for this?

The botulinum toxin blocks the junction between a nerve and a muscle, which partly and reversibly paralyses that muscle. It affects only the motor functions and does not disrupt the sensory ones. This type of treatment connects all of the other methods I have mentioned above – the strength of the dental occlusion is decreased by weakening the participating muscles. This means that the teeth (or dentures) are protected from further wear and breakages, while the muscles are not strained or tired, and the painful areas are contained. The temporomandibular joints are also under less pressure, so the patient sleeps better and feels better rested without experiencing pain. This type of treatment also improves the patient’s psycho-emotional state, as the muscles are weakened and the patient cannot clench their jaw as hard. This in turn changes the patient’s habits because it operates as biofeedback therapy, which leads to the elimination of bad habits (teeth grinding, jaw clenching). The most important benefit is that there is no need for any sleeping pills or sedatives. When this type of treatment is combined with a prescription mouth guard, it can achieve some exceptionally positive results.

What is the first thing you recommend to new patients who are seeking your help with their bruxism? How will the treatment start?

Most importantly, I would recommend that patients act quickly, confidently and without delay, because new permanent teeth will not grow back again. The treatment process always starts with a conversation between us and the patient, when we listen and ask questions about any health complains. Following this, the patient is examined by a dentist, who evaluates the factors I have mentioned above and plans the treatment to be carried out.