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November 20, 2018
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Don’t stress, clench or grind!

By: George Malkemus
September 14, 2018

Grinding or clenching the teeth is an unhealthy habit called bruxism. Bruxism is an unconscious habit that affects over five percent of the population, often causing damage and pain to the teeth, the facial muscles or the jaw joint [TMJ].  I often see signs in the mouth of bruxism: worn teeth, thickened lower jaw, or fractured teeth. Most bruxers are not aware of their grinding or clenching habits, and only 5percent go on to develop painful symptoms.  However, damage slowly develops.  Most bruxism problems occur during sleep when the person is totally unconscious. The best protection from bruxism is a protective mouth guard, often called a night guard for its use during sleep.

Grinding and clenching habits do occur during the day, though most people are totally unaware of this bruxism habit.  However, during the conscious, awaken times, a person can become aware of the habit and learn to stop grinding or clenching. 

Bruxism is a serious problem in our society.  It can cause joint pain, eyestrain, neck pain and headaches including migraines. There is evidence that bruxism, causing facial muscular tension, is a precursor to migraines which are debilitating, throbbing, vascular headaches.  The use of a night guard can prevent the migraine from starting in many cases.  However, once a migraine has begun, the use of a guard will not cause it to stop.

 Numerous dental problems are caused by grinding and clenching.  Bruxism is the leading cause of teeth trauma and a significant cause of tooth loss and gum recession. By moving the teeth around in the gums and bone, bruxism can contribute to gum disease. 

Bruxism can cause tooth fractures and the need for root canal therapy.  Many people are pounding their teeth to death.  I have been treating a 38-year-old female patient for whom I have done six root canal therapies over the last five years due to her night grinding.  I was unable to convince her to have a night guard fabricated because her insurance does not pay for guards.  However, her insurance does pay for root canals, so we keep doing them.  But I believe a preventive night mouth guard would be the best treatment for her and her insurance company. 

 If bruxism is not treated, teeth, fillings, or crowns may become worn down. Tooth enamel is worn away exposing the dentin, the softer inside of the tooth, which can become very sensitive.  Often a patient will complain of cold-sensitive teeth, unable to drink cold liquids or eat ice cream.  After wearing a night guard, the cold sensitivity often disappears. 

I recently treated a 25-year-old female high school teacher.  She has a stressful life contributing to a major teeth-grinding problem.  The tops of all of her teeth were worn down. Dentinal exposures appeared throughout her back teeth, causing sensitivity to cold, biting and sweets.  Tooth-colored fillings were bonded over the exposed dentinal areas. A protective mouth guard was fabricated which she wears every night and even during stressful times during the day.  To her relief, her teeth sensitivity is now gone.  For the first time since she was very young, she is able to enjoy ice-cream.

Sleep studies showed bruxism will vary through the night, most often during dreaming REM sleep, but sometimes even in deep sleep. The sleeper might have 25 bruxism episodes each night.  An episode typically lasts four-to-five seconds, but those few seconds can add up to severe damage to the teeth or jaw joint through years of time. There are several theories about the causes of bruxism, but stress is definitely a contributing factor.  A college student is the classic example of a stressful lifestyle that leads to bruxism, burning the candle at both ends between cramming, working, partying and lack of sleep. 

Even though many methods have been tried to stop night bruxism, nothing has been found effective. It is now believed that most people are genetically programmed to grind or clench during sleep to relieve stress.  Only by wearing a night guard can the symptoms of bruxism be lessened. The night guard, rather than the teeth, takes the force of biting and grinding to prevent further damage to the teeth and to keep them from shifting. By keeping the teeth apart, a night guard removes pressure from the jaw joint and keeps the jaw muscles in a relaxed rather than contracted position.

A custom dental lab-fabricated night guard is best. It looks like a plastic retainer.  An impression of the teeth is taken so that the night guard fits the bite precisely.  The material used is hard when in the mouth, making for strength and wear resistance.   But when warmed in hot water prior to insertion it softens slightly for comfort. There are various designs related to individual needs, but I have had great results with a night guard that fits only on the front six teeth because it takes the strain off the back teeth and the power back muscles. Plus, the design is comfortable to wear, being smaller than a full mouth guard.

Over-the-counter night guards are bulky, less comfortable and don’t fit very well.  Sometimes they are soft and people will chew them like bubble gum and stress their muscles even more than normal or they may become dislodged in a person’s mouth during sleeping due to poor fit.  I only recommend trying an over-the-counter night guard if finances do not allow a custom lab-fabricated guard.   However, an over-the counter guard is better than no guard at all.  If looking for a guard at the drug store, look for a top of the line, one that allows you to pre-warm the guard and fit it to your teeth.

When the facial muscles are in a relaxed state, there is space between the upper and lower teeth.  If the upper and lower teeth are touching, then the facial muscles are tightening.  The teeth should only touch when eating and then there is food between them to soften the trauma.  Often people will hold their mouth closed with teeth touching and not even realize this is an unnatural habit. By being conscious of this habit during the day, it can be stopped. Lightly massage your cheeks, relax the muscles and keep space between the upper and lower teeth.   At night a guard acts to protect the teeth and keeps the relaxed spaced between the upper and lower jaws.  

ENJOY LIFE AND KEEP SMILING!

 

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com