Bruxism

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Bruxism is a condition which is generally characterised by involuntary teeth grinding, clenching and gnashing, often performed unconsciously either throughout the day or whilst sleeping.

Although bruxism is not a dangerous condition, it can lead to permanent dental damage and a variety of unpleasant side effects such as headaches and jaw pain.

Bruxism can be divided into two categories, awake bruxism and sleep bruxism. The former is often characterised by involuntary teeth clenching whilst awake and the latter generally involves grinding teeth in sleep with continuous muscle contractions around the jaw area.

Why do we grind our teeth?

For some individuals, teeth grinding occurs as a side effect of a medical or psychiatric condition such as depression, anxiety or parkinson's disease. There are also links between the condition and various medications such as antidepressants and recreational drugs such as cocaine and ecstasy, with many sleep bruxists citing their psychological disorders as the reason for nocturnal teeth grinding.

There is evidence to suggest that sleep bruxism in some individuals actually happens as a response to sleep arousals, meaning that it may be indicative of a sleep disorder. According to The Bruxism Association, almost 80 per cent of episodes occur during sleep and are related to such arousals, with particularly strong associations between the condition and certain sleep conditions such as Obstructive Sleep Apnoea (small periods in which breathing stops during sleep), sleep talking, hallucinations and hypnagogic (the state of consciousness between sleep and wakefulness).

Whilst some negative effects of bruxism will disappear when the habit ceases, others will be more long term and sometimes permanent. Long term sufferers may go on to develop temporomandibular joint disorder TMJ and other will experience irreversible tooth wear and breakage.

Teeth grinding and Temporomandibular Joint Disorder

The area just in front of your ear on either side of your head is known as the temporomandibular joint (TMJ) and is where your maxilla (upper jaw) and mandible (lower jaw) meet. The joint is made up of components which allow the upper jaw to close on the lower jaw essentially using a ball and socket movement. The joint itself is one of the most frequently used joints of the human body, and is in action when we bite, chew, yawn and talk throughout the day.

A temporomandibular joint disorder usually occurs as the result of a problem in the jaw joint, meaning that the smooth series of events between the muscles, bones and tendons which allow the jaw to open and close comfortably have been disrupted. This disruption can lead to complex problems in the jaw joint, subsequently resulting in headaches, stiffness, clicking pain, ear pain and locked jaw. There are various actions which can lead to the development of a TMJ disorder, one of which is bruxism. Bruxism and the act of grinding and clenching the teeth can increase wear on the cartilage lining of the TMJ which can eventually cause discomfort.

Chewing and biting fingernails, dental misalignment and jaw trauma can also lead to the development of TMJ disorder and in most cases those who do grind and clench their teeth during sleep remain unaware of their behaviour until they are either told by someone who observes them doing so whilst sleeping or are informed by a dental professional that there are signs or wear on their teeth.

In terms of treatment for TMJ disorders there is no specialist dentistry treatment available and the normal route would be for the dentist to take x-rays and prescribe a mouthguard, though many individuals now choose to go down the alternative and complementary therapy route.

Symptoms of bruxism

There are various symptoms of this condition some of which can be found listed below. Please remember that each person will experience their own unique set of symptoms which may or may not include one or more of the following:

• anxiety
• aching jaw and facial muscles (facial myalgia)
• chronic facial pain
• clicking jaw
• depression
• earache (cause by severe muscle contractions)
• headaches
• inflamed gums
• jaw pain/ jaw pain one side
• limited jaw movement
• sensitive teeth
• sleep disruption
• stiffness and tension in the shoulders and or other areas
• stress
• teeth which are worn down, chipped or flattened
• thinning/ worn down tooth enamel
• waking your partner in the night due to loud teeth grinding.

Causes of bruxism

Doctors do not yet fully understand why bruxism happens in some individuals and not others, but it is thought that certain physical and psychological issues can act as contributing factors. For example, it is thought that the condition is more prevalent among individuals who regularly drink alcohol and caffeine and it is also thought that daily stress may be the trigger in many people. The cause will vary from person to person but there are certain factors which are thought to increase an individuals risk of developing the problem, including the following:

• abnormal alignment of the upper and lower teet.
• changes in sleep patterns
• growth and teething in children
• huntington's disease or Parkinson's disease
• increased anxiety, stress, anger and frustration
• psychiatric medicines such as antidepressants
• responses to pain caused by teething and earache in children.

When is it time to seek help for bruxism?

A large percentage of us are actually effected by bruxism but for many people it is so mild that we may not ever notice or require treatment. However, for those who frequently experience teeth grinding and clenchin to the point where they have developed damaged, worn or sensitive teeth and/or some of the side effects mentioned above, it is important to try and put a stop to the problem before more complications develop.

Regular dental check ups are essential not just to maintain good dental hygiene, but also because your dentist will be able to pick up on any changes and damage to your teeth so that preventative measures can be taken.

Treatment for bruxism

For many years now mouth guards and splints have been used to treat grinding teeth and clenching disorders. Most splints seem to work by ensuring your back teeth are separated as this protects the teeth from the pressure of clenching. For those among whom the symptoms are more extreme, orthodontic adjustment can be sought to change the bite pattern. Aside from dentistry treatment in recent years other approaches have emerged which may help to reduce pain and prevent permanent damage.

Many individuals find that drinking plenty of water, learning physical therapy to balance muscle and joint action, relaxation techniques to relax facial muscles and plenty of sleep in combination can help to reduce symptoms. However, whilst many of these approaches can have beneficial effects on awake bruxism, sleep bruxism is more difficult to control due to it being largely unconscious behaviour.

The use of psychoanalysis, autosuggestion, hypnotherapy and various other behavioural approaches have been used to treat both awake and sleep bruxism for years.

Hypnotherapy in particular is a well documented treatment for this condition and there are many techniques which a hypnotherapist may use in order to suit your individual needs. The use of hypnotherapy could help to cease clenching and grinding by eliminating any underlying problems, helping you to deal with stress triggers to your problem as well as helping to reinstate any lost confidence.

The techniques used by the hypnotherapist will be entirely dependent on your own specific circumstances. One of the most popular techniques used is that of hypnotic suggestion, which involves inducing a relaxed state of mind in an individual so that the practitioner is able to access the subconscious mind and make appropriate hypnotic suggestions. For instance, among those for whom stress is the root cause of bruxism, hypnotic suggestions will be made so that the mind is programmed to do something more relaxing and positive as a response to their stress.

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