I’d never heard of the term bruxism until a few months ago, when I found myself waking up with an ache in my jaw and clenching my back teeth during the day.
A quick Google search landed me at ‘bruxism’ – a medical (and dental) condition where you grind, gnash or clench your teeth in response to a number of factors including stress and anxiety, an abnormal bite or missing and cooked teeth, or it could be linked to a sleep disorder such as sleep apnea. I mentioned it to a few friends and colleagues and almost every person I spoke to had a story about how they were clenching or grinding their teeth, or had done so in the past. The Sleep Foundation suggests that up to 50 percent of children grind their teeth in their sleep but will likely grow out of it before adulthood; Almost 8 percent of middle-aged adults suffer with bruxism during sleep, others have the statistics as high as 30 percent for bruxism during the day and night, with some doctors and dentists suggesting that an increase could be linked to Covid-19 stress. They’ve even coined a term: pandemic bruxism.
Dr Khalid Al Ameri, consultant orthodontist and head of the department of dentistry at Healthpoint Abu Dhabi, gives some insight into prevalence.
“Studies show that around one in three people has bruxism for at least some portion of their life,” he explains. “This can happen while they are awake or while asleep. Sleep bruxism is considered a sleep-related movement disorder and closely associated with other sleep disorders such as snoring or sleep apnea. Sleep bruxism brings added risks, as people are not aware of the force with which they are clenching or grinding their teeth, which can cause added damage over time.”
While research has found a high correlation between those who suffer with obstructive sleep apnea and sleep bruxism, it’s still unclear what causes the association, which one triggers the other, or if they are occurring independently. But sleeping disorders are just one cause.
“Increased stress and anxiety can trigger bruxism in people,” says Dr Al Ameri. “Generally, patients with sleep bruxism find that they also have family members with the condition; it can also be a side effect of medications, such as antidepressants, and has also been linked with some mental health and medical disorders, such as Parkinson’s disease, dementia, gastro-esophageal reflux disorder (GERD), epilepsy, night terrors and attention-deficit/hyperactivity disorder (ADHD).”
He goes on to add: “Alcohol and caffeine consumption can also increase a person’s chances of triggering the condition — people who drink alcohol or smoke cigarettes have been found to be twice as likely to experience bruxism.”
There’s lesser-known causes too.
“Parasites and worms, which are very common in children and especially nail biters, can create a host of symptoms from mood changes, to bed-wetting to teeth grinding,” explains naturopathic doctor Faryal Luhar. “Parasitic infections disrupt the normal healthy microbiome or bacterial ecology within the gut and release toxic metabolites, which further disturbs digestive function and can impact other parts of the body as well.”
She goes on to explain why this occurs. “Naturopathic medicine has long associated the gut with the brain and how one influences the other and vice versa; this bidirectional communication takes place via the Vagus nerve, so it is not too surprising that when parasites abound, they release neurotoxins, which interfere with this bidirectional pathway leading to behaviors such as bruxism.”
Dr Luhar gives advice on how to check if parasites could be the cause.
“Addressing the root cause is key and checking for parasites if other symptoms such as anal itching or rashes are present is important,” she says. “A stool test can be ordered. Conventional anti-parasitic drugs may be required, and probiotics along with a low-sugar diet are essential if parasites are found.”
So, how bad can the teeth clenching get, and what damage can it cause?
“In most cases, bruxism doesn’t cause serious complications, but severe bruxism may lead to damage to your teeth, dental restorations, crowns or jaw,” explains Dr Marija Pavlovic, periodontist and oral implantologist at Medcare Hospital Al Safa. “You may also experience tension-type headaches, severe facial or jaw pain as well as disorders that occur in the temporomandibular joints [the TMJs – the two joints that connect your lower jaw to your skull], located just in front of your ears, which may sound like clicking when you open and close your mouth.”
But there are cases when damage to the teeth can be quite severe.
“Chronic tooth grinding can result in fracturing, loosening, or even the loss of teeth,” says Dr Al Ameri. “When this happens, bridges, crowns, root canal and implants, partial dentures, and even complete dentures may be needed. There are numerous cases where patients who suffer from severe bruxism have woken up to find they have cracked, damaged or broken their teeth while asleep.”
I start to wonder how long I was clenching my jaw in my sleep before noticing there was a problem.
“People often fail to realize, however, there are some telltale signs that can indicate bruxism,” explains Dr Al Ameri. “These include disrupted sleep, headaches or facial pain in the morning, painful or loose teeth, tooth fractures, wear on the teeth, sore jaw muscles and pain when eating.”
Dr Pavlovic lists some other symptoms: “Worn tooth enamel exposing deeper layers of your tooth, pain that feels like an earache — though it’s actually not a problem with your ear, increased tooth sensitivity and damage from chewing on the inside of your cheek. Or you may be teeth grinding loud enough to wake up your sleep partner.”
In many cases, treatment isn’t necessary, as most adults don’t clench or grind their teeth enough to cause damage, and avoiding stimulants such as caffeine before bed can help. But for others, there are some medical options.
“The primary treatment for bruxism is a tooth guard,” explains Dr Al Ameri. “These can be custom-made by a dentist and they protect your teeth, muscles and jaw from the force created during grinding.”
In some cases, muscle relaxants may be used to further reduce bruxism, and Dr Al Ameri advises on some home remedies, too.
“People can also make an effort to relax their jaw muscles by positioning their tongue on top of their teeth. Using a warm towel and holding it against your cheek can also relax your jaw muscles.“
Dr Pavlovic makes some other suggestions for treatment: “Injections of Botox, a form of botulinum toxin, may help some people with severe bruxism who don’t respond to other treatments,” she says.
She also advises tackling the root causes: “Addressing sleep-related disorders such as sleep apnea may improve sleep bruxism. If you grind your teeth because of stress, you may be able to prevent the problem by learning strategies that promote relaxation, such as meditation. If the bruxism is related to anxiety, advice from a licensed therapist or counsellor may help.”
There are holistic approaches too, including a number of smartphone apps for “awake bruxism”, such as Bruxapp and Kieferfreund which act as a way to monitor your teeth and jaw and as a reminder to relax the muscles.
Roxanne Francis, head physiotherapist at Nightingale Health Services, says her profession can play a big role in getting to the bottom of the problem.
“Physiotherapists play a role in the treatment of pain and restoration of normal function of the muscles and joints of the jaw,” she explains. “The patient’s temporomandibular region, cervical spine and posture should be accurately assessed, with the aim to mobilize immobile joints, stretch inflexible tissue, and strengthen weakened muscles. One of the techniques a physiotherapist may use is dry needling. This includes the insertion of fine needles into myofascial structures to help reduce hypertonicity, pain, and inflammation.”
When the small needles are inserted into the muscles of mastication — called the pterygoids and the masseter — as well as the joint capsule, the needle releases the trigger point/tension of the muscles, allowing them to relax, increase blood flow to the area and pave the way for normal function and decreased pain referral from trigger points. Your physiotherapist can also intervene by assessing, advising and assisting in posture correction, release of the neck muscles and strengthening the neck and jaw through targeted exercises.
If you’re looking for something less invasive, facial massages to relax the jaw can be a good first option before trying medical treatments. And remember to always seek medical advice as soon as possible to learn the cause of the bruxism.
Devinder Bains is journalist of 20 years, working as a writer and editor on some of the biggest national magazines, newspapers and online publications in the UK and the Middle East. She specialises in women’s empowerment, fashion, race, culture and travel, and as a qualified personal trainer and nutrition coach, she is an expert in health and fitness. She splits her time between freelance writing and running Fit Squad DXB – Dubai’s largest personal training and wellness company.