Teeth Grinding I Bruxism

Teeth grinding at night or during the day – causes and treatment options

Teeth grinding, also known as bruxism, is a common dysfunction of the masticatory apparatus that affects many people of all ages. The repetitive grinding or clenching of the teeth is characterized by tension and displacement of the lower jaw. It can occur both during the day and at night. During the day it is called waking bruxism and at night it is called sleep bruxism. Teeth grinding during sleep cannot be controlled.

Teeth grinding is one of the most common diseases that is often accompanied by pain and discomfort. Symptoms such as headaches and shoulder pain, migraines, muscle tension or difficulty swallowing are often cited. Women suffer from these pain symptoms more often than men.

It is also considered dangerous that a large proportion of patients diagnosed with dysfunction do not show any symptoms at all. In this way, the disease can remain undetected and, over time, the hard tooth substance can be removed.

This means that valuable tooth substance is lost and leads to dental caries and aesthetic problems in the long term. As a result, there is often a loss of bite height and an increased load on the temporomandibular joints leads to pain.

The figures reveal that bruxism is a widespread disease that affects many people. It is important that if you suspect TMD, you contact your dentist early to get a diagnosis and start treatment. Early treatment can help alleviate symptoms and prevent further dysfunction of the masticatory apparatus.

PUBLICATION Dr. Nina van Sprundel: The radiological imaging of the temporomanibular joint

Causes of teeth grinding

Most people find themselves in a situation where they grind their teeth at some point in their lives. Often, however, this remains an exceptional phenomenon due to stress. About 20 percent of patients develop craniomandibular dysfunction (TMD).

So far, little research has been done on teeth grinding and its causes. It is unclear whether grinding is a hereditary disorder or a treatable disease. However, there are studies and surveys that show that stress in everyday life in particular is responsible for this.

Malocclusion is also a common cause of bruxism. If the teeth of the upper and lower jaw do not meet simultaneously and evenly, early contacts occur. Possible causes of malocclusion that can lead to TMD:

• Crowns, fillings or bridges that are too high
• Untreated tooth gaps
• Ill-fitting prostheses
• Inadequately fitted dental implants
• Orthodontic dysregulation

Such cases can have serious effects on the dentition and the health of the whole body. Other known causes that can lead to teeth grinding:

• Genetic factors
• Emotional tension
• Restless Legs Syndrome
• Anxiety disorders and depression
• Insomnia
• nocturnal breathing disorders
• Excessive chewing of gum
• Incorrect posture
• Disorder of neurotransmitters in the brain
• Reflux disease
• Heavy alcohol consumption
• High consumption of caffeine
• Drug consumption

Certain medications, such as antidepressants, can trigger unwanted side effects such as bruxism.

Tooth damage and consequences of bruxism

• Sensitive teeth
• Toothache due to overuse of the tooth and inflammation of the tooth nerve
• Heavily overused and worn chewing surfaces (facets)
• Cracks and damage in tooth enamel
• Loose, shortened or brittle teeth
• Damage to veneers, crowns or bridges

Diagnosis of bruxism/TMD

Bruxism can be diagnosed by various signs. One symptom that often occurs is pressure-sensitive masticatory muscles. Furthermore, tooth impressions in the tongue and cheek, smoothly polished chewing surfaces, cracks and chips on the tooth enamel, chips on the tooth hard substance, the tooth necks and the incisor edges, as well as pain-sensitive teeth can be regarded as signs of bruxism.

The teeth are significantly shorter and look as if they have been abraded, while the canines no longer have any tips. The gums have receded and the enamel has become brittle. The teeth are badly worn.

Your dentist can clarify bruxism by taking a medical history and looking in the mouth. It is checked whether losses of tooth enamel or defects in the periodontium are visible. The masticatory muscles and the bite of the teeth are also examined. Craniomandibular dysfunction is manifested by pain when palpating the masticatory muscles and moving the jaw, lateral deviations when the mouth is opened, and a restricted opening of the mouth.

Electromyographic measurements are also helpful. Polysomnography is the most important method of diagnosing teeth grinding, as it helps to more accurately assess and assess the extent of bruxism.

Treatment of crunching/bruxism/TMD

Treatment of craniomandibular dysfunction (TMD) is based on the underlying causes. You cannot cure the teeth grinding itself, only measures can be taken to reduce the grinding. The most effective treatment for TMD is the occlusal splint, which protects the teeth from excessive abrasion. The splint should therefore be worn consistently and every night. It is possible that the splint therapy can be stopped after a few weeks if the discomfort caused by the splint subsides quickly.

Adjustable occlusal splints such as the Michigan splint can correct the malocclusion in the long term and create the conditions for the reconstruction of the aborted tooth substance.

To get rid of the crunch, it is necessary to find the reason for the crunch. Should the clenching or grinding of the teeth be attributed to this because stress is imminent and this is processed with the help of grinding? Then you should reduce the mental burden. Reflux diseases, such as massive reflux, can occur due to nicotine or alcohol consumption, certain medications, or even a mental disorder.

Psychotherapy for bruxism

Psychotherapy can help to identify and overcome the psychological causes of teeth grinding.  First, the psychotherapist identifies the psychological causes of bruxism. This can include stress, anxiety, depression, or other mental disorders.

Psychotherapeutic treatment is supported by various psychotherapeutic techniques to solve the problems. This can include behavioral therapy, cognitive behavioral therapy, biofeedback, hypnotherapy, stress reduction, emotion regulation, and relaxation techniques.

The therapist can assist the client in identifying and coping with stress. Breathing exercises, progressive muscle relaxation, visualization, meditation and other techniques can be part of a relaxation treatment.

The therapist helps the client change their learned behaviors by teaching them how to deal constructively with stress and other mental health issues. This can help reduce teeth grinding and solve the mental health issues.

Restoration of dental material after bruxism therapy

It is possible to cover worn teeth with a composite or ceramic filling. However, an analysis of the occlusion (how the teeth come into contact when the jaw is closed) must be carried out beforehand to ensure that the jaw does not become unbalanced.

In addition, the causes of bruxism must be addressed prior to therapy so that they do not recur. The goal of a prosthetic bite elevation is to restore the normal bite. To do this, the tooth substance must first be rebuilt in order to achieve a correct functioning. In dentistry, this can be done through dentures or a dental crown.

Subsequently, a complete aesthetic restoration is possible with the help of veneers, crowns and bridges. With the help of digital planning, we can plan their new smile on the screen in advance.

Bite elevation

Bruxism in children

Many younger children grind their teeth at night. This is not uncommon in primary dentition. Bones and muscles grow in spurts, so that individual teeth or entire groups can be unfavorably aligned with each other at times. Protrusions are then sanded down. As soon as the permanent teeth appear, teeth grinding should stop. This can be the case as early as the age of four.

It should also be mentioned that passive smoking in children is a risk factor for the development of bruxism in children.