Teeth Clenching & Grinding
A common issue that affects up to 80% of the population, the grinding of teeth and clenching of the jaw can cause tooth wear, breakages, pain, limited movement of the jaw joint (temporomandibular joint disorder), migraines and headaches. Most common in adults over 25 years old, the cause is not fully understood, though symptoms often worsen during stressful periods.
Effects of bruxism
Bruxism sufferers are affected in many ways and it can lead to more serious issues, often requiring a dentist's intervention.
Many symptoms, however, are unlikely to be dental related; often bruxism is left untreated for many years. It is common for patients to turn to their GP and have a magnitude of investigations for other medical conditions, including MRI and brain scans.
Short-term effects of bruxism
- Headaches and migraines
- Facial myalgia (aching jaw & facial muscles - often diagnosed as Atypical Facial Pain)
- Earache, tinnitus and sinus pains
- Stiff neck and shoulders
- Limited mouth opening
- Poor sleep quality
- Sleep disturbance of bed partner due to noise
- Tooth mobility and tooth wear
- Fractured tooth cusps and broken fillings
- Receding and inflamed gums
- Tongue scalloping
Long-term effects of bruxism
- Prolonged untreated migraines
- Excessive facial muscle tone
- Temporomandibular Joint Disorder (sometimes called TMJD or just TMJ)
- Clicking or popping jaw joint
- Tooth wear and tooth loss
Treatments for Bruxism
There are many ways to manage bruxism, the most common treatment being occlusal splints (dental appliances). There are other therapies and treatments available, but these are generally seen as less effective. It is becoming more popular for dentists to recommend a more holistic treatment plan. This may include combined treatments with physiotherapists, chiropractors, and sometimes hypnotherapists.
Occlusal splints are generally designed to act as a mechanical separation of the teeth and may be as simple as a soft mouthguard. Other dental treatments may also be considered, such as equilibration (grinding away tooth surface to make the teeth fit together better), orthodontics, or crowns and veneers.
Most common types of Dental Splints
- SCi - small splint that fits over the front teeth
- Soft mouthguards - often called 'bite-raising appliances'
- Michigan or Tanner stabilisation splints - full arch splints
SCi - Sleep Clench Inhibitor (previously known as NTI-tss) is the most clinically effective FDA-approved treatment for TMD, bruxism, and medically diagnosed migraines.
How does the SCi work ?
The SCi reduces abnormal or parafunctional intensity of the temporalis muscles, masseters muscles and to a degree, the lateral pterygoids (the tiny muscles at your jaw joints that open your jaw). This eliminates posterior and canine teeth contact, which reduces the temporalis muscle from clenching.
Try it yourself
Take a pencil and place it between your molars or canines. With your hands, feel the temporalis muscle bulge in the temple area.Then transfer the pencil between your incisors and press the temporalis at the same spot on your temples again: do you feel the difference? Studies show that the possible contraction intensity of the temporalis muscle when only the incisors come into contact is reduced by an average of 70%!
Headaches & Migraines
Bruxism (tooth grinding and tooth clenching) has many effects on the sufferer, most commonly - tooth wear and broken teeth. One of the most debilitating effects of bruxism is headaches, migraines and chronic tension headaches. These symptoms often go untreated because who would think that it is caused by tooth grinding or clenching? The severity of headaches can be assessed by using the HIT6 Questionnaire. Using a series of six simple questions, the level of severity can be monitored.
During sleep we all do strange things, such as snore, kick our legs and even talk. But one of the most common things we do at some time during our lives is grind our teeth. For lots of people, this goes unrecognised. Some people may notice their teeth are wearing down or breaking, but for the unlucky ones, they suffer with headaches and migraines.
Did you ever wonder what these symptoms have in common which all make your life miserable ?
They all are controlled and/or moderated by the Trigeminal Nerve System. When the muscles start making your jaw clench and grind your teeth, the Trigenminal Nerve System gets bombarded with signals. If the system is compromised, then it is unable to handle the signals and is misinterpreted. This results in a noxious stimulus to the fluid surrounding the brain, resulting in a pounding headache or migraine.
We now know that many symptoms can be related to this noxious input and our understanding of the Trigeminal nerve, and how the symptoms relate to a migraine sufferer.
The Trigeminal Nerve has to two divisions:
A) Motor Root, which sends nerve impulses to the jaw muscles to make them contract; the far more massive Sensory Division (made up of the nerves that bring in information from the periphery).
B) Sensory Division is divided into three distinct segments of sensory reception (thus the term Trigeminal):
- First Division: Opthalmic: receives sensory input from arteries that surround the brain to around and behind the eyes
- Second Division: Maxillary: receives sensory input from below the eyes to the upper jaw.
- Third Division: Mandibular: receives sensory input for the entire lower jaw.
All three divisions feed into the Trigeminal Sensory Nucleus.
The current understanding of the nature of the migraine is that it results from a disorder of "sensory modulation", meaning that information received by the Sensory
Nucleus is misinterpreted, thereby resulting in either a disproportionate response, or an inappropriate response altogether. For example, during a migraine attack, the
simple pressure changes of the fluid that surrounds the brain (resulting from the beating of the heart), is perceived as "pounding".
The therapeutic goal in migraine prevention is to limit the amount of noxious sensory input (that is, to limit your migraine "triggers") to the Trigeminal Sensory Nucleus. The way in which we can do this is by reducing the intensity of tooth grinding and clenching, thereby reducing the amount of signals being sent back to the Trigeminal nerve system. The most clinically effective device that can do this is SCi.
Tooth wear and broken teeth
Your teeth should last you a lifetime and not wear down. However, bruxism is a destructive condition. Normal chewing and eating does not cause wear or damage to your teeth. If you suffer from bruxism, you are putting your teeth and gums under massive amounts of pressure. During sleep, there is no feedback mechanism to tell your brain that your teeth are hurting because of too much pressure, hence we can put up to 40 times the amount of pressure on our teeth whilst we sleep - it is no surprise to see a lot of damage.
The most common sign of bruxism is shortened front teeth (incisal wear). However, in more severe cases, we see signs of cracks in enamel, abfractions (enamel loss at gum level), gum recession, bone overgrowths (bony exostosis), broken cusps of molar teeth, and damage to restorations (crowns & bridges).