Bruxism: The daily grind

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It's safe to say that sleep bruxism is a widespread problem. At least eight to 10% of the adult population grind their teeth every night, while the American Dental Association ranks it as one of the most common sleep disorders. The ADA estimates that up to 95% of adults are sporadically afflicted with the condition. It is more prevalent in children, but they often outgrow it.

Bruxism refers to the unconscious habit of clenching or grinding teeth, and is one of the leading causes of tooth destruction. During episodes, the upper and lower teeth may come into direct contact for as much as 40 minutes per hour, and with a force of up to 250 pounds. Without treatment, the condition can cause irreversible damage to tooth structure, leaving the dentition vulnerable to fractures and erosion. Diagnosis is often delayed because many patients do not realise they grind. Instead, the condition is typically picked up through evidence of wear patterns spotted by dental professionals. During intraoral/extraoral exams, hygienists must be attuned to these signs, to ensure patients receive prompt preventive therapy to minimise damage.

Canine clues

Patients that complain of dull headaches or sore jaws on waking may be displaying symptoms of sleep bruxism, so a routine query should form part of a full dental exam. On the physical front, the most obvious red flag is flat canines. Canines are designed to guide tooth movement, with well-defined incisal edges steering the teeth apart. The excessive force associated with bruxing, however, can break down the incisal anatomy, creating distinctively flat canines and leaving the remaining teeth vulnerable to wear. Be alert for incisors that display chipped and flattened incisal edges. As this wear develops, with an accompanying loss of vertical dimension, it can have a destructive impact on the entire dentition, leading some patients to seek corrective cosmetic dentistry.

Molars can also bear the brunt of bruxing. Sharp cusp tips are vital to proper occlusion, but the abrasive nature of grinding can wear tips down, forcing the anterior teeth to bear the added stress from chewing. In some cases, the loss of tooth enamel and dentin can be even more noticeable than that associated with severe decay.

Reading the signs

Broken or cracked teeth are one of the more severe indicators of occlusal trauma. They can be a source of pain of patients and often require lengthy and costly restoration. Patients that present with broken restorations, particularly if the restoration is comparatively new, should prompt alarm bells. Sound occlusion is the cornerstone of solid cosmetic dentistry, so any dental procedure that alters occlusion patterns may trigger bruxing. Patients who had grinding habits before extensive dental care are also likely to continue to grind once treatment has completed. Early detection can help to safeguard restorations, as well as the patient's overall dental health.

Signs of abfraction can also be suggestive of bruxism, although there is some debate as to the causes behind the lesions. Abfraction is defined as the loss of tooth substance in areas of stress concentration, specifically the cervical region. The dominant theory is that abfraction is the result of excessive occlusal loading forces, although a second camp blames artificial forces such as tooth brushing. More research is required to confirm this theory, but studies have noted a relationship between abfraction and wear facets and canine disclusion. If lesions are present, be alert for bruxing.

Question time

TMJ exams are the ideal time to question patients about any grinding or clenching habits. The muscles palpated as a part of complete TMJ exam are masseter, temporalis, medial pterygoid, lateral pterygoid, and sternocleidomastoid. Start by placing the fingers on the face in the area of the joint. Ask the patient to open as wide as possible and then to slide the jaw from left to right. Be alert for a limited range of motion. The normal range for vertical jaw opening, measured between the incisors, is 5cm, while protrusive and lateral mandibular movement is normally 1cm. During the analysis, look out for any muscle spasms, any obvious joint or muscle tenderness, and crepitation. In most patients, the abnormal joint movements that cause ‘popping' can be felt during palpation.

During the examination, quiz the patient on common bruxism symptoms. Ask if he or she is aware of any grinding or clenching habits, and whether they commonly experience headaches or jaw pain upon waking. Migraines have also been linked to the condition. Bruxing can often be quite audible, so ask if sleep partners have ever commented on the habit.

Grind over matter

Grinding is a common occurrence for many adults at some time or another. With a range of treatment options, including mouth guards or pharmacological remedies, prompt diagnosis can save teeth from years of abuse. When it comes to sleep bruxism, early prevention is still the best defence.

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USER COMMENTS (1 COMMENTS)

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You can stop grinding your teeth
Posted by michael R. on 8 January 2008 at 04:27 UAE time


Hi Guys,

I had bruxism for quite a few years. I would wake up during the night because I even chipped off a bit of my front tooth!

However, I dont grind my teeth anymore. I joined www.cureforbruxism.com and followed his plan. It seemed to work wonders for me.

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