May 17th 2020
Teeth grinding: are you wearing down your teeth without realising?
January 26th 2021 / 0 comment
It can be the root cause of everything from tooth breakage to migraines, but many of us grind our teeth without realising it. Here’s how to spot the signs…
Let's be honest, the past year has been a bit of a stressful one and by proxy, teeth grinding is becoming all the more common (the NHS estimates that 70 per cent of teeth grinding cases are caused by stress and anxiety). The increasing prevalence of teeth grinding is something that Dr Milad Shadrooh (aka, The Singing Dentist) is not only seeing on a regular basis in his practice but also that he himself has experienced. Exactly what constitutes and causes tooth grinding and are there any cures? We took a seat in the dentist’s chair to find out…
What is teeth grinding?
“The technical term for teeth grinding is bruxism, and it’s the process whereby people grind their teeth together and very often clench their jaw very tightly. In isolation, and considering their size, the jaw muscles are probably the strongest in the body, and if you think about the fact that when we grind our teeth, we can exert up to 120 per cent of the maximum force we can apply during the day for activities such as eating, you can see why it could cause quite significant and far-reaching damage.”
Speaking of damage…
The symptoms of teeth grinding
“As professionals, we can identify signs of tooth grinding both externally and internally.”
“Looking at a patient, hypertrophic (enlarged) jaw muscles are often an indicator. This means that the jaw has a more squared shape than normal. For a face shape point of reference, see Brad Pitt. This makes sense as when we grind our teeth, we’re essentially giving our jaw muscle a workout, and therefore it gets bigger. Interestingly if you look at Formula One drivers, this is often the case. The extreme G force that they endure when they’re driving means that they clench their jaw a lot, and as time goes on they develop a more pronounced, squared jaw.”
“Internal signs include tooth wear- the canines, in particular, flatten out, and the incisor teeth are often chipped, or else uniformly flat. Teeth fractures are another sign, and are especially common in teeth that have fillings, as the force involved in teeth grinding causes tiny breaks in brittle teeth. Tiny lines in teeth (called enamel craze) are also often telling of tooth grinding, and a patient will also often have tooth marks or indentations in their cheeks. There’s also the pain to consider- tooth grinding can trigger not only tooth sensitivity and jaw pain but migraines, tensions headaches and shoulder pain. In short, it’s not a lot of fun.”
Despite the rather horrific sounding manifestations of teeth grinding, it’s also quite possible that you’re doing it without even realising…
It strikes silently at night
At least, in some cases…
“Teeth grinding is generally a nocturnal habit, but a lot of people do it during the day too without noticing. They could be sitting at their desk, waiting in traffic or just going about their business, but all the while clenching their jaw and grinding their teeth.”
The silent part is up for debate too:
“More often you’re asleep when you’re grinding your teeth, so of course you wouldn’t be conscious that you’re doing it, but a partner might hear it and they would be quick to tell you as the sound can be quite loud and disconcerting. However, it is also important to note that just clenching your teeth together can also cause the same problems, but in that case, there’d be no sound at all.”
Other tooth grinding evidence includes waking up with a sore jaw, a headache or a migraine. Your dentist should also be able to tell you from a glance in your mouth and due to the number of patients who inadvertently grind their teeth, Dr Milad has taken to asking patients whether they’re aware that they’re doing it, rather than a straight-up question as to whether they are- it’s highly likely they’re oblivious to it and haven’t recognised the signs. Your dentist can demonstrate that your jaw muscle is hypertrophic by asking you to clench down on a finger or instrument, and once teeth grinding is on your radar, you may find that you identify with other symptoms too.
Another way that teeth grinding can be diagnosed is via a trip to your GP. Dr Milad treats many a patient who’s visited their GP seeking treatment for migraines and headaches and their doctor has recognised that a dental check-up might be the best way to get to the bottom of the issue. By way of example, Dr Milad once had a patient who was plagued with weekly migraines, and once teeth grinding had been identified and treated, he went on the suffer from migraines twice a year, max. Clearly it’s not the origin of all migraines (cheese, chocolate, loud noises...the list goes on), but it could play a part if you’re a regular sufferer and are struggling to work out why.
The causes of teeth grinding
“Nobody definitively knows the reasons why people grind their teeth, but stress is a big factor. Episodes of teeth grinding can often tally with stressful life events, for instance a pandemic (!), sitting exams, moving house, losing a job or starting a new one, trying for a baby or becoming parents, divorce...the triggers in this sense can be varied. Sometimes this means that teeth grinding comes and goes, but once you start teeth grinding it can become a habit- it can develop into a kind of “release” for the brain. This means that even if a patient is, say, retired and living a very chilled lifestyle, the teeth grinding continues.”
“Bite abnormalities, or a history of complex dental treatments, can also be factor. For example, if you’ve had braces in the past, you may be more likely to clench your jaw and grind your teeth. Sleep disorders such as sleep apnea have a strong association with teeth grinding too. In fact, sleep problems are commonly related to teeth grinding, as when we grind our teeth our brain is still active and we don’t go through REM sleep, the kind that lets your brain really switch off and process your day. As such, people who grind their teeth often wake up feeling groggy, despite getting a full eight hours sleep (or so they think), and it can have a real impact on cognitive activity and ability that day. In this case getting the right treatment (see below) can result in a dramatic improvement in your quality of life.”
“As for children, teeth grinding normally goes away by itself. It can be associated with teething, but usually kids grow out of it. It’s in adults that we see the biggest problems.”
“The initial step to stopping it is by identifying it. If you suspect you’re grinding your teeth, take a trip to your dentist to discuss your options. The first port of call is normally a dental splint or night guard. These are made of custom moulded plastic and keep teeth apart, plus they protect teeth as you grind. They can also work to deprogramme the habit in the first place as they reduce the force of the jaw. I actually use one as my wife told me I was not only snoring but grinding my teeth too (she must really love me). I noticed a real difference when I started to use it- no more thumping early morning headaches!”
“Another treatment that’s often combined with a dental splint is botulinum toxin (Nadia Sawalha revealed that she’s been treated with botulinum toxin for bruxism). It may sound odd, but botulinum toxin works to freeze and deactivate the muscle, so used in a targeted way it can reduce the bulk of the jaw muscle. This means that you’re less likely to grind your teeth. You have to be very careful with where you place it though, as delivered in the wrong way or location it can affect everything from eating to talking. Botulinum toxin is isolation is also not a long-term solution as it wears off. Combine botulinum toxin therapy with a dental splint, however, and in my experience, it’s a treatment that’s 95 per cent effective in treating and stopping teeth grinding among my patients.”
The temporary measures
While not treatment per se, a few day to day tweaks or meds can help to alleviate teeth grinding, or simply the pain that comes with it:
“Some people find relaxation techniques helpful, other people swear by holistic treatments such as acupuncture, particularly if they suffer from jaw spasms. Anti-inflammatory medication is useful for temporarily easing pain too.”
“In terms of lifestyle changes, anything that gets you “wired” is likely to make things worse. Caffeine and alcohol, particularly before bedtime, could make you more likely to grind your teeth.”
“In nine out of ten cases, the teeth grinding I see is related to the stresses of everyday life, but if I suspect that it’s related to severe ongoing anxiety or psychosis, I would refer a patient to a cognitive behavioral specialist or mental health professional.”
The bottom line
If in doubt, go for a dental check-up. It's as simple as that!