Nighttime grinding of teeth is extremely common. Your Kitchener-Waterloo Dentist is trained to diagnose this habit (also known as bruxism or bruxing). Unfortunately, many patients are in disbelief when their Family Dentist suggests they are grinding their teeth. This is reasonable given that bruxing occurs predominantly during sleep when people would be unaware of any ongoing habits.
Teeth grinding involves excessive application of heavy forces between opposing teeth. It is intuitive to most people that this could cause damage to their tooth enamel. However, effects on other oral structures often come as a surprise to patients.
Today, I'd like to describe how tooth grinding harms your teeth, gums and jaw. I will also outline strategies for managing tooth grinding and discuss treatments available to repair any damage that has already occurred.
If I told you that clenching together under hundreds of pounds of force and grinding your teeth could cause chip and wear down your enamel, you'd probably believe that. But, grinding has other effects on your teeth beyond possible wear or attrition.
Patients who grind can cause their teeth to sustain cracks over time. Sometimes, these cracks cause symptoms like sharp pain on biting. Grinding can also cause large pieces of your tooth to break. Lastly, tooth grinding can lead to divots or wedges (Dental Abfraction lesions) on your tooth near the gum line. These wedges in the tooth are caused by heavy sided-to-side forces exerted during grinding. Patients commonly notice these lesions when they become large or by being able to hook into them with their finger nail. If you think about the wedge that develops as someone progressively chips down a tree, you'll have a good idea as to what Abfractions look like.
A custom Night Guard can fit between your teeth and provide cushioning and protection during nighttime bruxing. When you grind, you'll now beat up on the night guard instead of your tooth enamel. Without a night guard, your teeth will be exposed to the chips, cracks, fractures and Abfractions discussed above.
Your Kitchener Dentist will usually be able to repair small chips and breaks with a dental filling. However, larger fractures to cusps or cracks through your tooth may require a dental crown to prevent a catastrophic fracture. These are circumstance where your Family Dentist is unable to repair your tooth and you will require tooth extraction.
The cost of tooth replacement with a dental bridge or dental implant is high. Therefore, it often makes practical and financial sense to repair teeth early on with a dental crown to avoid unnecessary future expenditures.
Finally, Abfraction wedges can generally be monitored without treatment. One exception to this rule is when the wedges become so deep that there is a likelihood the tooth breaks off at the gum line. Another exception would be where the abfraction becomes unbearably cold-sensitive. In these cases, your Waterloo Family Dentist can use dental bonding to insulate the sensitive area.
Grinding your teeth is a form of oral trauma. When grinding you apply hundreds of pounds of force between teeth. As your teeth lock into place, grinding produces extreme lateral forces. These forces move your teeth side-to-side and, over time, there is a reactive loss of bone and gum tissue. This causes gum recession.
Your Kitchener Family Dentist needs to catch the habit early. From there, she can suggest solutions that minimize damage to oral structures such as a Night Guard. Your Dentist may also suggest that you have a sleep assessment as Obstructive Sleep Apnea (OSA) can be a causative factor for tooth grinding.
If you control a tooth grinding habit your gums will not grow back. Unfortunately, the only way to increase coverage of tooth roots is with gum grafting (or connective tissue grafting). Gum grafting may be provided by your Kitchener Dentist or, they may refer you to a local Periodontist for treatment.
Disorder of the tempero-mandibular joint (TMJ) is a common finding in patients who grind their teeth. After applying hundreds of pounds of force on a nightly basis for years (sometimes decades), the wear and tear adds up. Patients who grind heavily or have had the habit for a long time may start to notice "clicking" sounds or sensations when they chew. They may also notice soreness of chewing muscles in the cheeks, temples and neck.
Often times, a Dentist will notice the clicking at a check up appointment. Other times, a patient will present with complaints of facial soreness or a stiff jaw. In extreme cases, patients may start to notice their jaw getting stuck in an open position.
Again, early diagnosis is critical. Luckily, functional stretches and exercises can help. Often times, we will refer patients experiencing TMD to a physiotherapist with whom they will develop an exercise routine. Your Dentist in Kitchener can make a custom night guard to reduce forces on your jaw during nighttime grinding.
With TMD, controlling bruxism or eliminating it where obstructive sleep apnea is a contributing factor can settle symptoms. For some individuals, heavy grinding over many years may produce damage to the TMJ that will not heal. These individuals may have degenerative pain when chewing or a gravel-like, grinding sensation around the jaw joint during function.
Night guards can be extremely helpful in protecting your teeth and gums from the harmful effects of tooth grinding. On challenge with night guards is that patients commonly find it difficult to acclimate to wearing them. We often hear patients describing how wearing a night guard negatively affects their sleep quality. Our solution? Most night guards are made to fit on upper teeth but they're uncomfortable because they are close to the roof of the mouth, airway, and they can cause gagging. Ask your Dentist about a custom lower Night Guard. This is our default, "go-to" design for night guards and, compared to upper night guards, they work just as well and are far more comfortable!
Many children grind their teeth during sleep. This is probably less of a concern compared to grinding in adults for a few reasons:
There is some anecdotal evidence suggesting that Botox injections around the jaw joint and related muscles can help reduce grinding. This may work because the Botox acts as a muscle relaxant or paralytic to reduce muscle activity that leads to grinding. Some experts suggest that botox injections can alter chewing muscles by disrupting their muscle memory. If this is the case, botox may "un-train" these muscles so that they no longer producing teeth grinding activity during sleep.
Nighttime grinding and clenching is highly correlated with sleep apnea. If you haven't heard of sleep apnea before, it is a condition where you stop breathing temporarily during sleep. The breathing interruption can result from collapse of your airway or because your brain stops sending the signals that trigger and maintain normal breathing.
Apnea resulting from collapse or closure of your airway is known as Obstructive Sleep Apnea or OSA. It is the most common form of sleep apnea. A medical doctor or Dentist may help to treat your OSA with an oral appliance or using a Continuous Positive Air Pressure (CPAP) machine.
One of the first things I'll ask a patient with signs of heavy tooth wear or attrition is if they grind their teeth at night. They may not be aware that they do so but oftentimes, a partner will hear them making funny noises with their teeth during sleep. Patients may also experience tension headaches or soreness in their cheeks and temples as a result of grinding.
Grinding can also result from low quality sleep that is not related to apnea. People that do not have a regular sleep routine or who have to wake up frequently (think new parents or shiftworkers) are far more likely to grind. These people generally don't fall into a continuous deep sleep and are often in and out of different stages of sleep. This can lead to restless sleep and erratic muscle function leading to tooth grinding.
Our Kitchener Dental Office is conveniently located in Downtown Kitchener and we are a short drive away for families in Waterloo, Breslau & St. Jacobs. Our central location means we truly offer family dentistry near you!
This article is meant to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis, or treatment. Accordingly, always seek the advice of your Dentist or other healthcare providers regarding a dental condition or treatment.