Bruxism
Involuntary grinding, gnashing, or clenching of teeth during sleep, which can cause dental damage, jaw pain, and headaches.
What is Bruxism?
Sleep bruxism is a sleep-related movement disorder characterized by grinding, gnashing, or clenching of teeth during sleep. It is classified as repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can cause significant dental damage (worn enamel, cracked teeth), jaw pain, temporomandibular joint (TMJ) disorders, headaches, and sleep disruption for bed partners due to grinding sounds. It often co-occurs with other sleep disorders and stress.
Prevalence
Sleep bruxism affects approximately 8-13% of adults and is more common in children and adolescents (14-17%). Prevalence decreases with age. It affects men and women equally. Approximately one-third of adults experience bruxism at some point. The disorder often runs in families and is strongly associated with stress, anxiety, and other sleep disorders like sleep apnea.
Causes
The exact cause of sleep bruxism is not fully understood. It appears to be related to central nervous system arousal mechanisms and may be associated with: stress and anxiety, sleep disorders (especially obstructive sleep apnea), certain medications (SSRIs, SNRIs, amphetamines), caffeine and alcohol use, smoking, genetic factors, malocclusion (though less evidence than previously thought), gastroesophageal reflux, and neurological conditions. Bruxism events often occur in association with microarousals during sleep.
Symptoms
Grinding or clenching sounds
Bed partners often report hearing grinding, gnashing, or clicking sounds during sleep. The sounds can be surprisingly loud.
Tooth damage
Worn tooth enamel, flattened or fractured teeth, and increased tooth sensitivity are common dental signs.
Jaw pain and fatigue
Morning jaw pain, stiffness, fatigue, or soreness in the jaw muscles, especially upon waking.
Headaches
Dull headaches, particularly in the temples, upon waking are common with bruxism.
TMJ symptoms
Temporomandibular joint pain, clicking, or difficulty opening the mouth fully may develop.
Ear pain
Pain near the ear (referred from the jaw muscles) that may be mistaken for ear infection.
Sleep disruption
While the bruxer may not wake, the activity can fragment sleep. Bed partners are often more disturbed.
Diagnosis
Self-Assessment Questions
If you answer yes to any of these questions, consider consulting a sleep specialist:
- 1Has a bed partner told you that you grind your teeth during sleep?
- 2Do you wake up with jaw pain, stiffness, or fatigue?
- 3Have you noticed worn, flattened, or chipped teeth?
- 4Do you have frequent morning headaches, especially in your temples?
- 5Do you have pain or clicking in your temporomandibular joint (TMJ)?
- 6Do you clench your jaw during the day when stressed?
Diagnosis is often made based on patient history and dental examination showing characteristic tooth wear. Polysomnography can confirm the diagnosis and assess severity, and is particularly useful if sleep apnea is suspected.
Clinical and Dental Examination
Assessment of tooth wear patterns, jaw muscle tenderness, TMJ function, and facial pain provides evidence of bruxism.
Polysomnography
Sleep study with EMG of jaw muscles can document bruxism episodes, quantify severity, and identify associated sleep disorders like apnea.
Bed Partner History
Reports of grinding sounds during sleep, when available, are helpful for diagnosis.
Sleep Apnea Evaluation
Given the association with sleep apnea, evaluation for this condition is often warranted.
Treatment
Treatment aims to prevent dental damage, relieve pain, and reduce bruxism frequency. A dental guard protects teeth, while addressing underlying causes and associated sleep disorders is essential.
Dental Guard (Occlusal Splint)
Custom-fitted mouthguards worn during sleep protect teeth from damage and may reduce grinding. This is the first-line treatment for dental protection.
Treat Sleep Apnea
When bruxism is associated with obstructive sleep apnea, treating the apnea (with CPAP or oral appliance) often reduces bruxism.
Stress Management
Cognitive behavioral therapy, relaxation techniques, and stress reduction can help when stress/anxiety contributes to bruxism.
Medication Review
If medications (particularly SSRIs) may be contributing, discussing alternatives with your doctor may help.
Botulinum Toxin (Botox)
Injections into the jaw muscles (masseter, temporalis) can reduce muscle activity and grinding force. Effects last 3-4 months.
Medications
Various medications (muscle relaxants, clonazepam, clonidine) have been tried with variable success, but none are specifically approved for bruxism.
Lifestyle Adjustments
- •Reduce stress through relaxation techniques
- •Avoid caffeine and alcohol, especially before bed
- •Don't chew on objects (pens, pencils) during the day
- •Avoid chewing gum, which can reinforce clenching patterns
- •Practice keeping jaw relaxed during the day (lips together, teeth apart)
- •Apply warm compresses to the jaw if sore
- •Maintain good sleep habits
- •Get regular dental checkups to monitor tooth wear
Find a Specialist
Search our directory for sleep clinics that specialize in treating bruxism.
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