A crash course on everything you need to know about teeth grinding and jaw clenching, aka bruxism. We've answered the most common questions people tend to have about bruxism in this elaborate article, covering the scientific background of bruxism and bruxism treatments and offering advice for those who think they might be suffering from bruxism.
Table of contents
What is bruxism?
Bruxism is an overarching name for parafunctional jaw activity characterized by repetitive clenching, grinding, gnashing, and/or thrusting of the teeth and/or jaw. Parafunctional means that the behavior is not functional like other jaw activities such as chewing, talking, and smiling. In general, people think about teeth grinding and jaw clenching as the two major forms of bruxism.
In clinical terms, there are two types of bruxism:
1. Awake bruxism: parafunctional jaw muscle activity that occurs during wakefulness.
2. Sleep bruxism: parafunctional jaw muscle activity that occurs during sleep.
Awake bruxism generally takes the form of sustained tooth contact or jaw clenching. Other forms of awake bruxism include thrusting or bracing of the mandible (the lower jaw) and some people even grind their teeth during the day.
Sleep bruxism generally takes the form of teeth grinding or jaw clenching. Teeth grinding can make pretty disturbing loud sounds, but it can be silent as well.
Typically, people are unaware of their bruxism behavior and the activities often happen subconsciously. Even awake bruxism, for example in the form of jaw clenching, tends to happen subconsciously.
Sleep bruxism is especially dangerous because you no longer consciously monitor the forces that are applied by your jaw. Sometimes this leads to people clenching or grinding their teeth with way more force than what they would voluntarily be able to do when awake.
How common is bruxism?
Several research studies have tried to estimate the prevalence rate of bruxism and came up with estimates ranging somewhere between 10-60%. Typically, it is assumed that at least 30% of the general population suffers from some form of bruxism. That means 1 in 3 people. Or more than 100 million people in the US alone.
To make things worse, there are some signs that the Covid-19 pandemic could have as much as doubled this number. Dentists have been sounding the alarm bell because they are seeing way more people with signs of bruxism than before the pandemic. Some research studies hypothesize that the increased stress and anxiety levels induced by the global health crisis, corresponding lockdowns, social isolation, and overall uncertainty have contributed to more teeth grinding and jaw clenching. The problem seems to be bigger than ever.
How do I know if I have bruxism?
There are a couple of signs that can suggest that you are suffering from some form of bruxism.
First and foremost, bruxism often has consequences for your dental health. You or your dentist can look out for things like excessive dental wear, chipped or cracked teeth, receding gums, sensitive teeth, or teeth imprints on your tongue.
Secondly, you can watch for signs based on your jaw muscles. If you are suffering from bruxism you are using your jaw muscles significantly more compared to what’s normal. This can lead to pain and discomfort in your muscles. So, ask yourself these questions:
Do your jaws often feel painful and tight?
Do you feel like you’re unable to relax your jaw muscles?
Do you suffer from frequent tension headaches? Especially when waking up?
If the answer to one or more of these questions is “yes”, it is likely that you are engaging in some sort of bruxism activity. Similarly, if you notice that your jaw muscles are becoming bigger or bulkier for no obvious reason, this could indicate that you are engaging in bruxism activities.
Some other signs of bruxism can be found by watching your actual behavior. If you often catch yourself clenching your jaw during the day, that could indicate that you’re suffering from awake bruxism. If you sleep next to a bed partner, you could ask them if they ever hear you making grinding noises during your sleep. Some people even catch themselves grinding their teeth during their sleep when they wake up during a bruxism episode.
The increased activity of your jaws can also have consequences for your jaw joint, officially called the temporomandibular joint (TMJ). If you feel pain in your joint, hear clicking or popping sounds, or have decreased mouth opening this could indicate issues with your TMJ. Sometimes TMJ disorders (TMD) can also lead to tinnitus and/or vertigo. TMD is not necessarily caused by bruxism, but if you experience these symptoms along with some of the previous signs, this is more evidence that you are suffering from severe bruxism.
Theoretically, a sleep study could help diagnose sleep bruxism. During a sleep study, you spend one or more nights in a sleep laboratory where your sleep behavior is monitored by medical specialists. Typically, a sleep study is only conducted when a sleep disorder is suspected, like for example sleep apnea.
Is bruxism bad for you?
Frequently grinding your teeth or clenching your jaws can have very serious consequences for your overall health. It is a risk factor for your dental health, but it can lead to other medical issues as well, such as jaw pain, tension headaches, migraines, TMJ disorders, neck and shoulder pain, tinnitus, and vertigo.
There is some research arguing that bruxism can also be functional behavior. For example, people suffering from sleep apnea often start grinding their teeth when they have an episode and stop breathing in their sleep. It has been suggested that this form of bruxism serves to wake someone up so that they can start breathing again. In general, though, bruxism is definitely a health risk and is best avoided or treated.
It’s important to note here that bruxism can become a health risk when you’re frequently engaging in bruxism activities. Occasionally grinding your teeth or clenching your jaw is not necessarily bad for you and tends to happen to all of us from time to time. It’s only when bruxism becomes a recurring behavior that it starts to become a risk factor for your health.
What causes bruxism?
The research on what causes bruxism is not conclusive yet. We don’t understand fully why someone starts grinding their teeth or starts clenching their jaw. That being said, research has uncovered several major risk factors that make it more likely that someone suffers from bruxism.
First and foremost, stress and anxiety are generally believed to be major risk factors for both awake and sleep bruxism. In particular job-related stress has been found to be associated with bruxism. Some hypothesize that bruxism is a coping mechanism to deal with frustration or psychological tension. Awake bruxism may be a coping strategy or a habit during deep concentration.
Your personality type might also make you more prone to bruxism. Bruxism often affects people with nervous tension, such as anger, pain, or frustration. It also affects people with aggressive, hurried, or overly competitive tendencies.
Other risk factors include lifestyle factors such as the consumption of alcohol, nicotine, caffeine, and other drugs. Some medications have also been shown to increase bruxism, including SSRI-type antidepressants and ADHD medications. All these substances increase arousal and may lead to sleeping problems which could be a further risk factor for developing bruxism.
Research has also shown that sleep bruxism is often accompanied by other sleep disorders, such as snoring, breathing pauses during sleep, and obstructive sleep apnea (OSA). Especially sleep apnea seems to be a high risk factor for bruxism.
Bruxism can also be associated with other mental health and medical disorders such as Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, and ADHD.
There is also some research showing that bruxism has a genetic component. So, if your parents are grinders or clenchers, they could have passed on genes that make you more prone to suffering from bruxism as well.
Note that things like malocclusion do not have an impact on the likelihood that someone suffers from bruxism. Some dentists may suggest that getting braces can help against teeth grinding, but this is not supported by research.
What can I do against bruxism?
If you suspect that you’re grinding or clenching your teeth, there are a couple of things you can do. Typically, the following treatment plans can be used to reduce or cure bruxism. Note that you can’t necessarily pick one and be done. A combination of treatment plans is often needed to combat several components of your bruxism behavior. You need to address the cause of your bruxism behavior, break your habit, and protect yourself from any short-term and long-term health effects.
1. Mouthguards
Mouthguards are probably the most frequently prescribed treatment against bruxism. But ironically, research shows that mouthguards do not help reduce bruxism. While a mouth guard can definitively help to protect your teeth, it won’t stop you from grinding your teeth or clenching your jaw.
This means that you are still at risk for developing bruxism-related health conditions, such as TMJ disorder, chronic headaches, or jaw pain. Some research even shows that wearing a mouth guard can make your bruxism worse or could lead to changes in your denture. This is especially a concern for over-the-counter mouthguards that aren’t fitted to your teeth.
There is some evidence that wearing a fitted occlusal splint could reduce sleep bruxism. If you are considering a mouth guard to help protect your teeth against the consequences of sleep bruxism, this seems to be the best option. Your dentist can help you if you want to go down this route. Whatever you do, don’t get an over-the-counter mouth guard that is not fitted to your teeth.
2. Botox injections
Botox injections administered to your jaw muscles (masseter and temporalis) can help counter your bruxism activities. The Botox injections contain a biological toxic substance that partly paralyzes your jaw muscles. Some may only know Botox as a cosmetic procedure, but the beneficial effects of Botox for treating painful muscle spasms have become widely accepted in the medical community.
The injections don’t control the source of your bruxism behavior, but they do limit the power of your jaw muscle and therefore contain the damage that can be done. Research studies show that people still have roughly the same amount of bruxism episodes after having had Botox injections. The amount of jaw activity and the force applied by your jaws is drastically reduced though. Therefore, Botox can have a significant positive impact on your jaw tension, headaches, or TMJ condition, and can help to protect your teeth.
Typically, the effect of the injections tends to last for around 3 months. At that point, you either need to have another solution against your bruxism habit in place or you would need new injections. The long-term health effects of chronically administering Botox have not been researched yet.
3. Biofeedback training
Biofeedback training is a behavioral training program to help you unlearn your bruxism habits. The training works by giving you a signal whenever you start engaging in bruxism activities such as teeth grinding or jaw clenching.
Several research studies have shown evidence that biofeedback training is effective in reducing both awake and sleep bruxism. It helps counter bruxism episodes when people are receiving biofeedback, but the effects remain after the training program has ended as well.
Biofeedback training is one of the only non-invasive treatments for bruxism that can have an immediate effect on your bruxism. In addition, it can be a long-term solution as well after participating in the training program for long enough and removing any primary causes of your bruxism behavior such as alcohol, stress, or sleep apnea.
4. Medication
Some research studies have been conducted to investigate the effect of a range of drugs on bruxism. So, is there a magic pill you can take to stop your teeth grinding and jaw clenching? Unfortunately, it doesn’t look that way.
While it was concluded that some medications can reduce bruxism behavior, the side effects of these drugs are pretty serious. They include drowsiness, low blood pressure, headaches, and more. Therefore, doctors won’t typically prescribe these medications for bruxism. Only in exceptional cases, for example, when you are recovering from jaw surgery, medications could help to ensure that you are not engaging in bruxism activities.
Furthermore, there are some medications that have been shown to increase bruxism. These include SSRI and ADHD medication. If you are on this type of medication and are experiencing bruxism symptoms, you could discuss alternative medications with your doctor as a slightly different pill might be able to help you stop your bruxism.
5. Stress management
Given that stress and anxiety are major risk factors in developing and sustaining both sleep and awake bruxism, stress management is an approach that could address the root cause of your bruxism behavior. Stress management can come in different forms. In particular, it might help to engage in some form of therapy, such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT).
6. Lifestyle changes
Research shows that drinking alcohol, smoking cigarettes, and consuming too much caffeine increase the odds of grinding your teeth. If you frequently engage in these activities, you might be able to reduce your bruxism behavior by making some lifestyle changes. For example, limiting your alcohol intake, quitting smoking, and only drinking limited caffeine in the morning could all help reduce teeth grinding and jaw clenching.
Lifestyle changes could also help with stress management. For example, building a healthy exercise routine, making sure you get enough sleep and eating a high-quality nutritional diet could all contribute to decreased stress levels and a lower probability of teeth grinding and jaw clenching. In particular, better sleep hygiene could help you spend more time in deeper sleep stages. This could help reduce sleep bruxism, given that bruxism episodes mainly occur during light sleep stages and tend to be preceded by a micro-arousal.
The lifestyle changes that could help you with your bruxism disorder could range from minor life adjustments to radical changes. For some, it might be enough to stop drinking coffee after 2 pm while others may need a career change.
7. Treating associated disorders
If an underlying condition, such as gastroesophageal reflux disease (GERD), is identified as the cause of your bruxism behavior, treating this condition may help. Similarly, addressing sleep-related disorders such as sleep apnea may improve sleep bruxism.
If you develop bruxism as a side effect of a drug, your doctor may be able to change your medication or prescribe a different one.
8. Behavioral changes
Although there is very limited research in this direction, it has been hypothesized by some that posture and functional behaviors of the jaw and related muscles and joints could be a contributing factors for bruxism. Learning how to properly breathe, swallow, and rest your tongue, teeth, and lips might help to reduce bruxism. Similarly, improving your posture could improve jaw functioning and reduce bruxism. Furthermore, learning how to rest the tongue upward to relieve discomfort on the jaw while keeping the teeth apart and lips closed could help alleviate the discomfort from previous bruxism episodes.
How can I relieve bruxism pain?
If you are suffering from headaches or jaw pain due to your bruxism, there are a few things you can do to relieve the pain. Note that none of these solutions are long-term and they don’t fix the underlying issue of your bruxism behavior. The ultimate way to relieve your bruxism pain in the long term is to stop your bruxism behavior.
First of all, NSAID over-the-counter painkillers such as paracetamol/Tylenol or ibuprofen can help take the sharp edges of the pain. Ironically, taking these medications for too long can actually lead to headaches and other side effects, so they should be seen as an ad hoc and temporary solution.
As an alternative or addition to taking pain medication, there are a few things you can try to relax your jaw muscles and reduce the pain and tension coming from your jaw muscles. For example, you can try gently massaging your masseter and temporalis muscle until the soreness reduces. You can try to do this yourself, or a massage therapist or physiotherapist could help you here. Acupuncture treatment can also be an effective way to relax your tight jaw muscles.
Furthermore, hot-cold therapy could reduce inflammation and tension. You can try this out by alternating between applying ice packs and heat packs to your sore jaw muscles. Some people find the most relief when only applying heat or cold, so you should experiment to see what works best for you.
To give your overworked jaw muscles a break, it could also help to switch to a soft-food diet until your bruxism pain has reduced. This means temporarily avoiding hard and chewy foods such as nuts, steak, or chewing gum. Cutting your food into smaller pieces also helps to reduce the strain on your jaw muscles while eating.
Generally, relaxing and getting sufficient sleep can reduce your sensitivity to pain. What makes you relax is of course highly personal and depends on your preferences and circumstances. For example, you could try things like yoga, meditation, aromatherapy, or taking a warm bath. The key is finding something that works for you.
How can I prevent bruxism?
If you’re not suffering from bruxism right now, that’s great! To make sure you keep it that way, you may want to consider taking away any risk factors that make it more likely that you will start your bruxism behavior (again) in the future.
Managing any stress and anxiety in your life can help prevent teeth grinding and jaw clenching in the future. Engaging in therapy or finding a good stress management system for yourself could help prevent bruxism and improve your overall health and quality of life.
Depending on your circumstances, you might also benefit from other lifestyle changes that help improve your sleep quality and stress levels. Building up an exercise routine, having a consistent sleep schedule, and eating a healthy and nutritious diet are just some of the changes that could benefit you. In particular, it can help to limit your alcohol, nicotine, and caffeine intake.
In general, leading a happy and healthy life might just be the best way to prevent bruxism and many other health conditions.
There’s no guarantee that you will always be able to prevent teeth grinding or clenching. We all experience some stressful periods in our life and we can’t sleep perfectly every night. Moreover, research shows that there is some genetic component in being more prone to grinding your teeth and clenching your jaw.
If you’re worried about your potential bruxism behavior, you may want to consider the JawSense headband to help you monitor your jaw functioning and detect early signs of bruxism.
What medical professions can help with bruxism?
If you think you’re suffering from bruxism and would like to get help, there is a very wide range of medical specialists who might be able to offer you treatment and advice. The best treatment plan for you will depend on your specific condition and circumstances. In general, your dentist and/or GP can serve as your first point of contact if you think you are suffering from bruxism and want help. They can help you find the right treatment path for you, or refer you to other specialists as they see suited.
Some of the medical specialists that could help you include an oro-myofascial surgeon, TMJ specialist, orthodontist, or orthotropist. In addition, you may be referred to a psychologist to help with stress management or any underlying psychological issues that may be causing you to engage in bruxism activities. A physiotherapist, chiropractor, or acupuncturist may also be able to help with improving jaw functioning, posture, muscle relaxation, and bone position. The medical help available to you may depend on your location and insurance.