Bruxism is a destructive process where a person involuntarily grinds their teeth either at night or during the day. The large majority of people who grind their teeth, do so at night and are unaware they do it until their bed partner tells them or the wear becomes evident on their teeth. Conservative estimates are that at least 10% of the population grinds significantly enough to cause damage. From my personal experience as a general dentist, I’d estimate that the percentage is even higher than that. Left unchecked, bruxism has the potential to cause serious damage to teeth, muscular pain, and irritation of the temporomandibular joint (TMJ).

Both children and adults are known to grind. We still don’t know exactly what causes this. A lot of really smart people have studied it and don’t have a great answer. We do know that there isn’t one single cause. It is likely a combination of many different factors. Some of the factors that we believe are involved are:

• Stress
• Anxiety
• Snoring and Sleep Apnea
• Alcohol
• Cigarette Smoking
• Caffeine
• Antidepressants

Consequences of Bruxism

Dentistry is one of the few areas in medicine in which good preventative care can eliminate most major long term issues (excluding TMJ issues). Everyone knows about brushing, flossing, and limiting sugar but what about the need to protect teeth from abnormal wear from grinding? It is estimated that you normally lose 0.3 mm of enamel every 10 years. A severe grinder can wear away nearly 2 mm of enamel in that same 10 year period. It usually isn’t a problem that you can quickly see so most people don’t see it as an urgent need to do something about.

The first and biggest consequnce of grinding is excessive tooth wear and fracture. Notice the chipping at the edge of the teeth, stress fractures, and wear of some teeth at the gum-line. These are very common patterns of wear with mild to moderate bruxism. People who grind severely, will achieve this look much earlier in life and by middle to late age will have multiple fractured teeth and significant shortening of their teeth.

Once it progresses to this point, fixing the teeth becomes very time consuming and expensive. Prevention is key!

In addition to the tooth wear, some people also develop significant muscular pain from the constant grinding. It is usually the worst in the morning, after a night of grinding in their sleep. The primary muscles involved in this are the masseter and temporalis muscles. The muscles work hard as you grind and as they become fatigued you develop muscle spasms and pain. As you can see from the diagram, the temporalis muscle extends high up into the scalp. When this muscle becomes fatigued, it can even lead to significant headaches.

Lastly, some people develop pain either from the muscles directly attached to the temporomandibular joint or from some portion of the joint itself. Please see our TMJ section for more information on how this joint works  and how the common sources of TMJ pain are treated.

Bruxism/Grinding Treatment

The challenge with grinding is that we don’t have a way to stop you from doing it. Most people who grind, start doing so in the late teenage years and it continues throughout their life. Some dentists will tell their patients that they just need to get their stress under control to help their grinding. Well, if we could just get rid of our stress, we wouldn’t be stressed out, right? My goal with treatment is to eliminate many of the negative consequences of grinding.

For most people, this means wearing a night guard while asleep. A night guard is a type of dental appliance that covers the chewing surfaces of the teeth. This appliance does several things. First, it keeps you from doing damage to your teeth while grinding. Many people are amazed how much wear they see on their night guard after they have worn it for a couple of weeks. The second thing a night guard can do is help relax the muscles that pull the jaw shut. By opening your mouth slightly, the muscles can’t contract quite as tightly. This helps minimize the problems you can develop with muscular or TMJ pain.

Many drug stores sell “boil and bite” night guards. In general, these appliances are a bad long term solution to grinding. The night guards end up being relatively soft and this softness will oftentimes increase the frequency of grinding. They also wear out very quickly as the material just doesn’t have enough strength to withstand the forces put on it by true grinding.

Custom dentist fabricated night guards generally work very well but can end up being quite expensive. They generally range from $300-500.

One other option, which is a bit more expensive, is to purchase a home impression kit from a dental lab. The kit will have materials to take an impression of your teeth. You’ll send this impression back to the dental lab and they’ll create a custom night guard for you. If you do it right, it will be identical to a night guard fabricated by a dentist. There are a several downsides to this method. The first is that getting an accurate impression of your own teeth can sometimes be challenging. If you mess up the impression, you generally have to purchase more material and try again. The second downside is that they can be difficult for you to adjust. If all your teeth aren’t hitting evenly on the night guard it can cause problems.  That said, this can be a good option for someone who wants the process to be as easy as possible.

Bruxism (Grinding) in Children

Teeth grinding in children is extremely common! Many parents come to me with stories of their children grinding so loudly that they can hear it through a closed door! They want to know what they can do to stop it…

Unfortunately, just like in adults, we don’t have a good way to make anyone stop grinding! We also don’t recommend any sort of appliance in children as their jaw is constantly growing and any sort of appliance can modify this process. DO NOT USE THESE GUIDES TO MAKE A GRINDING APPLIANCE FOR A CHILD! If you have a teenager who grinds and you can see wear on the teeth, you can consider a night guard once they have completed most of their growing. This is usually around age 15 to 18. It is earlier for girls than it is for boys. When in doubt, speak with your family or pediatric dentist or orthodontist.

The good news is that the majority of children grow out the grinding habit around the time they start getting their permanent teeth in (approximately age 6-7). There are a couple of things to keep in mind with a child who grinds.

1. Occasionally a child will grind their primary (baby) teeth down so significantly that dental work is needed to keep the nerve from being exposed. This is extremely rare. I’ve personally seen thousands of children and have only had one who required this type of work. If in doubt, check with your family or pediatric dentist.
2. In children who both grind and snore consistently, studies have shown there is a relatively high likelihood that they have sleep apnea (stop breathing in their sleep multiple times a night). See our section on sleep apnea for more information about this disease. Oddly enough in children with sleep apnea, there are higher rates of attention deficit hyperactivity disorder (ADHD). These children can lag behind in school as a result of getting less or poorer sleep. The most common treatment is removal of the tonsils in order to allow more space for the airway. Any concerns about sleep apnea with a child should be brought to your pediatrician or qualified sleep doctor. This is not something to ignore or attempt to treat at home as there can be very significant long term consequences with untreated sleep apnea.