BRUXISM
The
term bruxism is defined as:
“to grind the teeth, a clenching of the teeth, associated with forceful jaw
movements, resulting in rubbing, gritting, or grinding together of the teeth, usually during
sleep.”
What causes bruxing to occur?
This is a very difficult question to answer. Some researchers say that if the
occlusion (bite) of someone is not correct they will brux. Others say that it is a central
nervous system disorder. Others say it is a multifaceted problem.
For all practical purposes……EVERYONE bruxes.
Therefore, the question is NOT whether a person does in fact brux. Rather, the better
question is to what degree do they brux. There is not a scale of bruxing that
exists, but, we could imagine that there is such a scale. This scale could run from a 1
indicating a very very slight habit to a 10+
which would indicate a severe bruxer. A person at level 1 would not show any signs of
bruxing at all. On the other hand the people in the higher end on the scale
would show one or several signs. The pressure that can be generated across the teeth can
range from 100 to 600psi (pounds per square inch) this is an incredible amount
of force. The problems outlined below occur as a result of these forces being applied over
many years - slowly - and it can be difficult to recognize the cause/effect
sequence.
Possible signs, complications or damage
that may occur are:
- Wearing of teeth.
Wear occurs from the movement of the teeth harshly against one another. Although all
teeth may show this type wear, it is especially noticeable when a person has front teeth
that appear having the same length - as if they were filed down.
- Breaking of teeth.
As teeth wear, the edges of front teeth and the cusps or corners of back teeth will begin
to show microfractures or cracks. These cracks can not be seen on x-rays. It takes
magnified vision and/or an intraoral magnified image to diagnose them. Where this becomes
especially important, is that teeth with these type of fractures will either
eventually chip, break a corner, or yet require root canal therapy. The reason for root
canal therapy is that the fracture begins on the surface of the tooth and eventually
deepens until the crack enters the area of the nerve.
- Sensitive teeth.
Usually a generalized soreness and/or a cold sensitivity..
- Receeding gums and/or teeth with gum line “notches”.
Most people have been told or assume that receeding gums occur because of age, using a
hard bristle brush or the occurence of gum (periodontal) disease. In fact none of
these reasons are correct in a majority of the cases. These are referred to as
abrasion areas. When teeth grind hard against each other year after year, they flex
at the gum line and the enamel (which ends thinly at the gum line) microfractures away.
The end result is an area at the gum line that you can catch your fingernail in and
may get extremely sensitive to touch and/or cold.
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In this picture, there is exposed root surface
and advanced abrasion areas. |
- Loose teeth
Teeth loosen because of the "rocking" back forth that occurs. The best analogy
is the example of getting a fence post out of the ground by rocking it back and
forth.
- Periodontal pockets (loss of supporting bone around the teeth).
Sometimes instead of the tooth getting loose, there may be a generalized
horizontal loss of supporting bone and/or localized areas of bone loss.
- Bony ridges (tori)
Instead of losing bone support - some people actually form "extra" bone
to support the teeth (this appears as bony ridges that can be seen and felt on the jaw bones as a smooth raised area about at the level of
the roots.
This image is of the lower jaw showing
extra bone in the "floor" of the mouth
by the tongue. |
This picture shows the cheeks
pulled back and the ridge along
and above the upper back teeth. |
- Cheek irritation - A ridge or line of fibrosed (toughened) tissue on
the inside of the cheek that corresponds to where the teeth come together. Sometimes a
person will actually bite themselves along this line (especially in the most
posterior molar area).
- Sore muscles (especially in the cheek and temple area) When these two muscles are
overused. They may get sore - just like when you over exercise, your other
muscles get sore.
 
10. Headaches
(especially upon waking in the same muscle
areas mentioned above).
Instead of soreness, the muscle
aches will appear as a headache.
11. TMJ Problems (jaw joint pain / soreness / etc)
The jaw joint may be over loaded and
resulting problems occur.
These
signs take time (usually decades of years) to show themselves.
Does everyone show every problem? No they
don't, we are all very different. Some of us will exhibit none of these problems (thank
your genetic code for that), some of us will exhibit severe problems (curse your genetic
code for that). So any combination, or NO problems may exist for any one person.
So, what should anyone do about bruxism?
Is there a cure?
This is a very difficult thing to
answer. For a large number of people, the problem is that their bite is off - this
triggers through a series of physiological signals, a dramatic increase in the amount of
bruxing.
STRESS is a huge factor when it comes to bruxing.
In fact the mouth can show stress before any other area of the body. The more stress, the
more bruxing and the harder the bruxing.
NIGHTGUARD
It would be logical to think that an acrylic nightguard is simply a piece
of plastic used to cover and prevent the teeth from coming together while sleeping
at night. This is true - BUT - most importantly, when in place it provides a correct
bite so that muscles will relax and problems in a persons bite will not trigger
the bruxing action.. The aspect of making and delivering a nightguard CORRECTLY is difficult to
explain but you may see this process by clicking here.
A point needs to be made that tooth wear still slowly occurs when using a
nightguard. The reason for this is that a person (especially severe bruxers)
will clench and very slightly grind during the day time when their guard is not
being worn.
A nightguard is NOT a solution, rather a method of greatly decreasing the damage
caused by bruxing. It is possible to alter a bite so that a guard may not be
needed - the method varies from case to case.
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