War of Attrition
Teeth grinding (bruxism) is an ever-increasing problem in our society today and is worryingly becoming prevalent in younger demographics.
The reasons for bruxism are multifactorial but are usually an accumulation of stress leading to muscle tightness in the jaw which then manifests as involuntary movements of jaw muscles (parafunction) which typically takes place during deep sleep.
These involuntary muscle movements bring the teeth into contact with each other at significant torque levels, far higher than would be associated with normal chewing and eating. This leads to erosion and attrition of the tooth enamel alongside potential over wear of the Tempero-mandibular joint (TMJ).
Symptoms include teeth sensitivity, headaches, migraines, tinnitus, poor sleep, night waking, jaw ache, restricted mouth opening, clicking jaw, neck pain, broken/chipped teeth, and pain when biting crunchy foods.
Initially following a full medical history, it’s useful to begin a programme of massage and physiotherapy of the jaw muscles especially the masseter muscle which has connections from the cheekbone to the lower jaw. Ultrasound is very useful as a first port of call as it is very gentle, alongside manual manipulation and possibly acupuncture. Breathing exercises are an excellent adjunct to this which can be incorporated as part of yogic practices or Pilates to improve posture which helps ‘release’ the jaw muscles.
Passive and active management generally go hand in hand. This usually involves an assessment of the ‘bite’ (occlusal analysis) to see if there are any teeth which have an awkward contact or cause the other teeth to ‘slide’ when they come into contact. This ‘interference’ could potentially exacerbate the bruxism and need some adjustment with very careful tooth filing.
Following this analysis, a mouthguard would be made for wearing at night time. These come in various forms, including soft rubber mouth guards, Nti or Mci splints or full arch acrylic guards in the form of Michigan (upper teeth) and Tanner (lower teeth) splints.
The purpose of the mouth guard should be to stop the teeth meeting together but also to ‘de-programme’ the TMJ joint so it ‘forgets’ it’s grinding position and adopts the original more relaxed position.
Ultimately reprogramming of the TMJ will hopefully result in a break in the habitual chronic nature of the mechanism leading to a relaxed jaw and a decrease, if not a complete halt of the teeth grinding.
The effect can be reinforced by a series of hypnotherapy or Cognitive Behavioural Therapy (CBT) sessions to explore the sources of any physiological stress and to empower the patient to manage this stress with certain tools and techniques.
If you recognise any of the symptoms mentioned, please speak to your dentist about bruxism. It’s very common but equally very treatable, and management could prevent much more serious wear and tear of the teeth and jaw joint in the future.