How common is teeth grinding and clenching?
It’s very common. I notice signs of these habits in almost every patient I see. The severity of accompanying symptoms, including headaches, popping and clicking in the joint, jaw muscle soreness and tooth sensitivity, vary.
Is stress the main cause or are there other causes?
Stress is the most common cause. I’m not seeing it as much now as I did during the first year of the Covid pandemic. I probably saw more patients with these habits in that one year than in the 15 previous years I practiced. There were a lot of stressed-out people. The other causes are chronic pain and poor occlusion, which is how the upper and lower teeth meet and function together. Sleep apnea can also sometimes be a cause.
How do you diagnose grinding or clenching as the cause of headaches and jaw pain?
People will show up with symptoms that are confusing. They come in with a toothache or this horrific pain. Or, in some cases, they’ve seen two or three medical providers beforehand. In trying to find answers, they often end up with us. Patients may have pain that looks like a sinus infection or a migraine. In addition to asking about their pain, we talk to them about what’s going on in their lives.
We had a patient come in who had been dealing with pain for months. We learned she was going through a job change that was creating additional stress. That helped us narrow things down and look for other signs of teeth clenching in her bite and soft tissue.
What are the main symptoms of teeth clenching and grinding?
Because many patients clench or grind when they’re in deep sleep, it may be their partner or spouse who first notices it. People may have a radiating headache on the side of their head and down to their neck and shoulders because they’re tensing up.
Four signs I typically see, in any combination, are: tooth sensitivity to touch or temperature that tends to be on one side; jaw muscle tenderness; jaw joint popping, clicking or discomfort; and headaches on the side of the head.
How do you prevent and treat teeth clenching/grinding and its side effects?
Often, treatment is not that straight forward. Usually, we’ll try two or three different approaches and then follow up with patients to see how they’re doing. In the above patient’s case, we prescribed a muscle relaxer and recommended some stretching exercises for the jaw, neck and head. We also recommended ibuprofen for pain. She came back a week later and was doing much better.
The patient still had some symptoms, though, so we gave her a type of mouth device called a nociceptive trigeminal inhibition tension suppression system (NTI). It’s a small splint that is custom made for some upper teeth and is usually used when patients are asleep. It helps relax and retrain their muscles, keeping them from biting down.
We told the patient, “Your muscles are not going to be happy with you over the next few days.” She came back and said her muscles were very sore at first, but then they started feeling better. That’s why we talk to our patients about the importance of compliance and continuing to wear the device.
NTIs are a short-term treatment to get people to a point where they’re stable. After that, if the grinding and clenching happen regularly, we consider using a night guard.
I know it sounds simple, but reducing stress and having good sleep hygiene habits can help prevent and reduce the effects. When symptoms start, stretches and exercises can be helpful in combination with moist heat. For heat, patients can warm a sock with rice in a microwave for 30 to 45 seconds.
What types of night guards are available?
There are three types. Over-the-counter (OTC) guards enable patients to mold them to their mouths by placing them in boiling water until they’re soft and then biting down on them so they fit comfortably. Patients have mixed responses to these, often finding them softer and bulkier than other options.
A newer option is a semi-custom kit that is delivered to patients, who then take an impression of their teeth and mail it to a facility to make the guard.
The third option is a custom guard that a dentist makes. These typically fit best and result in better patient satisfaction.
You mentioned stretching exercises as part of the treatment. What do these involve and how do they help?
The three components involved in clenching and grinding are the teeth, jaw joint and muscles. Stretching and exercise can help with the muscle component. But if the underlying causes — like stress or pain — are not addressed, then the symptoms will persist.
You also mentioned sleep apnea. How does that contribute, and what can be done to prevent its role in grinding?
Patients with sleep apnea will often clench or grind during their sleep disruption cycles, but the underlying causes of sleep apnea are different than parafunctional habits. For mild cases of sleep apnea, we sometimes prescribe an oral appliance. It protects the teeth from grinding and shifts the lower jawbone forward to open the airway. These sleep apnea devices are often made by a dentist after a sleep test is done by a sleep specialist.
Which specialists get involved in treating teeth clenching beyond dentists?
Sleep, pain and sports medicine physicians can be involved in diagnoses and treatment. Often, though, they focus on other causes and symptoms and refer patients to dentists for the night guard and other dental concerns.
What long-term problems can develop from teeth clenching/grinding?
Tooth damage, including wear of the chewing surfaces, cracked teeth and tooth structure loss below the gumline. These issues can lead to irreparable harm and eventual tooth loss. If caught early, the damage can be treated with fillings, crowns or root canals before it gets too serious.
Are there ways to prevent teeth clenching/grinding long-term? Do people have to wear their night guards permanently?
If underlying causes like stress can be reduced, I often see these habits improve. But some patients habitually grind or clench their teeth, and a protective night guard may always be necessary. There also is ongoing research into using biofeedback devices, physical therapy and Botox to reduce these habits.
In addition, exercise, yoga and meditation may help lower stress. And during the day, people can set occasional reminder alarms to check whether they’re grinding or clenching. If patients’ stress levels are extremely high, dentists may refer them to a mental health provider for additional help.
