Bruxism or Grinding is a result of repeated lateral and forward movement of the lower jaw over the top jaw causing the teeth to slide over each other. Bruxism is the medical term for grinding and can be physiological (normal) or pathological (abnormal). While most of us can relate chipping, cracking and fracturing of teeth to bruxism and grinding, there is a lot more happening – let’s take a look. Bruxism has the following overall effect on our health:
- Attrition (wearing down of teeth) – this can be in the front and back teeth and may have unusual patterns depending on the grinding pattern, alignment of teeth and strength of muscles.
- Abfraction (chipping of teeth at the neck) – this usually happens on the neck of the tooth (that joints the top of the tooth to the root) on the outside surface of teeth (towards the lips and the cheek) but can also happen on the inside in severe cases of where teeth are not aligned properly. This can also cause sensitivity to hot and cold and become a limitation in your lifestyle.
- Bone loss – the jaw bone absorbs the pressures and forces transferred to the teeth. When there is an existing gum disease (due to lack of regular visits to your hygienist and improper hme care), the shock absorber (bone) becomes weak and is slowly reduced in size.
- Recession (pulling away of gum from the teeth) – this can happen due the abfraction or due to excessive pressures on the bone caused by grinding.
- TMJ (temporo-mandibular joint) disorders – this joint which facilitates movement of the lower jaw and hence the lower teeth comes under excessive pressure during grinding and bruxism and the discs and the ligaments present to support it become weak or damaged over time leading to TMD (temporo-mandibular disorders). In severe cases, the bone can start to degrade and cause permanent and irreversible damage which can debilitate the joints movements and motions (much like a knee).
- Head and Neck Muscles – these muscles allow the grinding to happen and just like a muscle that is constantly being overworked, may become sore, tear and cause pain and swelling.
- Headaches – can be directly causes by the muscles being in spasm or the TMJ causing pain that get’s referred to the head and neck areas.
There are many reasons why Bruxism and grinding can become pathological (abnormal):
- Misalignment of Teeth (malocclusion) – when your teeth are not in the right position, they start to collide with each other or interfere with the normal biting mechanism which relies on very precise timing and pressure to control and limit itself.
- Neural and Nervous Issues – several studies have linked stress and anxiety with bruxism, clenching and grinding.
- Sleep Apnoea and Snoring – a lot of people think that people who snore or go into apnoea sleep with their mouth open hence they can’t possibly be grinding or bruxing. There is a direct correlation between the severity of sleep apnoea (apnea) and bruxism and we believe it is a nervous response that is triggered by lack of oxygen in the brain.
- Loss of Tooth Structure – when excessive tooth structure is lost, flattening of the bite occurs which in turn almost eliminates the internal bruxism limiting mechanisms and causes increased grinding which then becomes a cyclic problem.
The good news is that, it is simple to reduce or prevent the effects of bruxism and grinding on our health by using an customized and balanced occlusal splint (also called as a night guard or a mouth guard). However, as with any other pathological condition or disease, our final aim is to resolve and remove what is causing it. The following are some of the solutions:
- Orthodontics – by aligning the teeth, we are able to reduce interferences and reduce or eliminate pathological bruxism. Traditional braces often had to resort to removing 2-4 teeth to make space to align others. We now know that removing teeth to align others does not help and can actually worsen bruxism and grinding. That is why, our philosophy at Stouffville Smiles has always been to start modifying the growth of the jaws soon enough to prevent this from happening altogether. We also offer clear aligner therapy (such as invisalign) to correct misaligned teeth and bites.
- Restorations – sometimes we suggest using a combination of orthodontics and restorations (such as crowns, bridges, veneers, onlays and fillings) to restore the shape of the teeth and recreate the internal bruxism stopping mechanisms. Restoration of the abfraction areas is also very important so as to avoid further damage to them and to reduce their sensitivity.
- Physiotherapy and Appliance Therapy – to relax the muscles and reduce headaches and TMJ issues. This is done through a series of appliances and massages to relax and rehabilitate certain muscles.