How to Handle Sleep Bruxism

About eight to 10 percent of the adult population have a secret malady called sleep bruxism, a sleep disorder characterized by the grinding or clenching of teeth.  Some people do it unconsciously even when they are awake.  Stress usually has something to do with it, but the origins of the disorder are quite varied.  The effects of bruxism are seldom anywhere near as bad as during sleep when the body’s protective mechanisms are turned off. Without proper treatment, the condition may cause serious damage to the teeth and surrounding tissue, as well as trigger headaches and jaw pain.

Bruxism can be a real nuisance. “It’s much like having a large football player standing on the tooth,” said Dr. Noshir Mehta, Chairman of General Dentistry at Tufts University School of Dental Medicine and Director of its Craniofacial Pain Center.

Under normal circumstances, a person’s teeth make contact for about 20 minutes a day with only 20 to 40 pounds of pressure to be able to chew. During sleep bruxism, however, the upper and lower teeth come into direct contact in as much as 40 minutes per hour, and with a force of about 250 pounds on the first molar.  

Sleep bruxism is not a disease, but it is the third most common sleep disorder after sleep talking and snoring.  This condition is more prevalent in children, who often outgrow it, and causes behind adult cases are very different from those of the younger age bracket.  

In the 1960s, Dr. Gilles Lavigne, a Professor of Dentistry and Medicine at the University of Montreal, and President of the Canadian Sleep Society explained that bruxism was thought to be the body’s response to “malocclusion” — a problem that arises when the upper and lower teeth don’t fit together.  Due to lack of clinical evidence, the theory was not accepted in the medical and dental community.  

Later on, stress was cited to be the cause of the sleep disorder proponents of this theory failed to explain why not everyone with sleep bruxism was stressed and not everyone with stress ground their teeth. Some recent research studies also reveal the connection of sleep bruxism to neurochemicals like dopamine, but its significance is still being questioned. Dr. Lavigne’s latest studies have identified a pattern of activation in the autonomic nervous system that correlates strongly with sleep bruxism. He emphasized that sleep bruxism is not an indicator of neurological disease.  No matter what science eventually discovers as the cause of sleep bruxism, current medical literature point out to stress, smoking, alcohol, caffeine as the main “triggers” of the disorder.

Relaxation techniques like yoga, meditation, or even acupuncture may help promote overall heath and wellness. Doctors, however, say that these alternative healing methods will not cure or relieve sleep bruxism.  

For treatment, anti-anxiety medications and other pharmacological treatments may be prescribed by doctors to help bring bruxism to a halt. Patients, however, must be aware of that these drugs are potentially habit-forming.  “It works too well,” said Dr. Michael Gelb, a clinical professor at the New York University College of Dentistry.  The drug “working well” also entails the potential of substance abuse if the patient is left to use the drug without doctor supervision.

In the meantime, dentists suggest that patients may use a mouth guard.  The mouth guard is a small plastic device that covers some or all of the teeth to protect them against damage, but does not really stop the grinding or clenching itself. The temporary relief can be quite expensive, as the device is customized to fit the user.  But a more affordable version can be bought at over-the-counter drugstores which are usually better than nothing.  

Dr. Charles McNeill, director of the Center for Orofacial Pain at the University of California, San Francisco agrees that mouth guards may protect the teeth but should only be for temporary use as it may also be more likely to induce a chewing response and increase bruxism.  They can also cause irreversible damage to the bite, or arrangement of the teeth. Customized mouth guards made by a dentist last longer, fit better and are generally designed to distribute the force of grinding to reduce jaw pain.

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