Overview article on bruxism

Since 2020, dentists and other oral health professionals around the world have seen a sharp increase in the number of patients seeking treatment for problems caused by bruxism, a fancy word for grinding and clenching your teeth with force. While bruxism is fairly common, with pre-pandemic data suggesting that 31% of adults were chronic chompers to some degree, some large clinics saw nearly three times as many bruxers as usual when the lockdown began. According to some experts, this increase has still not subsided. “My patients who had been suffering from soft pain and bruxism got worse, and those in whom I had never seen it before were now in a lot of pain,” says Mark Drangsholt, chair of the department of oral medicine at the University of Washington dental school, who assisted in this overview article on bruxism.

Detrimental effects

Most people with bruxism grind in their sleep, and those without symptoms may not even be aware of it. Although experts often distinguish between this nocturnal grinding, known as sleep bruxism, and daytime grinding (waking bruxism), in many individual cases the line between the two is blurred by a mixture of patterns and behaviours.

Bruxism is not always painful, but when it is, it can be severe. Certain behaviours (especially prolonged teeth clenching) can lead to chronic pain in the temporomandibular joints (TMJs), which are located on either side of the face near the ear. These joints, which are often compared to hinges, allow the jaw to move away from the rest of the skull and are directly affected by bruxism. People who frequently grind their teeth may experience TMJ problems, including clicking or pain when eating, general sensitivity and even jaw locking.

Then there is the risk to your teeth themselves. Aside from the small moments we spend eating, “your teeth don’t come together much during the day,” says Drangsholt. Even an hour spent grinding your teeth at work represents a huge amount of extra wear, which can put you at risk of cracked or worn teeth.

Bruxism becomes even more dangerous when you go to bed. Ever see those videos of hippos eating whole watermelons as if they were blueberries? That’s actually the unconscious superpower of humans. According to Drangsholt, when we are in REM sleep, we are able to exert three times the force we could consciously exert.

Causes

Bruxism has always been closely associated with anxiety in the dental world, and recent studies have begun to confirm the stories clinics tell about this pandemic boom. A small paper published in 2021 on Turkish healthcare workers found that about a third of people with no history of bruxism began experiencing symptoms in the first few months of the pandemic. Another study of Google search trends worldwide found a notable increase between May 2020 and October 2020 in searches for bruxism, grinding and clenching of teeth, compared to similar periods in 2016 to 2019.

Some psychoactive drugs can also affect bruxism. Antidepressants such as SSRIs and SNRIs can trigger the onset of bruxism within a month of use, and this is one of the first things Drangsholt says he asks new patients when assessing their symptoms. Most people who take antidepressants don’t develop bruxism, but “there seems to be a relationship for some people,” he says. “It’s something we look at very carefully, because if you can change your medication or change your dosage, that can be helpful.” Although rates of new antidepressant prescriptions in the US fell in the early months of the pandemic, overall figures in recent years show a continued increase in new prescriptions.

Michele Schultz-Robins, secretary of the American Academy of Orofacial Pain and professor at Rutgers School of Dental Medicine, says other lifestyle factors may have had an impact on the ever-increasing number of bruxism cases she has seen. “COVID is crazy,” she says. For years, adults and children have been more homebound during the day: staring at tiny screens, working from their sofas and in bed, and changing their postural habits during the day in ways that could lead to an increase in tooth clenching. “You hold your face differently,” she says. “You’re now constantly leaning forward and your jaw is not aligned properly, and you can start clenching your teeth. You’re a little more tense about it, and when you clench with your temporalis muscle and your masseter muscle, you’re going to get a headache.”

The effects of stress, she adds, can be huge. “I ended up with a 17-year-old who couldn’t open his mouth more than a finger because he was so stressed,” says Schultz-Robins. “During COVID, he was the sole provider for his family; his parents had both been laid off.” Schultz-Robins says she has seen 6-year-olds come in with pain from excessive grinding.

Treating bruxism

This intense psychological connection can sometimes make temporomandibular joint (TMJ) disorders difficult to treat. Something as simple as changing medication dosages to improve symptoms requires communication and coordination between psychiatrists and orofacial pain specialists, two specialties that don’t work together much. But success in treating TMD and bruxism varies from case to case, and combinations of approaches can be extremely beneficial in relieving symptoms, according to Drangsholt.

Psychologically, techniques such as mindfulness, cognitive behavioral therapy and other proven anxiety reduction practices can impact bruxism behaviors and TMJ pain, and are more accessible than ever with online therapy options. Nevertheless, treatment should always begin with an orofacial pain specialist, according to Schultz-Robins. A specialist can offer more physical treatment options, such as oral exercises, night guards that keep the upper and lower teeth from touching, and even regular anaesthetic injection therapies for severe pain.

A commonly used treatment in recent times is neurotoxin, or Botox,” says Drangsholt. Although this is a more expensive treatment reserved for the most severe cases, regular injections of Botox every three or four months can make all the difference for some grinders. “They don’t fracture braces, and they don’t have any of the tooth fractures,” says Drangsholt, “We are able to decrease the volume of their muscles in a reversible way.”

When action is needed

As Schultz-Robins says: “Does your jaw feel like it’s been partying in your mouth all night? Do you have a headache when you wake up?” These are signs to take action, and contact a professional.

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