Bruxism Parafunction Risk Assessment for Pain Patients

By James Fricton DDS, MS  

Bruxism parafunctional habits, including teeth grinding, clenching, oral habits, neck tensing, and shoulder bracing, are a primary cause of much pain.

These habits may trigger the following painful conditions: headache, temporomandibular disorders (TMD), neck pain, ear pain, and orofacial pain conditions. Unfortunately, they are often not identified and diagnosed in routine health care. They can also lead to dental fractures, periodontal problems, loss of teeth, ringing in the ears, and many other symptoms. A Bruxism Parafunction Risk Assessment helps people obtain a correct diagnosis and accurate treatment plan.

The confusion in identifying the diagnosis and cause can lead to delays, fragmentation, and failed and pain treatment for these conditions. There is a need for an integrative parafunction risk rating assessment used by all health professionals to diagnose and treat bruxism and other parafunctions to relieve related pain conditions faster and more long-term.

TMD and Orofacial Pain specialists recognize the need to improve the diagnostic process. Risk assessment tools identify the risk factors leading to more pain. They also improve integrated care programs to reduce these risks. People facing headache, neck pain, facial pain, dental pain, jaw functioning issues, and related issues often don’t know what’s causing their problems and who to contact for treatment.

Is Bruxism a Parafunction?

In medical terms, bruxism is classified as a parafunctional activity which involves clenching and grinding of the teeth and other muscle habits that increase strain to the muscles and joints. This may occur consciously when awake (awake bruxism) or at night during sleep (sleep bruxism). This classification is why dentists and pain specialists commonly begin with Bruxism Parafunction Risk Assessment.

Who do I see for head, neck and jaw pain problems due to bruxism?

Patients with these pain conditions have pain for years. They typically see several health professionals prior to being referred to a TMD and Orofacial Pain Specialist.

Healthcare professionals that these patients often seek initial care from:

• Family doctor or dentist.
• Internist.
• Orthopedic Surgeon.
• Rheumatologist.
• Neurologist.
• Neurosurgeon.
• Otolaryngologist.
• Medical Pain Specialist.
• Physical Therapist.
• Chiropractor.

It’s understandable with so many healthcare professionals are confused as to who to seek for jaw and facial pain help since these conditions fall between medicine and dentistry. While there is commonly overlay, if healthcare professionals were to use the same words, diagnosis, and treatment procedures, diagnosis and care would be more effective. The medical and dental specialists at Minnesota Head and Neck Pain Clinics not only work directly with pain patients but are also known as leaders in training peers and advancing the national pain care system.

It may help you, the patient, to understand why bruxism parafunction recognition and wide adoption is challenging.

What Can Jaw Pain Patients Expect During a Bruxism Assessment?

You can expect the following from a Bruxism Parafunction Risk Rating:

• Help to identify bruxism habits and factors that increase contributing habits, such as stressors, and strain of daily life.
• Use correct terminology and explain the risk assessment and resulting pain cycles caused by these risk factors. This should be done in words you understand and can share with other treatment partners.
• Explanations of both the treatment of the bruxism condition and training as to how you can reduce your risk factors. You can obtain support from telehealth coaches specifically trained in pain management.
• Help you set clear bruxism treatment expectations to avoid disappointment.
• Assist jaw pain patients so there are more comfortable engaging professional help. This is especially important earlier on versus leaning into what peers or family may recommend.
• Make it easy to review electronic health records and assure you of patient privacy.

Minnesota Head & Neck Pain specialists are prepared and passionate to help you. We recognize your need to obtain pain relief as quickly as possible, to improve your daily functioning, and quality of life. A place to start when assessing possible bruxism is with a parafunction risk rating assessment. You gain help to understand and embrace the bruxism assessment and training process.

What Habits Typically Lead to Bruxism Problems?

Coping methods or a habit may lead to bruxing due to emotions such as anxiety, stress, anger, frustration or tension.

COMMON BRUXISM HABITS:
Tooth clenching	Splint biting repeatedly
Touching upper and lower teeth together	Moving the jaw from side to side
Teeth Grinding	Moving jaw forward
Holding jaw muscles tense or rigid	Holding objects between teeth
Mouth or lip biting	Biting nails or cuticles
Tooth-tapping habit	Leaning on the chin
Holding the tongue thrust forward	Unilateral chew
Telephone bracing with a tense position	Stomach sleep
Chewing gum or sucking hard candy	Other

Parafunction Risk Assessment for TMD & Orofacial Pain

An initial conversation will discuss the signs and symptoms of TMD and an orofacial pain condition. You’ll learn how specific risk factors such as bruxism lead to strain, delay recovery, and cause chronic pain.

Studies indicate that up to 80% of people in the United States clench, grind or bring their upper and lower teeth together and are not aware of their condition. Bruxism (clenching or grinding) can occur during the daytime or night. It is harder to detect when you are sleeping. Pain patients report that their symptoms come and go, and occur more often while stressed, injured, or needing certain medications. The Washington Post published recent statistics stating that “Dentists reported a 69 percent jump in patients who clench or grind their teeth during the pandemic”. ^[1]

According to Military Health Teeth Grinding: You Won’t Believe How Harmful it Really Is 2/28/2022 article, “Up to 30% of people grind their teeth in some way, and estimates suggest that about 10% to 15% of adults suffer painful bruxing during sleep”. Author Janet Aker states that your jaw is capable of gritting and grinding with as much as 250 pounds of force!

Sleep bruxism is when bruxing only occurs at night without being aware of the condition during the day. This is called a parafunction. Delayed diagnosis of a parafunction may result in persistence of the jaw pain or a problem with the temporomandibular joint (TMJ).

Jaw pain, headaches, neck pain, and other symptoms often are what triggers a person to seek help. They may not understand how grinding their teeth while sleeping puts stress on the jaw muscles, joints, and teeth and may also lead to headaches and neck pain. A Parafunction Risk Assessment is a simple validated questionnaire that helps identify the possible risk of parafunctional habits. Without early diagnosis and treatment it may lead to locked jaw, or jaw muscle strain, and tension triggered headaches.

Bruxism Parafunction Risk Assessment Process

Your Functional Risk Assessment typically includes the following:

• Discuss your teeth clenching behavior together starting with what you are aware of if there are grind marks on your teeth, cheek and tongue ridging from jaw bracing or tongue thrust.
• Conduct a jaw muscle and joint examination to determine if there is significant TMD and orofacial pain, and bruxism symptoms.
• Assessment of bruxism factors behind the initial and/or ongoing muscle tension (see list above).
• If your assessment signals the need for a training program, health coaching, a jaw stabilizing device, or additional testing, or other treatment, it will be addressed.
• Follow up visits will determine if bruxism.
• Adjust your bruxism treatment plan as appropriate for additional jaw parafunction improvements.

How do I Change my Unconscious Bruxism Inducing Habits?

 

Learning to change bruxism habits involves three steps:

1. Readiness to learn, awareness of the old habit.
2. Gaining knowledge about the new habit (what to do).
3. Practice of the new habit of relaxing the jaw, gentle jaw stretching and avoid touching the upper and lower teeth together.

The first of these, readiness to learn, you’ve already completed this step or you would not typically be here. The importance of the new habit will be reviewed with you by the behavioral therapist/psychologist and/or the physical therapist. Please ask questions to get answers from any team member helping resolve the development of bruxism.

Learn what to do by acknowledging new habits that you need to learn involves how to relax the facial muscles, joints, and tongue. The correct (relaxed) jaw position is TONGUE UP, TEETH APART, JAW DROPPED AND RELAXED like a hammock hanging relaxed between the joints. Check for correct head and neck posture as well. Also, you may add a deep breath or two if this helps with general relaxation. If you are used to holding the tongue, teeth, and jaw muscles in a different position, learning a new habit may be challenging. Your personal education and follow-through may prevent a pending for additional pain disorder.

The third step, practicing new habits to help reduce bruxism, is often the most difficult. We would like you to practice the new habit 2-3 times per hour. We understand that this is easier said than done. The team members will work with you to help you find a way to build the practice into your daily routine. The new habit takes only 10-15 seconds to practice; the challenge is to practice often. For every minute you are relaxing the jaw in the TONGUE UP, TEETH APART, JAW DROPPED AND RELAXED position, this is a minute that you are not engaging in any of the incorrect oral habits listed above. In essence, this practice involves a muscle relaxation exercise specific to the jaw, head, and neck. At the same time, your awareness of incorrect oral habits will increase and you will soon find yourself automatically “correcting” and relaxing when you notice muscle tightening habits.

The above table is from an Oral Behavior Checklist (OBC) for four questions concerning grinding, clenching, tooth contact, and mandible bracing at the Assessment and Questionnaire for Assessing the Frequency of Waking-Time Non-Functional Oral Behaviors from the Journal of Clinical Medicine.

Other contributing risk factors for bruxism

Many other physical factors may contribute (directly or indirectly) to your pain, including sleep habits, dietary habits, use of caffeine, alcohol, medications, exercise habits, and stress. Take good care of your body. It appreciates regularity (e.g., eating and sleeping at about the same time each day). When you take care of yourself generally, your body improves in its ability to resist the stresses and challenges of everyday living.

Reducing stress and bruxism habits

Stress does not cause pain directly but increases poor habits that strain the muscles and joints of the jaw and neck. Stress may make it more difficult to tolerate pain and may affect your motivation or ability to follow through with muscle rehabilitation, relaxation, and other recommendations for healthier living. People engage in poor habits more when under stress. Please discuss this with members of the team. Learn general relaxation exercises and using alternative ways to deal with life’s challenges. It is most important that all possible contributors to your physical problem are addressed. Then you can have the best treatment result in the near future (3-6 months) as well as good long-term pain maintenance of relaxed and healthy muscles.

Embrace Realistic Expectations Once Bruxism Treatment Begins

In the field of oral parafunctions, it is important to set the right expectations for treatment and recovery.

1. It is better to use conservation bruxing treatment methods such as physical therapy, versus a reliance on medications and/or surgery to fix your jaw pain problems.
2. It requires a strong commitment on your part in your overall and self-care health.
3. Understand that you may need more than a quick fix.
4. Be prepared to make some lifestyle changes such as jaw clenching habits, biting your fingernails, poor posture corrections.

“TMDs are a group of conditions that cause pain and dysfunction of the masticatory muscles, the temporomandibular joints (TMJs) and associated structures. The most common features of TMD are regional pain, limited jaw movements and acoustic sounds from TMJs during mandibular motions. TMD patients often report that symptoms increase during stressful situations.

Both TMD and bruxism are prevalent in the adult general population, with more than 50% of the population presenting signs of TMDs.” – Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era, NIH, February 2022 ^[2]

 

If you find yourself with clenching or grinding your teeth and related jaw pain, headache symptoms, neck pain, facial pain, dental pain, jaw functioning issues, and related issues, contact us for treatment.

Schedule your Bruxism Parafunction Risk Assessment with our Minnesota orofacial pain specialists.

 

About the Author

James Fricton DDS, MS is a leading pain specialist at the Minnesota Head and Neck Pain Clinic, Chair of the Specialty Committee for the AAOP, and University of Minnesota Professor Emeritus References

[1] https://www.washingtonpost.com/health/2022/06/20/grinding-teeth-sleep-symptoms-treatments/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837112/