Clenching Teeth (Bruxism)

By Preetanjali Thakur, BDS, MS

Teeth clenching, jaw clenching or bruxism, is a common issue affecting many people and can happen at day or night.

Bruxism has historically referred to grinding or clenching of teeth particularly but not exclusively during sleep. However, a spectrum of sleep and waking behaviors clearly exist which can range from high force grinding of teeth to low levels of tension in the jaw without teeth contact. People with severe TMD pain intensity report significantly higher frequency of oral behaviors such as clenching teeth, and higher levels of anxiety and stress compared to others with only mild TMJ pain. Therefore, this article will address how to stop clenching teeth with a professional diagnosis and treatment. It involves identifying the underlying cause and then implementing the appropriate treatment options.

Table of Contents

• Clenching Teeth (Bruxism)
• What Does Clenching of Teeth Mean?
• What are the Risks of Untreated Teeth Clenching?
• Causes of Teeth Clenching
• When Does Clenching Become a Disorder?
• What are Symptoms of Clenching Teeth?
• Clenching Teeth Diagnosis
• Clenching Teeth Treatment Options
• The Importance of Seeking Help for Clenching Teeth

Accurate diagnosis may become a significant problem given that some people with oral behaviors may have jaw pain and headaches. It was seen in the Association between Temporomandibular Disorders Pain, Oral Behaviors, Anxiety and Stress study that people with severe TMD pain reported significantly higher frequency of oral behaviors such as clenching teeth, compared to people who reported mild TMJ pain. ^[1]

What Does Clenching of Teeth Mean?

Clenching teeth like “teeth clenching,” or “bruxism,” refers to an abnormal clenching or grinding of the teeth. It is a common issue affecting many people both during the day and at night. which serves no functional goal. Daytime bruxism is part of a larger set of overuse behaviors which occurs during waking hours and is also known as waking oral para function. Sleep bruxism on the contrary involves rhythmic contractions and activities of masticatory muscles which happen during sleep. Waking oral behaviors may include tooth to tooth contact, thrusting of the jaw, gum chewing, object biting and tongue thrusting among others.

1. Daytime Bruxism: Affects approximately 20% of the adult population.
2. Sleep Bruxism (Nocturnal Bruxism): Affects approximately 8% of the adult population. ^[2]

Next, lets answer the important question about probably risks of untreated teeth clenching.

What are the Risks of Untreated Teeth Clenching?

A patient can be facing multiple risks of if their teeth clenching and negative oral behaviors go untreated.

Clenching of teeth may produce higher forces on teeth. This may lead to abnormal teeth wear, tooth pain, gum recession, tooth fracture, implant failure and caused disrupted sleep. Studies are also suggestive of higher risk correlation between bruxism and TMD pain. The mechanical loading of the masticatory system may also include changes in the TM joints including wear and tear of the joints also known as arthritis, jaw joint pain and even contribute to tinnitus or ear ringing. There is conflicting, limited evidence of temporal headaches to be consequences of sleep bruxism regardless of long-term association of these factors. ^[3] In a study, 66.7% of patients attributed their TMD pain to sleep bruxism, while 53.8% identified awake bruxism as a contributing factor. Higher frequency of oral behaviors was reported to be clinically significant with higher levels of TMD pain compared to those with the lowest frequency of oral behaviors. ^[4]

Causes of Teeth Clenching

The exact causes of bruxism are often unknown, but several factors can contribute to these oral behaviors. It is also important to note that the contributing factors for daytime clenching and sleep bruxism may be different, however psychosocial factors are generally related with both day and nighttime behaviors.

Common causes of teeth clenching :

• Brain Activity: Evidence supports that sleep bruxism maybe a central nervous system phenomena.
• Anxiety & Depression: Common co-morbid conditions in individuals with both awake and sleep bruxism are greater levels of anxiety, depression, higher general distress, alcohol or tobacco use and heavy caffeine consumption.
• Stress: Greater level of stress hormones are also reported in patients compared to healthy group.
• Sudden Episode of Sleep or Drowsiness: Sleep-related micro-arousals are believed to be a factor in sleep bruxism, requiring further research. However, it is common to see sleep Bruxas having other sleep disorders as well.
• Sleep apnea (OSA) and sleep bruxism (SB): They are known to co-occur. The relationship between OSA and SB can depend on the degree of severity of OSA. OSA is correlated with SB in mild and moderate cases of OSA in the group of patients with increased risk of OSA. ^[5]
• Unawareness of Restful Jaw Position: There is evidence that oral parafunctional behaviors like clenching of teeth which happens early in life is a strong predictor for the same respective behaviors later in life.
• Movement Disorder: These behaviors can also occur in association with a movement disorder like idiopathic oral mandibular dystonia involving involuntary jaw movements. ^[6]
• Medication Side-Effects: Certain medications can contribute to bruxism as a side effect probably not as an ideology but as a drug interaction with other substances. Generally, there are insufficient evidence‐based data to draw definite conclusions concerning medications and addictive substances.

When Does Clenching Become a Disorder?

This behavior (uncontrollable) is often diagnosed as a “disorder” when clenching significantly impacts daily life due to negative consequences and distress.

Jaw clenching transitions from a common behavior to a disorder when it leads to negative consequences such as:

• Tooth Damage: You may first notice enamel wear; if left unattended to, it may even cause facial appearance changes.
• Failed Restorations (Fillings, Crowns): Teeth clenching and grinding can cause dental restorations to fail when it occurs regularly and over time.
• Periodontal Ligament Strain: This can occur when there is a lot of pressure on the structures that support your teeth.
• Gingival Recession (Gum Recession): The pressure from clenching can not only irritate and inflame the ligaments; it can eventually lead to gum recession.
• Jaw Pain and TMJ Issues: High-stress levels that trigger jaw clenching can lead to muscle tension, causing teeth grinding, which in turn strains the TMJ and leads to further complications.
• Headaches: Clenching and grinding your teeth can create trigger points, which are hyper-irritable spots in your muscles that may trigger tension headaches.
• Muscle Hypertrophy (Enlarged Jaw Muscles): Extended clenching can cause jaw muscles to enlarge by causing inflammation and swelling.

Professional help is necessary at this point and to avoid these consequences.

What are Symptoms of Clenching Teeth?

Signs or symptoms that may be suggestive of tooth clenching/sleep bruxism issues include:

• Repeat morning jaw pain.
• Jaw fatigue or stiffness.
• Clicking or popping sound in jaw joints.
• Substantial tooth wear.
• Enlarged jaw muscles.
• Worsening symptoms.

While people can clench or grind their teeth without developing TMJ disorders, prolonged clenching can cause degenerative changes in the jaw joint. This is why you need a professional diagnosis without delay.

Clenching Teeth Diagnosis

Seek professional help from an orofacial pain specialist if you suspect you’re clenching your teeth.

An orofacial pain specialist can:

• Initial examination: Examine your teeth and jaw, discuss your symptoms, and put forward a jaw pain treatment plan.
• Recommend tests or imaging (if necessary): They may suggest additional tests or imaging to determine the extent of the issue.
• Differentiate between awake and sleep bruxism: A clinical evaluation helps to differentiate between awake bruxism and sleep bruxism and to understand the etiology and contributing factors. At times a sleep study like a polysomnography or home sleep study may be helpful, especially when sleep comorbidities are present.
• Identify underlying causes and contributing factors: Secondary factors for jaw clenching may also include a medical disorder or medication side-effect.

Further testing, such as a sleep study (polysomnography or home sleep study), may be recommended, especially when sleep comorbidities are present. The Minnesota Head & Neck Pain Clinic aligns with Alessandro Bracci’s conclusion that awake bruxism (AB) extraoral clinical examinations should include inspection to identify the signs and symptoms possibly related with bruxism. This evaluation also assesses the jaw muscles (e.g., evident muscle hypertrophy), the TMJ (e.g., presence of TMJ noises suggestive of disc displacement or joint degeneration), and functional symptoms (e.g., difficulty opening the mouth wide). Moreover, there are multiple psychosocial factors which are clearly associated with both sleep and awake bruxism.

“Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies.” – Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations

 

Clenching Teeth Treatment Options

 

Treatment for bruxism often involves a combination of approaches:

• Counseling and Stress Management: Coping mechanisms, and awareness of jaw and tongue positioning in the oral cavity is often recommended as the initial step, as well as counseling on stress reduction.
• Sleep Hygiene Improvements: Addressing sleep habits and incorporating relaxation techniques.
• Occlusal Splints (Mouth Guards): Occlusal splints can effectively prevent dental damage and the grinding sounds associated with sleep bruxism. They also help reduce TMJ loading and muscle tension in individuals experiencing muscle pain or morning headaches.
• Muscle Relaxants: Medications may be prescribed in some cases to provide additional relief and reduce muscle pain.
• Physical Therapy: Can help improve jaw function and reduce pain.
• Botulinum Toxin Injections: Severe secondary bruxism that interferes with speaking, chewing, or swallowing has been observed in patients with neurological disorders, such as idiopathic oromandibular dystonia. For these patients, injections of botulinum toxin into the masticatory muscles can reduce bruxism for 1–3 months and improve pain and mandibular function.

Other considerations for clenching treatment

Orthodontic Treatment: There is limited evidence supporting the role of occlusal factors in the etiology of sleep bruxism, which means that orthodontic treatment is not an evidence-based approach for addressing clenching and bruxism. Genetic and Airway Factors: The potential roles of hereditary (genetic) factors and upper airway resistance in the development of rhythmic masticatory muscle activity and sleep bruxism are currently under investigation. Lifestyle Factors: Modern lifestyle, including work environment, diet, and habits, can significantly impact psycho-emotional well-being and contribute to bruxism. ^[7] The prevalence of bruxism appears to be increasing, likely due to the stresses of modern life. If you experience persistent jaw pain, frequent headaches, or notice tooth wear, consult your dentist or healthcare provider. By understanding the causes and effects of teeth clenching and taking proactive measures to address it, you can protect your oral health and enhance your overall well-being. ^[8]

The Importance of Seeking Help for Clenching Teeth

At Minnesota head and neck pain clinic we take a holistic approach to understand our patients and address contributing factors which can contribute to increased distress and dysfunctaion on a daily basis. As the evidence for sleep bruxism and daytime bruxism is incomplete, we try to draw interpretation from maximum evidence we have. Therefore, management of symptomatic awake and sleep bruxism may have to be made in collaboration with a team of providers including but not limited to orofacial pain specialists, clinical health psychologist, neurologist, sleep medicine specialists, psychiatrist, physical therapists among others.

It’s easy to get help from one of our MN Head & Neck Clinic locations. Stop Clenching Teeth Now!

 

• Plymouth: (763) 577-2484
• St. Paul: (651) 332-7474
• Burnsville: (952) 892-6222
• St. Cloud: 763-233-7252

 

About the author

Preetanjali Thakur, BDS, MS has a Masters in Dental Science and extensive experience that supports her expertise in chronic pain disorder treatments including TMJ, dry needling techniques, trigger point injections, and Botox treatment.   Resources: [1] Preetanjali Thakur, “Association between Temporomandibular Disorders Pain, Oral Behaviors, Anxiety and Stress,” University of Minnesota Digital Conservancy, 2019, https://hdl.handle.net/11299/202896 [2] Sona J. Lal, et al, “Bruxism Management,” May 2024, https://www.ncbi.nlm.nih.gov/books/NBK482466/ [3] Brigitte Ohlmann, et al, “Correlations between Sleep Bruxism and Temporomandibular Disorders,” Feb 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074179/ [4] Nawal Alketbi, et al, “Prevalence and characteristics of referred pain in patients diagnosed with temporomandibular disorders according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD),” Sept 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490275/ [5]Helena Martynowicz, et al., “The Relationship between Sleep Bruxism and Obstructive Sleep Apnea Based on Polysomnographic Findings”, Oct 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832407/ [6] Saeed Raoofi, et al., “Diagnosis and Management of Oromandibular Dystonia: an Update for Stomatologists”, June 2017 https://pubmed.ncbi.nlm.nih.gov/28620630/ [7] Eduardo Castrillon, et al., “Sleep Bruxism and Pain”, Oct 2018, https://www.sciencedirect.com/science/article/abs/pii/S0011853218300508 [8] Alessandro Bracci, et al, “Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations,” Aug 2022, J Clin Med, https://www.mdpi.com/2077-0383/11/17/5083