How to Stop Grinding Your Teeth

OOne morning around the sixth week of the COVID-19 lockdown, I woke up to find I’d gnashed a molar-sized crack in the back of my night guard, the device I wear to keep my teeth from grinding to protect that I make in my sleep . I had worn the acrylic barrier nightly with minimal erosion for years, but suddenly I had gnawed through it. Like many Americans who have wondered in recent years where the stress and anxiety building up in their bodies could possibly be going, turns out the answer was my mouth.

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 violent teeth grinding and clenching. While bruxism is fairly common, with pre-pandemic data suggesting up to 31% of adults were chronic chompers to some degree, some major clinics were seeing nearly three times the usual number of bruxists when lockdowns began. Some experts say the rise is still going strong. “My patients who had mild pain and bruxism got worse, and people I’d never seen it in before were now in severe pain,” says Mark Drangsholt, chair of the department of oral medicine at the University of Dentistry School of Dentistry washington .

Most people with bruxism grind their sleep, and those without symptoms may not even know they are doing it. Although experts often distinguish between that nighttime pounding, known as sleep bruxism, and daytime grinding (waking bruxism), in many individual cases, a mix of patterns and behaviors blur the lines between the two.

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Bruxism doesn’t always cause pain, but when it does, it can be serious. Certain patterns (especially sustained clenching) can lead to chronic pain in the jaw joints — TMJ for short — which are located on each side of your face near the ear. Often likened to hinges, these joints allow the jaw to move away from the rest of the skull and are directly stressed by bruxism. People who grind their teeth frequently can have TMJ problems that include clicking or pain when eating, general sensitivity, and even lockjaw.

Then there’s the danger to your teeth themselves. Aside from the short amount of time we spend eating, “teeth don’t really come together during the day,” says Drangsholt. Even an hour of grinding at work is a huge amount of extra wear and tear that can put you at risk for cracked or worn teeth.

Bruxism doesn’t become more dangerous until you jump into bed. Ever seen those videos of hippos eating whole watermelons like they’re blueberries? This is basically the unconscious superpower of humans. When we’re deep in REM sleep, says Drangsholt, We are able to exert three times the force with our bite than we could ever consciously exert.

Bruxism has always been closely linked to anxiety in dentistry, and recent studies have begun to corroborate the stories clinics have been telling about the pandemic boom. A small article published in 2021 looking at Turkish healthcare workers found that about a third of those with no history of bruxism developed symptoms in the early months of the pandemic. Another study looking at Google search trends worldwide found a notable increase in searches for bruxism, teeth grinding, and teeth clenching between May 2020 and October 2020 compared to similar periods from 2016 to 2019.

Some psychoactive medications can also affect bruxism. Antidepressants like SSRIs and SNRIs can trigger the onset of bruxism within a month of use, and is one of the first things he asks new patients about when assessing their symptoms, according to Drangsholt. Most people who take antidepressants don’t develop bruxism, but “it seems like there is a relationship in some people,” he says. “That’s something we’re looking at pretty closely, because if you can switch or change your dosage, that can help.” Although antidepressant re-prescribing rates in the United States fell in the early months of the pandemic, overall numbers over the past few years suggest to a steady increase in new prescriptions.

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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 still-rising number of bruxism cases she’s seen. “COVID – it was crazy,” she says. For years, adults and children have been more confined to their homes during the day: staring at tiny screens, working from sofas and in bed, and changing their daytime posture habits in ways that can lead to more clenching. “You hold your face differently,” she says. “You’re constantly leaning forward now and your jaw isn’t aligned properly and you can start clenching. It makes you a little more tense, and when you clench with your temporalis muscle and masseter muscle, you get a headache.”

The effects of stress, she adds, can be enormous. “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 only one supporting his family; His parents had both been released.” Schultz-Robins says she has seen children as young as 6 with pain caused by excessive grinding.

This intense psychological connection can sometimes complicate the management of temporomandibular joint disorders (TMD). Something as simple as tweaking medication dosage to improve symptoms requires communication and coordination between psychiatrists and orofacial pain specialists, two specialties that don’t usually work together much. However, successful treatment of TMD and bruxism varies from case to case, and combinations of approaches can be of great benefit in relieving symptoms, says Drangsholt.

On the psychological side, techniques like mindfulness, cognitive behavioral therapy, and other best practices for relieving anxiety can have an impact on bruxism behaviors and TMJ pain and are more accessible than ever thanks to online therapy options. Still, treatment should always begin with an orofacial pain expert, says Schultz-Robins. A specialist may offer other physical treatment options, such as: These include mouth exercises, night splints that prevent your upper and lower teeth from touching, and even regular injection therapy of anesthetics for severe pain.

“The treatment that’s really jumped in usage lately has been neurotoxin or botox,” says Drangsholt. Although it’s a more expensive treatment reserved for the most severe cases, regular Botox injections every three or four months can make a world of difference for some grinders. “They don’t break the appliances and they don’t have any of the tooth fractures,” says Drangsholt. “We are able to reversibly decrease the volume of their muscles.”

As Schultz-Robins puts it, “Does your jaw feel like you’ve had a party in your mouth all night? Do you have a headache when you wake up?” These are signs that it might be a good idea to see a professional – one from the directory available on the American Academy of Orofacial Pain website.

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