Tooth clenching & grinding. Is this you ?

By Dr George Druttman

Tooth clenching and grinding are two separate habits, although many associate both with stress. The clenching is a daytime habit and generally is conscious. That means patients finding themselves clenching, can stop (unclench). This is usually the result of someone feeling angry, impatient or frustrated.

The grinding (known as bruxism or bruxing) is a nighttime habit and generally, the individual is not aware of doing it while they are doing it (at night). Frequently it does create quite a loud ‘grating’ sound and, consequently, a sleeping partner can be kept awake /woken up by hearing this.

The cause of bruxing is quite likely to be of the individual having a ‘genetic predisposition’ (one or other parent may well be a grinder as well). The actual activity may then be triggered by a number of factors, the commonest being some form of lifetime stress. However, other local factors such as an unbalanced dental bite can also often be trigger mechanisms or tooth clenching and grinding.

Signs and Symptoms

Tooth clenching as such is unlikely to cause any significant problems as there is no ‘movement’ of teeth against each other nor is it likely to result in TM Joint issues.

Bruxing, on the other hand, certainly can and often does cause one or more of the following:

Signs

• Well developed (hypertrophic) ‘chewing ‘ cheek muscles can be very evident as ‘bulges’ at the sides of the lower half of the face.
• Excessive tooth wear and loss of vertical height of the teeth. The teeth can look short and stubby.
• The fracturing of tooth enamel, usually seen as chipped biting edges or even vertical ‘ micro-fracture’ lines in tooth enamel surfaces.
• An early ‘giveaway sign’ is the flattening, obvious wear of the ‘tips’ of (particularly) the upper canine teeth
• Ultimately the biting edges of all the upper front teeth become straight and in one line. They shouldn’t be. The 1^st incisors should be marginally longer than the 2^nd ones and the canines should be about the same length as the 1^st incisors. The edges of the lower front teeth also wear down and can ‘chip’.

Symptoms

Patients may observe or complain of one or more of the following:

• Waking up in the morning with tired and aching jaw muscles.
• Hypersensitivity of teeth particularly to hot/cold temperature changes.
• Headaches, particularly in the forehead area.
• Tenderness in the jaw muscles (often the lateral pterygoids).
• Tenderness in the area of the jaw joints.

What are the symptoms and signs to check and consider?

• Do your jaw muscles ever ache and particularly do you feel they are ever uncomfortable in the morning after waking?
• Do your jaw joints ever hurt?
• Do you get headaches?
• Have you noticed that your front teeth are getting smaller, wearing down or chipping at the edge

If so, do you feel that stress makes any of these symptoms worse?

• Check in the mirror
• Do the chewing muscles just above the jaw angles seem very strong and even slightly ‘bulging’ ?
• Short upper and lower front teeth that often have chipped biting edges?
• The biting edges of the upper front six teeth that are in a flat straight line with sharp corners.

If it looks as if tooth clenching and grinding is any sort of issue – are you aware of this? If so, is it because you know you grind; you have been told by a sleeping partner or you have been informed by a dentist?  If it is the latter, were you given treatment or any advice? Do you or have you been advised to wear a plastic night time grinding splint (can fit either upper or lower teeth)?

In conclusion, if you have any signs or symptoms that you are not aware are caused by this habit,  or you have had treatment or were given advice by the regular dentist that has not been effective, you should seek further professional dental advice, possibly from a specialist Prosthodontist  (i.e. reconstructive dental specialist).