Should I be wearing a guard?

Grinding and clenching of teeth has become a very common problem. While some patients are aware of their grinding and clenching, and may wake up with sore teeth, jaw muscles, or headaches, many patients are unaware of the damage that is happing to their teeth and jaws while they sleep.

During your periodic dental exams, your dentist will likely check for signs of bruxism. But if you suspect you may be grinding or clenching, be sure to mention it to you dentist.

Evaluation

Your dentist will look for changes in your teeth and evaluate your mouth over your next visits to see if the process is progressive and to determine if you need treatment.

Determining the cause

If your dentist suspects you have bruxism, they will try to determine the cause by asking questions about your general dental health, medications, daily routines and sleep habits.

To evaluate the extent of bruxism, your dentist may check for:

• Tension or tenderness in your jaw muscles

• Dental abnormalities, such as missing or fractured teeth

• Other wear or damage to teeth, the underlying bone, and the inside of your cheeks, usually with the help of X-rays

A dental exam may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint (TMJ) disorders, other dental problems or health conditions.

Referral

If bruxism appears to be related to major sleep issues, your dentist may recommend a sleep medicine evaluation. A sleep medicine specialist provides more tests, such as a sleep study that will evaluate for teeth grinding and determine if you have sleep apnea or other sleep disorders.

Treatment

For mild to moderate bruxism, having an appliance can help protect your teeth and improve the stability of your bone and muscles. If bruxism is severe, options include certain dental approaches, therapies and medications to prevent more tooth damage and relieve jaw pain or discomfort.

Although these methods may prevent or correct the wear to your teeth, they may not stop the bruxism:

• Splints and Night/day guards: These are designed to keep teeth separated to avoid the damage caused by clenching and grinding. They can be made of hard acrylic or soft materials and fit over your upper and/or lower teeth.

• Dental correction. In some cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to reshape the chewing surfaces of your teeth or use crowns to repair the damage.

Other approaches

One or more of these approaches may help relieve bruxism:

• Stress or anxiety management. If you grind your teeth because of stress, you may be able to prevent the problem by learning strategies that promote relaxation, such as meditation. If the bruxism is related to anxiety, advice from a licensed therapist or counselor may help.

• Behavior change. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Ask your dentist to show you the best position for your mouth and jaw.

• Biofeedback. If you're having a hard time changing your habits, you may benefit from biofeedback, a method that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw.

Medications

In general, medications aren't very effective for treatment of bruxism, and more research is needed to determine their effectiveness. Examples of medications that may be used for bruxism include:

• Muscle relaxants. In some cases, your doctor may suggest taking a muscle relaxant before bedtime, for a short period of time.

• Injections. Injections may help some people with severe bruxism who don't respond to other treatments.

• Medication for anxiety or stress. Your doctor may recommend short-term use of antidepressants or anti-anxiety medications to help you deal with stress or other emotional issues that may be causing your bruxism.

Treating associated disorders

Treatment for associated disorders may include:

• Medications. If you develop bruxism as a side effect of a drug, your doctor may change your medication or prescribe a different one.

• Sleep-related disorders. Addressing sleep-related disorders such as sleep apnea may improve sleep bruxism.

Self-care steps may help treat bruxism:

Reduce stress: Taking a relaxing warm bath, exercising, or listening to soothing music can help you relax and may reduce your risk of bruxism.

Avoid stimulating substances in the evening: Don't drink caffeinated drinks after dinner and avoid alcohol during the evening, as they may worsen bruxism.

Good sleep habits: A good night's sleep, which may include treatment for sleep problems, may help reduce bruxism.

Talk to your sleep partner: If you have a sleeping partner, ask them to pay attention to any grinding or clicking sounds that you might make while sleeping so you can report this to your dentist or doctor.

Regular dental exams: Dental exams are the best way to identify bruxism. A dentist can find signs of bruxism in your mouth and jaw during periodic visits and exams.

Preparing for your appointment

Start by seeing your dentist or your primary care doctor. In some cases, you may be referred to a sleep medicine specialist.

Prepare for your appointment by making a list of:

• Medical history; for instance, past bruxism-related problems and information on any medical conditions.

• Symptoms you're experiencing, including issues that seem unrelated to the reason for the appointment. If you experience pain, make a note of when it occurs, such as when you wake up or at the end of the day.

• Key personal information, including any major stresses or recent life changes.

• All medications, including over-the-counter medications, vitamins, herbs or other supplements, you're taking and the dosages. Let your doctor know about anything you've taken to help you sleep.

Questions to ask your dentist or doctor

• What's could be causing my symptoms?

• What are other possible causes?

• What tests do I need?

• Could my condition be temporary or long term?

• What are the best treatments?

• What are the alternatives to the approach suggested?

• My other health conditions. How can I manage them together?

• Is seeing a specialist appropriate?

• Is there any informational material that I can have?

What to expect at your doctor visit

Be prepared to answer questions from your doctor so can focus on the issues of concern. Some questions may include:

• When did your symptoms first begin?

• Have symptoms been occasional or continuous?

• How severe are the symptoms?

• What, if anything, improves your symptoms?

• What, if anything, worsens your symptoms?

While grinding and clenching can be bothersome and concerning, there are many ways to manage this issue and protect you oral and overall health.