Bruxism is the term that refers to an incessant and unintentional grinding and clenching of the teeth. Persons with bruxism are called bruxers. They are often unaware that they have developed this habit. 

Bruxism may be mild and may not even require treatment. However, it can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems. While bruxism may be a diurnal or nocturnal activity, it is bruxism during sleep that causes the majority of health issues and can even occur during short naps. It is one of the most common sleep disorders. People who have sleep bruxism may be unaware of it until complications develop. For this reason, it is important to know the signs and symptoms of teeth grinding and to seek regular dental care.  

According to Medilexicon's medical dictionary:

Bruxism is a clenching of the teeth, associated with forceful lateral or protrusive jaw movements, resulting in rubbing, gritting, or grinding together of the teeth, usually during sleep; sometimes a pathologic condition.

What are the signs and symptoms teeth grinding (bruxism)?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. 

Damage caused by bruxism often includes the following symptoms. However, each individual may experience symptoms differently. In many cases, a sleeping partner or parent will notice the bruxism before the person experiencing the problem becomes aware of it. Symptoms may include:

• a popping or clicking in the temporomandibular joint (TMJ)
• abraded teeth
• chronic facial pain
• damage to the tooth enamel, exposing the inside of the tooth (dentin)
• damage, chewed tissue to the inside of the cheek
• depression
• dislocation of the jaw
• earache, because of severe jaw muscle contractions, not related with the ear
• eating disorders
• enlarged jaw muscles
• facial pain
• headaches
• indentations on the tongue
• insomnia
• jaw pain
• oversensitive teeth
• teeth grinding or clenching, which may be loud enough to awaken sleep partner
• teeth that are worn down, flattened, fractured or chipped
tense facial and jaw muscles tongue indentations worn tooth enamel, exposing deeper layers of your tooth

The symptoms of bruxism may resemble other conditions or medical problems. Consult a dentist or physician for a diagnosis. 

Bruxism can result in abnormal wear patterns of the occlusal surface, abfractions and fractures in the teeth. This type of damage is categorized as a sign of occlusal trauma. Over time, dental damage will usually occur. Bruxism is the leading cause of occlusal trauma and a significant cause of tooth loss and gum recession. 

If you notice that your child is grinding his or her teeth or has other signs or symptoms of this condition - be sure to mention it at your child's next dental appointment.

What causes teeth grinding (bruxism)?

Doctors do not completely understand the causes of bruxism. Although this habit is unintentional, oral health specialists often point to excessive stress and certain personality types as typical causes of bruxism. 

Possible physical or psychological causes may include:

• Abnormal alignment of upper and lower teeth (malocclusion)
• Aggressive, competitive or hyperactive personality type
• Anxiety, stress or tension
• Changes that occur during sleep cycles
• Complication resulting from a disorder, such as Huntington's disease or Parkinson's disease
• Growth and development of the jaws and teeth (for children)
• Pain
• Persons with hurried tendencies
• Response to pain from an earache or teething (in children)
• Suppressed anger or frustration
• An uncommon side effect of some psychiatric medications, including certain antidepressants

What are the risk factors of teeth grinding (bruxism)?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetestype 2. Therefore, obesity is a risk factor for diabetes type 2. These factors increase the risk of bruxism:

• Stress. Increased anxiety or stress can lead to teeth grinding.
• Anger and frustration.
• Age. Bruxism is common in young children, but usually goes away by adolescence.

Associated factors: 

The following factors are associated with bruxism:

• Disorders such as Huntington's and Parkinson's diseases
• Disturbed sleep patterns and other sleep disorders (obstructive sleep apnea, hypopnea, snoring, moderate daytime sleepiness)
• Drug use, such as SSRIs and stimulants, including methylenedioxymethamphetamine (ecstasy), methylenedioxyamphetamine (MDA), methylphenidate and other amphetamines, including those taken for medical reasons
• GHB and similar GABA-inducing analogues such as Phenibut, when taken with high frequency
• High levels of anxiety, stress, work-related stress, irregular work shifts, stressful profession and inability to cope
• High levels of blood alcohol
• Hypersensitivity of the dopamine receptors in the brain
• Malocclusion, in which the upper and lower teeth occlude
• Obsessive Compulsive Disorder
• Relatively high levels of consumption of caffeinated drinks and foods, such as coffee, colas, and chocolate
• Smoking

What are the complications of teeth grinding (bruxism)?

In most cases, bruxism does not cause serious complications. 

However, severe bruxism may lead to:

• Damage to teeth (including restorations and crowns) or jaw
• Facial pain
• Tension-type headaches
• Temporomandibular disorders. This occurs in the temporomandibular joints (TMJs), located just in front of the ears and felt when opening and closing the mouth.

In severe, chronic cases, it can lead to arthritis of the temporomandibular joints. The jaw clenching that often accompanies bruxism can be an unconscious neuromuscular daytime activity, which should be treated as well, usually through physical therapy (recognition and stress response reduction).

How is teeth grinding (bruxism) diagnosed?

During regular visits to the dentist, the teeth are examined for evidence of bruxism. If symptoms are present, the condition will be observed for changes over the next several visits before a treatment program is established. 

Bruxism can sometimes be difficult to diagnose by visual evidence alone, as it is not the only cause of tooth wear. Over-vigorous brushing, abrasives in toothpaste, acidic soft drinks and abrasive foods can also be contributing factors, although each causes characteristic wear patterns that a trained professional can identify. 

Physical signs of bruxism, include:

• Continued breakdown of dental restorations, including loss of crowns
• The tips of the teeth appear flat
• Tooth fractures
• Tooth sensitivity
• Unusual wear and tear on teeth

If the dentist suspects that there is a case of bruxism, he or she will try to determine its cause by asking the patient about:

• General dental health
• Daily medications
• Whether patient routinely drinks alcohol or caffeinated beverages, especially during the evening
• Sleep habits, especially about any unusual grinding sounds heard by roommate or sleeping partner during the night

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

• Damage to teeth
• Damage to the underlying bone and the inside of the cheeks, usually with the help of X-rays
• Obvious dental abnormalities, such as broken or missing teeth or poor tooth alignment
• Tenderness in jaw muscles

A dental examination may detect other disorders that can cause similar jaw or ear pain, such as temporomandibular joint (TMJ) disorders, other dental disorders or an ear infection. 

If dentist suspects a significant psychological component to the patient's teeth grinding or a sleep-related disorder, there may be a referral referred to a therapist, counselor or sleep specialist. 

A reliable way to diagnose bruxism is through EMG (electromyographic) measurements. These measurements pick up electrical signals from the chewing muscles. This is the method used in sleep labs. Electrodes are adhesively attached to the user's face. The units can be purchased or rented from a dentist for home use.

What are the treatment options for teeth grinding (bruxism)?

There is no single accepted cure for bruxism. However, treatments are available. In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults do not grind or clench their teeth badly enough to require therapy. However, if the problem is severe, treatment options include certain therapies and medications. 

Specific treatment for bruxism will be determined based on:

• Patient's age, overall health, and medical history
• Extent of the disease
• Patient's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Patient's opinion or preference

In most cases, bruxism can be successfully treated. Treatment may involve:

• Stress management. If teeth grinding is caused by stress, the problem may be prevented with professional counseling or strategies that promote relaxation, such as exercise and meditation. If a child grinds his or her teeth because of tension or fear, it may help the child to talk about his or her fears just before bed or to relax with a warm bath or a favorite book.
• Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.
• Splints are usually constructed of hard acrylic and fit over the upper or lower teeth. Some dentists may make them right in the office, while others may send them to a laboratory to be made.
• Mouth guards are available over the counter and from dentists. A custom mouth guard can be made to fit your mouth. Mouth guards are less expensive than splints, but they generally do not fit well and can dislodge during teeth grinding. A dental guard is typically worn on a long-term basis during every night's sleep. Although mouth guards are a first response to bruxism, they do not in fact help cure it. Over the counter soft mouth guards, while very inexpensive, are not considered effective by dentists.
• Correcting misaligned teeth may help if bruxism seems to be associated with dental problems. In severe cases (when tooth wear has led to sensitivity or the inability to chew properly) there may be need to use overlays or crowns to entirely reshape the chewing surfaces of the teeth. Reconstructive treatment can be quite extensive and though it will correct the wear, it may not stop the bruxism.
• Behavior therapy or Behavior modification. Teaching the patient how to rest the tongue, teeth, and lips properly, and learning how to rest the tongue upward may relieve discomfort on the jaw while keeping the teeth apart and lips closed. Behavior can be changed by practicing proper mouth and jaw position.
• Biofeedback. It may be difficult to change habits. Biofeedback is a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach how to control involuntary body responses. 
  
  During a biofeedback session, electrical sensors are applied to different parts of the body. These sensors monitor the body's physiological responses to stress (such as teeth grinding) and then feed the information back to the patient via auditory and visual cues. This can be a beeping sound or a flashing light. With this feedback, the patient starts to associate teeth grinding or clenching with stress and learn to change the behavior. A portable biofeedback device may be given for at home use. 
  
  This is especially helpful for daytime bruxers. Further research is needed to develop a treatment program for bruxers who clench during the night.
• Medications In general, medications are not very effective for treatment of bruxism. In some cases, it may be suggested to take a muscle relaxant before bedtime. 
  
  If bruxism is developed as a side effect of an antidepressant medication, medication may be changed. 
  
  Botulinum toxin (Botox) injections may help some people with severe bruxism and who have not responded to other treatments. In extremely dilute form (Botox), this toxin is used as an injectable medication that weakens (partially paralyzes) muscles and has been used extensively in cosmetic procedures to relax the muscles of the face and decrease the appearance of wrinkles. The procedure involves about five or six simple, relatively painless injections into the masseter muscle. Some authorities caution that Botox should only be used for temporary relief for severe cases and should be followed by diagnosis and treatment to prevent future bruxism or jaw clenching, suggesting that prolonged use of Botox can lead to permanent damage to the jaw muscle.
• Dietary supplements. There is uncertain evidence that suggests taking certain combinations of dietary supplements may alleviate bruxism such as pantothenic acid, magnesium, and calcium. Calcium is known to be a treatment for gastric problems, and gastric problems such as acid reflux are known to increase bruxism.

Lifestyle and home remedies

Self-care steps may prevent or help treat bruxism:

• Reduce stress. Relaxing activities such as listening to music, taking a warm bath or exercising can help and may reduce the risk of developing bruxism.
• Talk to your sleep partner. If you have a roommate or bed partner, ask them to be aware of any grinding or clicking sounds that you might make while sleeping.
  
  Your sleep partner can then let you know if he or she notices any teeth-grinding sounds in the night.
• Schedule regular dental exams. Dental exams are the best way to screen against bruxism. A dentist can best spot signs of bruxism in the mouth and jaw with regular visits and examinations.