A good night’s sleep is something that 10-year-old Sahil Shetty can only dream of. The primary school student from Mumbai clenches his jaws and grinds his teeth at night. He wakes to drowsy days with jaw pain. His mother says that he is diagnosed with bruxism.
What is bruxism?
According to the Australia-based Sleep Health Foundation, bruxism is the habit of clenching teeth. Frequent teeth grinding can wear down the tooth enamel which is the outer layer that covers and protects each tooth.
Teeth grinding is not only the grinding of the teeth at night but also the unconscious grinding of the teeth when one is awake, says Dr Suchitra Mohan, consultant prosthodontist and implantologist, Apollo Speciality Hospital, Vanagaram, Tamil Nadu. “Sleep-related disorders such as sleep apnea and at times snoring can occur as a result of bruxism,” she says.
Experts also say that teeth grinding can occur in all age groups. “Over a period, this can cause jaw pain, and therefore affect an individual’s sleep because of this pain. The TMJ pain (temporomandibular joint – the connection between the skull and the lower jaw) and sensitivity of teeth can occur because of reduction in the tooth height and exposure of inner layers of the tooth,” says Dr Haziel Jenifer, associate professor, department of periodontology, Yenepoya Dental College, Mangaluru.
What causes teeth grinding?
Sathwik Varadraj (26), a dentist from Mangaluru, believes it is exam stress that caused his condition. He recalls that he used to experience bruxism only during examinations. “My episodes with teeth grinding were observed only during my final exams and it used to go away when the exams were done.”
“Stress, tension, frustration or anxiety can cause awake bruxism [clenching your teeth even when you are awake]. Sleep apnea can cause sleep bruxism,” says Dr Mohan.
Teeth grinding while sleeping
“Teeth grinding at night happens when we experience ‘micro-arousals’ wherein our nervous system is activated during the night. It can also occur because of lifestyle factors like caffeine and alcohol consumption, and it has been linked to certain medications as well. But two of the strongest predictors of teeth grinding are anxiety and stress. In fact, we saw a significant increase in teeth grinding during the pandemic, as people’s stress levels increased. And, because it is linked to disrupted sleep, if you are grinding your teeth at night, you are also more likely to experience other sleep disorders like sleepwalking and sleep apnea,” says Dr Nicola Cann, sleep psychologist, Singapore Psychological Society, Singapore.
“If teeth grinding occurs during sleep, it might go unnoticed. Sometimes people who sleep in the same room are the ones who address this issue by informing the individual about this habit,” points out Dr Mohan.
Signs of bruxism
- Attrition, a condition when the teeth are chipped, flattened or short.
- Deeper layers of the teeth are exposed due to wearing out of tooth enamel leading to tooth pain or sensitivity.
- Soreness of the jaw and pain while closing or opening the mouth.
- Earache and headache.
- Sleep disturbance.
Being aware that you are developing a habit of teeth grinding itself can be the first step to overcoming this condition. Dr Cann says, “If you have experienced a stressful event or have started a new medication, teeth grinding might be temporary.” But Dr Cann says that if the teeth grinding persists there are a few things one can do to address it.
- Mouth guard for teeth grinding: This is a non-surgical method used to separate teeth to avoid tooth damage. This guard is customised to fit the lower or upper teeth.
- If teeth grinding leads to difficulty in chewing, the tooth surface is reshaped by filing the tooth or placing a crown on the tooth.
- Stress management or anxiety management strategies such as counselling and meditation will help.
- In severe conditions muscle relaxants are prescribed for a short duration to avoid jaw pain.
- If teeth grinding is due to physical factors such as sleep apnea, then it should be treated to improve sleep bruxism.
Teeth grinding in children
According to experts, finding the root cause of teeth grinding/clenching in children is essential.
Dr Kaneez Fatima Merchant, consultant clinical child psychologist, Mumbai, says that teeth grinding could be because of anxiety or fear. “Other symptoms appear along with teeth grinding, such as bed-wetting, fevers at night and disturbance in sleep. But not all cases of teeth grinding are psychological. The root cause of teeth grinding is found by several sessions of counselling,” she adds.
Therapies such as ‘play therapy’ (engaging kids with toys) are conducted to resolve these symptoms. It is important to provide counselling to parents as well, to help the child sleep better, says Dr Merchant.
When to consult a doctor
Being aware of bruxism but not being able to control it, is a sign to reach out to the doctor for help, say experts.
“If you are looking after yourself but you are still grinding your teeth, it is stress related, and it could be time to contact a psychologist. They can help you to manage your stress better, which should fix the teeth grinding. In the meantime, you can also talk to your dentist about mouth guards, which can protect your teeth against wear from long-term teeth grinding,” says Dr Cann.
Bruxism is the habit of clenching teeth and it causes shortening of the teeth or ‘attrition’ leading to tooth pain, jaw pain, sensitivity, sleep disturbance, earache and headache. Bruxism can be managed by using a mouth guard and muscle relaxants. If the cause is psychological, stress management can help manage bruxism. Importantly sleep hygiene should be followed.