Grinding of teeth (bruxism)

and Sabine Schrör, medical journalist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

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When teeth grinding (bruxism), those affected involuntarily press their teeth against each other with great pressure (usually while sleeping). In this way, the enamel is rubbed off over time. The consequences are severe tooth damage and even tooth loss. In addition, there is often painful tension in the jaw muscles, which can lead to headaches, neck pain or facial pain. Read more about the causes, consequences and treatment options of teeth grinding here.

Brief overview

• Causes: Stress, misaligned teeth or jaws, crowns or fillings that are too large, too much alcohol or caffeine, certain medications, underlying diseases such as restless legs syndrome, nocturnal breathing pauses, circulatory disorders, cerebral hemorrhage, epilepsy, Huntington's disease, Parkinson's.
• Symptoms: rhythmic, involuntary clenching of the teeth, often with grinding, chewing-like movements. Mostly at night, but sometimes also during the day. Possible accompanying symptoms: muscle tension with pain in the head, neck, jaw and face. Pain-sensitive, porous teeth, severe tooth damage up to tooth loss.
• Treatment: depending on the cause, e.g. correction of large crowns or tooth fillings, bite splint, loosening and relaxation exercises for stress-related teeth grinding, physiotherapy and, if necessary, short-term use of painkillers and / or muscle-relaxing medication, psychotherapy for deeper psychological stressors, biofeedback procedures.
• Diagnosis: on the basis of typical signs such as pressure-sensitive chewing muscles, tooth impressions in the tongue / cheek, smoothly polished chewing surfaces, cracks / chipping off the tooth enamel, chipping off the hard tooth substance, the tooth necks and the incisal edges, teeth sensitive to pain.
• Prognosis: With early treatment, the prognosis is good. (Serious) consequential damage to the teeth can usually be avoided.

Grinding teeth: causes

The main causes of teeth grinding (bruxism) are:

• Stress: Every second person reacts to professional or private excessive demands with occasional grinding of their teeth. But only in one fifth of them develop into a chronic problem.
• Disturbed clenching: If the clenching of the jaw is disturbed, teeth grinding can follow. Misaligned teeth as well as incorrectly fitting crowns or fillings can trigger such jaw problems. Another cause are teeth growing out. This happens, for example, when you lose a tooth. The corresponding counterpart (in the opposite jaw) then no longer encounters resistance and can grow unhindered - the result is a disturbed clenching of the upper and lower jaw, often accompanied by teeth grinding.
• Alcohol, caffeine, medication: Excessive consumption of luxury foods and certain medications can also cause teeth grinding.
• Diseases: Sometimes the grinding of teeth is caused by diseases such as restless legs syndrome (syndrome of restless legs), obstructive sleep apnea (nocturnal breathing pauses), reduced blood flow (ischemia), cerebral hemorrhage, nocturnal epilepsy, Huntington's disease, Parkinson's syndrome.

If no clear medical cause for the teeth grinding can be found, primary bruxism is present. Then, for example, stress can play a role. Doctors speak of secondary bruxism if a certain trigger for the grinding of teeth can be identified, for example a neurological or psychiatric disorder, sleep disorders or medication.

Grinding teeth: baby & child

About half of all babies start grinding their teeth at the age of ten months. There is no need to worry, because in this way the new milk teeth are matched or “ground in”. When the last milk tooth has fallen out, the bruxism usually also disappears.

In schoolchildren, however, grinding teeth usually indicates stress - especially if there are other symptoms such as nail biting or gnawing on pens. Even children who talk in their sleep (somniloquie) or wet themselves at night (enuresis) often grind their teeth.

Grinding teeth: symptoms

When teeth grinding (bruxism), those affected involuntarily press the teeth of the upper and lower jaw against one another without pursuing a functional purpose (such as chewing). Rhythmic, grinding, chewing-like movements can also occur.

The fatal thing about teeth grinding: Very strong pressure is exerted on teeth and jaw joints. Up to 480 kilograms per square centimeter (kg / cm2) are possible - that's ten times the pressure that is created when chewing! And these enormous forces do not only put stress on teeth and jaws for a short time - teeth grinding can last up to 45 minutes a day.

Due to this enormous load, the tooth enamel is permanently rubbed off and the dentin (tooth bone) and the nerve tracts are exposed. The result is pain-sensitive, increasingly porous teeth.

In the long term, teeth grinding can seriously damage the teeth and even lead to tooth loss. There is also often muscle tension, which can lead to jaw, neck, face and headaches. Tension and pain in the back area are also possible.

Grinding teeth during sleep and during the day

Most people grind their teeth while sleeping. Doctors then speak of nocturnal bruxism or sleep bruxism.

Diurnal bruxism (awake bruxism), i.e. grinding of teeth during the day, is less common. The jaws are usually only pressed together strongly without grinding with the teeth.

Centric and eccentric bruxism

Some people unconsciously clench their teeth very hard. With this centric bruxism, extremely strong forces act on the teeth and jaw joints.

In eccentric bruxism, the teeth are rubbed against each other, which creates a more or less loud grinding noise.

Grinding teeth: what helps?

There are good ways to treat teeth grinding. Sometimes it is enough to just relax in a targeted manner. For example, regular walks and breaks at work as well as a warm relaxing bath in the evening (for adults and children who grind their teeth at night) are useful.

If none of this helps, you should consult your doctor or dentist. He advises you on the choice of the right therapy. If the cause of the grinding of the teeth is, for example, a crown or tooth filling that is too large, the dentist can grind it down and easily eliminate the bruxism. An occlusal splint protects the teeth from abrasion and further damage. If the grinding of teeth is triggered by an underlying disease (such as restless legs syndrome), this must be treated accordingly.

In the following you will learn more about important therapy options for teeth grinding.

Relaxation exercises

Mindfulness and targeted self-observation help against awake bruxism. To do this, you can, for example, attach a colored adhesive dot to your mobile phone, your wrist watch or your office screen. Whenever you look at this point, check whether your teeth are pressed together. If so, consciously loosen your jaw. To do this, repeatedly open your mouth wide and gently move your lower jaw back and forth.

You should also try relaxation methods for stress-related teeth grinding. This can reduce internal tension and counteract teeth grinding. The exercises can also help relieve headache and jaw pain associated with grinding your teeth.

Best practices to reduce stress include:

• Autogenic training
• Progressive muscle relaxation according to Jakobsen

Occlusal splint

A bite splint (occlusion splint) is individually adapted by the dentist. It prevents direct contact of the teeth when biting, thus protecting the hard tooth substance and the tooth-holding apparatus and contributing to a relaxed position of the upper and lower jaw.

Tip: Have your teeth checked regularly (every six months) by the dentist. In this way, any tooth damage can be detected at an early stage.

physical therapy

Physiotherapeutic exercises loosen tense muscles, promote blood flow to the tissue and train coordinated jaw movements. You can have your physiotherapist show you the corresponding exercises at home.

Medication

Pain relieving medication or muscle relaxants may be useful for grinding teeth. However, they should only be used for a short time.

psychotherapy

Often times, stress triggers the grinding of teeth. If this stress has deeper psychological causes, psychotherapy can help in addition to relaxation exercises such as autogenic training or progressive muscle relaxation according to Jakobsen.

Biofeedback procedure

Biofeedback methods are also effective in grinding teeth. With the help of electronic devices, one learns to become aware of unconscious physical processes such as teeth grinding. You can then control them at will - for example, by consciously relaxing the jaw muscles.

Grinding teeth: diagnosis

If you notice that you grind or clench your teeth more often during the day, you should go to the dentist. This also applies if your partner informs you about grinding their teeth at night. Usually you don't even notice it yourself. However, you should be vigilant if your lower jaw is stiff and tired after waking up in the morning or if it hurts to chew.

The dentist checks how severe the bruxism is and to what extent the teeth have already been damaged. Examples of signs of bruxism are:

• pressure-sensitive masticatory muscles
• Dental prints on the tongue and cheek
• smoothly polished occlusal surfaces
• Cracks and chipped off tooth enamel
• Chips on the hard tooth substance, the tooth necks and the incisal edges
• sensitive teeth

Grinding teeth: prognosis

Most bruxism sufferers can be helped well. The earlier the teeth grinding is treated, the better the prognosis. If you wait too long, severe tooth damage and accompanying symptoms such as pain and tension are usually unavoidable. Therefore, if you suspect grinding of your teeth, you should do something immediately. Sometimes simple relaxation exercises are enough to get the grinding of teeth under control. If not, you should contact your doctor or dentist.

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