Don’t Get Ground Down!

Posted: Friday 16 July 2010 09:50am

Clinically referred to as Bruxism, teeth grinding or clenching can occur consciously or unconsciously during the day or more commonly at night whilst you sleep. Both a medical and dental problem, bruxism affects the teeth and can bring about jaw, mouth and face problems, missing teeth and broken dentures if not diagnosed and cured.
Dental researchers now believe stress is the major cause of teeth grinding and clenching as opposed to malocclusion (the way your teeth fit together).

Bruxism is thought to be hereditary but the reasons why children grind remain unclear. Three times as many women as men grind their teeth. One in four adults suffers from bruxism and is most common between the ages of 20 and 40.

The main problem with bruxism is the wear and tear on teeth. Grinding wears away tooth enamel which can lead to sensitive teeth, tooth decay and damage to expensive dental work. Grinding also taxes the muscles and joints of the temporomandibular (jaw). Prolonged grinding may damage the jaw joint enough to cause osteoarthritis as well as bone loss in periodontal (gum) disease.
Melbourne’s Dr Derry Rogers believes teeth grinding is more prevalent – due to stress – since 9/11.
“The number of reconstruction cases we did before 9/11 were all very stable. We started to find chipping and cracking of porcelain work after 9/11 – that would suggest there is a very strong link between stress and teeth grinding.” Says Dr Rogers. “People are more stressed post 9/11. The world we knew before 9/11 has totally changed. We have a lot more stress and people are manifesting that stress with teeth grinding.”

“The stress in our world has increased and as such, people who have stress-related grinding is on the increase. It is across the board.” He adds.
Dr Rogers says there are 4 basic causes of bruxism.
“Two causes are related to what we call bite interferences – such as when front teeth don’t mesh correctly, people grind to give themselves more freedom in the front tooth. A back tooth interferes with the bite so the patient will try to grind away the interference such as a new filling or a tooth that has moved around.” Says Dr Rogers. “The third cause of grinding is directly related to stress. It’s commonly done at night when the patient is sleeping. The fourth cause is neurological which can be the side effect of some medications or neural or psychological problems. This cause needs to be treated by medical practitioners.”

Diagnosing Bruxism

Most importantly, says Dr Rogers, the bruxism cause needs to be diagnosed.
“The way to diagnose is to get the patient to wear a plastic plate or splint that de-programs the muscle. If the grinding is tooth induced, this will stop the grinding. If it’s stress-related or neurological-related grinding the plastic plate will show signs of wear – so you’ve got your diagnosis.” Says Dr Rogers. “But the diagnosis between stress and neurological causes is a full and thorough questionnaire and evaluation which involves speaking to the patient’s doctors as well.”
“Once you’ve done the diagnosis, if the grinding is stress related, it could be fixed simply by wearing a splint at night-time. It doesn’t stop the grinding but it stops the damage that grinding does.” Says Dr Rogers. “If you diagnose that it is tooth-related you have to do something in relation to the position of the teeth that is causing the wear. Whether it’s adjusting a filling or dealing with a tooth that is affecting the bite. The position of front teeth affecting the bite has to be treated either by orthodontics or by adjusting the teeth with veneers or any number of things. The cost is a bit like asking how long is a piece of string. You could be looking at a splint that costs around $600 to a full mouth reconstruction that may cost many thousands of dollars.”
Dr Rogers points to the (pictured) example of one of his patients.
“In this case, the bruxism was stress related. The 57-year-old patient had ground down all his teeth over a 25 year period. He had a full mouth reconstruction over three months. His lower front teeth were so badly ground down we had to surgically expose some of the tooth structure from under the bone areas. He was referred to a periodontist who did surgery on the lower front teeth. He made the tooth longer so we could actually rebuild them. His bite was open because it had been closed down by the grinding, so we rebuilt each tooth, they had layers of porcelain fused to them and built over them to rebuild his bite and restore his teeth back to what we think was his ‘pre-wear’ condition some 25 years ago. The patient now wears guards to protect his new teeth.”

Dr Cary Fraser of Baydental & Orthodontics in Double Bay concurs bruxism seems to be more prevalent.
“Teeth grinding and clenching seems to be more prevalent nowadays. This can be for many reasons. An old wives tale is that grinding is a sign of worms other people say it is related to stress.” Says Dr Fraser. “Then having seen babies and very young children with worn down teeth , you wonder what stress can they be under to cause such a great amount of destruction of teeth due to grinding?”
Grinding and the results of grinding can be seen from infants to the elderly across the board.
People with anxiety and sleep disordered breathing have a higher number of risk factors for Sleep Bruxism
“Newer research is looking into the fact that tooth grinding may be associated with a self preservation mechanism. This being, the jaw grinding is due to the body trying to open up the airway to get more oxygen.” Explains Dr Fraser. “It is important to get a sleep study done to see if there is Sleep Apnoae involved and muscle soreness of the head and neck.
Apart from the obvious chipping, fracturing and shortening of teeth due to wear, there are other problems associated with bruxism.
“Grinding can also contribute to loss of bone around teeth associated with periodontal (gum) disease. Bone loss is exacerbated by grinding which can lead to premature loss of teeth, sensitive teeth, headaches, migraines, TMD (jaw joint disorders), neck-ache, shoulder pain and back pain.” Says Dr Fraser. “The muscles of the face may show more stress and premature aging due to the overuse of the muscles causing deeper furrows and lines. Worst of all it may be so noisy as to disturb your partners sleep.”

Although bruxism most commonly occurs in a patient’s sleep, people can clench and grind whilst awake too.
“This can usually be reduced significantly by making the person aware of the habit. In extreme cases an appliance can be worn during the day as well. In some situations a muscle relaxant is needed as well.” Adds Dr Fraser.

Non-Surgical Treatment Options:

Treatment to prevent teeth grinding and clenching in addressing the structure and development of the jaws and teeth may involve orthopaedics (expansion plates) and orthodontics (braces) and can cost between $3000-$15,000.
Dr Fraser is a structuralist and says he looks at the problem from a wholistic viewpoint.
“I determine with the aid of Autonomic testing of the body to see where the problem is coming from and treat appropriately. Fabrication of a bite plate to help relax muscles and put the jaw in a better position can cost $1000-$2500.” He says. “We use laser and infrared treatments to help relax and repair structures. Once the jaw is in a more relaxed position the teeth may need to be built up to replace lost tooth structure and support the jaw. Occlusal rehabilitation s can be done with Composite fillings ($150-$400/tooth), Porcelain inlays onlays ($1000-$2000), Crowns ($1900-$2500/tooth) and implants.
Teeth clenching and grinding has implications for your facial shape as you age too.
“The implication of grinding is as you get older and you continue grinding your teeth away unchecked, your teeth will get smaller. You may possibly not show much or any teeth when you smile.” Says Dr Fraser. “As you grind away your chin will get closer to your nose, creating more wrinkles due to less support for the tissues and creating thinner lips. In extreme circumstances you may even get the ‘witch’ look.”

Dr Andrew Gerber of Gerber Dental Group in Queensland says the broader dental profession are more aware of the detrimental effects of bruxism and are more proactive in educating patients.
“It’s a multifactorial process – of which stress, emotional support, nutritional support, environment, anatomy, physiology play important roles.” Says Dr Gerber. “Diet ie chemicals introduced into processed food and drink may contribute to physiological modifications of young patients – affecting size of airway (reduce) which in turn causes patient to adapt head posture, develop mouth-breathing habits in attempt to breath more easily – resulting in narrow upper jaws, crowding, tooth grinding, mouth breathing.”
Dr Gerber lists the sorts of problems bruxism creates for a patient.
“Damage to teeth, gums and jawbone. Sore-ness (caused by over-use) of jaw clenching muscles – headache, neck ache, shoulder ache, back ache, alignment issues with neck and spine, pelvis, knees, ankle. Damage to jaw joint – compression of soft tissue disc – clicking popping, difficulty opening wide, pain on opening, pain on chewing, compression of nerve and blood vessel in jaw joint space – ringing in ears, blurred vision and even loss of balance.”

Treatments on a Budget:

For patients on a tight budget, there is also hope.
“On a tight budget, having consulted with your dentist a simple mouthguard, or prefabricated TMJ appliances that start at approx $200, prevent you grinding your teeth and help support the jaw joint. This still should be monitored by your practitioner.” Says Dr Fraser.
Dr Rogers suggests learning stress management to patients who have stress-related grinding.
“It might be as simple as learning to do meditation.” He says.

Alternative Treatment Options:

Other alternatives for bruxism can be handled by hypnotherapy and acupuncture.
Hypnotherapist Kathryn Sturtridge from Lotus Hypnosis in Perth says she has successfully treated cases of teeth grinding and clenching.
“Teeth grinding and clenching is usually emotionally driven so by working with the emotions and doing very direct ‘suggestion’ work, I’ve seen it stop completely.” Says Kathryn. “Suggestion work is feeding the subconscious mind to resolve whatever is causing the problems.”
“I’ve seen a lot of teeth grinding cases due to emotional stress. Often fear is involved with grinding. Fear about things that might be happening in the present or things that have happened in the past.” She adds. “Hypnotherapy is very effective. Most of the cases I’ve worked on, the patients haven’t come to me for that reason. It is one of the questions I always ask though, when I am gathering history about the client. I ask if they grind their teeth and if they do, we work that into the program.”
Kathryn says grinding will stop or significantly decrease after the first hypnotherapy session and even more so after the second.
“To get a long-standing I result I generally work with a client over 4 session over 8 weeks to resolve the emotional issue. My 90-minute sessions are $190 each. Teeth grinding is consistently ‘in the mix’ with my clients.” She says.
Acupuncture may relieve the jaw tension associated with bruxism. Massage therapy and deep tissue realignment, including rolfing, can also assist in releasing the clenching pattern.

by Monique Butterworth

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