About Bruxism (Clenching and Grinding)

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Do I clench? Am I a grinder? How can I tell? What’s the difference between one and the other anyway?

These are important questions that some of you may have asked. Others may have been told by their dentist that they are doing it, usually followed up by recommending the use of a mouth guard or night guard. In some circumstances, when a dentist in Tijuana detects signs of clenching and grinding he may recommend crowns, tmj treatment (temporal mandibular joint, located right next to your ear canal), selective  tooth grinding, among other things. I agree on all these treatments as relief for someone who suffers from this malady and I also like to get to the root of the problem, to know why my patient clenches and grinds.

So, let’s start by the title of the problem and take it from there. If you bring your teeth together and all upper and lower teeth are in contact and remain in this position, that’s clenching. If, while holding this position without bringing your teeth apart, you begin to move your mandible back and forth, left and right, even if it’s just a minor movement, then that’s grinding. And a bruxist is the patient who does the combination of both. Simple, right? In my opinion, you can’t be a grinder without being a clencher.

Ok, so let’s go back to the definition of clenching. Take into consideration that your upper teeth should only  make contact with their antagonist lower teeth while 1) chewing, 2) swallowing food, liquids or saliva 3) if you are using a protective guard, like during sports and 4) when your jaw searches for its ‘rest position’, lateral and prognathic movements… technical stuff not worth explaining. So this means that in any other situation other than these four, if you find yourself making upper and lower teeth contact, you are probably a clencher. Think about it, if while reading a book, driving, watching TV., even walking and you catch yourself making teeth contact, you are perhaps a clencher. Then, if after this you move your mandible around, then you are maybe a grinder as well; this normally occurs during the night.

Signs that might indicate you grind during sleep hours:

• You wake up feeling like you were chewing gum all night, like if you were lifting weights with your cheek muscles (weird, I know), you feel your whole body relaxed and ready to start your day but you feel your mouth tired.
• You see signs of wear and tear on the chewing surfaces of your teeth or around the gum line
• Your teeth are sensitive, especially around the gum line
• You begin to break teeth, fillings or crowns
• You have tmj pain

If you are assessed by a traditional dentist and he detects one or some of these signs, then he will recommend the according treatments. It is usually something like this:

• Sore chewing muscles = night guard
• Teeth wear and tear = fillings
• Sensitive teeth = sensitive tooth paste
• Broken fillings, teeth = crowns
• Tmj pain = referred to tmj specialist

Now let’s quickly review why you could clench or grind:

1.- Stress
2.- Anxiety
3.- Nervousness
4.- You developed a nervous tick
5.- Restlessness
6.- Traumatic reaction
7.- A previous dental filling was left too high
8.- You need braces ( malocclusion)

Personally, reasons #1 through #6 are all the same to me. They all come down to being stressed. Number 7 and 8 need to be attended accordingly. In my point of view, the main reason why the majority of people clenches and grinds their teeth is due to stress. Any type of stress, you name it: going through traffic, work, neighborhood, family issues, money, love, losing a love one or your job, expecting a child, winning the lottery, bills, among other. The first question to ask you is: “What could be stressing me out?” If you don’t have an answer, try guessing one. And this is step number 1: Identifying what is stressing you out. It is often the toughest step of all since it involves some deep inner awareness. Step number 2 is to deal with that issue appropriately to bring your level of stress down. It can be something as simple and routine as reading a book all the way to going to Yoga classes. It’s all about identifying what is the cause of stress and then dealing with it ; if it’s done naturally, all the better, although in some cases pharmaceuticals or non pharmaceuticals remedies are necessary. This might include one or many of the following:

• Doing Yoga, meditation or similar
• Praying
• Reading a book
• Walk in the beach or in a natural setting
• Begin your spiritual path
• Talking to a religious figure of your church
• Taking up a sport
• Breathing exercises
• Homeopathic
• Being assertive
• Among others

Easier said than done, right? Choose one or two that resonates to your lifestyle, something that would be simple for you to do and ease your way into them. So what can I, as a dentist, do for you in the mean time? Offer you a night guard, also called mouth guard or splint.

The guard is not the treatment for bruxism; it’s only a palliative solution while you work on what is stressing you out. The guard does two things for you: 1) keeps from grinding your tooth structure away (you’ll be grinding the acrylic away and you will need to replace it once you puncture through it) and 2) it will reprogram your jaw muscles and tmj to bring your grinding level / force down.

The trick is to control your stress level so you don’t have to depend on a mouth guard for the rest of your life.

On a personal note, every one of us needs to deal with stress in some way / level or another. Very few people live a stress-free life; I only know of one friend who lives like this, Johnny Blackburn. It is hard to get around stress, especially if it’s waiting for your right around the corner, on the next traffic light or once your reach your office. You cannot control any of these factors; it’s impossible to get rid of them; since you didn’t create them you cannot destroy them. The only thing you CAN control is how YOU are going to react to it. How your body is going to respond to stress…. and here is the magic of it all, you have absolute power over this. You can look stress right in the face and then be cool about it since you now have the information and tools to work on how your body will reply to it.

And in the mean time, let’s do your mouth guard.