Bruxism
- feature of unhealthy teeth
Definition:
Reason this is not good:
Occasional grinding of the teeth should not cause problems but regular nocturnal bruxing is likely to cause severe tooth wear and break down.
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Possible causes:
Bruxing can be attributed to several causes such as stress, occlusal trauma, and allergic reactions. Once started it can become a habit so that we continue to brux even when the original cause has been removed. Bruxing can also be caused by malocclusions which this page will focus upon.
Most severe bruxism occurs at night when you are asleep and conscious restraints (like “I mustn't do that”) are not active. Unless you have a partner who tells you that you grind during your sleep you may not know you do it – until the evidence of the wear patterns on your teeth become obvious or are shown to you by your dentist.
Malocclusal causes of bruxing are:
- Interferences between the rear teeth. These can cause the following bruxing patterns:
- Repeated clench-slide-open cycles creating back-to-front wear facets on the molars.
- Side to side grinding that attempts to remove the interference (a high point where teeth contact before the rest of the teeth). This is usually only possible when you do not have canine guidance.
- Side to side grinding where the lower front teeth rub on the backs of the upper front teeth. The interference prompts you to move the jaw forward, searching for a more comfortable position – you nearly get there but there's some contact between the front teeth so you try to make it more comfortable by grinding side-to-side to create more space.
- Avoiding the interference may take you further forward so that you end up with your front teeth sitting edge-to-edge. Bruxing side-to-side is almost a natural reaction to being in this position and will cause considerable reduction in the height of the front teeth. Although some people end-up with a straight, horizontal line of wear across the width of their front teeth, many see different lines of wear at angles to the horizontal because they move the jaw far to the left and right so that other teeth and the shape of the jaw joint influence the angle of the jaw during the motion. The extent of the movement can often be demonstrated by showing that the upper and lower teeth fit perfectly at jaw positions that are beyond the normal (conscious) movement of the jaw. The jaw joint influences the movement as, to move the jaw far to the left or right, the opposite jaw joint has to come out of its socket, which means it moves down as well as sideways – so the jaw is not simply moving horizontally from side-to-side.
Having worn the front teeth down a bit, the canines start to collide so they also will be worn down, and once they are worn down a bit the molars will start to collide because canine guidance has been lost. The end result is a mouth with severe wear on all teeth.
- Malformed teeth or jaws can make it easier for you to brux. For example if your jaw is large compared to the curve of your upper teeth, your lower teeth will not fit inside your upper teeth as they are meant to; in this situation the tips of your lower and upper teeth are likely to meet so you may do the edge-to-edge bruxing described above. Or if you have an overjet – where the upper front teeth are much further in front of the lower front teeth than normal – you will likely not have anterior or canine guidance making it easy for you to brux the back teeth.
- After orthodontics the smile may look good but the room for the lower teeth to fit within the upper teeth can sometimes be restricted causing the side-to-side grinding described above. It's also possible for orthodontics to introduce other occlusal problems if the jaw position is not taken into full consideration, leading to bruxing.
- After crown work, where the surfaces of the new crowns are too bulky so that natural movement is restricted.
What you should do about bruxism:
Unless you are a very light bruxer, continuing to brux is going to cause dental problems in the future, as described below. Your first stop should be an occlusally-aware dentist who can diagnose whether you have an occlusal problem that is causing the bruxing and recommend the appropriate treatment or refer you to another medical professional if the cause is not an occlusal/dental one. Dentists are also able to provide you with a splint which, when properly designed, can protect your teeth from the effects of bruxing until the cause is determined and corrected (or as a long-term “fix” if the cause is not easily determined or corrected).
Possible developments of bruxism:
- Worn teeth
- Sensitive teeth
- Root canal problems
- Abscesses
- Tooth mobility
- Tooth loss
- Gum recession
- Bone recession
- Abfractions
- Cracked tooth
- Tooth decay
- Loss of anterior guidance
- Loss of canine guidance
Other topics that might help you understand the occlusally-related causes of bruxism:
- Interferences - Coming soon!
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Video Transcript
Using BiteFX to explain bruxism
Bruxism, or bruxing, is the dental term given to the act of grinding teeth together which usually results in severe wear and other destructive effects.
Although some people brux when under stress, and will do so whatever the health of their occlusion, many brux because their bites do not feel right.
This video focuses on the occlusal reasons for bruxing.
In a healthy bite when you close your jaw your teeth contact at many points simultaneously, and your jaws are fully seated in their sockets.
And the geometry of the front teeth protect the back teeth from touching whenever the jaw is moved out of this full-contact position.
If you don't have simultaneous contacts, you are likely to sense it and do one of the following:
- A pair of teeth hit early so you slide forward until you make many teeth contact. You repeat this motion over and over.
- When you slide forward you hit on the backs of your front teeth, so you try to make more room by grinding side to side
- When you slide forward you are not comfortable until the tips of your front teeth are touching. You want more teeth to contact so you again grind from side to side, wearing down the tips and beyond.
- Instead of sliding forward you grind from side-to-side to remove that high point between those early-contacting teeth (you have to have something missing in your front tooth geometry to make this possible)
Obviously all these grinding motions can destroy your teeth but there can be other side effects of continual grinding.
Pain in the muscles in your temple, cheeks or close to your ear caused by overworking your muscles, usually at night.
You'll know this type of pain because of where you experience it and because you wake up with this type of headache.
Sometimes doctors will diagnose the headaches as migraine as they don't know it is caused by malocclusion.
Another side effect can be the deterioration of your jaw joint — called the temporomandibular joint or TMJ.
Because the muscles attached to the top of your jaw are overworking they can pull the disk out of place giving you clicks as the jaw moves onto and off the disk, stretch or tear the disk so that your jaw is rubbing bone-on-bone which leads to deforming your jaw joint and possible arthritis down the road.
As you can see continuing to grind your teeth is not good for them and may lead to other undesirable effects. Make sure you connect with a knowledgeable dentist who can correctly diagnose your problem and treat you or refer you to the appropriate expert who can.