Understanding Bruxism and How It Relates to Mental Health

Have you ever felt so stressed that you found yourself grinding or clenching your teeth? Bruxism is a repetitive movement disorder in which a person routinely grinds, clenches, or gnashes their teeth using the jaw muscles. The specific causes of bruxism aren't fully understood, but we do know that certain psychological factors are sometimes connected. Stress, anxiety, anger, and certain personality traits can increase the risk for teeth grinding in some individuals.

Bruxism can involve all the teeth or only the front teeth and can also include symptoms ranging from headaches or facial pain to temporomandibular joint (TMJ) disorder.

Certain medications increase the risk of bruxism, so sometimes, a prescription change could be all it takes to ​resolve the condition. Other people may need more help, such as taking measures to relieve stress (people often grind their teeth when they're nervous or under pressure) or wearing a mouth guard during sleep.

Types of Bruxism

There are two types of bruxism, and their symptoms and causes can differ:

• Awake bruxism (AB), also called diurnal bruxism, occurs when people are awake and symptoms often worsen as the day progresses. It is more common in women.
• Sleep bruxism (SB), also called nocturnal bruxism, occurs during the night, and symptoms are often worse when a person first wakes up.

Symptoms of Bruxism

symptoms can range from person to person depending on whether they grind their teeth during the day or overnight. Most of the time, bruxism isn't severe enough to cause major problems.

Signs and symptoms of bruxism may include:

• Aching jaw muscles
• Chewed places on the tongue or cheek
• Damage to teeth (e.g., chips fractures, worn enamel, flattened tops, loose teeth) 
• Disruption to sleep due to waking up from the sound of grounding
• Earaches (with no symptoms of an ear infection or other ear problems)
• Headaches (including tension headaches from day grinding and morning headaches for nighttime bruxism)
• Neck pain or soreness
• Noise from the grinding or clenching that wakes your sleeping partner
• Severe facial pain
• Teeth that are very sensitive to cold, heat, or pressure
• Temporomandibular joint (TMJ) disorder

How Doctors Diagnose Bruxism

In many cases, people with bruxism don't even realize the problem. Instead, it's often their sleep partner or parent who first notices since they may hear them grind their teeth during the night.

Bruxism is often diagnosed during a dental exam. A dentist will check for worn or broken teeth, damage to the inside of the cheek, jaw muscle tenderness, and TMJ. Your dentist may also take an X-ray to determine if there's been any damage to the underlying bone tissue.

Bruxism Causes and Risk Factors

There are many different reasons why you might grind your teeth. Several factors may increase a person’s risk of having bruxism, which include:

• Age: Kids are more likely to grind their teeth than adults. Sleep-related bruxism affects 15% to 40% of children compared to 8% to 10% of adults.
• Emotions: Frustration, stress, tension, anxiety, and suppressed anger are all potential culprits behind teeth grinding. 
• Genetics: Bruxism tends to run in families. Children are nearly two times more likely to have bruxism if a parent has the condition.
• Medication: Research shows that certain medications are known to cause bruxism, including those that are used to treat psychiatric conditions. It's thought that these drugs cause changes in the central nervous system that lead to teeth grinding and jaw clenching. Examples of such medications include antipsychotics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine).
• Personality: Bruxism has been associated with certain personality traits, such as neuroticism.
• Substance use: Cigarette smoking, caffeine, alcohol, and recreational drug use may increase the risk of bruxism.
  

Treatment for Bruxism

The good news is that bruxism is highly treatable. The key to successful treatment is to figure out what is causing you to grind your teeth and then target your treatment to the cause. 

Therapy

When chronic stress or anxiety is driving you to gnash and grind your teeth, it may be helpful to see a therapist.

Counseling can also help with sleep habit modification and relaxation techniques. If other efforts fail to help you stop grinding your teeth, biofeedback may be worth trying. This is a method that uses monitoring procedures and equipment to teach you to control muscle activity in your jaw. 

Mouthguards and Splint Therapy

If you're a night grinder, a mouthguard (also known as an appliance or occlusal splint) may be helpful. Some guards fit over the top teeth while others fit over the bottom teeth. They may be designed to keep your jaw in a more relaxed position or to provide some other function.

Medications

Many different medications have been tried for bruxism, and the data for their efficacy is limited. However, there is some evidence that certain medications may help manage bruxism. Muscle relaxants and even Botox injections have shown promise as temporary antidotes for teeth grinding when not caused by a medication or underlying condition.

Coping With Bruxism

While bruxism is often not serious, it can lead to a lot of discomfort. Your jaw and head may ache from your nightly tooth grinding. If your bruxism is causing you pain, try these steps at home to help:

• Don't chew gum, since this can make the pain worse.
• Stay away from hard candies, nuts, steak, and other foods that are difficult to chew.
• Try to relax your face throughout the day. Self-massage may be helpful.
• Feel for small, painful nodules called trigger points that can cause pain throughout your head and face.
• Manage stress by taking a bubble bath, going for a walk, or listening to your favorite music. You can also learn relaxation exercises such as mindfulness, deep breathing, or meditation.
• Change your behavior. Discuss techniques for practicing proper mouth and jaw positioning with your dentist. 
• If you grind in your sleep, don't have foods or beverages containing caffeine before bed. Alcohol and smoking in the evening also can make bruxism worse.
• Stay on top of your dental care so your dentist can monitor any damage you might be doing to your teeth.
• Practice good sleep hygiene.

Takeaways

Grinding your teeth, whether awake or asleep, can lead to serious pain and lasting damage to your teeth. You might not even realize you're doing it, but aching jaw muscles, damaged teeth, headaches, and neck pain are major clues that it might be happening.

If you are experiencing bruxism, it's important to consider some of the mental health factors that are playing a role. If stress, anxiety, or other emotions are contributing to bruxism, talk to your doctor about treatments that might help, including therapy, medications, and relaxation strategies.