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Bruxism cases may be on the rise, but fortunately there is a lot patients can do—with help from their dentist—in terms of prevention and treatment. By Tracey Porter
The increased stresses and strains of our daily lives caused by chronic busyness, the soaring cost of living and the lingering effects of the pandemic, are literally grinding us down. Or more specifically, they are causing us to literally grind our teeth down.
Bruxism, the technical term for excessive grinding and clenching of teeth, is on the rise in Australia, as it is around the world.
Dr Andrew Gikas, a Melbourne-based bruxism and sleep-disordered breathing expert and member of the Australian Dental Association’s (ADA) Federal Executive, says the pandemic has seen patients present with a higher rate of fractured teeth and fractured restorations—symptoms of bruxism.
“It makes sense that as stress levels increase and people have more worries in general, they will become more anxious and possibly sleep less,” Dr Gikas says.
Dr Anthony O’Rourke, the lead dentist at Maven Dental Collins St in Melbourne, has witnessed a “15-20 per cent increase of patients presenting with bruxism and associated symptoms and also in patients who have seen an increase in the intensity and severity of their symptoms.
“The initial increase coincided with the beginning of the pandemic and seems to have continued with the current cost-of-living crisis.”
There are two distinct types of bruxism: awake and sleep, according to Dr Gikas.
“Awake bruxism is a semi-voluntary activity that is mainly characterised by tooth clenching, which is self-reported by 20 per cent of the population; it is more common in females, and decreases with age. It is typically related to stress or when carrying out a task that requires concentration.
“Sleep bruxism is a sleep-related movement disorder; others in this classification include restless legs syndrome and periodic limb movement disorder. In the sleep literature, sleep bruxism is defined as a masticatory muscle activity during sleep that is characterised as a rhythmic (phasic) or non-rhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals.”
Dr O’Rourke says the symptoms of bruxism vary from person to person.
“Some people do not even realise they are doing it, but the most common signs include pain or soreness in the jaw, facial pain, cracked or fractured teeth or dental restorations, headaches, tooth sensitivity, tinnitus and sleep disturbances.
“Jaw pain or muscle soreness is often caused by the repeated motion of clenching and grinding the teeth, which can overwork the jaw muscles. Bruxism can also cause tension headaches, particularly in the temples; this is where a large muscle, the temporalis sits.
“Over time, bruxism can wear down the enamel of the teeth, leading to increased sensitivity to hot or cold foods and beverages. Excessive bruxism will cause teeth to crack or chip, particularly if they have pre-existing damage or weak spots. Eventually, the teeth can wear down resulting in a loss of the occlusal vertical dimension (OVD).”
Regular dental check-ups are the key to spotting these symptoms before they become a major issue that can be costly to fix.
Initial treatment involves coaching patients to help them manage stress, and exercises for the jaw muscles and TMJ (temporomandibular joints) to help them relax.
For Dr Gikas, making the patient aware of the risk factors that lead to an increased risk for bruxism is a good place to start.
“Smoking, caffeine, illicit drugs, alcohol, certain medications and poor sleep have been shown to have an effect, so lifestyle changes can be helpful.
“If it is thought to be a daytime habit, then raising awareness of the habit is the key to hopefully breaking the habit of clamping the mouth closed and having the upper and lower teeth contact. Many patients are not aware they are doing it so utilising mindfulness, relaxation or stress management techniques can be helpful.
“If it is nocturnal bruxism, then encouraging good sleep hygiene is a good start.”
Good sleep hygiene includes getting to bed at a set time each night, making the bedroom a comfortable environment, limiting screen time in the few hours preceding bedtime, limiting caffeine and alcohol before bed and trying to get a good seven to eight hours of sleep every night.
While poor sleep patterns often play a significant role in increasing a patient’s likelihood of suffering from bruxism, it is important to not confuse bruxism and poor sleep with the serious medical condition of sleep apnoea, Dr O’Rourke says.
“If any patient presents complaining of poor sleep patterns, I will always refer them for a sleep study to assess if they could be suffering from sleep apnoea, and then treat them accordingly.”
The treatment phase for bruxism can then progress to customising 3D-printed splints for patients, Dr O’Rourke explains.
“A digital scan is taken to accurately record the patient’s teeth. Analysis of this can show us how and where people are grinding on the surface of the teeth. A 3D-printed splint is then designed using AI and printed to try and make it feel like all teeth are touching at the same time and puts the TMJ and occlusion into a relaxed neutral position.
“This will relax the muscles involved in bruxism, relieving muscle tension, and the teeth will be physically protected from the grinding forces.”
In some cases, allied health professionals such as physiotherapists or myotherapists are brought in to assist in the management of TMJ.
Botox is another weapon in the treatment arsenal, Dr Gikas says.
“Botox doesn’t stop bruxism events, but it can decrease the intensity of the clenching and in some cases may be of benefit. It is of course short acting and needs to be repeated regularly, which does add to the considerable cost, which needs to be weighed against the potential benefits.”
In some good news, Dr O’Rourke has seen an increase in patient awareness around bruxism and grinding and people generally being better informed about the condition.
“There was a significant increase in Google searches for bruxism, teeth grinding, and teeth clenching during the COVID-19 pandemic, which shows that patients are becoming more aware of this issue, and the impact it can have on their general and dental health.”
Dr O’Rourke encourages dentists to incorporate a bruxism screen into their routine exams.
“Check the muscles of mastication and for tooth wear; you will be surprised how many cases of untreated bruxism you find.”