Health Matters: Grinding Teeth, Aching Head
A 35-year-old woman went to her doctor with the complaint that she was waking up with headaches every morning. Her temples throbbed and her face and neck muscles hurt. Her doctor asked her if she was aware of clenching her jaw or grinding her teeth during the night. She said that she wasn?t but that her jaw felt tired and stiff when she woke up.
An examination quickly revealed the source of her problem. When the doctor pressed the appropriate facial, head and neck muscles, she felt the same sort of pain that plagued her in the mornings. Her teeth were far too worn for someone her age, and the wear patterns were abnormal. The diagnosis: chronic teeth grinding and clenching, also known as bruxism, which played a role in her muscle pain and chronic tension-type headaches.
The case of this ?parafunctional? jaw activity?unrelated to the normal use of the jaw and mouth for chewing and talking?remains a mystery, though there is some evidence that it may be connected to psychological or physical stress. Psychological factors which can cause bruxism is anxiety, stress or tension, often from suppressed anger or frustration, or those who have aggressive personalities. Whatever the cause, many people grind or clench their teeth without ill effect. Only an unfortunate minority will develop the muscle pain and headaches that afflict some people. It is unclear why this is so; it may have to do with individual anatomical or genetic factors, or sleeping habits.
Bruxism usually occurs during sleep, even during short naps. In a typical case, the teeth move against each other in a side-to-side action. Untreated bruxism can ruin fillings, destroy tooth enamel, remove the sharp biting surfaces of the teeth, and flatten the tooth edges. The destruction of tooth enamel exposes the softer dentine of the tooth and will worsen the abrasion of the tooth, which can lead to dental decay. It can also loosen, cause chips in, or even fracture teeth, and stress the temporomandibular joint (TMJ), which connects the lower jaw to the skull. Tooth sensitivity to cold and hot is also a sign of bruxism. In some people, gum recession and damage to the tissues on the inside of the cheek is also evident. The pressure exerted by bruxism on the teeth is very high. Bruxism may also set off migraines in people whose trigger is muscle tension.
An Unconscious Habit
The main barrier to diagnosis is the fact that people may have no idea that they grind or clench their teeth because it usually happens when they are asleep. Often, the first indication of a problem comes when the scraping sound disturbs a bed partner. But some people are clenchers without being grinders; they?re tougher to spot because they don?t make any noise. Occasionally, people grind or clench their teeth unconsciously while awake. What usually leads sufferers to a dentist is the vague awareness that their symptoms seem to be centered on their teeth and jaws.
A dentist?s work-up for suspected cases of bruxism starts with a thorough review of the patient?s symptoms. The patient is asked to keep a pain and headache diary for a month in hopes of discerning a pattern to the symptoms. Pain in the jaw, face, ear or head on awakening strongly suggests nighttime bruxism. The dentist will look for abnormal tooth wear, and will press on the head and neck muscles involved in bruxism. If the patient reports that this replicates his or her usual pain, it indicates that the cause is bruxism. To confirm the diagnosis, the dentist may inject a local anesthetic or use a chilling spray to temporarily numb a particular muscle or muscle group to see if that stops the pain.
Multiple Treatments Needed
Creating bruxism can be a challenge because it is an unconscious behaviour that often happens during sleep. Bruxism is caused by the normal reflex activity of chewing when asleep, and in most cases is mild and does not require treatment. The more severe cases need intervention to prevent further tooth damage. Dentists will prescribe an occlusal guard?a custom-molded hard-plastic appliance that covers the tops of all the teeth in either the upper or lower jaw. The occlusal guard at a minimum stops the wear and tear on the patient?s teeth, and may also reduce the TMJ and muscle stress that lead to facial pain and headache.
For patients who have numerous painful and tense muscles, physical therapy should be prescribed.
If those treatments still haven’t done the job, patients should receive stress-reduction and relaxation techniques. Often getting stress management counselling will stop the problem. Doing relaxation exercises or meditating before sleep will help relieve the tension that causes bruxism.
Daytime bruxism is much easier to treat once the patient becomes aware of what my have been an unconscious habit. Often, all it takes is cognitive awareness of the abnormal jaw activity and a little bit of behavioural training, by practicing proper mouth and jaw positioning. Concentrate on resting your tongue upwards with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching.