Also known as Tooth Clenching and Grinding (Temporo-mandibular disorder (TMD))
What is it?
Bruxism is an oral "parafunctional activity" which means it is unrelated to normal function such as eating or talking. It is quite a common problem that afflicts a large percentage of people (somewhere between 10 and 30% depending on the source). Those that only grind at night won't even be aware of it, unless told by someone or their dentist notices that they are wearing down their teeth.
There are two main types of bruxism: that which occurs during sleep (sleep bruxism) and that which occurs during wakefulness (awake bruxism). Dental damage may be similar in both types, but the symptoms of sleep bruxism tend to be worse on waking and improve during the course of the day, and the symptoms of awake bruxism may not be present at all on waking, and then worsen over the day.
Awake bruxism is thought to have different causes from sleep bruxism, and is more common in females, whereas males and females are affected in equal proportions by sleep bruxism. Sleep bruxism is considered a sleep-related movement disorder. People who clench or grind their teeth (brux) during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing (sleep apnea).
The causes of bruxism are not known, but it is thought stress and anxiety may cause tension in the jaw, and that antidepressants may also be a trigger (1).
Why is it an Issue?
For people with mild Bruxism there maybe no real ill-effects or pain. Severe Bruxism can result in headaches, earaches, facial pain, chipped-teeth, damage to or fracture of crowns and fillings and may enlarge the masseter muscle, giving rise to a square face and wide jawline.
The pressure on the teeth during grinding can be 20 times greater than the force used in normal chewing and biting but interestingly, the amount of pain doesn't correlate with the severity of grinding or clenching that is occurring.
What type of Pain does it cause?
The pain in the muscles of mastication caused by bruxism is similar to muscle pain that occurs after exercise.The pain may be felt over the angle of the jaw (masseter) or in the temple (temporalis), and may be described as a headache or an aching jaw. Most (but not all) bruxism includes clenching force provided by masseter and temporalis muscle groups; but some bruxers clench and grind front teeth only, which involves minimal action of the masseter and temporalis muscles. The temporomandibular joints themselves may also become painful, which is usually felt just in front of the ear, or inside the ear itself. Clicking of the jaw joint may also develop. The forces exerted on the teeth are more than the periodontal ligament (tendons that hold the tooth to the bone) is biologically designed to handle, and so inflammation may result. A tooth may become sore to bite on, and further, tooth wear may reduce the insulating width of enamel and dentin that protects the pulp of the tooth and result in hypersensitivity, e.g. to cold stimuli.
Signs and symptoms of bruxism may include:
- Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
- Teeth that are flattened, fractured, chipped or loose
- Worn tooth enamel, exposing deeper layers of your tooth
- Increased tooth sensitivity
- Jaw or face pain or soreness
- Tired or tight jaw muscles
- Pain that feels like an earache, though it's actually not a problem with your ear
- Dull headache originating in the temples
- Damage from chewing on the inside of your cheek
- Indentations on your tongue
- Enlarged masseter muscles
What can we do?
As a Dentist and Medical Aesthetics practitioner Dr. Kelleher is in a unique position to offer a comprehensive range of treatments.
Diagnosis is made after a thorough history and examination of the muscle groups of your head and neck as well as a full dental examination. We can make you a night guard to try and discourage the habitual teeth clenching and grinding.
In addition, botulinum toxin can be used to target the muscle groups responsible, relaxing them and easing discomfort. This moderates the habitual tooth clenching and grinding and can have the added benefit of reducing muscle bulk and slimming the lower face.
The typical dose is 20 units of Btx injections per masseter muscle, or equivalent units of Dysport or Xeomin, and may help individuals with severe bruxism who haven't responded to traditional treatments, such as bite blocks that keep teeth from coming together at night.
What Patients will Botox help?
Botox is not suitable for every patient. Care must be taken as to when to use it, how to use it, and who is a good candidate. There are times when muscles hurt even though they have not been overused. When life circumstances, emotions or thoughts cause your muscles to tighten and ultimately ache, then Botox injections for TMJ will not likely help. Instead, counseling, talk therapy, cognitive behavioral therapy, may be better options.
If you’re considering Botox as part of your treatment for TMJ problems, jaw pain, pain in or around your teeth, or because of a change in the shape of your jaw - see if you fit into the following categories.
- If You Currently Wear a Night Guard- If you currently wear a night guard and still have morning symptoms of muscle pain or tightness, joint noises, locking, and/or pain, you may be a good candidate for Botox. This is particularly true if you find yourself biting hard on the guard when you wake up in the morning. Keep in mind however, that Botox will be most helpful if you continue to wear your night guard. Two strategies are better than one in this scenario.
- If You Can’t Tolerate A Night Guard- If you cannot tolerate a night guard (and have tried various types, with your dentist’s guidance) Botox injections for TMJ may provide meaningful benefit.
- If Your Jaw Muscles Are Too Big- If your jaw muscles are just too big and visibly over-built, Botox may be an option. One of the predictable things that Botox does is reduce muscle bulk when used over time. Botox has been shown to be effective in producing a flatter and more natural-looking profile. You will likely need three Botox sessions in three-month intervals to achieve the best results. However, jaw bulk may creep back if the reasons your muscles become larger have not been identified and dealt with.
What can I expect after treatment?
Results from Botox treatment of bruxism start after about a week and improve as the masseter muscles shrink over the following few treatments.
The treatment does not interfere with chewing, smiling or anything else, because the injected dose of Botox is relatively small, but big enough to stop the cycle of bruxism.
What does it cost?
Dr. Kelleher charges €300 for Bruxism treatment. It requires 40-50 of Botox units depending on severity of the problem. We offer free consultations if you want to come in an talk it through with us.
Any other benefits?
It should be noted that our patients treated for teeth grinding have also reported a marked reduction in their general stress level.
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- Ayes Milanlıoglu Paroxetine-induced severe sleep bruxism successfully treated with buspirone. Clinics (Sao Paulo). 2012 Feb; 67(2)
- Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K (February 2013). "An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions". JRSM Short Reports. 4 (2)