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Grinding and clenching, together called bruxism, is something most people do without knowing it, usually at night. The forces are far larger than chewing produces, and over years they wear teeth flat, crack them and leave the jaw muscles and joints sore. It cannot be cured, but the damage can be stopped: a custom night guard for the night, awareness of clenching by day, and a sleep assessment or a specialist referral when there is more to it than grinding.
The signs
- Jaw muscles that feel tight, tired or sore when you wake
- Teeth that ache or are sensitive in the morning and settle through the day
- Headaches around the temples, particularly on waking
- A partner who hears grinding at night
- Teeth that look flattened, shortened or chipped at the edges
- Cracked teeth or fillings, or restorations that keep breaking
- Scalloped edges along the tongue or a ridge inside the cheeks, from pressing against the teeth
Many patients already know they grind. Others only realize it when asked, and some discover it when a crown breaks.
What it does over time
Enamel is hard but not made for hours of grinding every night.
- Teeth wear flat and short, and the edges chip.
- Cracks start, especially in teeth with large old fillings.
- Dentin exposed by wear is sensitive.
- The jaw muscles, worked all night, become sore and can refer pain to the temples and ears.
- In some people the joint itself is affected.
Severe, long-standing wear is one of the common reasons a mouth eventually needs full-mouth rehabilitation, which is a great deal more involved than a guard would have been.
How we assess it
Mostly by asking. Other things wear teeth too, acid reflux among them, and that is treated with your physician rather than with a guard. So we combine your account, your partner’s, the examination of the teeth and muscles, and the history.
What helps
A custom night guard. The main treatment, and for most people the only one needed. We make a Michigan-style splint from a digital scan: every tooth meets it evenly when you close, and only the front teeth touch it when you grind, which reduces how hard the muscles can work. It wears instead of your teeth, and most patients feel the morning tightness ease over a few weeks. Our night guards page covers the design, the two visits, care, and how it fits with retainers.
Awareness by day. A guard works at night. Daytime clenching, at a desk, in traffic, in the gym, is stopped by noticing it: check several times a day that your teeth are apart and your jaw loose.
A sleep assessment when there are signs of apnea. Grinding and disturbed breathing during sleep sometimes go together. If you snore, wake unrefreshed or have been told you pause breathing at night, a sleep physician should assess you first; a standard guard is not a treatment for apnea.
More, when a guard is not enough. A few patients grind heavily through a well-fitted guard. For them, muscle-relaxing injections into the jaw muscles can be added alongside the guard. And when the jaw joint itself is painful, clicking or locking, that needs a proper evaluation by a specialist in jaw joint disorders rather than a dental appliance, and we refer.
Frequently asked questions
How do I know if I grind my teeth?
The usual clues are jaw muscles that feel tight or tired on waking, teeth that are sore or sensitive in the morning, headaches around the temples, and a partner who hears the noise. Worn teeth suggest grinding in the past but do not prove it is still happening, so we mostly ask.
Can grinding be cured?
No reliable cure exists. Stress, sleep and the bite all play a part, and they come and go. What can be done is to take the damage out of it, with a guard that wears instead of your teeth and a design that reduces how hard the muscles can work.
Is a store-bought guard enough?
For a few weeks while a custom guard is made, yes. For long-term use, no: they do not support the bite evenly and we have seen teeth shift in patients who wore them for years.
Could it be sleep apnea?
Grinding and disturbed breathing during sleep can go together. If you snore, wake unrefreshed or have been told you stop breathing at night, a sleep physician should assess you before a guard is made, because a standard guard is not a treatment for apnea.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database of Systematic Reviews. 2007;(4):CD005514. Cochrane
