Bruxism Health Article

Definition

Bruxism is a habitual grinding or clenching of the teeth. The behavior is usually unconscious, occurs most often during sleep, and is a reaction to periods of stress in the patient's life.

Description

Bruxers often unknowingly grind their teeth. Pencils, their fingernails, and the insides of their cheeks may be bitten. This habitual tooth gritting, grinding or clenching can lead to facial pain and tooth abrasion. Bruxism is common—as many as one in three people is a bruxer. The condition affects both adults and children. However, it often goes unrecognized until tooth damage is noticed by a dentist.

Causes and symptoms

Personality type may place a patient at risk for bruxism. People who are anxious, angry or stressed are more likely to succumb to the habitual grinding and clenching. Another cause of bruxism is an abnormal dental occlusion, which can cause the teeth to grind more easily due to their positioning. Clenching and grinding the teeth can cause jaw area tissue alterations.

Bruxism causes the teeth to wear and become flat at the tips. The teeth can become so severely worn that the dentin is exposed and sensitive. Bruxism can lead to temporomandibular joint pain and, as a result, the jaw might begin popping and clicking. Some bruxers have tongue indentations—another sign of bruxism.

Diagnosis

To diagnose bruxism, the dentist looks for signs of damage, such as chipped enamel, usual tooth wear and tear, radiographic bone changes, and sensitivity. Asking relevant questions can also help dentists make the diagnosis. The questions can include asking patients if their teeth or jaws hurt upon awakening in the morning and if they suffer from worry or stress. The dental exam helps to determine whether the grinding is caused by misaligned teeth or psychological forces.

Treatment

Often, treatment is aimed at getting bruxers to change their behavior. This might involve relaxation training and other stress management techniques. If relaxation doesn't suffice, dentists might recommend a plastic mouth appliance to relax the facial muscles and protect the teeth from the grinding and clenching. Another method of treatment is biofeedback. New treatments for bruxism, especially for nocturnal bruxers, are being studied. In some cases, psychological assessment or psychotherapy might be recommended.

Prognosis

Childhood grinding and clenching of the teeth are often outgrown by adolescence. By making an effort not to grind or clench their teeth, some people can address the problem successfully. Dental intervention to protect the teeth or correct misalign teeth, as well as attempts at stress and anxiety relief, often solve the problem.

Health care team roles

The first signs of bruxism, as well as its related problems, might be noticed by the dental hygienist during professional maintenance care; the patient may be referred to the dentist. Education of the patients about bruxism and options for treatment can be accomplished by the dental hygienist. If the patient comes to his or her primary health care provider complaining of jaw pain, the diagnosis may occur in the clinic or office setting. The patient would be referred to a dentist for a dental appliance.

Prevention

Bruxism precipitated by stress and anxiety can be avoided if patients treat their stress with proper management techniques.

KEY TERMS

Biofeedback—A training technique used to gain control over autonomic body functions.

Bruxers—People who grind and clench their teeth.

Dentin—The hard material of the main part of the tooth, situated beneath the enamel and contain the pulp.

Occlusion—Contact between the surfaces of the upper and lower teeth when the mouth is closed.

Temporomandibular joint—One of a pair of joints connecting the mandible in the lower jaw to the temporal bone in the skull.

ORGANIZATIONS

Academy of General Dentistry, 211 East Chicago Ave., Chicago, IL 600611. (312) 440-4800. <http://www.agd.org>.

American Dental Assistants Association, 208 North LaSalle Street, Suite 1320, Chicago, IL 60601-1225 (312) 541- 1550 (March 15, 2001) <http://www.dentalassistant.org>.

OTHER

InteliHealth: Merriam-Webster Medical Dictionary 1996-2001. <http://www.intelihealth.com> (March 15, 2001).

KidsHealth for Parents by the Nemours Foundation. "Bringing Bruxism to a Grinding Halt" (March 15, 2001) <http://www.kidshealth.org>.

Methodist Health Care System. "Bruxism." (March 15, 2001) <http://www.methodisthealth.com/oralhealth/bruxism.htm>.

Lisette Hilton