The Gnashing of Teeth

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The “gnashing of teeth” may sound biblical, but it may lead to some very modern day jaw disorders, headaches, damaged teeth and other problems. Known more clinically as bruxism, teeth grinding or clenching is an unconscious activity, and may even occur while you are sleeping.

No one knows what causes bruxism, but there are a few theories:

  • Complication resulting from a disorder such as Huntington's disease or Parkinson's disease
  • Emotions, such as anxiety, stress, anger, frustration or tension
  • A coping strategy or focusing habit
  • Aggressive, competitive or hyperactive personality type
  • Abnormal alignment of upper and lower teeth (malocclusion)
  • An uncommon side effect of some psychiatric medications, such as phenothiazines or certain antidepressants
  • Stomach acid reflux into the esophagus
  • Other sleep problems, such as sleep apnea
  • Response to pain from an earache or teething (in children)

If you have sleep bruxism, you may not know it. Keep on the look out for these signs:

  • Indentations on your tongue
  • Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
  • Teeth that are flattened, fractured, chipped or loose
  • Damage from chewing on the inside of your cheek
  • Worn tooth enamel, exposing deeper layers of your tooth
  • Dull headache originating in the temples
  • Pain that feels like an earache, though it's actually not a problem with your ear
  • Increased tooth sensitivity
  • Jaw or face pain or soreness
  • Tired or tight jaw muscles

Occasional or mild bruxism is not a cause for alarm, but you should consider seeing your dentist if:

  • You have pain in your jaw, face or ear
  • Your teeth are worn, damaged or sensitive
  • You have a locked jaw that won't open or close completely
  • Others complain that you make a grinding noise while you sleep

In order to diagnose bruxism, your dentist will physically check for tenderness in your jaw muscles, damage to your teeth, or damage to the underlying bone and the inside of your cheeks. Likely she will use X-rays to facilitate the diagnosis, and these may detect othertemporomandibular joint disorders, other dental problems or an ear infection.

It is possible, especially with sleep bruxism, that your dentist may refer you to a mental health specialist. A sleep specialist, in particular, may be called in to conduct more tests, such as assessment for sleep apnea, video monitoring and measuring how often your jaw muscles tighten while you sleep.

Some medications – particularly muscle relaxants and botox injections – might be prescribed for your bruxism, but the effectiveness of these is still being studied. Likely your mental health professional will provide you with solutions that can include stress management and behavior therapy.