Sleep Bruxism – Symptoms, Causes, Diagnosis, Treatment

Sleep Bruxism

Are you curious to know why some people grind their teeth in their sleep? Do you know someone who bites their teeth in sleep?

Nighttime teeth grinding or chewing is more common than most people think. According to a stat by the National Sleep Foundation, Sleep Bruxism is prevalent in children under age 11. 14% to 20% of children in this age range suffer from this condition. But, as the children in this category get older, they are more likely to stop grinding their sleep; and get more restful sleep as a result. 

Another interesting fact about this condition is that most people who grind their teeth in sleep have no way of knowing it unless a family member tells them about it, or they see visible damage on their teeth. 

Furthermore, it is common for people to grind or clench during the daytime. We all do it when we get angry, annoyed, or irritated about something. But doing the same at night time can have adverse effects on our health. Teeth grinding at nighttime can lead to a lot of other ailments. We have also discussed other symptoms of Sleep Bruxism, further in this post.

What is Sleep Bruxism

In case you are wondering, “what is Sleep Bruxism?”, this section will help you understand that in brief. 

Grinding, clenching, or gnashing of teeth is one of the most common symptoms of Sleep Bruxism. It is essentially a parafunctional habit — the use of body parts (the mouth, tongue, and jaw, in this case) for purposes other than what they originally were meant for. 

As we mentioned earlier, this condition also affects people during the daytime, but the symptoms of Sleep Bruxism are worse immediately upon waking up in the morning. Teeth grinding in sleep can also dissolve the joint that holds the upper and lower jaw (known as temporomandibular joint) together. Hence, it is one of those conditions that you cannot take lightly.

Symptoms of Sleep Bruxism

1) Dental Attrition

The dictionary definition of the word attrition is “the process of reducing something’s strength or effectiveness through sustained attack or pressure.” Dental attrition is a result of tooth-to-tooth contact in the nighttime. When a person suffering from Sleep Bruxism rubs his/her teeth onto each other, in sleep, the friction causes the biting surfaces to wear off. This wearing off leads to “loss of teeth.” 

2) Tooth Fractures

Along with dental attrition, tooth fracture is also a significant symptom of Sleep Bruxism. Mismanaged Bruxism usually leads to dental attrition. Secondly, when a person suffering from this condition is entirely unaware of the dental damages or chooses to neglect them, it is likely that one day, he/she will wake up with a noticeable fracture in their tooth/teeth.

Tooth fractures are also referred to as “cracked teeth” within some medical communities. A fractured tooth behaves quite similarly to a broken bone in some other part of your body, like arms or legs. 

You will go through prolonged episodes of erratic pains. With a tooth fracture, this is a more common post-lunch/dinner as you have to chew the food with a cracked tooth. Lastly, exposing your tooth to temperature extremes can also cause pain. 

3) Burning Sensation on the Tongue

Sleep Bruxism also generates a burning sensation on the tongue (also known as “tongue thrusting”). The medical term for this condition is Burning Mouth Syndrome (BMS). Sometimes, along with burning, the patient may also experience loss of taste or alteration of taste. 

Likewise, their ability to smell is also affected to a large extent. We know that Sleep Bruxism causes Burning Mouth Syndrome (BMS), but scientists don’t yet know how both are linked.

4) Inflammation in the Connective Tissue Fibers in Mouth

Sleep Bruxism also leads to inflammation in a group of connective tissue fibers known as the periodontal ligament (PDL). These are the fibers that keep your tooth attached with the alveolar bone (a part of the upper and lower jaw). Clenching your teeth leads to inflammation in PDL, which in turn can make it difficult for you to open your mouth. 

This was precisely the case with a 19-year-old male patient in Karnataka, India, who was experiencing intense pain in the left cheek and left lower back teeth region for 2 straight days. Examination by the Department of Periodontics of a local hospital revealed that this particular condition was a result of multiple periodontal abscesses.

5) Dentin Hypersensitivity

Sleep Bruxism

If you have ever experienced intense and sharp tooth pain immediately after chewing on something hard, you will know how it feels like to suffer from Dentin Hypersensitivity. Pain caused due to Dentin Hypersensitivity occurs when the dentin (a calcified tissue under the enamel of the teeth as shown in the picture above) is subject to extreme heat or cold, tactile pressure, or a particular chemical (like an acid etches during dental treatments). If you suspect having Dentin Hypersensitivity, it is better to get diagnosed by a dentist.

What Causes Sleep Bruxism?

The exact cause of Sleep Bruxism, or Bruxism in general, is yet not known. Scientists are still trying to figure out what makes a person grind their teeth in the middle of the night. However, there are speculations as to what might lead to this condition, but there is no scientific evidence to back them up. Researchers believe that stress and anxiety are the two leading causes of Bruxism. Some people grind their teeth as a way to cope with a particular issue in their personal life. 

Diagnosis of Sleep Bruxism

Sleep Bruxism can easily be self-diagnosed. Unless your treatment has already reached an advanced requirement, you don’t necessarily need to undergo sophisticated lab tests like actigraphy or polysomnogram. Simply place a video camera near your bed pointing towards you before you go to sleep. Let the camera run the whole night. 

The next day, you can see for yourself if you grind your teeth in sleep or not. If you do find yourself grinding your teeth or experiencing other symptoms of Sleep Bruxism, it is best to consult a family doctor in agreement with a dentist. AASM also advises maintaining a sleep diary for two weeks before heading for a medical check-up.

The Best Treatment Options for Sleep Bruxism

1) Wear Occlusal Splints at Nighttime

Sleep Bruxism effects

An occlusal splint is medical equipment that can be worn before going to sleep. It is also known as a mouthguard or a dental guard. In the image above, you can see that an occlusal splint is made up of a synthetic material (silicon, to be specific) and appears a lot like the mouthguard that professional martial artists wear to protect their teeth against injuries. 

Although, it should be noted that a wearable device like occlusal splint can only protect your teeth from getting damaged. It does not stop you from biting your teeth.

2) Psychosocial Interventions

Since the root cause of Sleep Bruxism is still unknown, popping pills just to limit the symptoms is not such a good idea. This is where non-medicinal interventions come into the picture. 

A psychosocial intervention involves a diseased person to interact with others around him/her and work towards a cure as a team. By doing this, the patient can conclude as to why he/she may be grinding their teeth in sleep. Is something troubling them?

Is There a Connection Between Sleep Bruxism and Sleep Apnea?

Several studies have been done to find the link between Sleep Bruxism and sleep-breathing related illnesses like Sleep Apnea. Researchers have noticed that in patients showing the symptoms of both Bruxism and Apnea, there is a positive correlation in the frequency of teeth clenching and that of apneic episodes. 

In short, both teeth clenching and breathing problems occur on the same night. Due to this fact, researchers believe that there is a link between both sleep disorders, but there is no evidence to support the association or causality of Bruxism and Apnea. 

However, an Australian study does prove that there is a link between Sleep Bruxism and sleep position. They also believe that the typical symptoms (like alteration in muscle activity/tone) exhibited by both Bruxism and Apnea patients may lead them to find the link between the two conditions. More research needs to be done on this subject.

Conclusion

As of 2019, patients suffering from Sleep Bruxism and their family members have come to peace with the fact that there is no cure to this condition. 

To fight with the dreadful symptoms, most people try taking medications like antidepressants, muscle relaxants, benzodiazepines, anticonvulsants, and beta-blockers. But all these drugs have done so far is mask the symptoms for a few days, make you prone to their side-effects. 

There is growing hope among the Sleep Bruxism community that the cure is around the corner, certainly not that patients shouldn’t be living their life at fullest.