Bruxism (Teeth Grinding): Types, Causes, and Treatments

Bruxism, also known as teeth grinding, is a sleep-related movement disorder that involves clenching jaw muscles together to grind upper and lower teeth together.

This condition causes a lot of symptoms that are quite uncomfortable, like a sore jaw, facial pain, and chronic headaches. It can also negatively impact your oral health and lead to the need for expensive dental work.

So…why do you grind your teeth?

There are two types of bruxism Awake Bruxism and Sleep Bruxism, they’re both caused by a combination of factors. Plus, some of the previous assumptions about grinding, like that it’s usually stress-related, have been challenged by science over the last couple of decades.

Actually, researchers have discovered that sleep apnea might play a part in some cases of bruxism. Treatments that have been “first line” in the past have been replaced with more effective (and sometimes less invasive) options.

Let’s take a look at the types and causes of bruxism, as well as the treatment options available to you. Grinding your teeth doesn’t have to be a lifetime sentence.

What happens when you grind your teeth?

Your teeth are made of incredibly strong particles of hydroxyapatite, the minerals that make up enamel (and bone structure). When you brux (grind), you’re exerting hundreds of pounds of force on these strong, but small, tooth structures.

Over time, your teeth will wear and your oral health will suffer. All the consequences of bruxism worsen the longer you grind your teeth. Here are the most common results of grinding your teeth for a long time without treatment.

Consequences of Untreated Teeth Grinding

Premature loss of enamel: Constant grinding can remove layers of your tooth enamel, making them more susceptible to sensitivity and tooth decay/cavities.

Fractured teeth: Teeth can cave to the unrelenting pressure of grinding and end up cracked or fractured, requiring a root canal or even extraction.

Yellowed teeth: The best way to make your teeth look whiter is to prevent yellowing or discoloration. Grinding can prematurely age teeth, accelerating their yellowing and worsening their aesthetics.

Gum recession: Grinding can exert 250 pounds of force per square inch of tooth surface. This muscle activity can push the gums away from the teeth and cause irreversible gum recession. Receding gums can then lead to decay as bacteria settles into the recessed space, as well as significant tooth sensitivity.

Temporomandibular joint disorder (TMD): Grinding teeth also puts a lot of pressure in the temporomandibular joint, which can lead to TMD. TMD is also sometimes called TMJ, and the disorder can cause ongoing pain in the joint muscles, clicking or popping of the jaw, as well as difficulty chewing and, sometimes, speaking.

Migraine headaches: Because of the force exerted on your facial muscles, grinding your teeth can cause tension headaches, migraine episodes, and chronic migraines.

Common Conditions Associated with Bruxism

There are also a number of conditions and other symptoms closely associated with teeth grinding and/or sleep apnea. I’ll explain the connection between grinding and sleep apnea below.

It’s not clear whether or not all of these conditions are caused by grinding or obstructed sleep breathing, or the other way around. But it’s possible that you’re at a higher risk for these medical conditions if you grind your teeth:

  • Restless leg syndrome (these findings are somewhat controversial)
  • Chronic kidney disease 
  • Depression
  • Sleep-disordered breathing
  • Behavioral problems in children
  • Gastroesophageal reflux disease (GERD)
  • Obstructive sleep apnea (more on this below)

Types of Grinding

In the past, all bruxism was attributed to similar causes. But today, science shows that there are two distinct types of grinding, and they aren’t always correlated with the same causes. All bruxism, though, seems to affect the teeth in the same way.

Awake Bruxism

Ever notice you’re staring at your computer screen and suddenly unclench your teeth? That’s an experience of tooth grinding while awake. If this happens often, you might have awake bruxism.

Awake bruxism may be due to emotions like anxiety, stress, anger, frustration, or tension. It could also be a coping strategy or simply a habit you practice while in deep concentration.

Sleep Bruxism

Grinding at night is a totally different issue for most people than grinding teeth throughout the day. While daytime grinding is often an emotional or habitual issue, sleep bruxism is more likely related to sleep quality. This sleep-related chewing activity could be happening in relation to being awakened during the night (even if you don’t remember waking up).

These arousals during sleep happen in the course of sleep apnea or other forms of sleep-disordered breathing.

Common Causes of Bruxism

Bruxism is what’s known as a “multifactorial” health issue. That means it’s often caused by a combination of factors, or that it can be hard to distinguish what actual causes are at play in a single person’s case. There isn’t a single cause of bruxism in every case.

This is a controversial area of research. However, in general, there are three basic parts defined in the etiology (cause) of bruxism. They are:

Peripheral Factors

These would be factors like misalignment of teeth that may cause grinding of teeth. Peripheral factors like poor occlusion of the teeth aren’t as clear a cause of bruxism as the other factors.

That being said, if your teeth aren’t lined up correctly, it may cause your jaw to be unstable. Especially if you’ve recently had a tooth extracted or had other major dental work done, talk to your dentist about misalignment. Although it may not be a direct “cause” of bruxing, it can contribute to the TMJ/TMD pain you may be experiencing.

Psychosocial Factors

It’s hard to draw conclusions about cause-and-relationship with psychosocial factors for bruxism. That’s because the types of studies that look at the relationships are larger studies of populations known as “epidemiological” studies. While epidemiological studies can help establish a correlation, these aren’t the same as clinical trials that establish direct conclusions.

Teeth grinding often happens more often in people who simultaneously deal with:

  • Depression
  • High levels of and sensitivity to stress
  • Abnormally high levels of hostility towards others
  • Anxiety
  • As you might have connected from the above section, psychosocial factors for teeth grinding are more often associated with awake bruxism, not sleep bruxism. If you catch yourself grinding during the day, relaxation techniques may help—but may not be as effective for sleep bruxism. Some cases of anxiety and stress-related bruxism during the day can exacerbate nighttime teeth grinding, though.

Central Factors

These causes, also called “pathophysiological factors,” are the focus of a lot of current research into sleep bruxism. Central factors for teeth grinding have to do with internal systems that may be out of balance in some way in the presence of bruxism, like the central nervous system.

For one, nighttime grinding is closely associated with arousal responses during sleep. “Arousal responses” refers to moments during sleep that you’re awakened or brought from a deep sleep into a lighter sleep, like REM sleep.

Often, you won’t remember most of your nighttime arousals, but a sleep study (and some home sleep tests) can help you identify whether or not you’re sleeping soundly or being aroused.

In bruxism, there’s also a connection between some neurotransmitters and the act of grinding. In fact, one of the systems your brain uses to communicate movement to the body seems to be disrupted in bruxism.

Another central factor for teeth grinding is heritability. Teeth grinding (and the resulting pain) seems to run in families.

Finally, the last group of central factors for bruxism is the use of certain medications. Grinding is a known side effect of these types of drugs:

  • SSRIs (a type of antidepressant)
  • L-dopa (although this can help with grinding when taken in very short-term periods)
  • Amphetamines, including drugs for ADHD
  • Nicotine
  • Anti-anxiety medications
  • Antipsychotics (neuroleptics)

Bruxism and Obstructive Sleep Apnea

As it turns out, your dentist might be the first person to warn you that you might have sleep apnea—because s/he is the first to see the signs of bruxism. Sleep disorders like sleep apnea (and the less severe UARS) could be a contributing factor to grinding.

Long considered a disease only common in obese, older men, obstructive sleep apnea may actually be more common than previously thought. According to the National Sleep Foundation, somewhere between 2-3% of Americans struggle with sleep apnea.

It’s not all that surprising that sleep apnea and bruxism are connected. During an apneic episode, the airway is closed and airway pressure drops to zero. In order to alert the body to re-open the airway, the brain will initiate arousal and essentially draw one out of deeper sleep. This arousal can happen by grinding the teeth together, which will cause some movement and re-start breathing.

I want to point out here that some of the evidence points to bruxism as a result of the poor sleep quality in sleep apnea, whereas other research suggests it’s a direct response to apneas.

Teeth Grinding in Kids

Children grind their teeth at night more often than you might think. A 2008 survey of parents of preschoolers found that almost 40% of the children were grinding their teeth at least once a week, with just under seven percent grinding four or more times every week. Kids in the second group were also more withdrawn and socially awkward.

Bruxism in children is associated with:

  • Mouth breathing
  • Snoring
  • Restless sleep
  • Drooling
  • Stomach sleeping
  • Lack of sleep

How can I find out if I’m grinding my teeth at night?

There are several symptoms of sleep-related bruxism, like:

  • Daytime sleepiness
  • The need to urinate in the middle of the night
  • Snoring
  • Waking up frequently at night
  • Jaw pain or clicking in the jawbone when you open your mouth
  • Chronic headaches
  • Tooth sensitivity
  • A metallic taste in your mouth, which can happen as a result of grinding on metal fillings

The best way to diagnose grinding, whether it’s related to sleep or not, will be to see your dentist. At your next six-month cleaning, ask your dentist if s/he sees signs of grinding.

Treatment Options for Bruxism

There is no known “cure” for bruxism in all patients. Because of the complicated nature of this condition, it’s hard to offer concrete medical advice without a very complete picture of an individual’s symptoms, medical history, and other important factors.

However, there are some ways to treat bruxism that are effective, depending on the root of your symptoms.

1. Night Guard

A night guard is often the first tool in a dentist’s arsenal in treating bruxism. It’s still the first recommendation of the American Dental Association (ADA) for nighttime grinding, accompanied by stress relief techniques. These devices are called an occlusal splints, because they are a specific type of night guard used to prevent damage from grinding

2. Sleep Apnea Treatment

If obstructive sleep apnea is the cause of your bruxing, you’ll need to follow through with sleep apnea treatment in order to stop or reduce grinding.

Here’s a quick list of some of the most common sleep apnea treatments (excluding oral appliance therapy, which I discuss in the following section). If you’ve been diagnosed with mild sleep apnea or UARS and given few treatment options, the first two on this list may give you some relief.

3. Botox / Xeomin

If you tend to grind your teeth, you have a condition people in the dental profession call bruxism. This involuntary behavior can be quite an annoyance for you, and it may even be causing jaw pain, headaches, the wearing down of tooth enamel, gum sensitivity, or chipped teeth. If you’ve already tried conventional approaches to changing this behavior and have been disappointed in the results, you may be surprised to learn that Botox/ Xeomin has proven effective as a treatment for grinding teeth.

If you’re treated with Botox or Xeomin, a small amount will be injected into the muscles responsible for moving your jaw – most likely the masseter muscle, which is responsible for chewing. It may also be injected into the frontalis and temporalis muscles according to your specific needs. The botulinum toxin will reduce clenching, and it will also help with any accompanying tension and aches in your head that you may be experiencing. Botulinum toxin usually kicks in about 1 to 3 days after injection (but can take up to two weeks), and the effects could last 3 to 6 months.

Key Takeaways: Teeth Grinding (Bruxism)

The habit of grinding your teeth, whether during the day or at night, is a complicated matter. There’s no “one-size-fits-all” cause—or cure—for bruxism.

There are bruxism treatments available for any budget, insurance plan, and/or lifestyle. It’s best for you to get to the root cause of your grinding issue so that you can experience the best results possible.