The Grind

My sister used to grind her teeth in her sleep. She found out about it in college, when her roommate heard a fingernails-on-chalkboard sound in the night.

Once she even woke herself up doing it. “I woke up with my jaw in that clenched mode with my teeth bearing down,” she recalls. “It was an unbelievable pressure.” But usually, the only telltale signs would be a dull headache and jaw pain in the morning.

Bruxism, as the clenching and grinding is called, is involuntary and usually happens during sleep. It generates pressure estimated to be 3 to 10 times that of normal chewing. Doctors guess that people “brux” because of too much stress, a misaligned bite, poor nervous-system function, or sleep disturbances. The drug Ecstasy causes bruxism, as do some antidepressants (as a rare side effect). People are also more likely to brux after drinking alcohol. But on the whole, doctors have few clear-cut answers about why someone starts bruxing, and no sure-fire cures.

Bruxism is not a well-understood or even well-accepted diagnosis among some doctors. And there aren't many medications that can help stop it.

“It happens to a greater or lesser extent in all of us,” says Dr. Gary Anderson, a University of Minnesota associate professor specializing in orofacial pain. “It’s fairly common for people to clench and grind their teeth from deeper- to lighter-stage sleep.” Kids, for example, often brux before getting their permanent teeth.

My sister says that as she got older and learned better ways to manage stress, her bruxism disappeared—at least as far as she knows. Her headaches and jaw pain are gone, and her dentist has never mentioned any unusual wear.

That’s the way it goes with this strange condition, Anderson says: “Some people appear to get away with it.”

Gnashing of Teeth

Those are the lucky ones. Other patients continue a pattern of bruxism for years, and fracture their teeth or have to wear mouth guards to prevent tooth damage. They suffer other symptoms, too: earache, toothache, pain in the jaw, face, or more generally around the head, chewed tissue on the inside of the cheeks, even hearing loss.

If you think you’re bruxing, you should see your dentist and your regular doctor as early as possible to try to prevent the problem from getting worse. Your dentist can correct a bite problem that might be causing the grinding, look for signs of wear on your teeth, and fit you with a mouth guard—typically a plastic device that fits over the teeth to absorb the force of grinding. Go back for follow-up visits to monitor whether the guard is changing your bite. “You prefer to have all the teeth covered” by a guard, Anderson says. “The risk could be that your bite shifts, but that’s more likely to happen with partial coverage.”

There aren’t many medications that are helpful for stopping bruxism. A doctor could prescribe a muscle relaxant for you, or maybe inject your jaw muscles with Botox. “Botox knocks out some of those muscles” needed to brux, Anderson says. But “it hasn’t quite been the overwhelming success we thought it might be,” he adds.

Because medical treatments don’t always do the trick, consider seeing a practitioner who can help you with stress-management techniques, such as meditation, biofeedback, or self-hypnosis.

The Jawbone’s Connected

There are your teeth to worry about, and the discomfort bruxism causes. But if you decide to ignore those things, know that grinding and clenching can wreak havoc on your temporomandibular joints, the ones on each side of your mouth that connect the lower jawbone to the skull.

Disorders in these joints could be the source of the pain or tenderness you feel around your jaw if you brux. They could also make it hard for you to open your mouth all the way, or to chew. And they might cause a locking or clicking in the jaw joint. Sometimes, tinnitus (a continual ringing in the ear) and hearing loss can be attributed to a temporomanidbular joint disorder.