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You may not be aware you’re doing it because it happens in your sleep. But if you’re suffering from inexplicable nagging headaches or pain in your jaw during the day you could be one of the many people who unconsciously grind their teeth. It’s called bruxism – a serious condition if it isn’t diagnosed and treated early …
By Michelle Pieters
It happened regularly: a dull pain that ripened during the day into a blinding headache. The pain was so intense she couldn’t read or look at her computer without difficulty. As a result her new dream job was at stake.
“I remember sitting at my desk and just holding my head,” says Janet* (38), a divorced single mother of Johannesburg. “I would panic every time the pain started because I knew how bad it was going to be and how helpless I’d become.” These definitely weren’t migraines. “I’d had migraines before – this pain was different. I tried all sorts of painkillers to make the headaches more bearable but I didn’t want to be living on pills.”
Because she’s not the stressed-out sort it didn’t occur to Janet that tension was to blame. “At first I thought it was my eyesight,” she says. “But my ophthalmologist gave me the all-clear. Then my GP referred me to a physiotherapist as the muscles from my neck into my head had gone into spasm.”
The physio suspected this wasn’t an ordinary case. Her recommendation? A visit to the dentist.
“After just a brief check-up my dentist diagnosed the problem,” Janet says. “I had been grinding my teeth. This had led to inflammation in my jaw and neck muscles – and the headaches.”
Fortunately Janet’s problem was diagnosed early. She could have woken up one morning with a cracked tooth or eventually ground her teeth down to nothing, which would have required surgery and having her teeth extracted and replaced with implants – a thoroughly unpleasant prospect for anyone, especially a 38-year-old career woman.
The solution was simple: a bite plate fitted over the surfaces of the teeth. Worn at night it acts as a buffer and helps to reduce grinding by preventing the upper and lower teeth from touching.
“I had to wait 10 days for the plate,” Janet says. “It was the most important thing in my life. After that I had just one headache but the dentist had warned me that might happen. But if there was anything that changed my life it was that plate. I haven’t had headaches like that again.”
She still wears the plate but not every night. The spasm in her neck has eased so much she can sleep without the plate for a few nights without any adverse effects. But dentists warn that teethgrinding can never be cured, which is why it’s advisable to wear the plate every night and not just when your jaw is sore or the headaches return.
Teeth-grinding or bruxism is a habit that stems from the brain’s central nervous system. Most people grind their teeth at some point in their life – about 20 per cent of all adults during the day and eight per cent at night, says Professor Greta Geerts of the faculty of dentistry at the University of the Western Cape.
“People who grind during the day usually do so as a result of stress or tension,” she says. “You might even do it subconsciously while exercising or jogging or when you’re deep in thought at your computer. After a while daytime grinders usually become aware of what they’re doing and can learn to break the habit.
“Nocturnal grinding, however, is done unconsciously while you’re asleep. You don’t know you’re doing it so you can’t learn to stop. This is why night bruxism is more serious and regarded as a sleep disorder.”
Researchers at sleep laboratories have found grinding doesn’t happen all night but only during certain phases of the sleep cycle. Contraction of the chewing muscles usually happens just before the REM phases of sleep. Some people just clench their jaws whereas others actively grind by gnashing the teeth against one another.
Both are equally bad but the symptoms vary. Some people don’t get the debilitating headaches Janet experienced. Others experience pain in the jaw or notice their teeth are wearing away.
That’s what happened to Michelle*, a 26-year-old accountant from Sandton. “My jaw was always sore in the morning,” she says. “Then I noticed one of my teeth was worn down a bit. I went to the dentist and he immediately prescribed a bite plate.”
It’s difficult to pinpoint the cause of bruxism because experts don’t know why some people are more inclined to do it than others. But it’s recognised that teeth-grinding is associated with the central nervous system, meaning the process must begin in the brain.
Factors such as anxiety, tension and frustration make it worse but according to Cape Town prosthodontist Dr Deon de Villiers, an unbalanced bite can also be a contributing factor.
The consequences can be serious and include toothache, damage to the nerves in the teeth, abscesses, pain in and loss of mobility of joints of the jaw, muscle pain affecting the neck and headaches.
“But wear and tear of the teeth is the most common consequence,” Dr de Villiers says. Deterioration begins with the front teeth, then affects those at the back. “Some people even grind so badly they crack or break a tooth,” Professor Geerts says.
Michelle was one of these people. “A loud crack woke me one night and I realised I must have been grinding because I’d broken off a piece of tooth.” She also cracked her bite plate two weeks after receiving it – an indication of just how hard she had been grinding her teeth.
“Sometimes during the day while working I’d hear an irritating noise,” she says. “I realised it was me grinding my teeth. It soon became clear I did it a lot around the end of the month when pressure at work was at its worst.”
It's possibleto grind your teeth so hard that you impair your speech and your ability to chew because of the damaged joints and muscle spasms in your jaw, Dr de Villiers says. Certain conditions and medications can make bruxism even worse: those suffering from cerebral palsy or Parkinson’s disease or who take certain antipsychotic medications tend to grind their teeth more than others.
Professor Geerts says research among drug addicts has shown drug and alcohol abuse can aggravate the condition, as does smoking.
To limit tooth damage bruxism needs to be diagnosed early. In extreme cases patients’ teeth are worn down almost to the gum and are unusually sensitive because the tooth enamel has been worn away and the much softer dentine is exposed.
“In some patients too little of the teeth remains for them to be fixed or crowned,” she says. “Gum surgery or extraction of some of the teeth is then necessary.”
Because the condition is incurable, treatment is symptomatic. Dentists always prescribe bite plates. These are different to the mouth guards worn by sportspeople and the ones you buy at the pharmacy, Professor Geerts says.
A bite plate prescribed by a dentist or a prosthodontist is usually made in a laboratory by a dental technician. Bite plates look almost like dentures; those intended for long-term use are usually made of hard, transparent resin about one or two millimetres thick.
Some bite plates fit over the front teeth on the top or bottom jaw. They work well to deprogramme the jaw-clenching muscles but they’re intended specifically for short-term use and are effective only if the patient follows the dentist’s directions closely.
“Wearing a bite plate doesn’t hurt, but it does affect your speech and appearance a little,” Professor Geerts says. “Your plate must be worn every night and sometimes also during the day when you’re alone. “Some patients eventually grind small holes into the plate and it needs to be replaced.”
Alternative treatments such as hypnosis, acupuncture or facial massage won’t stop you grinding your teeth.
“Acupuncture can be used to relieve muscle spasms and hypnosis may help to resolve the emotional issues that feed stress,” Dr de Villiers says. “Anti-inflammatories can also help to relieve the pain.”
If bruxism is diagnosed early a bite plate is usually enough to help a patient. But if a lot of damage has been done – for example the tooth enamel has been destroyed – the teeth have to be repaired before a bite plate can be worn. If the teeth are very badly worn it might be necessary to do surgical crown extensions (gum and bone recontouring to expose a healthy amount of tooth).
Little research has been done on bruxism but one of the few scientific studies involved testing botox on a small group of bruxism sufferers.
A series of about five botox injections into the masseter muscle (the chewing muscle attached to the corner of the bottom jaw) temporarily relieved muscle pain in the jaws of some of the test subjects. “But botox is not a routine procedure,” Professor Geerts says. “It’s something to watch out for in a few years.”
Dr de Villiers on the other hand says botox isn’t an effective treatment because it’s not possible to immobilise all the jaw muscles that cause grinding action.
* Not their real names.
Kids do it too
Even children who still have their milk teeth can be grinders – and sometimes the teeth are almost completely worn away before the permanent teeth replace them. Nocturnal bruxism can be more common among children who’ve been diagnosed with attention deficit hyperactivity disorder (ADHD) or those who have nasal obstructions.
“Because children are still growing and their bones are softer they don’t feel the pain as intensely as adults. But their parents will pick up the problem when they hear their kids grinding their teeth at night,” says Dr Soraya Yasin-Harnekar, a paediatric dental specialist at the University of the Western Cape.
It’s important to establish why children grind their teeth. It could be the result of psychological factors such as an inability to express anger, or of anxiety. If one tooth is longer than the others a child is also more inclined to grind.
“We usually talk to the parents first and establish the background before deciding on a course of treatment,” Dr Yasin-Harnekar says. “If a child is grinding because of anxiety we refer the child to a psychologist. If it’s because a tooth is sticking out we can file it down to the same length as the others. And if necessary we make a soft guard of vinyl plastic about three millimetres thick. It fits over the top teeth and usually helps break the habit in three months.”
Look out for
- Grinding noises when asleep
- Tired or lame chewing muscles on waking
- An overdeveloped masseter (chewing) muscle
- Ground-down teeth
- Toothache
- Neck, shoulder or back pain
- Sinus pain
Signs of grinding
- Short front teeth
- Canines lose their points
- Front teeth are the same length (normally the centre incisors are a little longer than the smaller incisors on either side)
- Front teeth become thin and seem transparent
- Bits of tooth break off and the edges look like the blade of a saw
Fixes and fees
Costs are usually covered by medical aid but it depends on your fund and plan. It’s always advisable to send a quotation to your medical aid first to find out how much it will pay.
- Depending on the type a bite plate can cost anything from R1 800, says Dr Freddie Senekal, a dentist in Durbanville, Cape Town.
- Sometimes crown and bridge work or implants need to be done first. Crowns cost from R3 000 each.
- Crown extensions cost from R3 000 for a quarter of the mouth. This excludes hospital and anaesthesia costs if the work has to be done in theatre.
- Replacing a tooth with an implant costs about R13 000.
