Treating bruxism for a better quality of life

Dr. Arabella Michelén

Sunday, April 21, 2024

Bruxism is a bad habit described as the involuntary grinding or clenching of teeth, commonly occurring at night while sleeping and repetitive in nature. It ranges from mild to severe, bringing various negative health consequences that vary from patient to patient. It is closely associated with stress, anxiety, poor occlusion, dental crowding, temporomandibular joint disorders, and sleep habits.

It's important to know that bruxism can occur at any age and in any gender, although it is more common in adulthood, where economic pressures and personal, family, and professional fulfillment demands are generally more pronounced (increasing stress and anxiety, and thus the possibility of developing it). However, there is also childhood bruxism, commonly seen in children between two and six years old, often associated with the shedding of primary teeth and is usually temporary. However, stress, so characteristic of our times, cannot be ruled out in the pediatric population. Adolescents, older adults, and others may also suffer from bruxism; the causes include those previously mentioned. However, each individual is unique, just like their life history and the situations that shape their existence, thus their well-being and physical and mental health differ significantly, and bruxism is closely related to these factors.

The patient with bruxism generally comes to the consultation complaining of discomfort or limitations when opening and closing the mouth, especially upon waking. They may notice that their teeth are getting smaller (worn down), have headaches or earaches that occasionally radiate to the neck or even the upper back, experience muscle tension, dental hypersensitivity, difficulty falling asleep, or their sleep partner hears a bothersome noise. Others may attend a routine check-up and receive the diagnosis during the consultation.

The symptoms mentioned above are not exclusive to bruxism, so for diagnosing this condition, the dentist needs:

A thorough medical and dental history, clinical examination, X-rays, evaluation of the temporomandibular joint, dental occlusion, and functionality of the masticatory muscles, among other aspects.

Treatment varies greatly from patient to patient, depending on the intensity of the habit, medical history, and the patient’s attitude towards the situation.

The first step is to eliminate, as far as possible, the underlying cause. For example, in cases of dental crowding or poorly fitted dental prostheses, the patient is referred to a specialist in these areas to work on restoring proper occlusion. Anxious patients or those under a lot of stress should seek the help of a mental health professional. Treatment is generally interdisciplinary, with several causative factors involved, and where muscle-relaxing mouthguards alone are not enough, but rather a set of measures addressing the root causes rather than merely reducing symptoms.

The oral health professional will utilize all scientific and technological advances available and certified by qualified studies, including:

• Medications, such as muscle relaxants, analgesics, anti-inflammatories, etc., prescribed based on each case's needs.
• Stress management and relaxation therapies. It is very common to involve mental health professionals.
• Recommendations to avoid drug use, alcohol, and tobacco, as these predispose individuals to bruxism. They are harmful not only to oral health but also to general health.
• Dental treatments to eliminate causes and symptoms and repair existing damage. These range from removing cavities, treating periodontal problems, and adjusting ill-fitting prostheses to replacing missing teeth, occlusal adjustments, and placing implants. The goal is to restore the bite, prevent improper occlusal contacts, and thus contribute to relaxing the masticatory muscles.

The aim is to restore health while adding beauty.

The application of botulinum toxin (Botox) relaxes the masseter muscles involved in chewing, reducing their activity, thus decreasing dental tissue wear, area pain, and discomfort when opening and closing the mouth. This is ideal in combination with muscle-relaxing mouthguards and other treatments in controlling this habit.

The use of mouthguards protects the teeth and distributes the forces from grinding. These are customized to meet the patient's needs and should be supervised according to the schedule indicated by the dentist.

Photodynamic therapies promote muscle relaxation, improving sleep and reducing teeth clenching.

It's essential to note that one treatment alone is rarely sufficient. Usually, a combination of several treatments will be effective and, as a result, will restore the patient’s quality of life. The effects of bruxism range from tooth wear and fractures, which can lead to the loss of one or more teeth, to a decrease in vertical dimension, giving a premature aging appearance. It can also cause damage to the temporomandibular joint and the entire masticatory system, as well as sleep disorders and, therefore, negatively impact physical and mental health, causing severe headaches, ear and neck pain, and even affecting the individual's personality.

Unfortunately, as life becomes increasingly hectic, the number of bruxism patients continues to rise. Still, thanks to continuous scientific and technological advances, today's treatments are more effective. The oral health professional has access to scanners that provide more accurate impressions for better-fitted guards. The incorporation of Botox and photodynamic therapies enhances the effectiveness of eliminating the underlying causes. Moreover, recognizing bruxism as a multifactorial condition has made consultations with other health fields, such as psychologists, behavioral therapists, psychiatrists, and dental specialties, an integral part of bruxism treatment, all of which significantly benefit the patient.

It's crucial to emphasize that although bruxism primarily manifests in the mouth, it affects not only oral health but also overall health. Speech, concentration, and eating are areas of daily life negatively impacted in these patients. Ignoring the rising number of patients with this condition is akin to turning a blind eye to a pervasive reality. Stress is a significant factor in most lifestyles adopted in recent years, and bruxism and anxiety are closely linked. Sometimes, diagnosing bruxism serves as a wake-up call that something beyond teeth grinding is amiss, signaling the need to pause and restructure several aspects of daily life and seek professional help in various fields, with some patients requiring one type of care and others different types.

The most common specializations involved include endodontics, orthodontics, rehabilitation, and periodontics in dentistry, as well as general medicine and behavioral therapies.

If the underlying causes of this habit reappear after treatment, teeth grinding and symptoms will return, hence the importance of regular control appointments with the dentist and taking serious measures to avoid recurrence.

Remember, at the first sign or suspicion of being a bruxism sufferer, schedule an appointment with your dentist. Remember, your dentist is your ally.