How to Diagnose and Care for Bruxism Patients

Friday, June 23, 2017

How to Diagnose and Care for Bruxism Patients

Forty percent of adults in the U.S. grind and clench their teeth during sleep – a good handful of these people we treat every day. As dentists, it is important to be able to identify the key indicators of bruxism – especially its strange, seemingly unconnected symptoms, and teach patients some simple ways to protect their smiles.

What is bruxism?

Sleep bruxism is typically a stress-related sleep disorder that manifests in teeth grinding and jaw clenching while sleeping, and affects over 60 million Americans. As healthcare professionals who often see their patients on a more regular basis than physicians, dentists and dental hygienists have recently become more actively involved in treating bruxism. Bruxism can result in a variety of dental and medical issues, including moderate to severe tooth wear and damage, tooth, jaw, facial and neck pain, headaches and sleep disruption. 

Why do people grind their teeth at night?

According to the Mayo Clinic, doctors don’t completely understand what causes bruxism, but it may be due to a combination of physical, psychological and genetic factors.Stress, anxiety and tension are generally the culprits and causes of teeth grinding. Others suspect evening consumption of alcohol, caffeine or some medications will increase nighttime grinding. Factors such as age, personality type and a history of bruxism in your family also can increase the chances of bruxism.

How to tell if a patient has bruxism?

Dentists usually can determine if a patient grinds or clenches his or her teeth in two ways: The first is by asking whether the gnashing of teeth wakes up their spouse or partner. This unsettling sound of enamel grinding against enamel is startling and alarming. It is not uncommon for patients to say that their spouse or partner often wakes them up with the hopes of stopping the grinding.

The second way a dentist can determine whether their patient grinds or clenches their teeth in their sleep is by asking if their facial and chewing muscles are fatigued or sore upon waking up.

But perhaps the most obvious sign of bruxism is when a patient shows up in the dental office with a broken or chipped tooth. If we “peel back the onion” and delve into the problem further, we may realize there are comorbidities as well, including:

  • Headaches
  • Tinnitus (ringing in the ear)
  • Muscle facial pain
  • Difficulty chewing or swallowing
  • Difficulty sleeping

Bruxism is a difficult thing for a patient to self-diagnose, mainly because they usually don’t know that they are grinding. So, as a dentist, the onus is on us to check for signs of tooth damage and ask the right questions to properly care for the patient.

What are the treatment options currently available for managing bruxism?

How is Ora-GUARD® Different?

Ora-GUARD

I decided to develop the Ora-GUARD® Dental Grind Guard because I wanted patients who couldn’t afford a custom bite guard to have an effective option to protect their teeth from grinding and clenching. Its soft and hard surface wedge design features soft medical grade fit material to cushion the jaws during clenching, while the hard surface design protects teeth from the effects of grinding. The bite plate wedge design is specially constructed to slide the lower jaw down and forward, in order to release tension on the TMJ muscle while preventing tooth damage.

To date, dentists have not figured out how to stop patients from grinding and clenching. The most common treatments are to have patients protect their teeth from the harmful effects of bruxism by wearing an occlusal guard, which is also referred to as a night guard. These guards can be custom fit based on a physical or digital impression which is sent to a lab for fabrication. However, the cost of these devices can be prohibitive for many patients, and FDA-approved over-the-counter occlusal guards such as Ora-Guard can provide these patients with an inexpensive yet effective device to protect their teeth from grinding and clenching.

Since there is no perfect treatment for grinding and clenching, you need to first prevent further damage to the patient’s teeth. Yes this is treating the “effect” and not the “cause,” but mitigating continued damage is an important first step.

What is truly amazing is that when patients wear an occlusal guard, they report that they wake up and their face doesn’t feel tired. It may seem like an odd way to describe a clinical situation, but patients feel the difference in the morning when using a guard.

Other recommendations for patients with bruxism, include:

  • Reduce nighttime stress and anxiety
  • Avoid alcohol and caffeine before bedtime
  • Relaxation or meditation techniques throughout the day and before bed
  • Anti-anxiety medication (e.g. Valium)

It may be impossible to stop a patient from grinding, but fortunately, with the right diagnosis and the right treatment, we can stop the damage and keep our patients healthy – and smiling.

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