Roy Suryo
Ella can’t remember when she first started grinding her teeth at night, but she can vividly recall the excruciating jaw ache, the headaches, and being told her molars were disappearing. "I was in so much pain," Ella says. "My face was changing shape and my teeth were at risk of breaking – I knew I had to do something about it." The 31-year-old has bruxism, a condition which can cause regular and often intense teeth grinding, but says the treatment she’s recently had has "without a doubt" changed her life.
Bruxism affects millions like Ella across the UK. Some studies suggest nearly one in four people experience the condition, although many may be unaware until symptoms appear. According to the British Dental Association, there is some anecdotal evidence that bruxism is becoming more common, but no specific figures. However, some dentists have told the BBC they are worried about the increasing number of young people they’re seeing with dental problems caused by incessant gnashing. "It is definitely on the rise," says Dr Aditi Desai, president of the British Society of Dental Sleep Medicine (BSDSM). "And it’s no surprise given that life itself nowadays can be so stressful."
Studies suggest many of us Bruxers do it because of stress – but why do our jaws carry the burden of our everyday lives? What can we do about it? And can it actually be a good thing in some cases? Bruxism is an umbrella term which groups together four different jaw movements – clenching, grinding, bracing and thrusting. Some people grind at night, others through the day. Some barely notice they’re doing it, while others can gnash through mouthguards and wake even the deepest sleeping bed partners. So how can you tell if you do it? Here are the signs to look out for:
- Dull headaches, often starting in the temples
- Aching jaw muscles, or a sore jaw
- Pain in your ear, or a feeling of fullness in your ear
- Damage to the inside of your cheek, from chewing
- A clicking sound when you open your mouth
- Teeth that are worn down, flattened, fractured or chipped
- Increased tooth sensitivity
- A dull ache in your face
- Disrupted sleep
- A partner complaining about a grinding or clenching sound during sleep
Teeth grinding is also mentioned more frequently in therapy according to the British Association for Counselling and Psychotherapy, which says people nowadays are more aware of how their mental health impacts their body. Psychotherapist Rahi Popat says more of his clients – particularly younger ones – say they or someone else have noticed they’ve been grinding their teeth, "and they can often link that to a really stressful time in their lives and realise that’s when their teeth grinding either increased or even started".
‘A way of releasing some of the stress’
Trauma and stress can put you in "fight or flight" mode, where your heart rate increases, you release adrenaline, and your muscles tense, preparing the body for an external threat, he says. And because the jaw and the nervous system are so closely linked through the major cranial nerves, our muscles are triggered and we clench and grind our teeth. "If we do it overnight, it’s a way of our bodies releasing some of the stress and tension we might have felt through the day," Popat explains.
For Ella, nocturnal teeth grinding in her sleep became a way to release tension that had built up while she was awake. "I know it’s to do with my stress levels," Ella says. "I have high functioning anxiety – you wouldn’t think it if you met me. I’m busy, and I go out a lot to mask it." In her 20s, she says she just "put up" with the pain. But a few years later, when her dentist told her that her teeth were at risk, Ella decided to get treatment. Even though it’s not routinely offered on the NHS, Ella decided to pay her dentist to inject Botox into her masseter muscles – the ones that control her jaw. The procedure relaxed them and reduced the tension in her face, and should last 3 to 4 months. "Over the past few months I’ve been able to sleep properly," she says. "I’ve got so much more energy in the mornings, the pain has reduced and my face is not as square."
Dr Simon Cove, a dentist who treats both private and NHS patients, says the physical impact of grinding on our teeth can be huge. He uses a 3D scanner to assess his patients’ teeth, and can see the wear over time. "Often people are not even aware they are doing it, but then we get to see the damage," he says. "If the teeth have been worn down to such an extent, treatment can be extremely complex and can cost thousands of pounds." But he says such cases are relatively uncommon and can take years to develop.
While you can treat the symptoms – by wearing a mouthguard, for example – getting to the source of what’s causing your teeth grinding is just as important, says dental sleep specialist, Dr Aditi Desai. "Too often," she says, "dentists give out mouthguards without checking why it is happening." It’s vital that serious, underlying conditions like obstructive sleep apnoea (OSA) are considered, she says. OSA is caused by a blocked airway, so a patient may grind their teeth to move the blockage in order to be able to breathe again. "That’s a very good example of why bruxism can keep you alive," says Prof Frank Lobbezoo, a leading researcher on the condition.
And even though bruxism has its negatives (tooth damage, sleep disruption, jaw ache, to name but a few), it’s not always the "bad guy", he explains. "Bruxism is also important for the production of saliva," Lobbezoo says. "Moving the jaw muscles activates the big salivary glands. It cleans the mouth, it protects the teeth and it’s vital for digestion." Some studies also suggest that chewing can help with cognition. "We know this in animals, and our preliminary research is showing it in humans," he says. "By working our jaw muscles we are stimulating blood flow to the brain." But teeth grinding can also cause chronic pain, which can have a huge impact on your daily life.
What is the treatment for bruxism?
Dentist Riaz Yar, a specialist in prosthodontics, treats patients struggling with the effects of severe bruxism – worn, cracked and fractured teeth, and dental work that keeps failing. Many also arrive with chronic jaw or facial pain and report poor sleep, all of which need assessing in their own right, he says, rather than simply being blamed on the grinding. In the past, Yar says, teeth grinding was considered simply a mechanical problem of the jaw, but now there is strong evidence that it is much more complex. It’s a "biopsychosocial issue", he says, driven by the brain and nervous system and shaped by the whole person. "We take into account their sleep patterns, their diet, their weight, the amount they exercise, what medication they might be taking and we assess for signs of sleep disorders," he says. "Many factors can contribute to a patient grinding their teeth, so addressing the condition requires a multidisciplinary approach."
How best to tackle it? These things might help:
- Stress management techniques: mindfulness, meditation, yoga, or deep breathing exercises
- Cognitive behavioural therapy (CBT)
- Lifestyle changes: reducing caffeine and alcohol intake, particularly before bed
- Avoiding chewing gum and hard or chewy foods
- Regular dental check-ups to monitor tooth wear and discuss potential treatments
- Mouthguards or splints to protect teeth during sleep
- Botox injections to relax overactive jaw muscles (in some cases)
- Addressing underlying medical conditions, such as sleep apnoea
Along with muscle-relaxing injections, Ella says she is also meditating to try to reduce her anxiety and free herself from the tension she regularly carries. "Having treatment has transformed my life," Ella says, "now I want to try and figure out the root cause."
Nakalama John
atisusanti
Ramos Leo