Asst. Prof. Fatma Yüce
Faculty Member –  Istanbul Kent University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology
"Bruxism silently damages your health. Awareness and early intervention are essential to protect your teeth and jaw!"
ARE YOU UNKNOWINGLY DAMAGING YOUR TEETH? THE SILENT THREAT OF BRUXISM AND WHAT YOU NEED TO KNOW

What Is Bruxism?

Bruxism is defined as an unusual activity where individuals consciously or unconsciously clench or grind their teeth. Although it often occurs during sleep (nocturnal bruxism), it can also be observed while awake (diurnal bruxism). Factors such as stress, anxiety, parafunctional habits, and jaw structure problems can trigger bruxism. The presence of bruxism may lead to tooth wear, jaw muscle pain, headaches, and, in the long term, problems with the jaw joint. It is seen in both children and adults, but many people are unaware of this habit, which is often detected during routine dental check-ups.
Bruxism is considered a widespread parafunctional habit both in Turkish society and globally. Studies show that while the global awareness rate of bruxism is between 15-23%, this rate is approximately 33.9% in Turkish society. These statistics highlight that bruxism is a significant health issue worldwide and in Turkey. If left untreated, bruxism can negatively impact oral health and overall quality of life.

Causes and Risk Factors of Bruxism

Although the exact mechanism of bruxism is not fully understood, it is believed to result from a combination of psychological factors, such as stress and anxiety, and physical factors, such as joint disorders and misaligned teeth.

Physical Factors:

•Malocclusion (Bite Problems): Improper alignment of the upper and lower teeth can cause excessive jaw muscle activity, increasing the likelihood of bruxism.

•Temporomandibular Joint (TMJ) Disorders: Disorders in the TMJ, the only movable joint in the skull, or muscle sensitivity in the jaw can lead to involuntary jaw movements.

•Genetics: Bruxism may run in families, suggesting a potential genetic predisposition.

•Medication and Substance Effects: Certain antidepressants, amphetamines, and caffeine can trigger bruxism.

•Neurological Disorders: Conditions like Parkinson's disease and Huntington’s disease may cause involuntary jaw movements.

Psychological Factors:
•Stress and Anxiety: Stress and anxiety are the most common psychological causes of bruxism, often leading to involuntary muscle activity. Rising stress levels in today’s world contribute to the prevalence of bruxism.
•Emotional Fluctuations: Repressed emotions such as anger or frustration may trigger bruxism, especially during sleep.
•Sleep Disorders: Issues like sleep apnea can increase the risk of sleep bruxism.
•Personality Traits: Individuals with competitive, perfectionist, or highly energetic personalities may be more prone to bruxism.
•Trauma and Psychological Conditions: Childhood trauma, depression, and post-traumatic stress disorder have been linked to bruxism.

Problems and Symptoms Caused by Bruxism

Tooth and Jaw Pain:

Overworked jaw muscles may lead to stiffness, pain, and sensitivity, especially in the mornings. This clenching and grinding may cause enamel erosion and tooth sensitivity. Additionally, TMJ pain, swelling, and limited jaw movement may occur due to joint strain caused by bruxism.

Teeth Grinding:

Teeth grinding during sleep is often noticed by those around the individual. The sound, caused by the friction of teeth, can disturb both the person’s sleep and those nearby.

Tooth Wear:

Prolonged teeth clenching can result in wear, cracks, or fractures in the teeth. Over time, excessive force may lead to enamel loss, thinning, or shortening of the teeth. Teeth may appear excessively shiny, or changes in shape and texture may become apparent.

Headaches:

People with sleep bruxism may wake up with headaches caused by tension in the overworked jaw muscles.

Sleep Disorders:

The habit of clenching teeth during sleep can significantly impact sleep quality, leading to symptoms such as insomnia or restlessness during the day.

Diagnosis and Treatment Methods

Bruxism is usually diagnosed by a dentist based on the patient’s complaints, oral examination, and, if necessary, imaging techniques. In some cases, sleep studies (polysomnography) may be used to confirm sleep bruxism. Risk factors like stress and anxiety are also considered during diagnosis. Treatment often involves dental interventions or psychotherapy.

Common Bruxism Treatment Methods:

1. Dental Treatments

•Night Guards (Splints): Transparent plastic devices designed to protect the teeth and relax the jaw muscles. These are widely used for nocturnal bruxism.

•Bite Adjustment: Correcting the alignment of the teeth to ensure proper closure can help reduce bruxism.

2. Behavioral Therapies
•Awareness Training: Exercises to help individuals recognize and prevent daytime clenching.
•Stress Management: Relaxation techniques, yoga, meditation, or psychotherapy can be beneficial due to the link between stress and bruxism.
3. Physiotherapy and Muscle Treatments
•Jaw Exercises: Exercises to strengthen and relax jaw muscles.
•Hot/Cold Therapy: Applying hot or cold compresses to reduce pain in jaw muscles.
•Massage: Massaging facial and jaw muscles can relieve tension.
4. Medical Treatments
•Botulinum Toxin (Botox): Botox is an effective non-surgical option, especially for cases where excessive muscle activity is predominant. Low doses of Botox are injected into the chewing muscles (e.g., masseter and temporalis) to reduce excessive contractions. This minimizes damage to the teeth and jaw while alleviating pain and muscle tension. Effects typically last 3-6 months and can be repeated if needed.
•Muscle Relaxants: Prescription medications can help relax muscles, especially for nighttime use.
•Painkillers: May be used to reduce jaw or muscle pain.
5. Psychological Support
•Psychotherapy: Effective for bruxism cases linked to stress and anxiety.
•Cognitive Behavioral Therapy (CBT): Focuses on changing thought patterns and behaviors that trigger teeth clenching.
6. Lifestyle Changes
•Reduce Caffeine and Alcohol Intake: These substances can worsen bruxism and should be limited.
•Improve Sleep Hygiene: Quality sleep can reduce the severity of bruxism.
A multidisciplinary approach is often required for bruxism treatment. Dentists, physiotherapists, and psychologists may collaborate to create the best treatment plan tailored to the patient’s needs.

Misconceptions About Bruxism

"Bruxism only affects stressed individuals."

•Truth: While stress is a common factor, genetic predisposition, sleep disorders (e.g., sleep apnea), certain medications, and malocclusion also contribute to bruxism.

"Bruxism does not occur in children."

•Truth: Bruxism is common in children, often as a normal part of development. It is more frequent during periods of stress or tooth changes but usually resolves as the child grows.

"Bruxism only happens at night."

•Truth: Bruxism can occur both during the day and at night. Nighttime bruxism is unconscious, whereas daytime bruxism is often stress or habit-related.

"Bruxism is harmless."

•Truth: Untreated bruxism can lead to tooth wear, cracks, gum recession, TMJ issues, facial pain, headaches, and even disrupted sleep quality.

"Bruxism will go away on its own."

•Truth: While mild cases may resolve naturally, untreated bruxism can worsen and lead to serious complications.

"Bruxism has a definitive cure."

•Truth: Bruxism is often a chronic condition without a definitive cure. However, various treatments (night guards, Botox, stress management) can effectively manage symptoms and minimize damage.

"Botox completely stops bruxism."

•Truth: Botox alleviates bruxism symptoms but does not eliminate the habit entirely. A multidisciplinary approach is typically required for comprehensive management.


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