Q. Dr. Share, I’ve been told by my partner that I make noises with my teeth at night while I’m asleep. I can actually see little yellow spots starting to form on the tops of my teeth. Do you think that I’m grinding my teeth in my sleep?
A. The verification of noises and jaw movement by a sleep partner is an excellent indication that you are grinding your teeth. Yellow areas on the biting surfaces of the teeth, especially if they are sensitive, could be the start of wear into the dentin, the softer tooth tissue that lies under the enamel. Keep in mind that dentin can be exposed for other reasons than teeth grinding. Your chewing patterns, type of bite, diet, and even aging will cause wear, exposing the dentin. So in time, wearing of the teeth is perfectly normal. The big question is whether you’re accelerating the process of wear by grinding your teeth while you are asleep.
Q. If I am grinding my teeth, why am I doing it…I’m not even aware of it?
A. Grinding or bruxism is extremely common and occurs most often during sleep, when you’re least conscious of the movement; however, many individuals clench and grind their teeth during the day. This is considered to be an indication of stress, anger, frustration or anxiety.
Q. I’ve done some googling. It sounds like I have “TMJ.” Exactly what does that mean?
A. The letters TMJ refer to the temporomandibular or jaw joint. They are the hinges that attach the lower jaw to the skull, one on each side directly in front of the ears. It also refers to a complex disorder, with many varied symptoms and many varied names, involving the jaw, jaw joint and the surrounding facial muscles that control chewing and jaw movement.
Q. I have noticed jaw pain and some facial tightness in the morning when I awaken. I have even noticed tightness in my jaws during the day as well. What might the explanation be for that?
A. Your lower jaw is a curved bone that houses the teeth. It is attached to the skull by muscles, ligaments, and the two temporomandibular joints on each side. From a night of grinding or clenching, the TMJ can become sore and actually feel like an earache, because of its closeness to the ear. The muscles that work the jaw can even ache and become tender from overuse and fatigue. Often, this is at the cheekbone or where the jaw comes to an angle near the neck. Upon awakening the jaw can feel tight and difficult to open due to the tightness of the muscles. This can make the bite feel like it’s off. Sometimes a headache will appear at the sides of the head from tight muscles. Also, the joint itself can be a source of popping and grating sounds called crepitus that can also be painful. It’s important to mention that pain and aching in the jaws and face may not be accompanied by ear or jaw joint pain.
Q. How does all this affect the teeth?
A. Years of grinding can cause the teeth to become sensitive as the protective enamel wears down. This exposes the yellow dentin underneath the enamel exposing the nerve endings. Grinding the teeth can be destructive and painful, but clenching, which has no movement, can be painful as well, but wear is not a factor.
Q. It sounds like I might be a bruxer. How do we confirm my suspicions?
A. The first step is to schedule an appointment at the office. An examination of your teeth might disclose patterns of wear called facets that indicate habitual use. We also complete an examination of the muscles of the head and neck, and exam your jaw joints for sounds and freedom of movement. In some circumstances an x-ray examination of your TMJ is recommended. The results of the exam along with your history of symptoms may suggest bruxism.
Q. What are the treatments for clenching and grinding?
A. Once a diagnosis has been made, we can suggest various forms of treatment. Several options exist and need to be addressed on an individual basis. At home, a soft diet with no gum-chewing is recommended to rest tired, over-worked muscles and joints. Analgesics such as Advil or Motrin, if tolerated medically, should alleviate the pain and reduce the inflammation in the muscles and tendons. Slow, careful stretching exercises work well, but try to limit wide opening of the jaw, which includes eating and even yawning. Thermal towel-treatments applied facially can be very soothing. Often bruxism is episodic related to work stress, and family and personal issues. A stress reduction program and regular exercise for healthy relaxation is suggested. Caffeine in the evening is discouraged in order to promote sound sleep. At the professional level, often patients find great relief through stress management. Assuming the stress-induced sleep activity is not short-lived, as from a career change or an imminent wedding, we can provide you with a custom-fitted, plastic mouth guard worn during sleep. This may alleviate or eliminate the painful symptoms and prevent the wear from damaging your teeth. Most patients find that sleeping with a mouth guard will provide dramatic relief.