Zahara Hasham of Vancouver, a busy mother of two young children and part-time MRI technologist, knew she ground her teeth. ‘My husband complained of the noises I made at night,’ says Hasham, whose grinding resulted in a broken tooth needing emergency root canal treatment.
As a dental hygienist, I have seen many patients who suffer from the side effects of clenching and grinding, a habit known as ‘bruxism’ that has become more prevalent in recent years, perhaps due to our often stressful lifestyles. Clenching your teeth’tightly clamping the upper and lower teeth together’should not be disregarded as harmless. The biting force of an adult human can equal up to 200 pounds per square inch. Clench your teeth on a regular basis, and that prolonged pressure takes its toll not only on teeth and their supporting structures, but on muscles, tendons, ligaments and joints of the jaw, skull, neck and shoulders.
During sleep, clenching is sometimes accompanied by grinding’the back-and-forth or sideways movement of the top and bottom teeth against each other. But some people do it during the day, too. If not treated, grinding can wear out your tooth enamel, exposing the soft, sensitive and cavity-prone layer of dentin beneath.
The harmful effects of teeth grinding
While approximately eight percent of Canadians report being aware that they grind during sleep, many cases go un-reported, suggesting that the total may be much higher. Though patients may be unaware, the evidence of grinding and clenching is obvious: intermittent tooth sensitivity; unexplained toothaches; broken or chipped teeth; cracks; flattened tooth surfaces; receding gums; clicking, popping and/or pain in the jaw joint; and difficulty chewing or opening wide. Not surprisingly, clenchers and grinders complain of stiffness and tenderness in the neck and shoulders, headaches and unexplained earaches.
What causes teeth grinding?
Causes that contribute to clenching and grinding include hidden stress, poor alignment of teeth, ill-fitting dental work, previous trauma to the head and neck area, and diseases such as Parkinson’s or Huntington’s. Studies have also linked bruxism to sleep apnea (the temporary cessation of breathing during sleep), and the use of certain antidepressants. Studies by the University of Montreal’s Dr. Gilles Lavigne, a dentist and expert on sleep disorders and pain’his lab is internationally recognized for its cutting-edge research in sleep bruxism‘show that grinding is influenced by brain stem activity.
When Hasham visited Cathy Russell, a Vancouver physiotherapist who specializes in treating the problems that arise from clenching and grinding, Russell had no problem relating: The majority of patients in her waiting room are there for the same reason, and suffer from temporomandibular disorder (TMD). Clenching and grinding often results in TMD, a condition in which the ball-and-socket joint in front of your ear (that allows your lower jaw to move up, down or sideways) becomes stiff and painful, and pops or clicks upon opening. In extreme cases, the joint becomes so inflamed the mouth can be opened only a few millimetres.
What do dentists reccommend?
Dr. Ron Smith, a dentist in Duncan, B.C., recommends the fabrication of a bruxing guard, a custom-moulded, hard-plastic appliance that fits over the teeth. Designed to be worn during sleep, its purpose is twofold: to protect teeth against further wear, and to reduce the force reaching the teeth.
‘Patients are much happier once they start wearing it,’ says Smith, who sees signs of bruxism in about 20 percent of his patients. Prices for the guards vary according to province, but can cost hundreds of dollars. Many dental insurance plans cover it. Everyone who clenches and grinds their teeth should use a bruxing guard to prevent further damage; talk to your dentist about it.
Other treatment options
But treatment shouldn’t stop there. Russell is just one of a new breed of health practitioners using an integrative approach to shed light on a multitude of other symptoms, causes and relief of TMD. Treatments to help reduce spasm and muscle tightness, and restore the joint to its normal function, are varied and include acupuncture, massage therapy, physiotherapy, meditation and even hypnosis. When not in the clinic, Russell spends time creating awareness among health professionals and the public through seminars liberally sprinkled with her brand of colourful Scottish humour (she sometimes makes appearances dressed as a tooth fairy). That’s because humour helps reduce stress, and she believes that educating patients about stress-reduction techniques is crucial.
Pansy Jang’s treatment for clenching and TMD depends on the results of a thorough medical history screening, including dental health. This acupuncturist, massage therapist and registered doctor of traditional Chinese medicine based in New Westminster, B.C., holds a diploma in osteopathic manual practice. She thinks of the body as a whole. ‘Sometimes jaw dysfunction can be related to poor posture, digestive problems or trauma, both physical and psychological,’ says Jang, whose treatments are often a combination of osteopathic manual therapy, craniosacral therapy, acupuncture, massage, traditional Chinese medicine and sometimes hypnotherapy. She encourages patients to adopt stress-reduction techniques, such as meditation and mindfulness, to reduce the body’s response to stress.
Surprising causes of tooth and jaw pain
Russell, who has specialized in treating TMD and clenching problems with a combination of physiotherapy and craniosacral therapy for more than 15 years, says patients often don’t connect incidents in their past to the problems they are having. She speaks from experience: A jaw injury at age five, and three whiplash injuries, resulted in her own TMD symptoms. ‘Previous car accidents, sports injuries, trauma to the head as a child, and even a difficult birth can predispose people to TMD, which may not surface right away,’ says Russell, who also teaches yoga classes (attended by some of her patients) and emphasizes proper breathing. Russell says many of her TMD patients have other symptoms in common, such as sinusitis, indigestion and even unexplained sore throats and earwax buildup.
Hasham sought treatment with Russell after a lengthy root canal procedure resulted in painful jaw spasms that prevented her from opening her mouth more than a finger-width. ‘I was in a lot of pain when I arrived,’ she says. Fortunately, after several treatments, which included massage to relax mouth muscles, and breathing exercises, the problems disappeared, and so did her frequent headaches.
What you can do
‘ Adopt lifestyle and behavioural changes that will reduce your stress. Grinding and clenching can be signs of hidden anxieties, suppressed frustration or anger, sleep apnea or overly competitive behaviour.
‘ Several times throughout the day’say, once per hour’stop and do an awareness check. Are you clenching your jaw muscles?
‘ Learn to consciously relax your face and jaw muscles.
‘ Perform periodic stretching and massaging of the neck and shoulders.
‘ If you suffer stiffness, clicking or pain in the jaw, avoid biting down on hard foods, such as nuts, candies or ice, and don’t overextend the jaw by opening too wide when you yawn.
‘ Try this meditative technique: Place your tongue on the roof of your mouth, close your lips but keep your teeth apart. Breathe deeply and slowly in and out through your nose, and with each breath repeat ‘in, out’ to yourself.
‘ Have your dentist check for damaged teeth and ask about a night-guard; Russell recommends it for lower teeth.