Page last updated at 16:17 GMT, Tuesday, 2 March 2010

Why are we grinding our teeth so much?

Stressed man

By Finlo Rohrer
BBC News Magazine

Some dentists are reporting that we are grinding our teeth more, as stress and even fears over the recession grip us. What's wrong with us?

Dentists often call it bruxism. To the layman it is "teethgrinding", although it may only be clenching rather than grinding.

A lot of it happens at night, but there can be clenching during the day.

Juliet Conner
I bit into this soft sandwich and heard this crack
Juliet Conner

Some people may suffer headaches as a result, or shooting pains in their jaw. But many may not realise they are doing it until the dentist spots it.

Dentists look for particular patterns of wear, which can involve flaking of the enamel, although in more serious cases the "cusps" at the corners of molars may snap off, or they may be a total fracture of a tooth.

Often, irate sleeping partners are the first to discover the activity. It is not a pleasant thing to be woken by.

"It is the most horrendous noise," says dentist Andre Hedger, who has a practice near Gatwick airport, and saw a 20% rise in cases in 2008 and 2009. "It is like a concrete mixer running down a blackboard."

A full explanation for why we grind our teeth is yet to be established, but it is believed that stress and anxiety are at least exacerbating factors.

"Often the reason they are doing the grinding or clenching is stress, the recession", says Dr Hedger. "We have never seen so many stressed patients. They all say things have changed in the workplace - they are working longer hours."

TELL-TALE SIGNS OF BRUXISM
Teeth damage
1. Enamel is worn away and softer, orange coloured dentine is exposed
2. The lower incisors are worn flat
3. Upper teeth become more angled, thin, and translucent, also putting them at-risk for chips
4. The roof of the nerve chamber is visible in the tooth's centre

A paucity of studies means it is not easy to establish the numbers of sufferers in the UK. The advisers who man the helpline at the British Dental Health Foundation anecdotally report an increase in calls. And an unscientific straw poll by the British Dental Association identifies a number of dentists who think it is on the rise.

One reports: "I have definitely seen a huge interest in grinding-related problems since the start of the recession… I would say that I am probably seeing about five times as many cases as usual."

Another suggests: "We have seen a lot of grinding and clenching of late. Because grinding can take a long time to show up as tooth wear it would be difficult to say that clinically obvious examples have started within the last twelve months or so."

Yet another notes: "Whilst I haven't noted a particular increase of signs and symptoms associated with parafunctional [not to do with normal actions] clenching and grinding during the period of the recession, this is generally a phenomenon that is slowly increasing in prevalence."

Colchester dentist Francois Roussouw has noted a marked rise in people suffering the effects of teethgrinding.

Dentists
Dentists have developed treatments for bruxism

"Over the last six-to-nine months there has been a 30% increase," he says.

"We see fracturing teeth without any decay being present. People who fractured a healthy tooth in the past - that was very rare. In the past two months I've seen three patients where a perfectly healthy virgin tooth has been fractured into the root."

Juliet Conner is one such patient.

"I bit into this soft sandwich and heard this crack. There was pain and I thought 'what was that'."

Mrs Conner suffered a broken tooth in October. And then another one in December. But she doesn't fit the pattern of stressed, recession-fixated business people.

SOME SYMPTOMS
Abnormal wear on teeth
Fractures in healthy teeth
Headaches
Pain in jaw

"I lost my husband six-and-a-half years ago - whether it's subconscious worry over that I don't know.

"I'm not a particularly stressed person."

Yann Maidment, who is part of a three-dentist-practice in central Edinburgh, can't be sure that the recession is to blame for the increase in patients with bruxism at his dental practice.

"We are sitting right in the middle of a financial district. We have seen a higher instance of clenching and grinding of the teeth. You ask them about stress - they are under more pressure

"We know that stress is involved in the process but there can be other factors. When we take histories from people they will often describe an increase in stress levels that have accompanied the onset."

But while stress is a big factor, it's certainly not the only thing causing teethgrinding.

"There are other factors for example the anatomy of the jaw, the shape of the jawbone, the position of the teeth in respect of each other," says Dr Maidment.

Something more fundamental in Western lifestyle could be to blame, says Dr Hedger.

English breakfast
Soft foods could be leading to underdeveloped jaws, Dr Hedger says

"It is common in the West because we have underdeveloped upper jaws. We have a very soft diet - our jaws are getting smaller and more crowded."

Dr Hedger also works on patients who have Temporo Mandibular Joint Dysfunction, a group of conditions related to bruxism. Some are terribly affected, he says, reduced to crawling at the start of the day and afflicted by a range of unpleasant conditions.

"They are very ill with it. They have chronic fatigue, headaches, migraines and tinnitus."

When given questionnaires many patients say they have been accused of imagining or faking symptoms, and a fifth have considered suicide.

Opening bite

For those with run-of-the-mill bruxism, a nightguard is often offered by the dentist. In the UK this can cost anything from £100 to a few hundred pounds. Typically this resembles a sport gumshield and is custom-fitted to the lower teeth. It is to be worn every night.

But the use of the one of these nightguards can sometimes fall short, says Dr Hedger.


We have a very soft diet - our jaws are getting smaller and more crowded

Andre Hedger

"They actually can increase the clenching activity. Where they win is they slightly open the bite by a number of millimetres, which often relieves the jaw joint."

But he is one of the dentists promoting an alternative, the catchily-named nociceptive trigeminal inhibitor.

"They are designed to put pressure on the front teeth. When the grinding starts in the night the pressure is applied to the two front teeth… they send quite a strong signal to the brain saying 'what are you doing?'."

The aim is to stop the grinding rather than, as with a basic nightguard, mainly to protect the teeth from damage by covering them.

Other treatments range from muscle massage to relieve symptoms, counselling to reduce stress, and even hypnosis.

But the important thing, the dentists say, is getting early treatment. Otherwise bigger dental problems may beckon.


Send us your comments using the form below.

Bruxism can have a funny side too. One night my husband tried to stop me grinding my teeth without waking me, by holding onto my lower jaw. I awoke to find my husband apparently trying to strangle me...
Karen, Wiltshire

I'm a long-term sufferer. My bruxism is caused by an overcrowded mouth and over-small jaw; I simply can't close my mouth completely comfortably. I use the traditional kind of night-guard, but the wear on my teeth during the day is very heavy, and the enamel on the back of my front teeth is in a pretty poor state. Without the night-guard, though, I'd have ground my teeth to powder by now. I'd simply echo the advice in the article - do go and see a dentist sooner rather than later. You can save yourself a lot of pain and dental destruction.
Stuart, Birmingham

I developed pains in my jaw some years ago after a bereavement. The dentist put it down to stress and teeth grinding at night. He made me a bite guard which solved the problem in a few days. I'd recommend one to anybody suffering this problem.
Andrew Leonard, United Kingdom

What a strange feeling of relief to read this article. The stresses caused by my partner's nocturnal tooth grinding was one of the factors in the break up of our twenty one year relationship. Obviously there were bigger, more important factors, but the issue over the grinding became an incredible catalyst for all our tensions and resentments. I was being woken every night - sometimes three or four times in a single night - as bad as with a new born baby. Was I exaggerating it? Was it unreasonable of me to ask my ex to go to the doctor to try to do something about it? Was I the cause of her stress?

She did get a gum shield, but found it incredibly uncomfortable and refused to wear it (which actually was fair enough - it looked pretty horrible). But then it became impossible for me to gets a good night's sleep in the same bed. So increasingly I would end up on the sofa. And when that starts happening... it's the beginning of the end.
Anon, UK

I have been a grinder of teeth for years, since I was a young child my parents always reported hearing me grind my teeth at night. During my teenage years my front teeth has very faint crack marks running vertical up then and the bite surface was very smooth. In my early 20s I noticed a sort of "v" shaped pattern in my top two front teeth and the bottom front teeth were worn away to about 1/2 their original size. I've always had to have treatment to repair my fillings throughout the years because I grind my original ones away.

As for gum shields - a few months and I'm grinding a hole through the hard plastic. At the moment I have been suffering from Trigeminal Neuralgia since Halloween, another typical symptom of teeth grinding. If anyone else has had TGN neuralgia you'll know of the intense agony it causes - I liken it to a "screwdriver in the ear". I'm in my late 30s and if I am having all these symptoms at the moment, what will I be like in 20-30 years time? My front four teeth are now crowns, replaced, not through decay but through my intense grinding. My advice? See your dentist as soon as possible.
Red246, Glasgow

I notice that antidepressants cause me to grind my teeth, something confirmed by a friend who took the same tablets. Bearing in mind the huge surge in prescriptions for these drugs in recent years, I wouldn't be surprised if that was a major contributor.
Frank Smith, Buxton, Derbyshire

It's funny, I was remarking on the pain in my jaw muscles to my girlfriend only yesterday then, today, I see this article! Around 4 years ago I had both lower wisdom teeth extracted and, ever since, I've had recurring problems with TMJ. Apparently this can be caused by an imbalance in one's bite and, presumably, this can be a side effect of such extractions. I'm blaming it squarely on the extractions, not the recession though! Although I had my wisdom teeth removed on the NHS it looks like I'll now have to fork out myself if I want to get my dentist to do something about it.
Oli, Edinburgh

I was grinding my teeth for 10 years and all various dentists would say to me was that it was stress, even though I wasn't stressed. I'd given up until I mentioned it in passing to a new dentist... turns out, having my wisdom teeth out changed the alignment of my teeth so they didn't sit properly on top of each other and effectively my jaw was always tense, hence the grinding. All he did was file a millimetre or so off my back teeth (painlessly!) and I haven't ground them since. It was so simple yet quite life changing. He said at the time many problems like this are caused by damage dentists do during treatments... I knew it wasn't stress, just wish it wasn't used so readily as a diagnosis.
JC, London

Yep I used to clench my teeth very hard when I had to wear a brace (the plastic insert type) because it was so irritating. Now I suffer from "clicky jaw syndrome" which apparently is called TMJ. The dentist wants £5,000 to fix it. No way I am paying that kind of money.
Richard Lewis, Southampton

I have always found the "stress" explanation for bruxism overly convenient. I am in my mid-twenties and have been aware that I grind my teeth for four years or so. After being told by a friend that I make funny noises while I sleep I had a look at my teeth and could see that they were being worn down. Now I wear a mouthguard every night, and have found that when I don't I frequently wake myself up clicking my teeth together. Fortunately I don't have any other problems such as jaw pain or headaches, but it is a pain in the rear to think that I might have to sleep with a piece or rubber in my mouth for the rest of my life (which I have to get replaced every year or so when it has (A) had holes worn in it (B) become an unsightly yellow colour (C) gone into the washing machine/drier by accident). I have heard the stress argument fairly often but I find that my teeth-grinding has no relation to how stressed I am.
Tom, London

I have just got back from a dentist appointment due to ongoing jaw problems, resulting in discomfort in the joint and the development of headaches during the course of the day. My other half has also suffered exactly the same thing recently. It would appear that both of us have been grinding our teeth in our sleep, and I also quite often find my teeth clenched whilst driving, which I do a lot of. An NHS dentist will fit you with a bite guard, which you can expect to cost around £200, though they can also refer you to your local hospital if preferred, where the same treatment shouldn't cost you a penny. I am now at the point where my jaw is not sitting 'flush' in the socket, though I am advised that surgery is often more of a problem than a cure, so I would urge anybody suffering the same symptoms to go and see their dentist as soon as they experience any discomfort.
Jim Lee, Newton Abbot

I've been grinding my teeth for years and as mentioned in the report I was told about it by my then partner. The standard mouthguards do only prevent damage to the teeth, and don't prevent the grinding, but beware, the NTI technology is not yet proven and half of the clinical trials have indicated that the device may cause more problems than it solves. It's important not only to try to de-stress but to find a solution that works for you.
Ade, Edinburgh

According to my girlfriend, I grind my teeth in my sleep. Not with any great frequency, mind, but every now and again she'll wake up to the most awful noise. She'll try to get me to stop doing it by holding my jaw, poking me, or suchlike, but I just sleep straight through. Apparently I don't do it for very long; just long enough to disturb her sleep. I'm not a particularly stressed person - very laid back in general - and I don't get jaw-ache and my dentist hasn't noticed any side-effects of the grinding. It's just something I do every so often with no rhyme or reason which really annoys my girlfriend. Sorry, petal!
George, London, England

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