Teeth grinding / teeth clenching
Grinding and clenching your teeth (“bruxism”) is not nice. It can happen here and there, but it regularly damages the teeth and the chewing organ. But many sufferers don’t even realize that they are affected at first. The following symptoms indicate that you are affected:
- Feeling of tension or tiredness in the cheeks, temporary stiffness;
- Temporary temporal headache;
- Change in your cheek contours (due to an increase in the size of the muscles;
- Enamel cracks in the anterior teeth;
- Fracture of incisal edges in the anterior region;
- Damage in the area of the tooth necks;
- Crumbling of existing fillings or veneering crowns;
- Tooth fractures in the posterior region.
Bruxism – what is it?
Teeth grinding and clenching are collectively referred to as“bruxism” (ancient Greek, with a Latin ending). The current guideline of the responsible professional association DGFDT distinguishes between
- Sleep bruxism from
- Waking bruxism
and on the other hand
- Teeth clenching and
- Teeth grinding.
Teeth grinding and clenching (bruxism) used to be considered part of craniomandibular dysfunction (CMD). The two have since been differentiated from each other, as it has become clear that both have different causes – even though CMD is often caused by bruxism.
Bruxism is primarily characterized by the high muscular tension of the affected masticatory muscles. This in turn exerts great forces on the teeth, the periodontium (gums or periodontium) and the temporomandibular joints. This can also lead to pain in the masticatory muscles, especially after sleep.
In contrast, CMD is defined by pain and/or dysfunction of the masticatory muscles, the temporomandibular joints and the teeth or occlusal surfaces.
There is therefore an overlap between the two in the case of muscle pain. In addition, the tension in the masticatory muscles during bruxism promotes overloading of the muscles, teeth and jaw joints and therefore also the development of CMD – although not all patients with bruxism develop CMD.
In any case, the consequences of excessive bruxism for the teeth, jaw joints and gums are considerable.
Tooth wear can occur to an increased extent in the area of the hard tooth substance, especially as a result of teeth grinding. Further towards the neck of the tooth, certain flaking (wedge-shaped defects) can occur.
The gums can also recede, which is caused by reduced blood flow as a result of the force exerted on the gums and the underlying bone. IN severe cases, gum pockets can also develop. It is still unclear whether these are the result of the application of force or whether this initially favors the introduction of bacteria; ultimately, however, this is of secondary importance insofar as the bruxism needs to be treated in order to improve.
In the area of the temporomandibular joints, the application of force can lead to the joint structures sticking together, with the result that a malfunction gradually develops – the transition to craniomandibular dysfunction (CMD) is thus possible.
Due to the different causes, a distinction must also be made in diagnosis and treatment between bruxism and craniomandibular dysfunction (CMD) – even though the two often go hand in hand.
Bruxism is diagnosed on the basis of a newly introduced test, the Bruxism Screening Index (BSI). The BSI was developed by a working group of the German Society for Functional Diagnostics and Therapy (DGFDT). One of the developers is PD Dr. M. Oliver Ahlers. The BSI distinguishes between unlikely, possible and probable bruxism. If the diagnosis is to be reliable, additional examinations are required. One possibility for this is the use of indicator splints. These are wafer-thin foils colored on one side, which are worn for a few nights during sleep and then examined for signs of abrasion. Characteristic abrasion detects bruxism and allows further conclusions to be drawn.
Active rails with integrated measuring electronics offer another possibility. The first form of these splints was once developed by a working group at the Technical University of Munich in collaboration with PD Dr. Ahlers. A follow-up version is now available under the name Bruxane personal. Its use requires very precise dental preparations and the evaluation of bruxism events using special software. The examining dentists must be qualified for this, which the manufacturer Bruxane confirms individually. The CMD Center Hamburg-Eppendorf has this approval and we can therefore use this form of diagnostics and therapy if required.
Based on the different causes, the treatment of bruxism and CMD must also be different – but both treatments can be combined.
In the case of teeth clenching and grinding, the focus is on finding possible causes and – if possible – treating them. Special relaxation methods, sufficient sleep and moderate endurance sports can help.
Dentists also use special occlusal splints with innovative technology that incorporate electronic sensors that react to tooth clenching and emit an inhibitory impulse when an individually set threshold value is exceeded (Bruxane personal data). A related study from the Ludwig Maximilian University of Munich was able to show that such active splints are effective in the treatment of severe bruxism. Patients find that other splint variants are more effective for the treatment of bruxism than for the treatment of CMD. This makes the underlying dental diagnosis all the more important.
Bruxism is sometimes associated with a lack of oxygen supply during sleep. If this is the case in individual cases, patients have to clench their teeth at night to increase the tension of the soft tissue and thus keep the airways open better. Instead of mask ventilation, this can be done using a mandibular advancement splint – this not only improves the air supply, but is also effective against bruxism.
Treatment with botulinum toxin alpha (e.g. Botox®) only makes sense in exceptional cases; however, the drug has not yet been approved for the treatment of bruxism. In such cases, it is necessary to apply the botulinum toxin precisely to the muscles responsible. As specialists in CMD and bruxism, we are familiar with this.
Including tooth wear
Increased tooth wear can occur as a result of bruxism. If bruxism is suspected, it is therefore necessary to at least screen for tooth wear in order to detect increased tooth wear and treat it if necessary.
Gentle restoration of worn teeth
And if teeth fracture as a result of bruxism, the affected teeth need to be repaired as minimally invasively as possible – we are also equipped for this as part of our specialization. PD Dr. Ahlers once developed a procedure at the University Medical Center Hamburg-Eppendorf to repair damaged tooth-coloured fillings made of composite resins as atraumatically as possible. We use this procedure routinely today.