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Bruxism: solutions to avoid grinding your teeth at night

Bruxism may not mean anything to you. Your spouse can’t stand you grinding your teeth at night (and you don’t believe him or her)? Your dentist is concerned about the premature erosion of your teeth? Or do you simply want to stop grinding your teeth? Whatever the case, you’ve come to the right place to find out what’s behind sleep-related bruxism.

If doctors recognize bruxism as a sleep disorder, the general public knows little about it, although it affects almost 10% of the French population. If you suffer from bruxism, you should know that it disturbs your sleep and weakens your teeth. Fortunately, serious and effective solutions exist to remedy it.

Bruxism linked to sleep = teeth grinding at night
Sleep-related bruxism is characterized by teeth grinding or jaw clenching during sleep.

This teeth grinding, which has no known purpose, can have unfortunate consequences: abnormal wear of the teeth, jaw pain or headache upon awakening, locking or clenching of the jaws in the morning and finally, deterioration of the quality of sleep and associated fatigue during the day.

The intensity and duration of teeth grinding during the night varies. But there can be several hundred episodes of teeth grinding during a single night! Despite this, most of the time, these episodes of bruxism do not wake up the sleeper who, in fact, will not remember them. However, they will weaken the sleep of the “bruxer” by reducing its efficiency. Teeth grinding will take the sleeper out of his deep sleep stages and make him go back to light sleep. Consequences: a modification of the sleep architecture of the person and more tiredness in the morning when waking up!

Bruxism is not just a nighttime problem
Bruxism is, by definition, also a daytime disorder as opposed to sleep-related bruxism, which occurs only at night.

This (daytime) bruxism is characterized by involuntary clenching of the teeth, usually without grinding, in response to certain stimuli during the day. This daytime bruxism is associated with a bad habit or tic. And as long as the person is awake and aware, this clenching is much easier to control. For this reason, it is usually not a problem for the person concerned, and not a subject developed in this article.

Nighttime bruxism: who is affected by teeth grinding?
Some experts now consider that sleep-related bruxism is useful for making children’s baby teeth fall out. This theory is consistent with the age of those affected. Indeed, bruxism is very frequent in early childhood and then gradually decreases with age.

Tooth grinding mainly affects children

Teeth grinding can appear as early as 1 year old, with the arrival of the first teeth.
The latest studies estimate that 10% of children aged 2 and a half suffer from bruxism. This percentage increases progressively up to 33% of 6 year olds. The number of children affected then decreases to 9% by the beginning of adolescence (at the age of 13 here).

About 8% of adults have bruxism. However, there is a constant decrease in the number of people affected with advancing age. This disorder does not affect many elderly people.

Among these 8%, it is estimated that only 0.5 to 2% of the people affected by teeth grinding need treatment, due to different levels of severity. These are the people who are most affected.

85% to 90% of the population grinds their teeth at some time, but it is not generally considered a disorder. The 8% mentioned here is the percentage of adults affected at a pathological level.

Male or female, no sexism, but a genetic factor
There is a strong genetic influence among affected sleepers.
The presence of sleep-related bruxism in childhood and then in adulthood is highly correlated. Adults who grinded their teeth as children are therefore more exposed. But this is also true for their own children, who are more likely to be affected than those of others.

There is no gender difference, however. Men and women are affected in the same way. Also, studies have shown that people’s morphology has no impact and is therefore not a factor in bruxism.

Screening and diagnosis: do I grind my teeth?
The causes of bruxism are still unknown and probably multiple. There are still debates between experts to try to determine if this untimely teeth grinding is an unconscious habit or on the contrary a totally involuntary “parafunction” during our sleep (what is then called “parasomnia”).

Limited knowledge about bruxism makes it difficult to detect
A study published in 2014 [1] (relatively recently) on bruxism confirms that there are still many unknowns about this disorder. The objective of the study was to review the state of scientific knowledge in order to raise awareness of the subject among all physicians.

Because of this lack of knowledge, and also because the sleeper himself is not aware of these disorders (as is often the case during sleep), nocturnal bruxism is a difficult pathology to detect. Therefore, it is generally its consequences that are detected, and not the disorder itself.

Its main “symptoms” are tooth erosion (abnormal wear or excessive damage) and headaches upon awakening (pain in the jaw and/or temples).
The following are also considered in the diagnosis: jaw disorders, pain in the mouth and face (orofacial pain), and even an increase in the volume of the jaw muscles.

Also, people around them are often the cause of the diagnosis because of the discomfort they experience. While the “bruxer” sleeper is not woken up by the noise of his or her teeth grinding, it can unfortunately become unbearable for the bed partner or the family.

A sleep laboratory visit is often necessary
Although abnormal tooth wear is very characteristic of sleep bruxism, a definitive diagnosis is ideally based on the presence of rhythmic muscle activity and grinding sounds during a night polysomnographic recording.

As a reminder, these reference sleep recordings are performed in sleep laboratories, dedicated care structures. Bruxism episodes occur more frequently in stage 2 sleep (light slow wave). But they can in fact occur in all stages of sleep.

However, the passage in the sleep laboratory is not the most pleasant. Indeed, the apparatus is heavy, uncomfortable, and in general, the laboratories are not close by. For sleep problems in general, we have designed the Dreem 2 headband which helps to improve sleep and is made of small brain activity sensors.
These sensors allow the headband to measure the sleeper’s sleep as accurately as laboratory equipment, but from the bed and in a much more comfortable way.

80% of bruxism episodes during sleep are associated with micro-awakenings. That’s a lot! Proof of these micro-awakenings: there is systematically a modification of the cardiac rhythm and a peak of stress just before the beginning of an episode of bruxism.

Treatments against bruxism: medication, dental splint or occlusal plate?
Depending on the severity and consequences of your bruxism, various proven treatments can be proposed. Occlusal plates, dental splints, medication, or relaxation techniques will help you stop grinding your teeth!

How to get them and where to turn? We take stock of the issue.

Medication solutions exist, BUT
Today, there are no medications marketed specifically to treat bruxism. However, some medications have been shown to be beneficial in various experimental studies [2].

Of course, we don’t need to remind you that medication is synonymous with a doctor. Do not take any medication without first consulting your doctor and obtaining a prescription from him or her!

So, clonidine is the most effective medication to help you stop grinding your teeth. Unfortunately, there are side effects: suppression of REM sleep and low blood pressure in the morning [3]. Apart from bruxism, it is a drug that is usually used in the management of high blood pressure…

Clonazepam also seems to be an acceptable alternative, but only in the short term. It is a benzodiazepine, which implies a risk of dependence and medium/long term negative effects on your sleep and your health.

In short, do not hesitate to call your general practitioner if you have problems with bruxism. He will be able to guide you or prescribe a solution that he deems adapted to your personal case. By going to consult him, you will already know that there are serious natural alternatives to stop grinding your teeth without medication.

For an occlusal plate, go to the dentist
When teeth touch or get damaged, people with bruxism naturally turn to a dentist who will suggest an occlusal plate. The patient may first have to be convinced that he or she is suffering from bruxism. Not being aware of grinding their teeth, many people, even with damaged teeth, will be surprised to hear this… Sometimes called a dental tray or occlusal tray, this solution remains the reference treatment against bruxism, notably because its mold is custom-made. As such, it presents “less inconvenience” when worn at night.

The principle is quite simple: this occlusal mouthpiece will protect your teeth wearing out in their place. It is worn on one side of your jaw, during the night only. Once the bite plate is in place, your teeth no longer touch. You are therefore protected from the negative effects of sleep-related bruxism.

Good to know:

To have “your” bite plate made, your dentist will first make a mold of your teeth.
In terms of price, an occlusal plate is quite expensive. Count on a few hundred euros, but a good mutual insurance company will reimburse you.
Beware of sleep apnea: the occlusal plate can promote sleep apnea for people who already suffer from it. It is therefore important to check that this is not your case (in case of doubt) before adopting this solution.
To know more about the occlusal plate, watch the short video below. Made by a Canadian dental office and very well done!
From the mandibular advancement orthosis to the anti-bruxism mouthpiece
Dental aligners are the latest solution with recognized benefits to stop grinding your teeth. Initially, these trays were orthoses or mandibular advancement devices intended to fight snoring and sleep apnea.

But again, these products have demonstrated their effectiveness against bruxism in various scientific studies. As a result, a small number of manufacturers have decided to adapt and specialize certain dental aligners specifically against teeth grinding.

Most of the time, and especially the first days, the use of a dental mouthpiece will create some discomfort. But its benefits are at this price. Finding the right device for your own mouth is ideal. There are sometimes several sizes, and in some cases, you will need to boil your mouthpiece to adapt it to your dentition. This is often the case with anti-snoring braces.

In any case, you will need a few days to get used to wearing the mouthpiece.

The price of a dental mouthpiece? Count up to 75 euros for a very good quality mouthpiece. You will probably find them at all prices, but be careful to use quality products.

Aggravating factors: fight against stress
There are several recognized aggravating factors that promote teeth grinding at night.
The first and most important of these is stress and anxiety. Although little is known about the mechanisms involved, the cause and effect relationship has been demonstrated. If you suffer from stress, you are more likely to grind your teeth! And it’s a factor in children, adolescents and adults alike.

Combating stress is easier said than done, but any solution is a good one: playing sports during the day, for example, or any other form of outlet that suits you.
Some people also use sophrology or even hypnosis to deal with this stress.
As long as it works for you, it’s beneficial.

Other aggravating factors to avoid in order to limit the severity of the disorder are alcohol and smoking before sleeping. Less commonly (I hope), amphetamines and the medication prescribed for Parkinson’s (L-Dopa) are also known to aggravate bruxism at night.

Bruxism: a sleep disorder that has long been (re)known
In the medical world of sleep, there is an international classification of sleep disorders. Its official name in English is “International Classification of Sleep Disorders” (or ICSD). It lists teeth grinding or “bruxism”.

In the first version of the International Classification of Sleep Disorders, bruxism is classified as a parasomnia. By definition, parasomnias are physical events or undesirable experiences that occur at sleep onset, during sleep or during partial awakenings [4]. This definition does indeed fit our teeth grinding problem.

But since 2005, year of publication of the 2nd edition of the International Classification of Sleep Disorders, bruxism is now classified as a sleep-related motor disorder. A finer definition, but just as accurate, is still found in the latest edition of this classification, the 3rd published in 2014.

Is tooth grinding better treated in Canada?
If you are looking for information on the web about teeth grinding (and my little finger tells me that this is the kind of thing you could do…), you will quickly come across many websites of French-speaking dentists’ offices in Canada. They are more complete and better provided than those of our dentists in France.

Overall, our North American friends may be more comfortable with new technologies, but it also seems obvious that bruxism is a disorder better treated on the other side of the Atlantic. This is also consistent with what I was saying about the international/US classification of sleep disorders.

In conclusion
On your side, you have no more excuses! It is time to take care of your teeth as well as your sleep (or your spouse’s) by implementing one of the adapted solutions mentioned in this article. One goal: stop grinding your teeth! Your teeth will be safe and the quality of your sleep will be better. For you, this means more energy in the morning and less coffee during the day.