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Teeth grinding, or bruxism, can cause pain, tooth damage

  At first Ruth Heatherington thought her migraines, the cleaving headaches that had stalked her as a young woman, were coming back. Yet this time there was something more ominous — a burning in her face. "I woke up with it every morning," said Heatherington, 54. "One side of my face would be sore all day long."

A mother of five, with 10 grandchildren and a full schedule of family activities, Heatherington suddenly was concerned about her health. Was it something to do with blood pressure? Some kind of progressive disease? It was time to see a doctor.

Noise in the night

Symptoms of bruxism The signs and symptoms of bruxism may include: • Severe or loud teeth grinding or clenching that occurs during sleep or while awake during times of anxiety or stress. • Tips of teeth that are worn down, flattened or chipped. • Worn tooth enamel, exposing the inside of your tooth. • Increased tooth sensitivity. • Jaw clenching or muscle contractions. • Jaw pain or tightness in your jaw muscles. • Popping, clicking or locking of your jaw joint. • Earache, due to violent jaw-muscle contractions, not the ear itself. • Dull morning headache. • Chronic facial pain. • Chewed tissue on the inside of the cheek in your mouth. MayoClinic.com

But then her husband, Dale, made a discovery. He woke up one night to a sound like footsteps on gravel or a low growling or tearing noise. Tracing it to its source, he turned to his wife and said, "What are you doing?"

Morris Fink, a Los Angeles dentist, diagnosed bruxism, or teeth grinding. "Most people have no idea they're doing it," he said, "and don't like to admit it even if they do know."

Heatherington's muscles were sore, her jaw ached, and after grinding through the night for months or longer, her molars were beginning to flatten. One was fractured and had begun to tilt forward under the pressure.

According to Jack Broussard, director of the University of Southern California's Oral Health Center, stress by itself doesn't cause teeth grinding, nor do sleeping problems, although grinding is usually worse at night. Rather, bruxism is a central nervous system habit that almost everyone develops at some point during childhood. For reasons no one understands, the repetitive side-to-side or back-and-forth motion becomes more pronounced in 15 percent to 20 percent of people, beginning as early as puberty or as late as retirement. These people clench and grind the most — and with more force — at night, during the dream-filled REM phase of sleep.

Over time the grinding wears away crowns, flattens molars and can create small cracks in teeth, which is what alerts dentists to the problem. If untreated, teeth can fracture, requiring replacement or restoration, dentists say.

"Some people grind side to side with big, drastic movements that are very noticeable," said Broussard, "others clench ... and go through small micro-motions that are not so obvious, so they might be getting headaches or facial pain."

Doctors have tried to treat bruxism with talk therapy, as if it were an anxiety problem. They have also tried techniques designed to improve and deepen sleep, from cutting down on caffeine and alcohol to increasing exercise, which can help.

Some doctors suggest that people who are moody or anxious by nature are especially prone to the problem. But grinders are no more likely to be depressed than anyone else, it appears, and often they're good sleepers.

That's why dentists tend to favor intraoral appliances — plastic mouth guards — which are considered standard treatment for bruxism. Most insurance plans will cover at least part of the $300-to-$800 cost of the devices.

After identifying the problem, Fink first fixed Heatherington's broken molar. He then took an imprint of her upper teeth, and in weeks she had a mouth guard that snapped into place.

"The guards aren't a cure; people usually continue to grind their teeth," said Fink, "but we can protect the teeth and stop the damage."

It can take a week or more to get used to sleeping with a piece of plastic in your mouth, and some people never feel comfortable. Some severe grinders wear out the hard plastic in a year or so and need to be fitted all over again, while many others return every few years to be refitted.

"All I was worried about was that the thing wouldn't stay in place, that it would keep falling out," Heatherington said. No such trouble: In her case, the guard prevented more tooth damage, and seems to have reduced clenching and grinding.

"My face was sore for a little while, but then the pain was gone, and I could sleep well again," she said. "I got so used to the night guard that sometimes I'd forget to take it out."

Exercises may help

To stop the grinding itself, some dentists recommend simple exercise. In one, patients touch the tip of their tongue to the roof of their mouth, just behind the teeth, then open slowly, and close, without touching the teeth; this is repeated a half-dozen times. Broussard said the exercise keeps the jaw joint properly aligned and trains the muscles to move as they should, while keeping people aware of daytime clenching and grinding.

Another technique: Lick the lips, swallow and relax the jaw. In this relaxed position the lips and teeth are slightly parted.

After a couple of months, Heatherington began sleeping without the guard on some nights to see what happened. The facial pain and headaches did not return, and she's convinced that she's grinding far less than before, if at all. Now she uses the mouth guard only two or three times a week.

"I just wear it when I'm feeling especially stressed," she said. "But just having it gives me a sense of security; psychologically, I feel I'm cured."