High Risk for Teeth Grinding

High Risk for Teeth Grinding 

What is bruxism? 

Bruxism is the medical term for the grinding of teeth or the clenching of jaws. Bruxism often occurs during deep sleep or while under stress.  Clenching and/or grinding the teeth can be a subconscious act, meaning you are unaware that you are doing it.  Many people clench or grind their teeth when they are concentrating, driving or working out in addition to while they are sleeping.

What are the causes of bruxism?

Bruxism can have several different causes.  Some people have irregularities in the way the teeth come together (occlusion) that cause increased muscle activity.  Other people clench or grind their teeth when they are under stress.  Often, bruxism is a sign of a sleep-disordered breathing problem, like sleep apnea.  It can also be a side effect of certain medications, including some antidepressants and ADHD medications.

What does it mean that I am high risk? 

There are multiple factors that can show your dentist that you are at high risk for clenching or grinding your teeth.

  • Wear facets – damage to the biting surfaces of teeth that looks like flattened areas

  • Tightness or soreness in the muscles of the jaws

  • Excessive muscle force – evidenced by large facial muscles

  • Recession – loss of gum attachment, teeth appear longer

  • Abfractions – notching of enamel at the gumline

  • Potholes on the biting surfaces of back teeth – the enamel is completely worn away, and the underlying tooth structure becomes deep and concave, just like a pothole in the road

  • Linea alba – white callous line on inner cheeks

  • Scalloped tongue – the outer edges of the tongue become shaped like the inner edges of the teeth

What can I do about it? 

You can prevent some of the damage to your teeth and gums by having a dental nightguard custom made for your mouth.  When you sleep in a protective nightguard, you decrease the stressful forces applied to the teeth as you sleep and protect them from further breakdown.  If you find yourself clenching during the daytime, talk with Dr. Jason, Dr. Alex or Dr. Serena about techniques to help break that habit.

What if I don’t do anything?

Bruxism can lead to multiple complications of your oral health.  Inside the mouth, bruxism can cause cracked teeth, loss of tooth structure, shortened teeth, gum recession, abfraction or notching of the teeth at the gumline.  These complications can result in many different types of damage to the teeth and an increased cost of dental care over your lifetime.  Outside the oral cavity, bruxism can cause problems in the chewing muscles or in the jaw joint itself.  Muscle tension can lead to facial pain or headaches.  Problems in the joint can lead to arthritis and slipped disks within the jaw joint.  This all can lead to pain, limited function, and decreased overall quality of life.

How do I find out if I am grinding my teeth?

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Do I Really Grind My Teeth?

Do I Really Grind My Teeth?

Some of our patients are surprised when we inform them that we see evidence in their mouths of teeth grinding, or bruxism.  Many people have no idea that they are grinding their teeth.  And what happens very frequently is they come back in six months and say, “You know . . . I think I might be grinding my teeth.  Ever since you told me that six months ago, I’ve been noticing {insert symptom here}.” 

Signs vs. Symptoms

In order to explain this phenomenon of a dentist telling the patient about something they are doing which they are unaware of, it is important to understand signs and symptoms.  Signs are objective, observable facts.  This means they are not swayed by opinions or feelings, and they can be shown by a photograph, an x-ray or other type of image, a lab result, etc…  Signs are noted by the dentist during an evaluation of your mouth.  Signs can exist without any symptoms, so it is possible that a dentist can inform you of the signs of a condition without your being aware of any issues.

Symptoms are subjective evidences of a condition or disease of which the patient is aware.  For instance, pain is a symptom because it cannot be observed, and the patient must describe it to their doctor for it to be properly documented and used to aid in diagnosis.  Other examples of symptoms include anxiety, fatigue, or muscle tension.

Bruxism (Teeth Grinding)

Bruxism is a very common condition in which a person closes the upper and lower jaws, creating high pressure on the teeth, gums, supporting jaw bones, facial muscles and jaw joints.  It can include hard squeezing called clenching, or a side-to-side or back-and-forth movement called grinding.  When bruxism occurs, it will manifest in one or more clinical signs and possibly some symptoms. 

Signs of Bruxism

  • Attrition – the flattening of the biting surfaces of teeth and loss of enamel caused by clenching or grinding

  • Potholes – a specific type of attrition where the enamel has been worn through, and the underlying dentin is exposed and worn down into a concavity

  • Gum Recession – movement of the gum attachment away from stressful biting forces on the tooth to a position further toward the root, can cause exposure of the root and tooth sensitivity

 

  • Tooth Abfraction – a loss of tooth structure at the gumline causing a notch or concavity

  • Facial Muscle Enlargement – as with any other muscle in the body, when exercised frequently, they will enlarge

  • Linea Alba – Latin for “white line”, this is a visible line on the inside of your cheeks caused by friction against the grinding teeth, like a callous

  • Scalloped Tongue – the sides of your tongue can be pressed against the inner surfaces of the teeth when clenching or grinding, causing it to conform to the shape of the teeth and have a scalloped appearance

Symptoms of Bruxism

  • Facial pain, including headaches – constant clenching of muscles can create muscle soreness in the cheeks, temples, forehead, and the neck

  • Muscle tightness – a tight or tense feeling in the muscles of the cheeks and temples

  • Joint pain or sounds – the jaw joints, located in front of your ears, can be tender to touch, have sharp shooting pains, or make popping, clicking, or crunching sounds

  • Generalized tooth pain or sensitivity – the pressure of clenching or grinding can cause all of the teeth to be sore or sensitive to temperature

 

Not everyone who clenches or grinds his or her teeth will exhibit all of these signs or symptoms.  It is important for the dentist to get the whole picture and put together each patient’s specific signs and/or symptoms in order to accurately diagnose the condition of bruxism.

What Can I Do About It?

The most common treatment for bruxism is a hard, custom-made nightguard to protect the teeth, gums, bone, muscles and joints at night.  People who clench during the day can follow some habit-breaking techniques to prevent daytime damage.  If extensive damage is present, you will probably need some dental work to repair it before moving on to the preventive phase. 

Will an Over-the-Counter Nightguard Work?

OTC nightguards are typically made of a soft, thermoplastic material that you can heat and shape to fit your teeth.  This material is not great at preventing the damage from bruxism because the soft, squishiness actually increases muscle action and deteriorates very quickly.  The best protection for your teeth, gums, bone, muscles and joints is a hard nightguard that is custom-made for you by your dentist.  These will actually reduce muscle force and provide real protection.

Need More Information?

If you think you may exhibit one or more of the listed signs and symptoms, please don’t hesitate call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Why is My Dentist Asking How I Sleep?

Why is my dentist asking how I sleep?

Patients at our offices in Freeman, Parkston and Viborg may be accustomed to the dentists, hygienists, and assistants asking about their quality of sleep, but this is usually something new or surprising for patients who are new to our practice.  There are a few reasons dentists are involved in the recognition and treatment of sleep-disordered breathing:

  • Dentists are in a unique position to recognize a potential problem with sleep-disordered breathing.

  • Sleep-disordered breathing often causes dental signs and symptoms that your dentist will notice during an evaluation.

  • One of the treatment options for a patient who has been diagnosed with mild or moderate obstructive sleep apnea is a dental appliance to position the lower jaw and open the airway.

Recognizing airway risk

Dr. Jason, Dr. Alex and Dr. Serena have been trained to recognize patients with high risk for a possible sleep-disordered breathing issue.  Obstructive sleep apnea happens when the upper airway is partially or completely obstructed (or blocked) during sleep, which causes a disruption in breathing.  There are two ways that our doctors evaluate the upper airway on our patients.  The first is through an intraoral evaluation, which allows them to visualize the opening into the upper airway at the back of the mouth.  The anatomy of this area (the oropharynx) varies widely among patients, and certain anatomical variants cause a very high risk of airway obstruction during sleep.  The second way the upper airway is evaluated during a dental visit is with 3D imaging.  At our practice, we have the ability to obtain a 3D image of the head and neck, which allows us to take a measurement of the airway and determine a patient's anatomical risk for sleep-disordered breathing.

 

The dental signs and symptoms

One of the body's responses to a reduction in oxygen levels is to grind the teeth in a protrusive motion, pushing the lower jaw forward to open the airway.  This can lead to noticeable attrition (surface wear) on the upper and lower front teeth.  An example of severe attrition is shown in the picture below.  This makes the teeth look like they are getting shorter.  Some dental symptoms patients may experience are facial muscle pain or tension, jaw discomfort, and sensitive teeth.  Patients with sleep apnea often also experience GERD (acid reflux), which brings the pH level of the mouth down and can lead to acid erosion of the teeth.

 

A dental treatment option

A dental appliance is an alternative to breathing machine treatment options.  Obstructive sleep apnea is a medical condition that must be diagnosed by a medical doctor, and it may be treated with a dental appliance, which must be fabricated and overseen by a dentist.  Our practice has been treating sleep-disordered breathing for over 13 years and understands this relationship well.  An oral appliance is not the best treatment for everyone, and it’s important to evaluate the severity of sleep-disordered breathing and whether or not a dental appliance would adequately treat it.  Your dentist needs to evaluate the health of your teeth, their supporting gums and bone, and your temporomandibular (TMJ or jaw) joint to make sure a dental appliance will be properly supported and do no harm.

 

How can I get started?

The first step in treating sleep apnea is having it diagnosed by your physician.  Our practices offer a home screening monitor that can be used to evaluate the quality of your sleep.  It gathers several types of data while you sleep, including whether or not you grind your teeth.  Our doctors will advise you based on the preliminary data reported by the home sleep screening monitor.  You may be referred to your physician for a more in-depth evaluation of your sleep prior to treatment.  If you have already been diagnosed with sleep apnea and have not had success with previous treatment options, we can help discuss options that might be available to you with oral appliances.

Some great resources for information on sleep-disordered breathing:

American Academy of Dental Sleep Medicine

Narval Oral Appliance

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!