To find out if you are suffering from sleep bruxism, it’s probably best to ask someone else. Teeth grinding is a subconscious malady, one we rarely realise we are doing. Usually it’s only when a partner complains that the noise of your gnashing is keeping them awake or a dentist spots teeth being worn away at an alarming rate that it becomes apparent that you may be one of the growing number afflicted by the latest lifestyle-induced health problem. A friend of mine suffered sleepless nights for weeks before realising it was not a plumbing fault in her flat that was causing clicking and grating noises, but her husband’s jaw.
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It’s a familiar story. According to the NHS, as many as six million people grind their teeth — often to the point where they begin to erode or fall out — although Andrew Eder, a professor at the UCL Eastman Dental Institute, believes this figure to be a conservative estimate. With the teeth of 75 per cent of the adult population (and 50 per cent of children) displaying signs of significant wear, he says that grinders are probably more prevalent than statistics suggest.
“From a clinical perspective it is higher than ever and on the increase,” Eder says. “I spend two to three days of every working week dealing with it.” Anecdotally, the rise is backed by upmarket private dental clinics, including Elleven Dental in Harley Street, London, which reported that 30 per cent more patients seek help to deal with bruxism than five years ago.
A 2012 review in the International Dental Journal found that muscle-paralysing Botox jabs could reduce grinding and its associated pain. Since then cosmetic surgeons have reportedly been inundated with requests for injections to help to relax tense masseter and temporalis muscles, which close the jaw as it chews and bites.
Although it can happen at any time, bruxism is much more common at night when some of the body’s protective mechanisms switch off. It’s hardly surprising that it hurts. Normally, your upper and lower teeth are in direct contact for about 20 minutes a day, mainly when chewing. If you are a night grinder that can shoot up to as much as 40 minutes in every hour, with an incredible force estimated to be the equivalent of 250lb. Over time it can cause damage to the teeth and surrounding tissue, resulting in headaches and jaw muscles so knotted that pain is referred to other parts of the face and neck. Sufferers often develop problems with the temporomandibular joint, the hinge at the corner of the jaw.
For many, stress is an underlying factor. The jaw muscles are the strongest in the body and react to mental stress by tightening. This is why in times of recession cases of bruxism shoot up. Eder says people affected by divorce, redundancy or family illness often find they are grinding for the first time. Appearing on The Tonight Show Starring Jimmy Fallon in June, Demi Moore revealed that she lost her two front teeth through night grinding. “I sheared off my front teeth,” the 54-year-old actress said. “I’d love to say it was skateboarding or something really kind of cool, but I think it’s something that’s important to share because I think it’s literally, probably after heart disease, one of the biggest killers in America, which is stress.”
In March US Vogue reported that Trump-induced jaw clenching, a response to the political strain felt by Americans to the actions of Donald Trump’s presidency, was being seen by dentists and dermatologists. “Clenching and grinding are for some people an attempt to relieve stress,” Eder says. “Yet by doing it they are effectively storing up more tension.”
In teenagers it can be linked to the many anxieties of growing up, with one recent Brazilian study showing that 13 to 15-year-olds who are bullied are more likely to grind their teeth at night. Findings published in the Journal of Oral Rehabilitation in July showed that verbal bullying in school meant that children were four times as likely to suffer sleep bruxism than those who weren’t bullied. Eder says he also sees a sharp rise in the number of young people at his clinics during summer. “They come in with acute and severe joint strain around their ears and jaw, which is a classic sign of grinding,” he says. “It’s a classic reaction to the pressure they are under with exams.”
Yet not every tooth grinder is stressed. Genetics also play a role in the condition. A 2015 study in the Journal of Pharmacy and Bioallied Sciences showed that 21 to 50 per cent of people who grind their teeth have a direct family member who does the same. Other studies have found genetic variations in the way our tooth enamel is formed, making us more or less prone to erosion when the teeth are clenched. Researchers have linked high intakes of alcohol, drugs and caffeine with higher risks of the condition, although none has shown them to be a direct cause.
What is known is that our diets are implicated in the bruxing boom. Consuming large amounts of acidic drinks — which includes everything from sports drinks and prosecco to fruit smoothies and fizzy cola — weakens tooth enamel, making it more vulnerable to the effects of even mild grinding. “Any acidic food or drink will soften tooth enamel over time,” says Professor Damien Walmsley, scientific adviser to the British Dental Association. “That means that even if you only grind your teeth occasionally the effect could be more pronounced.”
If your night grinding goes unnoticed at home, a dentist should spot the signs easily. Grinding inevitably wears down the teeth, weakening them and causing heightened sensitivity to hot and cold food. Tiny cracks and chips can appear and these pick up brown staining, particularly where there are cavities or old fillings. The chronic effects can be drastic and tooth loss is common. “I’ve seen a 40-year-old-man in my clinic today who has worn his teeth down to almost nothing through a combination of a fizzy-drink habit and grinding,” Eder says. “And such cases are not unusual.”
Treatment typically involves wearing at night a mouthguard made from durable plastic and tailored to your mouth. “In normal circumstances your jaw naturally sags a little bit,” Walmsley says. “Once you start clenching and grinding, you are effectively engaging the biting muscles all the time. A mouthguard restores your jaw to its rested state.”
Seek help if you get headaches or jaw pain, or sensitive teeth
Using over-the-counter mouthguards or those designed for sports is not a good idea. “They are counterproductive,” Eder says. “Because they are made from a softer material, they can induce a chewing response and increase grinding at night. It’s a bit like sucking a fruit pastille in that you eventually relent and starting chewing it.” In the long term, the wrong sort of mouthguard can cause more damage than it prevents, altering the bite or alignment of the teeth.
And what of Botox? It’s the preferred choice of the Loose Women presenter Nadia Sawalha, who, having lost one tooth to bruxism, started the procedure to stop her grinding her teeth. Speaking on the programme in April, the 52-year-old said she grinds her teeth so much she resorted to extreme measures to try to cure it. “I actually had Botox,” she said. “I have Botox injected into the muscle there because otherwise I could potentially lose all my teeth.” She said she undergoes the procedure “about every six months, but it doesn’t stop it”. Eder says he’s not an advocate of this approach. “It’s definitely not something I’d recommend,” he says. “There’s the potential for damage to the area around the jaw and a loss of bone density if it’s done repeatedly.”
Some grinders find relief with acupuncture, although evidence for its success is limited. There’s also a new system called Cerezen that, at a cost of about £500, involves inserting 6mm-long plugs into the ear canal to encourage relaxation of the jaw so you are less inclined to grind. Several thousand procedures have been carried out in the UK and Eder says the results are promising, although many dentists are wary of recommending it until the scientific backing is conclusive.
Mouthguards remain the best form of defence and Walmsley says he wears one, having been a bruxist for years. “With bruxism you need to stay one step ahead,” he says. “If you get frequent headaches or jaw pain, or sensitive teeth, seek help.” Some people find the problem resolves after weeks of wearing a mouthguard, others that it persists for decades and requires nightly attention. It’s a grind, but a necessary one.
