Bruxism is the medical term for grinding or clenching your teeth, often unconsciously. This condition can occur during the day (awake bruxism) or at night (sleep bruxism). The persistent force placed on the teeth leads to wear and damage over time. A range of dental interventions can repair this damage and restore oral health. Understanding these solutions is the first step toward addressing the consequences of bruxism.
Assessing the Damage from Teeth Grinding
The effects of bruxism on teeth occur progressively. Initial signs include minor wear facets, which are small, flat spots on the biting surfaces of the teeth, often appearing first on the canines. As the condition continues, these facets become more pronounced, leading to a general flattening of the tooth cusps and incisal edges.
As the damage advances, the protective outer layer of the tooth, the enamel, wears away and exposes the underlying dentin. Since dentin is yellower and softer than enamel, this can cause teeth to appear discolored and become sensitive to temperature and pressure. Small chips and fractures may also start to appear along the edges of the teeth, altering their shape and weakening the overall tooth structure.
In severe cases, the damage is extensive. The loss of tooth height becomes significant, which can alter the vertical dimension of the face, or the distance between the nose and chin when the jaw is closed. This may result in a sunken appearance around the mouth. Teeth can suffer from large fractures or cracks that extend deep into the tooth, and in some instances, become loose or require removal.
Restorative Options for Worn Teeth
Once damage from grinding has occurred, several restorative procedures can repair the teeth, with the choice depending on the extent of the wear.
- Dental bonding is a solution for minor issues like small chips or slight wear. This procedure uses a tooth-colored composite resin, which is applied, sculpted, and hardened to repair the damaged area and match the natural tooth contour.
- Porcelain veneers are an option for more visible teeth that have sustained moderate wear. Veneers are thin, custom-made ceramic shells designed to cover the front surface of teeth. A dentist removes a small amount of enamel to accommodate the veneer, which is then permanently bonded in place.
- Dental crowns are recommended when teeth are severely worn, cracked, or fractured. A crown, or cap, covers the entire tooth structure for comprehensive protection. The damaged tooth is reshaped, and a custom-fit crown is cemented over it to restore function and appearance.
- Inlays or onlays may be used when damage is too extensive for a filling but not severe enough for a full crown. An inlay fits within the cusps of a tooth, while an onlay covers one or more cusps. They are a conservative option for repairing moderate damage to molars and premolars.
Addressing Bite and Alignment Issues
A misaligned bite (malocclusion), where teeth do not meet properly, can contribute to or worsen grinding. This imbalance may cause the jaw muscles to work unevenly to find a comfortable resting position, which can trigger clenching. Correcting this underlying issue can be part of a long-term management strategy.
Orthodontic treatment is one method used to address malocclusion. Procedures like braces or clear aligners gradually move teeth into their proper positions to create a more balanced bite. By improving alignment, the pressure exerted during chewing and at rest is distributed more evenly across the teeth, which can reduce strain on the jaw muscles and joints.
Another technique is bite adjustment, also called occlusal equilibration. This procedure involves a dentist making very slight modifications to the biting surfaces of the teeth. By carefully reshaping specific contact points, the dentist can help the upper and lower teeth meet more harmoniously, which can eliminate interferences that may trigger the grinding reflex.
Preventing Further Grinding Damage
Protecting teeth from ongoing grinding is necessary for both natural teeth and new dental restorations. A custom-fitted occlusal splint, or night guard, is the most common method for this. This removable oral appliance fits over the upper or lower teeth and creates a physical barrier that absorbs the forces of clenching and grinding during sleep.
Beyond physical barriers, certain management strategies can help reduce the frequency of bruxism. Since stress and anxiety are contributing factors, techniques like meditation, yoga, or counseling can help manage stress-related grinding. It is also recommended to avoid stimulants, such as caffeine and alcohol, particularly in the hours before bedtime, as they can interfere with sleep quality.
For severe cases of bruxism with very high muscle activity, injections of botulinum toxin (Botox) may be considered. When injected in small amounts into the large jaw muscles, it temporarily weakens their ability to contract with excessive force. This can reduce the intensity of grinding, alleviate associated symptoms like jaw pain, and protect the teeth from damaging forces.