Are You Grinding Your Teeth? Here’s How to Know and How to Stop This Harmful Habit (2023)

Imagine a force 3 to 10 times greater than what’s required to crack a walnut. Now picture that force hammering inside your mouth.

You’ve just imagined bruxism, more commonly known as grinding of the teeth.

This clash of teeth against teeth was called “brukhé,” or gnashing, by the ancient Greeks. Nowadays, experts tend to agree that bruxism is more nuanced and varied than that: Characterized by some as a “behavior” and by others as a “disorder” in otherwise healthy individuals, bruxism is repetitive jaw muscle activity that involves grinding, clenching, bracing, or thrusting.

Wakeful clenching, known as daytime or awake bruxism, and sleep grinding, known as sleep or nighttime bruxism, are related but distinct conditions with both unique and shared treatment protocols. Some people engage in a combination of the two.

“Grinding of the teeth is officially bruxism, while clenching, which is related, is a different parafunctional jaw habit,” says James M. Uyanik, DDS, a clinical assistant professor at New York University College of Dentistry in New York City and the director of the NYU Orofacial and Head Pain Clinic.

Almost half of all children go through a period of nighttime grinding, while up to one-third of the general U.S. population experiences bruxism at some point in their lives, according to the Academy of General Dentistry, a professional organization of general dentists from the United States and Canada.

If Google searches are any indication, research shows bruxism has risen since the COVID-19 pandemic began — not surprising, given bruxism’s link to stress. Still, oral health professionals such as Anne Clemons, DMD, a general dentist with the Cleveland Clinic in Ohio, say bruxism is dramatically underreported — "especially these days.”

That may be in part because many grinders and gnashers have no idea that they’re bruxing.

“Eighty percent of the time, when I tell someone that they’re grinding, they’re hearing it for the first time,” says Lokesh Rao, DDS, of Westchester Dental Design in Yonkers, New York.

Who’s at Risk for Teeth Grinding?

According to a study published in 2019 by the Journal of Research in Medical Sciencesout of Isfahan University, many youngsters who grind outgrow the problem before adulthood. Those who continue into maturity and those who acquire the habit later in life range from occasional bruxers to powerful gnashers who can shatter dental work. “Anyone can be a bruxer,” says Dr. Uyanik. But some people are more at risk than others.

The stressed “Someone undergoing major changes or facing stressful events, such as moving to a new location, starting a new job, dealing with a birth, a marriage, a death, or a divorce in the family, is at particular risk,” Uyanik says.

A study published in the September 2019 issue of the International Journal of Environmental ResearchandPublic Health found a strong positive correlation between perceived stress levels and the amount of grinding. This relationship was dramatically, albeit anecdotally, illustrated in an ABC News story from July 2021, about U.S. dentists reports of cracked teeth and broken dental work — casualties of intense grinding — soaring during the pandemic.

“Even when people are oblivious to their own grinding,” Dr. Rao says, “stressful background conditions can increase it, and this pandemic has been a major one.”

Problem sleepers With the majority of bruxers overworking their jaw muscles overnight, Dr. Clemons begins the diagnostic journey with queries about sleep. “I’ll ask whether it’s good and restful, or if there’s some other disorder involved,” she says.

For example, a misaligned bite (when the bottom and top teeth don’t properly meet) and breathing problems during sleep, such as nocturnal asthma and sleep apnea, can occasionally contribute to nighttime bruxism. Indeed, nighttime bruxism is often considered a sleep disorder that calls for people to have their overnight behavior monitored and analyzed.

“It could be critical in identifying possible additional sleep and breathing concerns that may contribute to or be related to bruxism events while sleeping, so they don’t go unaddressed,” Clemons says.

Caffeine or alcohol users and abusers Excessive consumption of coffee or alcohol can increase the tendency to grind, possibly by altering sleep patterns through overstimulation and dehydration, respectively. Tobacco and recreational drugs may also be bruxism risk factors.

Genetically predisposedAn article in the Spring 2020 Journal of Craniomaxillofacial Research describeda genetic predisposition to grind, andone study, reported online in the January 2018 Biomedical Reports, suggested that bruxers tend to share traits such as anxiety. Occasionally, an inherited dental misalignment will lead to bruxism. “For these people, the grinding will decrease after we improve the problem with their bite,” says Clemons.

Antidepressant usersBruxism is among the rare but possible side effects of some selective serotonin reuptake inhibitor (SSRI) antidepressants, which rank among the most-prescribed drugs in the United States.

Diagnosed with Parkinson’s disease or other conditions People with Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, or attention deficit hyperactivity disorder (ADHD) are more likely than the general population to develop a bruxing habit, according to the Mayo Clinic. So, too, are people who face some ongoing mental illnesses.

Signs of Bruxism

When people come to them complaining of headaches, sleep disruption, or pain, dentists search for some characteristic “tells” to confirm bruxism. These include:

Damaged teeth or dental work Teeth or dental restorations that show visible signs of wear, flattening, cracks, or chips serve as strong evidence of ongoing grinding. In severe cases, the destruction is so pronounced that teeth are barely visible above the gumline, or the internal structure of the tooth has been exposed.

“I’ll see back teeth where the peaks are worn down or have little potholes, or where the body of the tooth has turned yellowish or brownish because of missing enamel, the white ‘candy coating’ of teeth,” says Rao.

Extreme, persistent gnashing can also unmoor teeth from their attachments to the jaw. “When the surrounding bone has been broken down, the tooth becomes like a fence post planted in soil that’s too loose,” Rao says. “If you rock it too much, it falls.”

Noise For some, the impetus to seek medical help comes from a frustrated sleeping partner who’s sick of the noise. The temporomandibular joint itself (that’s the hinge where the top and bottom jaws meet) can generate popping or snapping sounds. Audio recording devices or applications can help suspected bruxers determine whether they’re making a racket overnight.

Sensitivity Teeth may become especially sensitive to pain, cold, heat, or other stimuli. That’s often because of tiny fractures created by the repeated force of the jaws. These breaches allow heat, cold, or bacteria to enter and compromise the body of the tooth, potentially requiring a root canal treatment.

Muscle, jaw, and neck pain The jaw muscles may be noticeably tight or overdeveloped, or they may be painful to the touch. The ability to open and close the mouth may be diminished, while the neck can be sore and fatigued. Some bruxers unconsciously create small sores from chewing the insides of their cheeks.

Headaches Referred pain that originates in the muscles of mastication (those involved in chewing and controlling the jaw’s movement) can radiate to other portions of the head and face. Bruxers may experience pain or a sense of fullness near the ear, or they may have headaches, particularly upon awakening.

“If someone tells me they wake up with a headache or pain and fatigue in their jaw, my brain immediately goes to the possibility of nighttime parafunctional activity,” Uyanik says. “If the pain occurs near the evening, it suggests there’s been daytime grinding or clenching.”

Sleep disruption The American Sleep Association notes that bruxism can impair normal sleep cycles, particularly in the earlier sleep stages. That kind of disruption can delay the most restful and deepest sleep phases, leaving the bruxer feeling insufficiently rested the following day.

Vertigo and earache By preventing the muscles, bones, and joints associated with the jaw from working together smoothly, bruxism can sometimes lead to dizziness and otalgia, or earache — an argument for ear-nose-throat (ENT) clinicians and dentists to work together.

Treatments for Daytime Clenching

Many daytime bruxers clench their teeth — often unconsciously — during times of intense emotion, anxiety, and concentration. Because awareness, attention, and practice are critical for these people to stop bruxing, their optimum strategies fall into two categories.

Catch yourself bruxing.The first treatment milestone for many involves convincing themselves that their bruxism is real. The challenge, their dentists will say, is to catch themselves bruxing, particularly when they’re preoccupied or concentrating. Uyanik suggests the following:

• Set an alarm to chime every 20 minutes, signaling a bruxing check.
• Try one of several smartphone applications that automatically chime, and document your experiences. (See the resources listed below.)
• Maintain a bruxing journal for noting the circumstances that trigger jaw action.
• Keep lips together, teeth apart. “If it feels off or uncomfortable, it’s easier for me to convince people that it’s because they’re accustomed to always clenching their teeth,” Uyanik says.

Implement replacement activities.Once people are convinced that their go-to behavior is gritting and gnashing, Clemons says, they can improve their ability to counter those behaviors with deliberate replacement activities. That was confirmed in a paper published in the December 2020 Frontiers of Neurology, which concluded that while daytime bruxers are likely to experience heightened general anxiety, they’re also better equipped to defeat their bruxism.

“These people can often figure out ways to consciously modify their behavior,” says Clemons. Here are some alternatives:

• Practice pronouncing the letter “N.” “That automatically separates your bottom and top teeth and puts your mouth in a kind of psychological rest position, creating a new habit,” says Uyanik.
• Try small in-ear monitors that detect and warn of a bruxing episode so that the wearer can interrupt and correct it. As described in the December 2020 International Journal of Environmental Research and Public Health, this new approach is based on the discovery that the ear canal tightens during clenching.

Treatments for Nighttime Grinding

Nighttime bruxing and its daytime sibling may be closely related, but if you grind and gnash, according to a study published in the March 2019 issue of Journal of Oral Rehabilitation, you’re three times more likely do it while asleep rather than awake.

For nighttime bruxers, the researchers speculated, chewing may function as a natural way to dissipate stress. But targeting and replacing the habit without disturbing sleep is tough, which is why dentists tend to try more passive approaches:

Sleep hygiene Practicing good sleep hygiene is essential for bruxers. Bedrooms should be kept dark, cool, quiet, and free of electronic devices, and a calming evening ritual should precede lights-out.

Stress relief Stress reeducation strategies provide ongoing benefits. Progressive relaxation, yoga, breathing exercises, massage, guided imagery, and sometimes medication can tone down the tension level and, ideally, the level of jaw activity.

Occlusal devices (mouthguards or nightguards) Occlusal (meaning “where the teeth come together”) splints are wearable devices most frequently created to snugly fit over the lower teeth, where they create a cushioning, indestructible biting surface. The splints protect against damage and can reduce bruxism’s noise. They don’t prevent the muscular activity itself.

Fortunately some of the less consistent or powerful grinders need very little intervention. “Everybody is different,” Rao says. “Some people are able to get by with the bare minimum of tooth protection offered by a nightguard that costs around $25 and is available at any drugstore.”

By contrast, serious bruxers need the real thing: custom-created, durable splints, usually constructed of soft plastic, hard acrylic, or layers of shock-absorbing materials. These personalized appliances average between $300 and $500 and, with proper care, can safeguard teeth for many years.

“There’s some evidence that ill-fitting over-the-counter guards may actually contribute to tooth damage,” Clemson says, “but custom guards allow the teeth to strike evenly, so the muscles aren’t working as hard.”

Medication reevaluation Since antidepressants can occasionally contribute to bruxism, some dentists urge people to inventory their medications. Drugs such as fluoxetine (Prozac), sertraline (Zoloft), and venlafaxine (Effexor) have been implicated in grinding increases.

“It’s not a common side effect of these drugs, but it’s a possible one, especially if the grinding behavior first emerged shortly after a patient began taking something likeCelexa, Prozac, or one of the antipsychotics,” says Uyanik.

If they suspect a drug is worsening the bruxism, dentists will commonly work with other medical professionals to switch to comparable medications with fewer side effects.

Botox Repeat injections of Botox — a common, local paralytic used in cosmetic procedures and to treat migraine — are sometimes used to relax overactive jaw muscles. Many practitioners, though, approach this neurotoxin with care.

“Botox shouldn’t be the first thing you think about, but it can benefit some patients whose jaw muscles are very hyperactive by limiting the force the muscle puts into grinding,” says Clemons.

Transcutaneous electrical nerve stimulation (TENS) TENS has long been used in physical therapy to block the transmission of pain signals to the brain. It’s been used in treating bruxism to both mitigate the pain and relax the jaw muscles. TENS is also believed to increase the release of endorphins, the body’s feel-good chemicals, in the brain.

Physical therapy Therapists trained in craniofacial structure work suggest that massage, heat, and stretching exercises can help loosen cramped, overworked jaw muscles. A research review in the June 2018 Journal of Manipulative and Physiological Therapeutics concludes that there is “very low-quality evidence” of these kinds of interventions working, but that seemed to be primarily because poor methodology was used when the techniques were initially investigated.

Medication In extreme cases, some dentists prescribe muscle relaxants for a short period, but the medications have their own side effects and may interfere with the normal sleep cycle.

The Bruxism-TMD Connection

When bruxism wreaks serious havoc or leads to significant pain, the diagnosis may include the more complicated temporomandibular joint disorder (TMD) designation, per Johns Hopkins Medicine, denoting a dysfunction of the temporomandibular joint (TMJ).

“This joint is the one that moves when you open or close your mouth or move the lower jaw from side to side,” Clemons says.

People with TMD may experience a clicking, popping, or locking of the temporomandibular jaw joint, or may be unable to fully open their mouths. In the most advanced instances, the damage escalates to where it can threaten the integrity of the face.

“As the teeth are worn down, the nose and the mouth can be drawn closer together,” Rao says. “That shortens the vertical dimension of the face, causing it to, in essence, collapse.”

To treat TMD, people often seek care from orofacial pain specialists who are board-certified to deal with TMD-related disorders, or from prosthodontists, who address dental and facial problems that require the restoration of missing teeth or jaw structure. The specialists commonly work with larger teams that may include specially trained physical therapists, massage therapists, and experts proficient in administering TENS or heat therapy.

Grinding to a Halt

Researchers haven’t pinpointed a single cause for grinding, nor have they found a sole, reliable treatment. Still, the overall prognosis for bruxers who stick with their treatments is promising.

Indeed, many dentists find that the biggest obstacle to defeating bruxism involves denial.

“Some people are offended when they’re told that they grind, even though we’ve definitely seen the wear on their teeth,” Clemons says. “We have to become better at opening their eyes to something that really needs to be addressed.”

Resources for Teeth Grinders and Jaw Clenchers

Your partner insists that your tooth grinding has reached the legal noise limit, but you’re convinced that you’re not a bruxer. What to do? Try one of the applications or special devices created to determine whether and how much mouth mayhem you’re generating.

This list offers a quick overview — a representative sampling of a broad range, really — of what’s available to detect and calibrate snoring, grinding, and scraping sounds overnight. Some can be accessed only through a dentist; others are accessible to the public anytime, anywhere, with new and updated versions regularly reaching the marketplace.

SnoreLab Developed by Jules Goldberg, an English researcher, after his wife complained about his overnight noisemaking, SnoreLab is a free application available for both iPhones (iOS) and Androids. Although created to track snoring, the program’s sophisticated algorithms can pick up and record bruxism’s telltale cacophony. With a 4.7 user rating, it’s among the top-rated among smartphone medical applications.

BruxApp Calling itself the world’s “first scientific smartphone application” specifically designed for bruxism, BruxApp is available in 25 languages for iPhone and iPad users. Sold for $1.99 through the Apple store, the application targets the daytime habit of jaw clenching (“mandible bracing”) by sending customized sound alerts that allow people to recognize the behavior in real time and correct it. With user input, incidents are tracked and calibrated according to severity, making users further aware of the tension-generating situations that may prompt the bruxing. Data from BruxApp have been used in research conducted around the world.

Do I Snore or Grind? Another free-of-charge iPhone and iPad application, Do I Snore or Grind? records and charts grinding and snoring. A separate wearable paired with the program can send an alert warning of grinding during light phases of sleep.

BiteStrip A small, disposable electronic electromyographic device, BiteStrip measures muscle activity by sensing its electrical signals. Medical professionals can order BiteStrip for home use to accurately detect and measure muscle activity around the jaw. The validity of such devices was confirmed in a literature review published in the journal Cranio in September 2020. The kit requires users to position strips at key points, practice clenching to set a baseline, and wear the monitor overnight. Dentists can then assess the frequency and severity of the condition and formulate the best treatment plan.