What Is Bruxism?
Bruxism is a very common habit among people of all ages. It is seen in children as young as 1 and 2 years of age. Clenching is the name given where the teeth are squeezed together and then released repeatedly. Grinding is the name given where teeth in the upper jaw are rubbed against the teeth of the lower jaw by a repeating grinding movement of the lower jaw. These actions or behavior patterns are grouped together under the term Bruxism – or clenching and grinding.
This habit or behavior pattern programme is essentially unconscious although it is possible to become aware of it. This means that very few people are aware that it is happening in their mouths and sometimes this is difficult for people to accept or believe that it is happening when a dentist notices and brings it to their attention. In most cases it is the dental professional on close examination who will notice the particular wear patterns on the teeth (like facets of a diamond).
Symptoms & Causes of Bruxism
The habit of Bruxism creates extremely heavy forces on all the tissues of the oral or mouth system, and so, it affects all the tissues in the system. It has been estimated that the forces generated by the clenching grinding habit are at least 1000 times greater than those of the natural process of chewing. Given that the mouth is designed for very small (chewing) forces, the bruxism habit therefore can often test these tissues to their absolute limit, in terms of the amount of continual forces they can cope with. It affects all tissue, the teeth, gums, and the large joints of the jaw located in front of the ears (TMJ).
How Can We Manage Bruxism?
In terms of management, we need to consider the causes of the condition and the effects of the condition on the tissues. For example if teeth are being heavily worn or broken due to the excessive force our priority may be to to find a way to protect the teeth. The same is true of the gums and/or tooth (periodontal) ligaments. And the same is true for the TMJ or larger jaw joints. We have already mentioned the emotional stress and how it is the predominant factor in producing this habit – and therefore stress management in itself will be an important aspect of the management and treatment.
This addresses the cause but the effects will need to be managed also. Essentially the management is about protecting the tissues from the heavy forces. In order to address this, we attempt to create a “shock absorber” mechanism placed between the upper and lower teeth. This is usually made of soft acrylic (plastic) material which can be distorted by force but then rebound back to its original shape (flexible). In this way, it acts as a shock absorber. Such an appliance is often referred to as a night guard for the teeth. It is important to know that the shock absorbing night guard does NOT de-programme the habit itself. Its use is merely as a protection for the tissues. Dealing with stress and management of stress has the potential to re-programme the brain (computer) away from the behaviour, but this process needs special education and learning and can take considerable time. We will consider this later.
The Physical Management Of Bruxism
The most common method of occlusal equilibration (Bite Adjustment) is what is called “subtractive equilibration” where the teeth are polished and reshaped in such a way as to create a balanced alignment between the upper and lower jaws. Often involved the reshaping on existing fillings so very little tooth substance is lost. It is also possible to do an additive equilibration but this is generally more costly, involving dental crowns.
The next stage involves the taking of Impressions or moulds of the upper and lower teeth along with the record of a new bite alignment relationship. These are then sent to a laboratory technician by the dentist. The technician constructs a soft acrylic (plastic) night guard being mindful to ensure that the bite balance that was achieved in the equilibration in maintained in the appliance. This appliance is then fitted and adjusted by the dentist. The person uses the appliance nightly (and daytime wear if required) to protect the tissues from the excessive forces.
Care for your Appliance
A Solution of Milton and water (1 – 2 teaspoons of Milton, in enough water to completely cover the appliance) is sufficient to maintain the appliance on a daily basis. Please be careful to wash the appliance carefully after Milton exposure before placing it in the mouth for nighttime wear. The next morning the appliance is rinsed and placed in the Milton solution for the day. The Milton solution should be changed weekly.
IMPORTANT NOTICE BEFORE BOOKING AN APPOINTMENT
***Attention Non-English Speaking Patients***
If you are unable to communicate effectively in the English language, please bring someone with you who can communicate with us on your behalf when attending your dental appointment