Teeth Grinding (Bruxism): Causes, Symptoms & Treatment

What Is Teeth Grinding (Bruxism)?

Bruxism is the medical term for involuntary teeth grinding or jaw clenching. It can occur during sleep (sleep bruxism) or while awake (awake bruxism). The condition affects 8-31% of the general population and can cause tooth damage, jaw pain, headaches, and temporomandibular joint disorders if left untreated.

Teeth grinding and jaw clenching are extremely common oral habits that many people are unaware they have. The condition involves repetitive jaw muscle activity that causes the teeth to slide back and forth against each other (grinding) or to press firmly together without movement (clenching). While occasional grinding is usually harmless, chronic bruxism can lead to significant dental and medical problems over time.

Understanding the distinction between grinding and clenching is important because they can cause different types of symptoms and damage. Teeth grinding involves a lateral movement of the jaw that produces a characteristic grinding sound and causes distinctive wear patterns on the tooth surfaces. Jaw clenching, on the other hand, involves sustained forceful contact between the upper and lower teeth without movement, which primarily affects the jaw muscles and joints rather than the tooth surfaces.

Medical professionals classify bruxism into two main categories based on when it occurs. Sleep bruxism is considered a sleep-related movement disorder and occurs unconsciously during sleep, often during transitions between sleep stages. Awake bruxism occurs during waking hours and is often associated with concentration, stress, or habitual jaw tension. Many people have both types, though the causes and contributing factors may differ.

How common is teeth grinding?

Bruxism is one of the most common oral health conditions worldwide. Research suggests that sleep bruxism affects approximately 8-31% of the general adult population, though estimates vary widely due to differences in diagnostic criteria and the fact that many cases go undiagnosed. The condition appears to be more common in younger adults, with prevalence decreasing with age.

In children, teeth grinding is even more common, affecting an estimated 14-20% of children under age 11. The good news for parents is that pediatric bruxism typically decreases significantly around age 7 and often resolves completely by the teenage years as the permanent teeth fully develop and the bite matures.

What Are the Symptoms of Teeth Grinding?

The main symptoms of teeth grinding include worn or flattened tooth surfaces, jaw pain and stiffness, morning headaches (especially in the temples), clicking or popping jaw sounds, tooth sensitivity, and sore jaw muscles. Symptoms are often worse upon waking for sleep bruxism and accumulate throughout the day for awake bruxism.

The symptoms of bruxism can vary significantly depending on whether you primarily grind your teeth, clench your jaw, or do both. They also differ based on when the behavior occurs (during sleep or while awake) and how severe and long-standing the condition is. Many people with mild bruxism have no noticeable symptoms, while others experience significant discomfort and dental damage.

One of the challenging aspects of diagnosing bruxism is that many people are completely unaware they grind their teeth, especially if it occurs during sleep. Often, the condition is first noticed by a sleep partner who hears the grinding sounds, or by a dentist who observes characteristic wear patterns on the teeth during a routine examination. Recognizing the symptoms can help you seek appropriate treatment before significant damage occurs.

Symptoms of teeth grinding (sleep bruxism)

Sleep bruxism produces distinctive symptoms that are often most noticeable in the morning, immediately after waking. The grinding motion wears down the tooth surfaces over time, creating visible changes to the teeth that a dentist can identify. Common symptoms of sleep grinding include:

• Worn tooth surfaces: The chewing surfaces of the teeth become flattened, and the edges of front teeth may appear chipped or jagged. Tooth enamel may wear through to expose the underlying dentin.
• Audible grinding sounds: Sleep partners often report hearing loud grinding or squeaking sounds during the night, which can be surprisingly loud and disturbing.
• Morning jaw stiffness: The jaw muscles may feel tight, tired, or sore upon waking, similar to the feeling of muscle fatigue after exercise.
• Temple headaches: Dull, aching headaches centered in the temples are common, as the temporalis muscle (which attaches at the temple) becomes overworked.
• Increased tooth sensitivity: As enamel wears away, teeth may become more sensitive to hot, cold, and sweet foods and drinks.

Symptoms of jaw clenching

Jaw clenching tends to cause more symptoms related to muscle tension and joint stress rather than tooth wear. Because clenching involves sustained muscle contraction, it can lead to significant overloading of the jaw structures. If you primarily clench your jaw, you may notice:

• Jaw muscle pain and fatigue: The masseter and temporalis muscles may feel tired, sore, or tender, similar to having "workout soreness" in the face.
• Difficulty opening the mouth fully: You may have trouble opening your mouth wide, and it may be painful to yawn or take large bites of food.
• Clicking or popping jaw sounds: The temporomandibular joints may make clicking, popping, or grating sounds when you open or close your mouth.
• Pain when chewing: Eating may become uncomfortable, especially with tough or chewy foods that require significant jaw effort.
• Tooth pain that moves around: Teeth may feel sore or tender, with the discomfort often shifting from tooth to tooth over time.
• Dull headaches: A persistent, aching pain in the temples or forehead, often present upon waking and worsening throughout the day.

What Causes Teeth Grinding?

Teeth grinding has multiple causes including stress and anxiety, sleep disorders like sleep apnea, malocclusion (misaligned bite), certain medications (especially SSRIs), and lifestyle factors such as alcohol, caffeine, and tobacco use. The exact mechanism of sleep bruxism is not fully understood but involves central nervous system activation during sleep.

Understanding what causes bruxism is important because effective treatment often depends on addressing the underlying factors. Unlike many medical conditions with a single clear cause, teeth grinding typically results from a combination of psychological, physical, and lifestyle factors working together. Research has identified several key contributors to bruxism.

Stress and psychological factors

Stress and anxiety are among the strongest risk factors for bruxism, particularly for awake bruxism. When we're under stress, we often hold tension in our jaw muscles without realizing it. This habitual clenching can become an unconscious response to emotional pressure. Studies have consistently shown that people experiencing high levels of stress, anxiety, or emotional tension are significantly more likely to grind or clench their teeth.

The relationship between stress and sleep bruxism is more complex. While stressful life events can increase sleep grinding episodes, the mechanism appears to involve changes in sleep patterns and brain activity rather than direct muscle tension. Stress may disrupt sleep architecture, increasing the arousal events during which bruxism typically occurs.

Sleep disorders and bruxism

Sleep bruxism is classified as a sleep-related movement disorder and is strongly associated with other sleep conditions. Research has found significant connections between teeth grinding and:

• Obstructive sleep apnea: People with sleep apnea are much more likely to grind their teeth, possibly as a reflex response to airway obstruction
• Sleep arousals: Grinding episodes typically occur during brief awakenings or transitions between sleep stages
• REM sleep behavior disorder: Abnormal movements during sleep may include bruxism
• Insomnia: Poor sleep quality is associated with increased grinding episodes

Bite alignment and dental factors

The way your teeth come together (your occlusion) can contribute to bruxism. When the upper and lower teeth don't align properly, the jaw muscles may work overtime trying to find a comfortable resting position. Missing teeth, poorly fitting dental restorations, or significant changes to the bite can trigger or worsen grinding and clenching.

Medications and substances

Certain medications have been linked to increased bruxism, particularly:

• Selective serotonin reuptake inhibitors (SSRIs): These common antidepressants can cause or worsen teeth grinding as a side effect
• Stimulant medications: Medications for ADHD and other stimulants may increase grinding
• Recreational drugs: Cocaine, ecstasy, and methamphetamine are strongly associated with severe bruxism

Lifestyle substances also play a role. Caffeine, alcohol, and tobacco have all been linked to increased grinding, particularly when consumed in the evening. Alcohol disrupts sleep architecture, while caffeine and nicotine increase nervous system arousal.

Do Children Outgrow Teeth Grinding?

Yes, most children outgrow teeth grinding. Bruxism is common in children between ages 3-10, often related to jaw development and erupting teeth. It typically decreases significantly by age 7 and often resolves completely by adolescence. Treatment is usually unnecessary unless the grinding causes significant pain or tooth damage.

Parents are often concerned when they hear their child grinding their teeth loudly at night. While the sounds can be alarming, pediatric bruxism is usually a normal developmental phenomenon that resolves on its own. Understanding why children grind their teeth can help parents decide when to seek professional evaluation.

Children's teeth grinding is often related to the development of their teeth and jaw. As new teeth emerge and the bite changes, the child's nervous system may generate grinding movements as a way to "test" the new tooth positions. The soft, developing enamel of baby teeth can wear down quickly, making the grinding sounds particularly loud and noticeable.

In most cases, pediatric bruxism doesn't require treatment. However, parents should consult a dentist if their child experiences jaw pain, severe headaches, significant tooth wear, or if the grinding persists past age 10. A pediatric dentist can evaluate whether treatment is needed and rule out other contributing factors.

How Is Teeth Grinding Diagnosed?

Teeth grinding is diagnosed primarily through dental examination, patient history, and assessment of symptoms. The dentist examines wear patterns on teeth, evaluates jaw muscle tenderness, tests jaw movement range, and reviews sleep and stress factors. In some cases, a sleep study (polysomnography) may be recommended to confirm sleep bruxism and check for sleep apnea.

Diagnosing bruxism involves a comprehensive evaluation because the condition can have multiple contributing factors. Your dentist or doctor will gather information from several sources to understand the full picture of your symptoms and their causes.

Dental examination

A thorough dental examination is the cornerstone of bruxism diagnosis. Your dentist will look for characteristic signs of grinding and clenching, including:

• Tooth wear patterns: Flattened chewing surfaces, worn enamel, and characteristic wear facets that indicate grinding
• Tooth damage: Cracks, chips, or fractures in teeth or dental restorations
• Soft tissue changes: Indentations on the tongue or inner cheeks from pressing against teeth
• Jaw muscle examination: Palpation of the jaw muscles to check for tenderness, enlargement, or trigger points
• Jaw joint assessment: Checking for clicking, popping, or limited range of motion in the temporomandibular joints
• Bite analysis: Evaluating how the upper and lower teeth meet when you close your mouth and when you move your jaw side to side

Monitoring tooth wear over time

To determine how quickly your teeth are wearing, your dentist may create reference records including dental impressions, photographs, or 3D digital scans. These can be compared at future appointments to track changes and assess whether treatment is effectively protecting your teeth.

Sleep study considerations

If sleep bruxism is suspected and you have symptoms suggesting sleep apnea (such as snoring, daytime sleepiness, or witnessed breathing pauses), your dentist may refer you for a sleep study. Polysomnography can definitively diagnose sleep bruxism by recording jaw muscle activity during sleep and can identify sleep apnea, which often coexists with grinding.

How Is Teeth Grinding Treated?

Treatment for teeth grinding includes occlusal splints (night guards) to protect teeth, jaw muscle exercises to reduce tension, stress management techniques, and addressing underlying causes like sleep apnea. Custom-fitted splints from a dentist are most effective. Medication may be prescribed short-term for severe cases, and bite adjustment may be needed if malocclusion contributes to the problem.

Effective treatment for bruxism typically requires a multi-faceted approach that addresses both the symptoms and the underlying causes. Treatment goals include protecting the teeth from further damage, reducing pain and muscle tension, and identifying and managing contributing factors. The specific treatments recommended will depend on the type and severity of your bruxism.

Occlusal splints (night guards)

Occlusal splints, commonly called night guards or bite guards, are the most widely used treatment for sleep bruxism. These custom-made devices are worn over the upper or lower teeth during sleep to create a protective barrier between the tooth surfaces. While night guards don't stop the grinding habit itself, they provide several important benefits:

• Tooth protection: The splint absorbs the grinding forces, preventing further wear on the natural teeth
• Muscle relaxation: A properly adjusted splint can reduce jaw muscle activity and tension
• Joint stress reduction: By optimizing the bite position, splints can decrease stress on the temporomandibular joints
• Reduced grinding intensity: Many people report grinding less forcefully when wearing a splint

Custom-fitted splints made by your dentist are significantly more effective than over-the-counter options. They're designed to fit your teeth precisely, distribute forces evenly, and maintain a proper jaw position. While more expensive initially, custom splints are more comfortable, last longer, and provide better protection.

Jaw exercises and physical therapy

Exercise programs designed to relax and coordinate the jaw muscles can be very effective, especially for awake bruxism. These exercises typically involve gentle stretching, controlled jaw movements, and relaxation techniques. Your dentist or a physical therapist can teach you a specific program tailored to your needs.

Key components of jaw exercise therapy include:

• Gentle stretching exercises to improve jaw mobility
• Relaxation exercises to reduce muscle tension
• Postural exercises, as neck and shoulder tension often contributes to jaw problems
• Awareness training to recognize and interrupt clenching habits during the day

Stress management

Because stress is a major contributing factor to bruxism, stress management techniques can significantly reduce symptoms for many people. Effective approaches include:

• Cognitive behavioral therapy (CBT): Helps identify and change thought patterns and behaviors that contribute to stress and anxiety
• Relaxation techniques: Progressive muscle relaxation, deep breathing, and meditation can reduce overall tension
• Biofeedback: Uses monitoring devices to help you learn to recognize and control jaw muscle tension
• Regular exercise: Physical activity is one of the most effective stress reducers

Bite adjustment and dental work

If your bite alignment contributes to bruxism, your dentist may recommend adjusting the way your teeth meet. This might involve:

• Selective grinding (equilibration): Carefully reshaping tooth surfaces to improve how the teeth contact
• Restorative work: Replacing missing teeth or repairing damaged ones to restore proper bite function
• Orthodontic treatment: In some cases, braces or aligners may be recommended to correct significant bite problems

Medications

Medications are not typically a first-line treatment for bruxism, but they may be helpful in certain situations:

• Muscle relaxants: May be prescribed short-term for acute symptoms
• Anti-inflammatory medications: Can help manage pain and inflammation
• Botox injections: Some patients benefit from botulinum toxin injections into the jaw muscles, which reduces grinding force

When Should You See a Dentist About Teeth Grinding?

See a dentist if you experience persistent jaw pain, notice your teeth are worn or damaged, wake with morning headaches, have difficulty fully opening your mouth, or if a sleep partner reports loud grinding sounds. Early treatment can prevent serious dental damage and chronic pain conditions.

While occasional teeth grinding may not require professional treatment, there are several situations where you should schedule an appointment with your dentist. Seeking care early can prevent progression to more serious problems and may save you from extensive dental work in the future.

You should consult a dentist about teeth grinding if you experience any of the following:

• Your teeth appear worn, flattened, or chipped
• You have persistent jaw pain, stiffness, or fatigue
• You frequently wake with headaches, especially in the temple area
• Your jaw clicks, pops, or locks when you open or close your mouth
• A sleep partner reports hearing you grind your teeth at night
• You have tooth sensitivity that wasn't there before
• You catch yourself clenching your jaw during the day
• You have facial pain that doesn't improve with over-the-counter pain relievers

During your appointment, be prepared to discuss your symptoms, when they occur, your stress levels, sleep quality, medications, and lifestyle factors like caffeine and alcohol consumption. This information will help your dentist determine the best treatment approach for your specific situation.

How Can You Prevent Teeth Grinding?

Prevention strategies for teeth grinding include managing stress through relaxation techniques, reducing caffeine and alcohol especially in the evening, maintaining good sleep hygiene, being aware of jaw tension during the day, and avoiding chewing non-food items like pens or ice. If you already grind, a night guard can prevent tooth damage.

While it may not be possible to completely prevent bruxism, especially if you have genetic predispositions or certain underlying conditions, there are many strategies that can reduce the frequency and severity of grinding and clenching. Implementing these lifestyle changes can also enhance the effectiveness of other treatments.

Daytime awareness training

For awake bruxism, developing awareness of your jaw position throughout the day is crucial. Many people unconsciously clench their teeth while working at a computer, driving, or during stressful situations. Try setting periodic reminders to check your jaw position and practice keeping your teeth slightly apart, with your tongue resting gently on the roof of your mouth.

Lifestyle modifications

Several lifestyle changes can help reduce teeth grinding:

• Limit caffeine: Reduce coffee, tea, energy drinks, and chocolate, especially after noon
• Avoid alcohol before bed: Alcohol disrupts sleep patterns and can increase grinding
• Quit smoking: Nicotine stimulates muscle activity and is associated with increased bruxism
• Don't chew non-food items: Avoid chewing gum, pens, ice, or fingernails, as these habits can train your jaw muscles to clench
• Practice good sleep hygiene: Maintain consistent sleep times, create a relaxing bedtime routine, and ensure your bedroom is dark and quiet

Stress reduction techniques

Since stress is a major trigger for bruxism, incorporating regular stress-reduction practices into your routine can be very helpful:

• Regular physical exercise
• Meditation or mindfulness practice
• Deep breathing exercises
• Progressive muscle relaxation
• Yoga or tai chi
• Adequate leisure time and hobbies