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Is a term used to describe the mostly unconscious neuromuscular activity of the mandible (lower jaw) in either a static (clenching) or dynamic (grinding) manner.  Bruxism probably occurs at some point for all of us, but, like everything else in health and disease, the intensity, frequency, and duration of this activity is what separates a healthy state from a pathologic state.  Prolonged bruxism activity can lead to serious long term pathologic consequences to all areas associated with chewing, speaking and swallowing.  Which system--teeth, muscles, bone, joints--is affected most is usually determined by which structures are least able to withstand these constant forces.


Why do we clench and/or grind our Teeth?

This is the million-dollar question!  There are as many theories about this common function as there are remedies.  Today, as has been the case for decades, the go to treatment is a night/bite guard--a piece of acrylic or vinyl fabricated to protect the teeth from excessive forces.  Basically, the idea--a good idea--is that it's less expensive to replace worn plastic than worn teeth.  But, at Sausalito Dentistry, we have not been satisfied with that basic solution.  We have for decades been interested in why we clench and grind.  If we can tap into the sources of this fundamental neurologic function, we may be able to not only protect teeth and relieve acute pain (in itself a noble goal!), but we may be able to stop bruxism all together.  Here are some facts about bruxism:

  • Clenching and Grinding is a mostly unconscious neuromuscular event, like breathing, being able to stand up against gravity (posture), blinking, etc.--it's an activity that's just done for us.  We become aware of clenching/grinding only when we realize our jaw muscles are tired or sore at the end of the day or in the morning or when our dentist tells us we are wearing our teeth down.
  • Bruxism is not just a phenomenon of sleep.  It is a phenomenon of existence, meaning many of us clench/grind during wakefulness as well as during sleep.  Sleep bruxism gets all the headlines because this muscle activity can be much stronger while we are asleep.
  • Chronic destruction of teeth and muscle/joint pain are not a result of too much or improper chewing.  Teeth should very rarely be in contact.  The only time teeth should contact--and there are differing opinions on the duration--is for an instant during a swallow and very occasionally during chewing.  Otherwise, in a proper postural rest position, teeth should be between 2-4 mm apart.  Think about it:  do your teeth touch when you eat?  No!  They almost touch, separating just before they come together.  There are about 14,000 nerves in the ligament of each tooth (!!), all there to facilitate that proper, non-teeth-banging-into-each-other masticatory function.  And, amazingly, all signals of these nerves are blocked from conscious awareness during bruxism!
  • Chewing-a mostly voluntary event-and Bruxism-a mostly unconscious event-use many of the same muscles and tissues but are mediated by different neurological systems.  The priority of function of autonomic neurologic systems--including that which mediates bruxism--is based on survival.  The most important biologic functions to our survival--breathing, swallowing and not falling over--get the highest priority of maintenance by this nervous system, many times at the expense of other systems and tissues, causing pain and damage (i.e., worn teeth, jaw muscle pain, etc.), all of which, in the neurological patterning of the autonomic nervous system, is a worthy trade off.

So, why do we clench and grind our teeth?  There are no long-term clinical trials that have clearly demonstrated the reasons for clenching and grinding.  Suffice to say, considering the facts above, we treat this activity primarily in terms of breathing, swallowing and posture facilitation--which is what we feel is the source of the activity-- and secondarily, but importantly, in terms of protecting the teeth.

If it's unconscious, how do I know I clench or grind my teeth?

If you're clenching, press your fingers into different areas of the masseter muscles, the muscles on the side of the jaw.  If you experience moderate to significant pain at certain points of the muscle when pressed, you are clenching.  Muscles not injured from trauma that are working according to their capacities-like, for the masseter, during chewing-don't hurt when pressed.  If you're grinding, your muscles likely won't hurt when pressed as with the above test.  The defining presentation of grinding is destruction of teeth and supporting gum/bone (periodontal) tissues.  Many times, this is hard to assess and your dentist is the best source of diagnosis.

How do we treat Bruxism?

Firstly we assess for other areas in the body of discomfort and dysfunction for participation in bruxism.  It is common for other areas of pain and dysfunction to be associated with pathologic bruxism.  Secondly, we assess the jaw position at which sympathetic activity seems to be least--if a particular jaw position helps us breathe, swallow or stand up better, our autonomic nervous does not need to be as vigilant, that is, by bruxing.  We make a lower acrylic or acrylic/vinyl appliance because a lower is less noticeable (there are other reasons as well!), and we want our patients to wear it night and day.  We adjust the bite on the appliance for full, balanced bite, front/back, left/right.  Finally, we check the appliance and adjust as needed, as changing postural relationships usually occur as healing takes place. 

f you have questions or concerns about bruxism, please contact our office.




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