Nov 21

I Don’t Grind My Teeth!

The nocturnal habit of grinding your teeth is called Bruxism.

The daytime habit of keeping your teeth together under pressure is called clenching.  Some patients do both and both will show different wear patterns.  Bruxism patients will show polished “wear facets” on back molars with cusps tips being cupped out looking like dice hole markings on playing dice.    Front teeth will have edges worn with tilted angles and even sargent stripped typed chevrons.

When I inform patients they have a Bruxism habit half the time the patient will be unaware they will be doing it.  A quarter of the time they will vehemently deny it.   Many times a patient will say ” I chew very hard or its just my age”.

In order to demonstrate it to the patient, I then give them a hand mirror.  Then with my direction have them move their teeth until the wear pattern matches together like a jigsaw puzzle piece.  It is at this time that the patient is amazed at the exaggerated position it takes to get the pieces to line up correctly.  The patient then finally acknowledges the effect since the evidence is now irrefutable .  The patient also then recognizes that the posture and position is so odd it most certainly cannot be from chewing.

Most times wear patterns on left and right sides are not equal.  Most times I can then  ascertain if they sleep on a particular side or on their stomachs with their head tilted to the left or right.  The weight of the patient’s head as they sleep on their jaw is what pushes the jaw to one side or the other.   The wear on the teeth will be worse on the oposite side of the patient’s preference sleeping side.

Clenching habits are a daytime habit and front teeth will have small shelf type “steps” on the palat side.

Patients that have eating disorders, severe gastric reflux or alcohol addiction will have erosion on the palate aspect of upper front teeth.   There will literally be no enamal on this side of the teeth due to the severe stomach acid erosion.

With the last whitening campaign we completed at our office, two patients presented that had an eating disorder in additon to a Bruxism habit.  Both of these patients were in their mid 20’s and unfortunately both had destroyed and very mutilated dentitions.   Each had recognized what they perceived was just a cosmetic issue with their teeth.  There was no enamal on the palate side of their upper front teeth and the enamal on the lip side was now jagged and broken away on the edges.  I did not perform the whitening since the teeth would have gotten too inflamed and in reality there was very little enamal to whiten.

Patients will ask me “why do I grind my teeth”?  In the past, I would tell them multiple reasons but which one I don’t know.  However, now I tell them that over half of my grinders do so as a symptom of obstructive sleep apnea.  The tooth grinding is really a “protective mechanism” which is done unconsciously to protect your airway.

The diagnosis of obstructive sleep apnea can be diagnoised by a physician after a sleep study has been performed on the patient.  Patients who brux need a night guard to protect their teeth.  For this doctor my night guard appliance of choice is made out of material called Brux-eeze.  This plastic material is very hard but adjustments for fit are easy and patient comfort is ideal.

Many times patient’s tooth sensitivity is due to grinding and continuous use of a sensitivity toothpaste will do little to help the wear caused on the edges as well as on the necks of the teeth.  Patients that brux heavy will lose tooth structure on the neck of the tooth from a process called abfraction.  Microscopic pieces of the tooth actually chip away as the tooth flexes during the grinding habit.  Wear at the necks of the teeth can be due to toothbrush abrasion however, unfortunately many dentists don’t recognize this abfraction process.

Very frequently patients report to my office with cosmetic dentistry they have had performed elsewhere that they report being done poorly.  When I examine the patients huge Bruxism habits are evident.  The patient of course blames the dentist for things that keep popping off but it is the patient’s (parafunctional) clenching or Bruxism habit that has caused the failure of the dentistry.  However, very unfortunately even the dentist didn’t recognize the habit and never fabricated an appliance in order to protect the dentistry from this abusive habit.  Its very unfortunate that the problem was not recognized prior.

Untreated Bruxism can damage fillings, crowns, the patient’s jaws and joints as well as to lead to symptoms of migraine headaches.  If you suspect that you may have issues, consults are always free and we can help.