Signs of Grinding

How can a dentist tell if you grind your teeth? For some background, teeth are made up of different sections called cusps, which are the pointy parts you feel when you run your tongue along the biting surface. If teeth are used only to bite and chew regular food, these cusps generally remain sharp and well-defined. However, when teeth are rubbed against something abrasive, the cusps can wear down and become flattened. Since teeth themselves are abrasive, rubbing your top and bottom teeth together—intentionally or not—can cause noticeable flattening. This type of wear is known as attrition.

What Causes Grinding?

The direct cause of teeth grinding is neurological—something triggers the jaws to move against each other. However, the underlying reasons for this neurological response can vary widely. Grinding, also known as bruxism, may be indirectly caused by medications, stress, psychological conditions or hormonal factors.

Because of the complex and often involuntary nature of bruxism, it can be challenging to stop. Most people grind their teeth unconsciously, particularly during sleep. Even if the indirect cause can be identified, eliminating it isn’t always possible. For instance, if grinding is linked to essential heart or anxiety medications, discontinuing them may not be an option. Similarly, stress from work or home life may not have an immediate or simple resolution.

What’s Wrong With Grinding?

Teeth grinding can lead to several negative outcomes. The most obvious is damage to the teeth themselves. Chronic grinding can wear down the enamel (the hard outer layer) and even reach the dentin (the softer inner layer). This exposes the dentin to a higher risk of decay and, in some cases, can lead to tooth sensitivity. However, tooth sensitivity is typically a concern only when grinding progresses rapidly. In most cases, attrition occurs slowly, allowing the nerve inside the tooth to recede and adapt as the damage progresses.

Another potential consequence of grinding is joint or facial muscle pain. The excessive and repetitive motion of the lower jaw can strain the temporomandibular joint (TMJ) and overwork the muscles that control the jaw. This overuse can lead to inflammation, often manifesting as pain. In some cases, this pain is worse in the morning (after a night of grinding) and subsides throughout the day.

In severe cases, chronic inflammation of the jaw joint can even cause structural changes to the joint itself, which can lead to additional complications. While such situations are rare, they highlight the potential seriousness of unchecked grinding.

What Can Be Done?

One of the most common recommendations from dentists is: “I see signs that you grind your teeth. I recommend wearing a night guard while you sleep.” Night guards are a popular treatment option. These custom-fitted plastic devices are worn during sleep to create a barrier between the teeth.

While night guards can effectively protect tooth structure by preventing further wear, they typically do not stop the grinding itself. Remember, grinding is caused by a neurological response, and placing a piece of plastic between your teeth doesn’t address that underlying cause. With a night guard, you may continue to grind, but the damage is redirected to the plastic instead of your teeth.

It’s important to note that night guards primarily address tooth damage. They do not necessarily prevent joint or muscle issues because the grinding motion continues, and the overuse of the jaw muscles and joints persists.

In some cases, night guards can even introduce new problems. For certain individuals, keeping the mouth open for extended periods with a night guard can exacerbate joint or muscle issues. Additionally, some patients find night guards uncomfortable and difficult to tolerate while sleeping.

Not a Simple Topic

As you can see, the topic of grinding and night guards is more nuanced than it might initially appear. Prescribing a night guard should not be an automatic solution for every patient showing signs of grinding.

An easy treatment that sometimes helps with grinding patterns and/or muscle pain is the use of simple jaw muscle stretches. These stretches can sometimes reprogram muscle patterns that lead to grinding, and they certainly help to alleviate inflammation in the muscles that build up with overuse.

Mild grinding is relatively common and may not always require intervention. Many people experience some level of grinding throughout their lives, leading to shortened teeth. However, the body often compensates by growing the bone that supports the teeth, maintaining the overall facial height. In these cases, grinding and the resulting wear may simply be a normal variation rather than a pathological problem.

A dentist must consider the whole picture: the extent of tooth damage, signs of joint or muscle problems, and whether the patient reports sleep disturbances or discomfort. Combining all this information allows the dentist to determine whether the grinding is a problem that requires treatment or something that can be monitored over time.

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Dr. Isaac Kleinman is a general dentist at My Dentist Fair Lawn, in New Jersey. He works to provide customized care that serves the best interests of each patient. He can be reached with questions at [email protected].