Stress and other factors contribute to teeth-grinding

McClatchy Newspapers (MCT) - Sometimes it's a spouse who hears the horrible grinding in the bed next to them. Other times, the problem isn't discovered until a trip to the dentist reveals well-worn teeth on the verge of chipping or cracking.

It's called bruxism _ the subconscious grinding of one's teeth.

If left untreated, it can cause serious damage to the teeth by wearing down the enamel and dentin, experts say.

Dr. Irving Zamikoff, of Zamikoff, Klement and Jungman, DDS, has seen the telltale signs of tooth-grinding in plenty of the patients who come to his practice in Bradenton, Fla.. He estimates about 25 percent of the patients at the average practice have bruxing issues.

Bruxing has been attributed to stress, anger or tension, and in these recent times of economic turmoil, one might assume cases were on the rise. But Zamikoff said the causes aren't entirely known.

"We don't really entirely know about all the causes and factors," Zamikoff says. "Stress is one of them. Another factor is the positions of teeth in the jaw. Sometimes we get our jaw size from our mom and our tooth size from our pop, and they don't always mesh together."

Often, it's the dentist that has to bring the problem to the patient's attention.

"Sometimes a spouse will hear a gnashing of teeth and the person bruxing doesn't even know they're bruxing," Zamikoff says. "I would say the vast majority of patients don't even know they're bruxing until the dentist tells them.

"What happens when a patient bruxes, they actually wear down the enamel of the teeth extraordinarily fast," Zamikoff says. "Once the patient wears down through that enamel layer it exposes some of that dentin layer. Once it gets down into that dentin layer it starts cupping and chipping, and the teeth start breaking."

The effects of bruxism can be treated through minor structural adjustments to the teeth.

"Sometimes it's with bonding. Sometimes it's with a crown," Zamikoff said. "Sometimes it's just a little reshaping of the enamel itself."

Patients also are often advised to wear a night guard, a special device that fits in the mouth to help ease the effects of grinding on the teeth.

During eating, the pressure on the teeth ranges from 25 to 50 pounds per square inch. But during bruxing, that pressure can increase to 250 pounds per square inch, says Dr. Noshir Mehta, professor and chairman of general dentistry and director of the Craniofacial Pain Center at Tufts University Dental School in Boston.

That pressure can be devastating to teeth, Mehta says.

"More often than not, the average person ends up flattening the teeth, wearing the teeth down or creating problems with tooth movement or loosening of the teeth," he says.

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Bruxing can also cause headaches and temporomandibular joint erosion, or TMJ.

Sometimes patients will have their tooth damage repaired, but because they fail to wear a night guard, they start the cycle all over again, he says.

"My suggestion to all dentists and patients is if you grind your teeth to the point that you need dental work, then make sure you wear a night guard every night to protect the dental work," Mehta says. "The night guard is the only thing that is going to help us stabilize the constant grinding of the teeth."

There haven't been any studies done to show whether stressful economic times like the current period contribute to bruxing, Mehta says. But it wouldn't surprise him.

"The prevailing wisdom would be, yes, there's the likelihood of more grinding," Mehta says. "But that just could be from the fact that stress brings less sleep. So people are (sleeping less) because of financial difficulties and could be grinding more because they're getting less sleep."

Mehta concurs with Zamikoff that there is no definitive cause for bruxism. "We don't know for sure," he says. "You can have 50 people grind for different reasons."

Lisa Potter, a patient of Zamikoff's, has been wearing a night guard for 15 years, and it has made all the difference in the way she feels. "I love it," she says. "I can't sleep without it. I was having a toothache in the beginning and it was because I was clenching and bruxing my teeth."

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TIPS FOR AVOIDING TEETH-GRINDING

_Do not eat or drink at for least one hour before bedtime.

_Do not drink alcohol at night. A glass of wine may calm you but alcohol in any quantity has been found to aggravate bruxism.

_Do not take vitamins, minerals or any herbal medication that might excite you at night before bed.

_Do not work up to the time you plan to go to sleep. Let yourself relax and settle down before you plan on going to bed.

_Use techniques of deep breathing and progressive relaxation before bedtime.

_If you have pain in the face or jaw, use ice on your jaw joints or a wet, hot towel on the face to help relax the muscles until you can get to the dentist.

_Analgesics like Tylenol, Aspirin, Advil or Aleve can help reduce minor pains. If the pain continues for more than three days you should see your physician or your dentist.

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_Stretching the jaw muscles can help relax them. Take the knuckles of your hands, place them under your cheek-bones and slowly drag them down towards the angles of your jaws on both sides while keeping your teeth apart and repeat the stretch five times. You can repeat this five to six times a day if needed.

_Another stretch you can try involves your tongue. Placing your tongue tip behind the upper front teeth, slowly open your mouth to a slow long stretch. Only open until you feel a stretch and not if you have pain when you do so.

_There are over-the-counter mouth guards that have been approved by the U.S. Food and Drug Administration for bruxism or tooth grinding. These are usually "boil and bite guards" that can be used on a temporary basis till you see your dentist. They are usually found at your local pharmacy or larger stores that carry health-care products.

SOURCE: Dr. Noshir Mehta

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© 2009, Bradenton Herald (Bradenton, Fla.).