Constant grinding and clenching of the teeth does not count as a disease in its own right. Teeth grinding, i.e. bruxism, is a symptom of another, underlying disease of the body. If the cause of the bruxism is eliminated, the constant teeth grinding will also stop. Causes could be, for example, a misalignment of the jaw or stress.
Human teeth can exert enormous force. Men, for example, can exert up to 400 kg of pressure with their teeth, women up to 300 kg. When we grind our teeth, this force is directed against our own teeth. This damages the teeth and the periodontium in the long term.
Normally, teeth grinding is an unconscious process and often occurs in stressful situations to relieve inner tension. Bruxism has also been scientifically investigated in sleep laboratories during the REM phases of sleep (the shallower stages of sleep).
Unfortunately, teeth grinding itself remains undetected for a long time. It is often only diagnosed when the tooth has already been damaged.
Up to 90 percent of the population has grinded their teeth in the past or still does so today. Teeth grinding is therefore by no means a rare problem.
People affected by bruxism often grind their teeth unconsciously at night © gballgiggs | AdobeStock
The causes of teeth grinding are extremely varied. On the one hand, misalignments in the head area can trigger bruxism, but on the other hand, psychological causes are also possible.
The physical risk factors include
- a misalignment of the head with the jaw (known as craniomandibular dysfunction),
- a misalignment of the upper jaw compared to the lower jaw or
- simple misaligned teeth (including crowns, bridges and implants).
However, the most important factor for unconscious teeth grinding appears to be psychological stress. Studies have shown that many people grind their teeth more often in stressful situations. Teeth grinding also continues during sleep, when the subconscious mind processes the stress of the day.
Misalignments of the jaw and teeth should also not be underestimated. Common causes of teeth grinding:
- The dental crown or dental bridge is set too high in contrast to the rest of the teeth
- Crooked teeth that do not fit well with their counterparts on the other side of the jaw
- Misalignment of the entire temporomandibular joint following injury or cartilage loss in the temporomandibular joint (osteoarthritis of the temporomandibular joint). This impairs the mobility of the temporomandibular joint, causing the teeth to rub against each other unnaturally.
If all possible physical causes for teeth grinding have been ruled out, you should look for psychological causes. In this case, your dentist will then refer you to a suitable psychotherapist for further treatment.
Teeth grinding often indicates other illnesses. This is why in most cases it occurs together with accompanying symptoms:
- Sore muscles in the jaw muscles due to the tense muscles during unconscious teeth grinding
- Tension in the neck muscles and tension headaches due to tension in the jaw muscles
Changes and diseases of the teeth
Another typical characteristic of teeth grinding is the so-called grinding grooves on the teeth. The constant grinding of the teeth quickly wears down the enamel. This results in grooves and furrows on the surfaces of the teeth. These are the first signs of a defect in the enamel.
If grinding and clenching continue, the enamel may be completely destroyed. Now a completely new symptom can suddenly appear: Due to the destruction of the enamel, bacteria have free rein and can colonize unhindered directly on the unprotected tooth surface.
Caries now often form. If the bacteria migrate through the fine dentinal tubules into the interior of the tooth, they can cause
- pulpitis (inflammation of the dental pulp) or
- periodontitis
can be triggered.
Very severe tooth grinding can lead to total tooth loss. If the teeth are pressed together too hard over a longer period of time, the tooth can split and break through lengthwise. If the tooth only splits at the crown, a quick visit to the dentist and a costly repair can still save the tooth.
However, if it breaks through to the root, the tooth is completely lost and must be extracted. The gap between the teeth means that the teeth in the upper and lower jaw can no longer fit together seamlessly. This in turn leads to increased teeth grinding. This creates a vicious circle that can only be stopped with complex and expensive means. That's why you shouldn't let it get that far in the first place.
In the worst case, teeth can be completely worn down or destroyed by teeth grinding © Alexandr Mitiuc | AdobeStock
Changes to the temporomandibular joint
The constant strain on the temporomandibular joint during bruxism can also cause side effects at this point. However, tension and soreness in the jaw muscles are only the least of the problems. The constant strain causes changes in the jawbone, which can lead to the joint disc of the temporomandibular joint slipping out of place.
The joint can no longer move normally and becomes blocked when opening and closing the mouth. The consequences are cracking noises during mouth movement or an impaired opening width of the mouth.
The temporomandibular joint is also very susceptible to inflammation under constant strain. With permanent teeth grinding, the joint capsules
- the joint capsules,
- the ligaments,
- the tendons and
- the muscles
can quickly become inflamed. This is very painful for the person affected.
In most cases, the diagnosis of teeth grinding is made purely by chance during a routine examination at the dentist. During the anamnesis, i.e. the patient interview, doctors should therefore also ask about complaints that initially have nothing to do with the teeth:
- Increased headaches,
- tense muscles in the neck,
- sore muscles in the chewing muscles,
- increased stress at work and in the family.
If increased abrasion and small grooves can be seen when teeth are checked, a suspected diagnosis of bruxism can already be made. In order to prescribe a suitable treatment, the doctor must first find out the cause of the teeth grinding.
The dentist will then first examine the mouth and jaw area for the physical causes of teeth grinding. He will check how far and where exactly the teeth touch after closing the jaw.
Is there
- a tooth,
- a dental crown,
- a dental bridge or
- an implant (or several),
that protrudes beyond the height of the other teeth, this can be a cause of bruxism.
By palpating the jawbone from the outside and inside, the dentist can also determine whether there is a misalignment. If it also hurts when touched, the dentist may be able to determine an inflammation in the temporomandibular joint after further detailed examination. Inflammation can be the cause or a concomitant symptom of teeth grinding.
The dentist can clarify most physical causes during an examination. If the dentist does not come to any conclusions, he will refer his patient to a psychotherapist for more detailed clarification.
The treatment of bruxism depends primarily on the cause.
If misalignments in the mouth are the cause of the constant grinding, these must be eliminated.
- Dental crowns and bridges that are too high are ground down,
- incorrectly fitted dentures and implants are adjusted,
- incorrectly positioned teeth are straightened by an orthodontist.
If the causes of teeth grinding lie in the temporomandibular joint, the specific treatment becomes more difficult. The misalignment of the temporomandibular joint that causes teeth grinding is often the cause of cartilage loss (osteoarthritis) in the joint.
However, this cannot be successfully treated. To date, there are no medical methods for rebuilding destroyed cartilage. In this case, only the symptoms can be treated. Targeted training is therefore used to try to consciously achieve the correct position of the teeth. If this is successful, the teeth of the upper and lower jaw no longer touch and the teeth grinding stops.
If the causes of teeth grinding are psychological, psychotherapy should be considered. The psychotherapist will help with stress management and teach techniques for stress reduction and relaxation.
The following arealso helpful
- Yoga,
- progressive muscle relaxation and
- Sport to regenerate the body.
A grinding splint is often used to immediately stop the harmful effects of teeth grinding. A causal therapy only leads to the desired success very quickly in very few cases. A grinding splint can prevent consequential damage to the teeth.
Bite splints, also known as grinding splints, are available for this purpose. They are usually made of transparent plastic and are placed over the teeth of the lower jaw. As a barrier between the teeth, they prevent abrasion of the tooth surface during teeth grinding. They therefore do not prevent teeth grinding per se, but only the destruction of the tooth enamel.
Grinding splints must be worn when the person concerned grinds their teeth. A splint worn at night does not help if the patient grinds mainly during the day.
A bite splint prevents the teeth from rubbing directly against each other © Joaquin Corbalan | AdobeStock
The cost of a simple grinding splint is usually covered by statutory health insurance. However, these splints are not individually adapted to the jaw and are therefore not based on which teeth are ground and clenched the most. As a result, they often do not fit well, slip over the teeth and fall out of the mouth, especially at night.
In most cases, statutory health insurance companies do not cover the costs of customized grinding splints. If you have supplementary dental insurance, it is worth calling your insurer. Most supplementary insurers already cover part of the costs.
