Ever woken up with a headache? It could be that you are grinding your teeth at night. Find out more.

 

Have you ever woken up with a headache? It could be what is called bruxism where you are grinding your teeth at night.

Ageless Online talks to Clinical Associate Professor Chua Ee Kiam, senior consultant, prosthodontics in the Department of Restorative Dentistry, National Dental Centre Singapore, about this condition and Temporomandibular Joint Disorder (TMJ), which is clenching the jaw when awake or asleep:

 

Can you explain what bruxism is?

Bruxism is defined as the repetitive jaw muscle activity characterised by the clenching or grinding of teeth. According to the International Classification of Sleep Disorders – Revised (ICSD-R), 85 to 90 percent of the population grind their teeth at some point during their life and only five percent will develop a clinical condition.

Patients who experience bruxism often seek consultation from different doctors, ranging from neurologists to otorhinolaryngologists. Acute episodes are initially of a short duration, and symptoms often temporarily resolve while waiting for consultation. Occasional teeth grinding, does not usually cause harm, but when it occurs on a regular basis, teeth can be damaged and other oral health complications can arise.

Bruxism can appear in three forms – clenching, grinding or a mixture of both. Usually bruxism occurs when one is asleep (nocturnal bruxism). However, some people are aware of clenching in the day (diurnal clenching) but most of the time, impact forces become gradually lower as the individual becomes aware of the habit. This is unlike in nocturnal clenching or grinding, where the impact forces are much greater.

 

What is the occurrence amongst seniors in Singapore? Does it happen more in men than women?

In the past, the age group of my patients were between 14 years to 50 years. I have seen an increasing number of patients who are aged 60 years and above. The ratio of female to male patients is about 3:1. This could be explained by the fact that females more commonly take on more roles and responsibilities, such as a mother, wife or caregiver to their ageing parents, as well as having a career.

 

Many conditions like Alzheimer’s disease, Lewy body dementia, stroke, Parkinson’s disease and many medications can cause bruxism. Is this true?

Secondary bruxism can be due to the side effects of medication, such anti-psychotics or medications to treat schizophrenia, bipolar disorders, depression and Alzheimer’s disease. Amphetamine, a type of stimulant, and recreational drugs like ecstasy and cocaine may cause nocturnal bruxism.

 

Sometimes seniors may not be aware it is happening since at night. What happens then in the morning – do they get headaches?

Most of our patients are not aware of nocturnal bruxism. Their sleeping partners may complain of loud grinding noises during grinding, but in clenching, there are no noises.

A telltale sign in the morning, is patients will often complain of aches, pains and headaches. In severe cases, some patients may visibly see cracks on their teeth, which is a result of high-impact grinding over long periods of time.

 

What others signs and symptoms are with bruxism? How is TMJ related to bruxism?

Some of the signs and symptoms of TMJ include an increased sensitivity of teeth, cracked and or worn out teeth, headaches, jaw pain, clicking or grating sounds on the jaw joints and limited mobility of mouth opening. Bruxism is a common cause for TMJ problems.

 

And with tooth enamel wearing off with ageing leaving teeth vulnerable to damage and decay and there is also tooth loss, treating teeth grinding and jaw clenching is important. If left untreated, what can happen overtime? Can bruxism go away with time?

Teeth may get increasing shorter or may crack, leading to expensive and complicated dental treatment. In most cases, bruxism continues throughout life but the intensity varies.

 

One mode of treatment is a night guard but this might be difficult as it is big and bulky, and uncomfortable to wear. What other options are there? I heard Botox can be effective in some instances.

Botulinum toxin or Botox is found to reduce the bruxism events and is useful in acute painful episodes but often need repeated injections to the jaw muscles after four to six months.

I find that engaging in psychological therapy and counselling has helped me better understand my patients. This has allowed me to find the most suitable treatment for them, and usually leads to a more sustainable treatment plan.