Bruxism refers to the subconscious clenching and grinding of the teeth. People with this condition are known as “bruxers”. Bruxism commonly take place at night when the person is asleep. This is known as “nocturnal bruxism” and most people do not know they have been clenching or grinding as they are sound asleep. Many times, they only realise it when their partners told them about it. The other kind is known as “daytime bruxism” which as the name suggests takes place in the day and may happen subconsciously when they are deep in their thoughts or at work.
Causes of bruxism are largely unknown. Most people attribute it to stress or stressful
environments. Some postulated causes of bruxism include:
Problems arising from bruxism include:
At the first consultation appointment, we will look at the range of motion of your jaw, discuss symptoms, and feel around for sore spots that elicit pain.
We may also need more information like:
We may prescribe medication to relieve pain such as:
If the pain does not resolve with more-conservative treatments and it appears to be caused by a structural problem in the joint, we may suggest a joint washout (arthrocentesis) to remove the inflammatory mediators, a scope or open-joint surgery (arthrotomy) to repair the joint.
Botulinum Toxin injections may also be necessary to reduce the strength of the chewing muscles (muscles of mastication). By relaxing the chewing muscles, Botulinum Toxin injections can reduce the collateral damage to the teeth, dental restorations, periodontium, muscles, temporomandibular joints that can arise from bruxism. Other benefits may involve facial slimming and improved sleep.
Botulinum Toxin injections are only administered by qualified medical or dental practitioners, such as an oral surgeon, who know where to inject the BTX to help manage bruxism symptoms. The effects of an injection may start to subside gradually from three to five months and will require follow-up sessions to maintain its effects in managing your bruxism. Over time, your bruxism symptoms may gradually reduce in severity.
After the BTX injection, it may take a week to three weeks for results to be noticeable. You may notice reduced teeth grinding or clenching and less jaw pain and tension. Some people may notice the masseter muscles slowly shrinking to their original size which may result in a slimming effect on the lower face.
You may also need to wear a mouth guard (occlusal appliance) inserted in between the upper and lower jaw to provide a cushion between the upper and lower teeth and reduce pressure on the joint.
Mouth guards are available in either over-the-counter (OTC) or custom-made variants. OTC mouth guards are relatively inexpensive and widely available in pharmacies, providing short-term protection for your teeth. In most cases, OTC ones are made of thermoplastic or acrylic of varying thickness. However, they have poorer fit and may cause your teeth or bite to shift, as they are not custom designed specifically to the shape of your teeth or to your bite.
Custom-made mouth guards are created at a dental clinic and require an impression or a 3-D scan of your teeth for a comfortable fit. A custom-made set is typically designed for long-term use to ensure your comfort while managing bruxism symptoms. With proper care, a custom-made mouth guard can last a relatively long time without needing frequent replacements, unlike OTC mouth guards.
Read more on Mouth Guard or Botox – Which Is Right for You?
Dr Seah Tian Ee is an Oral & Maxillofacial Surgeon with a special interest in facial aesthetic procedures and the correction of jaw anomalies.
He was the scholarship recipient of the Health Manpower Development Programme in 2009 and trained in the United Kingdom for facial aesthetic surgery.
Dr Seah is the course director for the “Botulinum Toxin Injection Workshop” for the Association of Oral & Maxillofacial Surgeons, Singapore; and is a lecturer and instructor at the annual “International Cadaver Workshop on Facial Contouring & Maxillofacial Aesthetic Surgery” in Korea.
His clinical interests are in the areas of combined rhinoplasty and orthognathic surgery, non-surgical and surgical facial aesthetic procedures, treatment of temporomandibular joint disorders and oral-maxillofacial pathology. He also does routine oral surgery such as wisdom teeth removal, dental implants etc.
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