Bruxism – it’s the clenching of the jaw and grinding of the teeth sometimes to the point of actually breaking a tooth. When you’re awake and conscious the force your body can produce by grinding your teeth together is around 250 psi (pounds per square inch) in the back molars and 85 psi in the front teeth. That may seem like a lot but many are able to easily triple that pressure, achieving around 800-900 psi while they’re sleeping. This of course is when bruxism, (officially referred to as sleep or nocturnal bruxism), becomes more of a problem. And if you think it’s amazing that the body can provide that much pressure during what should be a restful period, it can even double that force to around 2,000 psi if you’re on certain antidepressant (mood-altering) medications. Pressure that high is teeth-breaking, tissue-damaging force along with a whole lot of pain and discomfort to the head, neck, and jaw region.
What Causes Bruxism?
Though bruxism can be due to a variety of health problems, in a nutshell it comes down to one thing – too much stress to the body. At a time when your body should be relaxing and recovering (sleeping), the nervous system is actually unable to calm down into this parasympathetic (relaxed) state. Rather, it remains in sympathetic dominance (flight-or-fight); perhaps the worst time your body can be in such a state as the jaw clenches and grinds as if your body is fighting a battle for survival. Ultimately hormones and neurochemicals are altered as you’re grinding away.
The stress or life stressors which result in bruxism can be any type or combination of emotional/mental, chemical/nutritional, or physical/structural stressors. You could have one big stress – say the loss of a loved one (emotional stress), or a major physical accident (structural damage to your body), which results in bruxism either immediately or over time. You could also have several smaller stressors that add up over a period of time and eventually affect your sleep either with insomnia, restless sleep, or bruxism. If your diet is high in refined carbohydrates and caffeine, you have a high stress job, and you have some health problems to add to the list, then bruxism may be the way your nervous system tries to deal with this stress when you finally try to get some shut-eye. Antioxidant depletion is also common in those who are under too much stress, especially dietary stress. Not only does this impair overall health but there is an association with sleep problems such as bruxism. High levels of anxiety, antioxidant depletion, and bruxism all tend to run together.*
Bruxism is even associated with taking certain medications. Interestingly enough these same medications which are thought to help one deal with stress can be the same trigger for more nervous system stress and bruxism. Then again, if you “need” a certain medication there is almost always a health problem in the first place.
Grinding Teeth and Medications
There is a strong link between certain drugs, particularly the neurotransmitter-type (antidepressant) drugs, with bruxism. These are the medications people take for depression, anxiety, addictions, and other mental health related disorders. As mentioned, the pressure a person can elicit on certain medications can easily push nine times or more than what they can consciously achieve. As you may realize, those who take these types of medications are already under a certain amount of stress as it is – or else they would not need these drugs in the first place.
As with everything in the human body, it’s all about balance, and neurotransmitters are no different. These chemical messengers provide so many functions from shaping our personalities to affecting each and every mood and feeling we have throughout the day including how we interpret pain. The balance is between excitation (“the uppers”) and inhibition (“the downers”). Often those who feel the “need” for some drug support or are prescribed such by their physician have too much excitation and lack inhibition so they’re given a drug to help try to create some balance out of the imbalance. I stress the word “try” because the full mechanism of action of these drugs is still unknown and some researchers feel as though the majority (70% or more) have a placebo effect. Dietary excitotoxins such as MSG and aspartame are thought to incur an excitatory prevalence in the body, resulting in stress which can then produce symptoms such as bruxism.
There is a definite link between diet, depression/anxiety, and antidepressant use, particularly with the common selective serotonin reuptake inhibitor medications, commonly known as SSRIs. The majority of serotonin, (90%) is produced by cells which line the digestive tract, so eating foods which impair digestion can easily affect serotonin production and therefore result in stress to the nervous system and bruxism. It is known that bruxism can occur from taking SSRI medications* (called SSRI-induced bruxism) such as Paxil, Prozac, Celexa, and Zoloft, as well as drugs which also affect the dopamine pathway.
Restless leg syndrome (RLS: akathisia) has been associated with nocturnal bruxism as they both are linked with imbalances in the neurotransmitter dopamine.* Whereas RLS affects the legs often due to low dopamine bruxism affects the jaw often from high dopamine levels. Dopamine is a reward-driven and pleasure type of neurotransmitter and imbalances are linked to addictive personalities and those with attention deficit disorder (ADD & ADHD). Actually, some studies show that those taking medications for ADHD have a higher prevalence of bruxism* than those not treated with such medications for their ADHD.
Caffeine, Stress, and Bruxism
When someone is under too much stress they tend to turn to caffeine for its stimulatory affect so they can continue to push through their day. Along with the caffeine are chemicals in these products (coffee, tea, cacao) which act as central nervous system stimulants, providing a further “get-up-and-go”. The problem here is that those who use caffeine and such products typically abuse them to the point where they begin to have other health problems such as hormonal, neurochemical, sleep and memory issues – all of which can then result in bruxism.
Grinding Teeth and the Military
I have personally learned of the problems with bruxism in the military through several meetings with a dentist who specializes in the production and fitting of a branch of the military with oral orthotic devices, commonly known as bite splints. Many people know at least one person who is in the military and perhaps you are one yourself. The stress these individuals are under, especially if they’re in a combat situation, is one which few can comprehend unless they have been in such a situation. Though the teeth may be the last thing a solider is concerned about, there is a huge bruxism problem in the military.
Those in the armed forces often are under high physical and mental stress and are provided inadequate nutrition. Adding to this stress is a huge amount of caffeine intake per individual. Most soldiers consume more coffee, tea, and high caffeine/high sugar energy drinks by noon than most should consume all week if not longer. Then to help deal with all the physical, emotional, and nutritional stress, many are prescribed an antidepressant drug (Wellbutrin is common which slows down the reuptake of dopamine) which then kicks the bruxism into full swing to the point where they’ll quickly break down their night splint or their teeth if they don’t wear it.
Night Splints For Grinding Teeth and Treating Bruxism
Often when I see a patent who grinds their teeth they already have been fitted for a night splint. These devices are typically fitted by a dentist though you can get one at any drug store (not a good idea unless that’s your only option). Many people don’t even realize they grind their teeth until their dentist sees some wear and tear or perhaps their significant other sleeping next to them has told them they sound like a machine factory whose gears need oil.
Understand that these night splints don’t correct any problem – they hopefully keep you from ruining your teeth and maybe also take some stress off your jaw and cranial muscles. Unfortunately many night splints are made incorrectly by those in the profession. As my dentist correspondent likes to say – it’s like “putting a rectangle into a triangle”. For every 1mm the teeth are separated in the back (your molars) the front teeth then separate by a factor of three. So for many, wearing a splint with the same thickness throughout its entirely can cause more problems either immediately or in the future. Actually this is not as uncommon as it may sound since it is the common practice to make splints in such a way. Typically within 72 hours the body begins to adjust to the new splint often by grinding into the splint to create a more proper fit. It may a good idea to have your splint re-fitted every few years or sooner if you notice excessive wear or breaking points in the splint. Last year I saw a woman with sleep problems that were solely from her night splint. The back part of one side had broken off but neither she nor her dentist thought it was a problem. I helped her realize this through the testing procedures I use in my office and as soon as she was fitted for a new splint her sleep problem resolved fully and immediately.
Resolve the Stress, Resolve the Bruxism
To get to the source of the bruxism you need to deal with the stress or stressors at their source and not try to cover up the problem with medications, other drugs (such as caffeine), or other symptom-based treatments. This means figuring out what the stressors are and correcting them whether it’s your diet, mental stress, or any health problem, including medication use (yeah – ask (or inform) your doctor).
Prevention is always easier than resolving a chronic bruxism problem, that’s for sure. Though bruxism can be resolved it is typically not a simple fix; unfortunately it is common to continue to grind your teeth and keep grinding them even after health improves; it’s not an overnight process as the nervous system can get stuck in this stress pattern. But like most health issues there is a reason for everything and your body can and will heal given some time, persistence, and full dedication to the problem.
* Click link to see studies mentioned if you’re the nerdy-type.
Hi doc. Even though this is totally unrelated to the post i wanted to ask about how gynemocastia forms and how you would reccomend treating it. Thanks doc.
That’s an estrogen/testosterone problem (imbalance). Treatment would involve figuring out why testosterone is breaking down into estrogen rather than detoxed properly.
Very intereting article- thankyou! I was wondering if you think hypnosis might help with bruxism. I’m not and haven’t been on any type of depression/anxiety medications, I don’t consume caffeine, I don’t consider my life at this time to be very stressfull, but my the pain in my jaw has escalated to the point of hurting every time I chew. Not sure if it’s related, but my teeth have changed allignment and one side no longer meets when biting. I was told I need braces (again!) to correct this. I have worn an invisilign-type retainer for many years to protect the enamel, but have often wondered if the presence of a foreign thing in my mouth causes the bruxism. Any thoughts?
Don’t know but it has helped many with certain conditions.
The article is very interesting. I wore an occlusal splint for 5 years and then another one for 5 years more. After having my second baby a pain in my neck appeared and my jaws were very exhausted. The bruxism worsened. So I was given a new hard upper-teeth splint which didn’t fit. A soft lower-teeth splint which moved my jaws and gave as a result three days with locked jaws.Then, two hard splints more that damaged my front teeth which were ok before. All in different places. When I went to the specialist recommended me botox or antidepresants which I didn’t take because they bring more problems than solutions. So I have receded gums, neck pain, tired jaws and headaches.
I wondered if the hormones have something to do with this, because my nose bleeds at least once before or after my period -which are very painful and heavy. I started with headaches after having my second baby I didn’t have before.
I don’t know what to do, the splints make me feel bad but not wearing them doesn’t help either.
In England is very difficult to find a dentist who could be able to treat me.
Thank you in advance for your help.
Nosebleeds, especially during your period, are most often a sign of iron deficiency.
With respect to the jaw/splint issues perhaps look for a chiropractor in the UK who knows how to address those issues.
Robert Bates says
Is it true that some one who could be caffeine in-tolerant could have problems at night when they consume high amounts of caffeine (such as a energy drink) in the morning?
Jeremy Meserve says
This bruxism article is great. I’ve been on Zoloft for about a year and a half. About 4 months in, I noticed my teeth were chattering a little bit and I had a tremor in my jaw. A few months later and my jaw was (and still is) clenching all through the day and into the night (just like the Kinks song). Caffeine has to stop, and I’m going to wean off the Zoloft to see what happens with the bruxism.
Thanks & glad it has informed you!
My dentist recommended a night splint, but I realized when I don’t have sinus pain, I don’t grind.
jennifer eng says
Does chemo medication eribulan (halaven) cause bruxism? I am on eribulan for over 6 months, i have a terrible neuropathy on my hands and feet.
Any stress to the nervous system, whether emotional, physical, or nutritional/chemical, can result in bruxism.
This is the best article I have read on this topic.
I have a night guard and I have been working reducing stressors in my life. Issue is I have changed jobs to a less stressful job, I have changed my diet and my marriage is good and enjoyable but I still grind my teeth….am not sure what else to do .
Could be something asymptomatic such as a gut infection (parasitic infections have been known to cause bruxism), or a mineral/vitamin deficiency. I know that’s not very specific, but it’s the best I can offer w/o seeing you.
Can clenching cause a sensation that feels sinus related? I get this strange sinus feeling that is between the top of my forehead to the middle of my skull. I’ve been panicking thinking it is a sinus infection in my brain but recently I realized my mouth guard shows significant wear on the same side I feel this odd draining feeling. Thanks in advance
Clenching can cause a variety of symptoms, not just in the head but the entire body. I’m currently working with a woman whose jaw and night splint have been adversely causing her foot pain every morning.
Although I’m typically not one to post on websites publicly, I wonder what you would advise a bruxism patient who suffers from small wounds/sore, swollen spots on insides of cheeks and tongue? Often, when nearly falling asleep, I wake myself up by the startle and pain caused by the clenching (basically, my tongue/cheek will get stuck between my teeth when I hammer them together). These are relatively minor injuries, but the spots usually remain sore for various days and often hinder my chewing. Also, my dentist points out slight wear of teeth, but is not of opinion that a splint might be of help for my teeth since, according to him, the saliva which remains in the splint during sleep is more harmful than the grinding/clenching itself (in my case). However, I would like to hear your opinion on the matter. Thanks in advance.
In your opinion and experience, how successful is Botox therapy with bruxism? I have heard that it often only involves one series of Botox injections, which, in theory, forces your jaw to relax and therefore, slowly your brain is retrained accordingly and the bruxism resolved.
No experience on my end so can’t comment.
I had my wisdom tooth taken out last Feb. 2014. I cant feel half my mouth, and developed clenching because of it. I do it 24/7 now. I dont remenber how I had my mouth before when it was relaxed. I bought a personalized mouth piece in Dec 2014. Its been more than a year. what else can I do? im tired and all my teeth have little cracks.
You should consult a doc or therapist specializing in TMJ and dental issues.
Thank you for an excellent article. I was fitted for a night guard after the hygienist not the dentist recommended it. Woke myself up the first night grinding on it. Wore it two nights then bought a soft one from store and woke myself up chewing on it. Stopped wearing it all together. My teeth didn’t fit together properly for month. Had braces as a teenager now in early 40s so definitely not happy about that. Still don’t fit together like they used to but i can close my mouth again. Dentist apologized and she offered me a refund. Off and on my jaws feel tight. Could being fit for a guard I did not need have started my grinding? I notice my jaw sort of pops when I open and close my mouth wide.
Yes, I’ve seen issues before with patients when the night splint was formed improperly.
I have so much of a problem with clenching and grinding that im in severe jaw sinus ear neck or head pain almost 24 hours. I had a splint but it made the grinding worse. I tried some anti depressants that didnt work i tried magnesium suppliments that didnt work. I have even seen an OT and physio with little relief. I barely have any back teeth left. Im not overly stressed ive had bigger problems. It got this bad after a severe sinus infection. I am exhausted all the time and the constant pain is terrible. I rarely sleep unless with medication or alcohol but sleeping tablets interrupt me going into a deep sleep. No sure if its related but when in my house i always hear a constant humming noise which seems to agravate the clenching. Is there anything i can do. Chewing gum makes it worse sucking lollies helps a little.
ilmy bruxis had gotten really bad after I started using a nasal CPAP with a chin strap to keep my mouth closed. I tried loosening the strap and it just falls off. I also tried using a teeth whitening tray that my dentist made and I still wake up with pain in my two front teeth. Suggestions? I’m afraid of breaking my teeth.
You should let your prescribing doctor know and see what he/she can advise there.
i have a guard for when im sleeping as it was found i grind my teeth. However i now have an issue with what im calling alligator jaw.
When i chew or eat anything or even when i am sat quite relaxed like watching tv or on the laptop, my jaw will snap together like an alligators out of nowhere :( its painful and its always the left side that smashes together. it has chipped one front tooth and one back tooth from force of the impact. I have told my dentist he cant find anything wrong with my teeth etc. He also cant think of anyone to prevent this, please can you help me, its like the left side of my jaw is magnets and just keeps smashing together like a alligator going for the kill. many thanks
Find yourself a doc/therapist who treats TMJ issues.
Have you found any relationship between bruxism and plantar faschitis (not sure of the spelling.) I’ve been having progressively worse pain in my feet and about two weeks ago my jaw muscles started spasming because of clenching.
Typically when there is a TMJ problem there are other issues too as I explain.
Justin Rosenthal says
Are there any supplements you can recommend? I’ve read Magnesium can help.
I individualize it when I see a patient in the office.
Amy James says
Hello. I have facial spasms, twitching, pressure. I’ve been told this is from tmd from clenching. My jaw is ok. My front teeth hurt too. Do you have any recommendations of specialists in the uk. I am also Going through the menopause so I don’t know if it is related. Thank you
Robin Frans says
Thank you for all of the info; what type of Doctor would be considered a “TMJ/TMD specialist”? Because despite having chipped 2 teeth and experiencing years of severe jaw and neck pain, none of my doctors think I have a problem. My dentist, who made me my night guard, couldn’t have cared less about the root cause of my grinding or about the overall toll it’s taking on my body. The only medical professional offering any support is my chiropractor. It’s all very discouraging. :(
Yes look for a chiropractor who works with TMJ issues and/or a physician who uses applied kinesiology techniques.
peter gatty says
Most of my bruxism damaged teeth are in the lower jaw. However, the guard I have been prescribed is for the upper jaw. Would i be better off with one that covers the lower jaw?
Dr. Stephen Gangemi says
It depends on the person. I’ve seen both work well, and not so well.
Thank you for this article. I don’t grind my teeth but often notice my jaw chattering on it’s own. This sometimes happens after I’ve had a few drinks, or had a lot of coffee. What can I do to help this not happen to me? My jaw also chatters/ shakes in my sleep. No teeth grinding, though.
Dr. Stephen Gangemi says
Ah – probably don’t have all those drinks or drink all the coffee? :) And even the teeth shaking at night is typically a stress response.
Sir I am not able to clinch my teeths properly because of irregular arrangements of teeth,am getting more sleep and can’t able to concentrate..pls give me a solution..?
Dr. Stephen Gangemi says
That would be something a good dentist can help you with!
Hello Dr Gangemi,
I have been wearing a mouth splint for nearly 30 years. Over this time I have had two splints. I have very bad receeding gums and wonder why given I have worned the splint every night over this period. Your thoughts?
I recently was fitted for a new splint and expected to get the same as I have had before. The one that my dentist presented is much thicker than my previous ones and actually distorts the way my mouth closes. Are all mouth splints made thicker these days?
Dr. Stephen Gangemi says
You might ask your dentist (or consult with another one) for a different splint – there are several different types. It would also be a good idea to see a doctor/therapist who can evaluate the TMJ and cranial bones with the splint in – that’s what I do to see how it is affecting (or not) the person’s body.
Thanks. I have ADHD and take stimulants. My bruxism started after the adhd meds started.
Anything that can be done without stopping the ADHD meds? Those are helping me so much.
Dr. Stephen Gangemi says
Well if that’s definitely what started your problem it may be hard to resolve without removing them.