BRUXISM is linked to psychological stress as a necessary component. While mental tension provides the spark to start this habit and the fuel to continue it, this energy comes from the individual’s genetically determined drives and needs. Any unsatisfied need or interference with one’s satisfaction, which may be experienced as frustration, anger or fear, may result in tension and the possibility of teeth grinding.
The phenomenon is primarily involuntary or unconscious. Sometimes it occurs when the person is awake and may be linked to anxiety or deep concentration while driving or working.
Other causes, such as epilepsy and high fillings, have been implicated, but their relation to psychological tension should be obvious. So, while mental stress may manifest itself anywhere in the body, in this case, the structures in and around the mouth appear to be the focus of this tension. The reason the mouth is selected for this habit is best understood by reflecting on the infant’s activities.
Since the mouth is the means of receiving food and the earliest method of exploring the environment, it is intimately tied to emotions such as satisfaction, frustration, anger and anxiety. These early associations are significant and seem to last a lifetime, and they explain why the mature individual reverts to the oral cavity during periods of stress by smoking, eating, chewing gum, and grinding teeth.
For bruxism to occur, the chewing muscles must receive psychological tension for discharge. The first reaction to anxiety is increased tonicity (contraction) in preparation for either fight or flight. Other stress inducers, such as pain or the physical exertion of lifting heavy objects, may also cause muscular tension. The net effect of this uptightness and movement is a vicious circle. Suppressing our emotions during the day for socio-cultural reasons may cause clenching or grinding of the teeth, which in turn increases tension.
If grinding movements during sleep reduce tension, the habit may be helpful. But unfortunately, this type of discharge is highly inefficient, and the tension may accumulate. Incidentally, bruxism may be practised even by people without teeth.
What are the effects of teeth grinding? Most symptoms in the lower jaw joints are a consequence of muscle spasm caused by bruxism. The areas in front of the ears become painful and tender to the touch. In addition to localised discomfort, pain may refer to neighbouring muscles in the scalp, neck, shoulder, and back. The mouth may not open fully because fatigued muscles remain contracted. This leads to tissue breakdown and, with it, an inflammatory response. You may also have worn, flattened, or chipped enamel, along with tooth sensitivity.
Grooves on the teeth near the gum line are caused by unconscious clenching during episodes of anxiety and social stress. Blunting and wearing down (attrition) of the enamel and dentine can lead to periodontal abscesses and eventual extraction.
Treatment includes a custom mouth guard professionally fitted to the patient. This is the standard solution. The objective is to absorb biting forces and prevent tooth damage using the mouth guard and splints. Additionally, managing the underlying cause is vital. You may take short-duration muscle relaxants before bedtime, as prescribed by your doctor. Also, there are cognitive behavioural therapy (conducted by a physiotherapist), meditation, regular exercise (for stress), reducing alcohol intake, caffeine and cigarette smoking at night.
