Does teeth grinding only affect the teeth?

A tired jaw in the morning, sensitive teeth, aching temples… Could complaints that seem unrelated share a common cause?

Do you wake up with a tired jaw? Do you catch yourself pressing your teeth together during the day? Or are you finding wear and fractures even though you look after your teeth well?

Clenching and grinding should also be considered when these complaints are assessed, because their effects may not be limited to the teeth themselves; they can also show up as fatigue in the chewing muscles or pain in the jaw and face. That said, none of these signs on its own is proof of teeth grinding.

Teeth grinding is not something that only happens at night

Clenching and grinding — bruxism — can occur both during sleep and while awake. While awake, it is not only pressing the teeth together that matters: holding the jaw constantly tensed, even when the teeth are not in contact, is also a behaviour worth assessing.

So saying “my teeth don’t make any noise at night” does not mean there is no clenching. It is also worth noticing what your jaw is doing during the day — while working, driving, or concentrating on something.

On the other hand, not every clenching behaviour necessarily means disease or damage. What matters is whether this muscle activity is causing pain, tissue damage or loss of function in that person.

“I brush my teeth well. So why am I having problems?”

Good oral hygiene is very valuable; but it does not remove the repeated forces the teeth are exposed to. In some people, clenching and grinding may contribute to wear of the tooth surfaces, to cracks and fractures, or to damage to existing fillings and crowns.

There is an important distinction here: wear, cracks and decay are not the same thing.

Tooth decay develops when acids — produced as bacteria in the mouth interact with sugars and starches in food — cause mineral loss in the tooth tissue. It is not accurate to present teeth grinding as the direct or main cause of decay.

For someone who says “I brush regularly but I still get decay”, several things should be assessed together: how effective the brushing is, cleaning between the teeth, how often sugary food and drinks are consumed, the protective effect of saliva, and fluoride use. If clenching is present, that is addressed as a separate heading.

Can it be related to headaches and jaw joint complaints?

Some problems involving the chewing muscles and the jaw joint may present with pain in the face or head as well as in the jaw. However, it is not correct to attribute every headache to teeth grinding. In the same way, not every jaw joint problem stems from clenching alone.

Complaints such as difficulty opening the mouth, catching or locking of the jaw, and pain while chewing should be assessed. By contrast, a joint sound heard without pain or restricted movement is not, on its own, necessarily a condition that requires treatment.

The assessment should not be limited to looking at the teeth

During the examination, alongside wear on the teeth and existing restorations, muscle tenderness, jaw movements and when the complaints appear are also assessed. A complaint that is more marked in the morning and one that increases towards the end of the day may not be approached in the same way.

Stress may play a part in some people; but attributing clenching to stress alone is also incomplete. Sleep patterns, certain medications and personal habits may be included in the assessment as well. If there are complaints of snoring or of breathing during sleep, it is important to report these to the dentist too.

The solution is not the same for everyone

For some people, noticing daytime clenching and changing behavioural habits comes first, while for others an intraoral appliance to protect the teeth may be considered. Where needed, assessment and support from other fields may also be sought.

A night guard is not a device that necessarily stops teeth grinding. It may help protect the teeth; but it cannot be said that it will remove every pain or solve every joint problem. The decision to use one, and the follow-up, should be tailored to the individual.

While reading this you can check one small thing: are you pressing your teeth together? Not keeping your teeth in constant contact when you are at rest during the day can be the start of noticing a clenching habit. If there is recurring pain, sensitivity or fracturing, it should not be brushed aside as “just stress”.