Grinding and Clenching

Clues That You Grind or Clench

Bruxism, the clinical name, is often noticed by a dentist, or a partner, long before the person doing it. Look out for:

• Waking with a tight, tired or aching jaw, or pain in front of the ears
• Headaches at the temples first thing in the morning that ease as the day goes on
• Front teeth that look shorter, flatter or more even than they used to, or have tiny chips along the edges
• Sensitivity to cold on several teeth, from enamel worn thin
• Fillings, crowns or composite bonding that crack or come loose more than you'd expect
• A scalloped edge along the sides of your tongue, or a white line on the inside of your cheek
• Clicking, stiffness or difficulty opening wide in the morning
• Someone telling you they can hear you grinding at night

Clenching makes no noise at all, so it's easily missed. We check every patient's teeth for wear patterns at their examination and will tell you if we see signs of it.

Why It Happens

There's rarely a single cause. Stress and anxiety are the biggest triggers, and grinding often flares during a hard spell at work or at home. Other contributing factors include:

• Caffeine late in the day, alcohol and smoking
• Poor or disrupted sleep, and snoring or sleep apnoea
• Some medicines, including certain antidepressants
• Concentrating hard, driving or lifting weights, which can set off daytime clenching
• A bite that meets unevenly, or a new filling that's a touch high

At night, the jaw muscles can clamp with much greater force than you'd ever use to chew, and for far longer. That's why the damage from a few hours of sleep-grinding can be so out of proportion to what you feel.

The Damage It Does

Enamel can't regrow. Years of grinding gradually wear the biting edges down, exposing the darker, softer dentine underneath, which then wears faster still. Clenching concentrates force on single points, and that's how cusps crack off, fillings fracture and crowns work loose. A cracked tooth can need an onlay, a crown or root canal treatment, and occasionally a crack runs down the root and the tooth is lost.

The jaw pays too. Overworked muscles cause aching cheeks and tension headaches, and the jaw joint can become sore, click or occasionally lock. If that's your main symptom, our jaw pain page explains what we can do. None of this happens quickly, which is exactly why it's worth protecting your teeth before the repairs start to add up.

How a Night Guard Protects You

A custom night guard is a thin, close-fitting layer of hard-wearing plastic that clips over your top or bottom teeth while you sleep. It doesn't stop the grinding itself. What it does is put a cushion between your teeth, so the guard wears instead of your enamel, and spread the force over all your teeth rather than one or two cusps. Many people find their jaw feels less tight in the morning once they're used to it.

We make ours from a digital scan on our iTero Lumina, so the fit is precise and there's no tray of putty. A custom night guard is £210, or £189 on a dental plan. ¹ For heavy grinders or people with jaw joint symptoms, a harder occlusal splint, from £620, may suit better, and we'll tell you which we'd recommend. More on the options is on our night guards page.

What to Expect

1. Assessment. At your examination we look at the wear on your teeth, feel the jaw muscles and joint and check how your bite meets. A high filling or uneven contact can be adjusted there and then
2. Scan. A few minutes with the iTero Lumina wand captures both arches in 3D
3. Fitting. When the guard comes back from the laboratory, we try it in, check it's snug but comfortable, and adjust it so your bite lands evenly on it

It will feel odd for the first few nights, and you may produce more saliva at first. After a week or two, most people forget it's there. Rinse it in cold water and brush it gently each morning, keep it in its case, away from hot water and radiators, and pop it in your bag for dental examinations so we can see how it's wearing. If you finished Invisalign with us and wear Vivera retainers, mention any grinding. Retainers aren't designed to take that force, and we may suggest a separate guard.

Habits That Help

• Lips together, teeth apart. At rest, your teeth shouldn't touch. If you catch yourself clenching during the day, let your jaw drop slightly and rest your tongue on the roof of your mouth
• Cut the evening caffeine, and keep alcohol and cigarettes away from bedtime
• Protect your sleep: a regular bedtime, screens off for half an hour beforehand, a cool, dark room
• Warmth and stretching: a warm flannel on tight jaw muscles and gentle opening stretches help when they're sore
• Give your jaw a rest: skip chewing gum and very chewy food while it's aching
• Tackle the stress where you can, whether through exercise, talking to someone or a breathing technique you can use when you notice tension

If you snore heavily or wake up unrefreshed, mention it to your GP as well. Grinding and sleep-disordered breathing often go together.

If You've Had Cosmetic Work

Composite bonding, porcelain veneers, crowns and implant crowns all dislike grinding. Composite edges are thin and can chip. Porcelain is very hard but brittle under repeated loading. Implants are fixed directly into bone with no ligament to give a little under pressure, so the crowns and screws take the full force. Grinding is one of the most common reasons cosmetic dental work fails early.

That's why we check for wear before we start cosmetic treatment, and why Dr Nikhil Sharma may recommend a night guard once bonding, veneers or implants are finished. If your wear pattern is heavy, we'll tell you the guard isn't optional. Our guides to looking after bonding and how long implants last go into this in more detail.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.