As an orofacial and TMJ dentist, I spend a considerable amount of time with patients who grind or clench their teeth during the day and/or at night. Bruxism is the medical term to characterize grinding or clenching of the upper and lower jaw. Though we do not completely understand the etiology behind nocturnal bruxism (grinding or clenching at night) in all patients, we know that certain behaviors, medications and conditions may predispose an individual to nocturnal bruxism.
Nocturnal bruxism may lead to temporomandibular joint (TMJ) disorders. Individuals who grind their teeth at night may complain of:
pain upon opening his/her/their mouth
pain upon chewing
pain with eating
a feeling of tightness in the jaw or face upon awaking
limitation in opening of the jaw
Not all individuals with a history of grinding or clenching their teeth will develop TMD symptoms. Some of the risk factors for sleep related bruxism include:
Although we do not completely understand the relationship between stress and sleep related bruxism, we know that there is a connection. Stress leads to a release of cortisol and epinephrine, fight or flight endogenous chemicals, into the bloodstream which prepares the body for battle. Cortisol and epinephrine helps us run from bears in the wild and burn the midnight oil the night before a term paper is due. These chemicals also interfere with our ability to engage in deep, restful sleep and are implicated in bruxism activity.
2. Obstructive Sleep Apnea and Sleep Related Breathing Disorders
Obstructive Sleep Apnea (OSA) is a medical condition characterized by cessations in breathing while sleeping. These cessations, often heard by a bed partner, may present as gasping, choking or snoring. During a period of apnea (a cessation of breathing), the tongue collapses on the airway preventing an individual from breathing. In an attempt to breath and alleviate the tongue from obstructing the airway, the body will encourage choking or gasping for air thus moving the tongue. In some individuals, bruxism represents a sign of OSA. These individuals grind and/or clench their teeth as a mechanism to open their airway.
3. ADHD Medications
ADHD medications such as Vyvanse, Adderall and Strattera, are stimulants that may activate the sympathetic nervous system which is responsible for our fight or flight response. These medications may be associated nocturnal bruxism in some individuals.
4. Vaping and Smoking
Nicotine, which is present in cigarettes as well as vapes, is a powerful stimulant which may encourage bruxism activity. Although we do not completely understand the relationship between nicotine and bruxism, we do know that stimulants are associated with jaw muscle activity.
5. Anti-depressant Medications
Certain anti-depressant medications, such as serotonin re-uptake inhibitors (SSRIs) are associated with nocturnal bruxism. An estimated 15% of individuals taking SSRIs have a history of nocturnal bruxism.
If you are waking up with jaw pain, jaw stiffness, and headaches, you may be grinding and/or clenching your teeth at night. Speak to your dentist about methods to manage the effects of bruxism so that you can achieve a restful night of sleep.