Sleep bruxism: night-time teeth grinding, jaw pain and splints

Bruxism means clenching and grinding of the teeth. Leeds Teaching Hospitals NHS Trust explains that it can happen asleep (sleep bruxism) or awake (awake bruxism), and that it is common: around 1 in 10 people grind their teeth while sleeping and up to 1 in 5 clench while awake. Many people who grind do not realise it. The NHS says teeth grinding can occur while you are awake or asleep, and that treatment is not always needed.

Leeds Dental Institute describes sleep bruxism as the result of brain activity during sleep that you cannot control, with the brain signals for bruxism occurring in the lighter stages of sleep. It stresses that sleep bruxism is not necessarily a problem in itself, and that it does not damage the jaw muscles or joints, so treatment is only needed when it causes pain or problems with the teeth.

Signs include noise that a sleeping partner has heard, ridges on the insides of the cheeks or tooth-prints on the sides of the tongue, worn, cracked or broken teeth or fillings, stiff or sore jaw muscles on waking, headaches, and sore, sensitive or loose teeth. The NHS adds earache, disturbed sleep and, with ongoing jaw pain, a risk of temporomandibular disorder (TMD). Worn-down or broken teeth can cause increased sensitivity and loss of teeth and fillings.

Because sensitive or loose teeth can also reflect gum disease or tooth decay, Leeds advises seeing a dentist to rule those out rather than assuming bruxism is the only explanation.

• Grinding noises noticed by a partner.

• Jaw ache, stiffness or headaches on waking.

• Worn, flattened, chipped or cracked teeth.

• Cheek ridges or scalloped tongue edges.

• Sensitive teeth and disturbed sleep.

The NHS says it is not always clear what causes teeth grinding but that it is often linked to stress and anxiety, which is the most common cause, sleep problems such as snoring and sleep apnoea, taking medicines for sleep problems, depression or anxiety, smoking, and drinking lots of alcohol or caffeine. Leeds Dental Institute adds that caffeine, alcohol and smoking can increase the risk of sleep bruxism, that bruxism may be worse if you are not sleeping well, feeling stressed or anxious or frequently woken, and that people with obstructive sleep apnoea and acid reflux may be more likely to have sleep bruxism. Some neurological conditions, including Parkinson's disease, increase the risk.

The link with sleep apnoea matters. If a partner also reports breathing pauses, or you are very tired by day, mention it to your GP or dentist, since treating apnoea may reduce the grinding.

Leeds explains there is no way of stopping the brain signals that trigger bruxism, so treatment usually focuses on the problems it causes. Your dentist will talk about any damage to teeth that looks to be caused by bruxism. The NHS says a dentist may recommend a mouth guard or splint, worn at night to protect teeth from damage and made to fit precisely over upper or lower teeth.

Leeds describes soft splints, made from slightly flexible material like a thin sports gumshield, which some people find make them clench or grind more and which can wear through quickly, and stabilisation splints made from hard plastic that last longer and are made so teeth meet evenly. It stresses that a splint should be made by a dentist, because poorly fitting splints can cause problems with teeth or gums. A mandibular advancement device may be recommended for people with suspected or confirmed obstructive sleep apnoea. Botulinum toxin injections into the jaw muscles can relax muscles in the short term but are not suitable for everyone, and some medicines have an effect of reducing bruxism but are unlikely to be prescribed for bruxism itself.

The NHS also suggests relaxation (breathing exercises, music, regular exercise), improving sleep routines, painkillers such as paracetamol or ibuprofen for jaw pain or swelling, an ice pack wrapped in a tea towel for 20 to 30 minutes, regular dental check-ups, avoiding smoking, excess alcohol and caffeine, and avoiding chewing gum or hard foods if the teeth or jaw hurt.

Awake bruxism is a subconscious habit that, according to Leeds, can be changed with practice. During the day, maintain good posture with the neck straight and shoulders relaxed, keep the jaw muscles relaxed and the teeth slightly apart, and use reminders such as phone alarms, stickers around the home or asking family to point out clenching. It takes time to change habits.

Leeds states that bruxism does not cause temporomandibular disorders (TMD) but can make the symptoms worse if you already have TMD, so persistent jaw clicking, locking or pain should be assessed separately by a dentist or doctor. The NHS advice is to see a dentist if you have tooth damage or sensitivity, pain in the jaw, face or ear, or if you are worried about your child grinding their teeth, and to see a GP if you need help with causes such as stress, anxiety, smoking or alcohol.

Routine assessment is by an NHS or private dentist, who examines teeth, bite and jaw muscles and decides whether a splint is needed. NHS dental availability varies by area, and splints may be provided privately in some practices; ask about the type, cost and expected lifespan before agreeing, and about follow-up checks for fit.

If sleep apnoea is suspected, a GP can refer to a sleep clinic. Persistent anxiety or sleep problems may benefit from talking therapy or sleep-focused CBT. Dentists can also refer to oral and maxillofacial or hospital dental services for complex jaw problems.