Grinding your teeth at night: why it happens and what to do about it

Bruxism is the involuntary clenching of the jaw or grinding of teeth, which a person most often doesn't control or even notice themselves, especially when it happens during sleep. The first signs are usually noticed not by the patients themselves but by their partners: a distinctive sound at night, like a creak or crunch, that disturbs sleep and repeats night after night.

How to tell if you have bruxism

Patients themselves more often notice indirect signs, which appear gradually:

• morning fatigue or tightness in the chewing muscles, as if you'd just spent a long time chewing something hard;
• a dull headache in the temples or in the temporomandibular joint area, which appears specifically in the morning and gradually fades during the day;
• increased tooth sensitivity to cold, sweet foods, or breathing in cool air;
• noticeable enamel wear on the chewing surfaces, small chips on the edges of teeth or fillings that used to be unnoticeable.

Some patients also notice indentations from their teeth on the inside of their cheeks or on the sides of their tongue - this is also an indirect sign of the habit of clenching the jaw. That said, none of these signs on its own is a hundred percent confirmation of bruxism: they can also point to other conditions, so it's important not to diagnose yourself based on just one or two signs. Noticing these signs yourself is useful, but they're only a reason to book a consultation, not a reason to self-treat or try to "fix your bite" on your own.

If you recognise yourself in this, it's not yet a diagnosis - the exact cause of your symptoms, and whether it really is bruxism, is determined by a doctor at an in-person examination, assessing the condition of the enamel, muscles and joint together. We've written about other ways enamel changes can show up, and what to tell them apart from, in the article about tooth sensitivity.

Why bruxism happens

Ideas about the causes of bruxism have changed significantly in recent years. It used to be thought that the main cause of teeth grinding was a bad bite - as if the teeth were "searching" for a comfortable way to close during sleep, causing excessive strain on the jaw. Today this theory is considered too simplistic: the bite may be one of the factors affecting how the load is distributed, but on its own it's rarely the sole or main cause of bruxism, so reducing everything to how the teeth meet isn't accurate.

Instead, more and more attention is being paid to other factors linked to how the nervous system works during sleep and to the body's overall state:

• stress and heightened anxiety, emotional tension built up during the day that the body "discharges" during sleep;
• sleep characteristics - frequent waking, shallow sleep, certain breathing disorders during sleep, which are sometimes accompanied by episodes of grinding;
• consuming caffeine, energy drinks, alcohol or other stimulants, especially in the afternoon and evening;
• taking certain groups of medication - this is worth discussing with the doctor who prescribed them, rather than changing the dosing schedule yourself.

Bruxism most often arises from a combination of several factors at once, rather than one single obvious cause. That's why the modern approach involves looking at bruxism comprehensively, rather than searching for a single cause that can be quickly removed. Which specific factors play a role in your case can only be worked out after talking with a doctor and, if needed, consulting related specialists - for example, if it concerns sleep quality or stress levels.

If the doctor sees signs specifically linked to the bite, an orthodontic consultation can help assess it and correct it if needed - more on this in the article about correcting the bite in adults.

How it puts your teeth and restorations at risk

Regular excessive load on the teeth gradually changes their condition, even if the person doesn't feel it every day and doesn't notice any discomfort for a long time. The problem with bruxism is precisely that the effects build up unnoticed, and people most often seek help only once the changes become obvious or acute discomfort appears.

Typical effects include:

• accelerated enamel wear, which makes teeth shorter and their edges sharp, uneven, or too thin;
• cracks and micro-chips in the teeth themselves, as well as on the edges of fillings that used to last a long time without issue;
• damage to cosmetic restorations - veneers or crowns, which aren't designed for constant impact loading and can chip or come loose;
• an increased risk of overloading dental implants, if any are already placed in the mouth;
• discomfort, clicking, or pain in the temporomandibular joint if the condition continues for a long time without any correction.

Teeth that already have large fillings or restorations become especially vulnerable: they're designed for normal chewing loads, not for constant clenching throughout the night, so they wear down and break faster than healthy natural enamel.

If a chip or other damage has already happened, it's not worth putting off a visit in the hope that it will "wait": temporary delay usually only makes things worse and increases the amount of treatment needed later. We've covered in detail what to do if a filling falls out or part of a tooth chips off in a separate article about a lost filling or a chipped tooth.

What the doctor does

At the consultation, the doctor examines the teeth and oral mucosa, assesses the degree of enamel wear, the condition of existing restorations, and the movement and condition of the temporomandibular joint. If needed, the examination is supplemented with a conversation about sleep quality, stress levels, and lifestyle - this helps build a fuller picture and understand what exactly the grinding might be linked to in your particular case.

To track changes over time, the doctor may take photos or impressions of the teeth, so as to compare the state of the enamel after a certain period and see whether the wear is progressing. This is especially important if the changes develop slowly and go unnoticed by the patient themselves.

One of the most common solutions is an individually made protective night guard, produced from impressions or a digital scan of the jaws for the specific patient. It's important to understand: a night guard doesn't remove the cause of bruxism - it redistributes the load and protects the enamel, fillings, and restorations from further damage while the cause of the symptoms is being worked out or addressed by other methods. The material and thickness of the guard are chosen individually: some people need a firmer version for constant nightly wear, while others need a thinner, softer design. The main thing is that the guard fits the teeth snugly and doesn't cause extra discomfort, otherwise it will be hard to wear regularly and the point of prevention will be lost.

If wear or chips have already led to loss of tooth structure, the doctor offers options for restoring it - from fillings to restoration with veneers or crowns, depending on the extent of damage and the patient's preferences. If needed, the doctor may also suggest seeing related specialists if they suspect the cause is linked to sleep or overall health. Such decisions are always made individually at an appointment in the general dentistry department.

What you can do yourself

While the cause of bruxism is being worked out and the doctor is putting together a plan, there are a few habits that may ease things a little, although on their own they don't replace a consultation and don't guarantee results:

• keep a regular sleep schedule - go to bed and wake up at roughly the same time, and avoid sleep deprivation before demanding days;
• limit caffeine, energy drinks, and alcohol in the afternoon, especially in the evening before bed;
• during the day, pay attention to the habit of clenching your jaw, biting a pen, or chewing gum unnecessarily, and consciously relax your chewing muscles whenever you notice it;
• look for ways to lower your daily stress levels - this can be helped either by changing your daily routine or by working with a mental health professional;
• if needed, try a warm compress on the chewing muscle area in the evening if you feel tension after a long day.

These steps don't guarantee the grinding will disappear completely and aren't a substitute for treatment, but together with the doctor's recommendations they can reduce the load on the teeth and chewing muscles during the day and ease the overall condition.

When to see a doctor sooner

Some symptoms are a reason to see a doctor sooner than your next scheduled check-up:

• pain in the temporomandibular joint that doesn't go away for several days in a row;
• clicking, crunching, or a feeling of the jaw "getting stuck" when opening your mouth;
• a noticeable limit on how wide your mouth opens, or asymmetric jaw movement;
• a fresh chip in a tooth, filling, veneer, or crown, even if it seems minor;
• a sudden increase in tooth sensitivity that wasn't there before;
• persistent pain in the chewing muscles that doesn't ease during the day.

In these cases it's better not to wait for a scheduled check-up but to come in sooner: the faster the doctor assesses the situation, the easier it is to prevent further damage to teeth, restorations and the joint, and to find a comfortable solution for your particular case. Even if none of these symptoms are present, a check-up every six months makes it possible to spot the first enamel changes before any pain or discomfort appears.

Frequently asked questions

Oleksii Sydorenko

Prosthodontist

2+ years of practice. Prosthodontics, veneers, crowns.

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