Bruxism; At A Glance
- Best Results1-2 injection sessions
- Treatment RecoveryNo downtime
- Procedure Time1-5 min
- Skin SpecialistDavin Lim
- Duration of Results4-6 months
- AnaestheticNil required
- Back to WorkImmediately
Bruxism is a common condition that can present medically or aesthetically. Symptoms include frequent headaches, & teeth grinding. Signs include prominent masseter muscles giving a powerful broad jawline. Teeth grinding can lead to cracks & damage on the surfaces of teeth.
FactsFacts on Bruxism
- This condition is related to stress & sleeping habits
- Patients may experience teeth grinding during sleep
- Headaches, jaw & neck pain are frequent complaints
- Prominent masseter & temple muscle are prominent signs
- Dental examination may reveal worn or cracked teeth
- Treatments include muscle relaxing injections
- Dental splints can be a useful adjunct to injections
What is bruxism?
By definition, bruxism is classified as a sleep related disorder. This is because patients frequently clench or grind their teeth during their sleep. They may have unrelated disorders including sleep apnoea. Not infrequently their partners may suffer poor sleep due to awakening secondary to teeth grinding.
How do you know if you suffer from bruxism?
- Pain just below the jawline. Headaches, jaw, neck & face pain.
- Dull ache in the temples
- Poor sleep, teeth grinding
- Accidental cheek chewing
Signs of bruxism include-
- Worn & or broken teeth
- Tight & prominent jaw muscles (masseters)
- A prominent & square jawline
When to see a specialist?
Consider seeing a specialist if you have persistent signs or symptoms of bruxism including broken teeth, persistent, frequent & debilitating headaches, anxiety or tension.
Bruxism can also present as an aesthetic concern, namely a broad lower one third of the face. This is due to overactive masseter muscles. Though more commonly seen in Asian & European women, bruxism & masseter hypertrophy can be seen across all cultures.
What is the most effective way to treat bruxism?
Simple muscle relaxing injections can make a dramatic difference in the signs & symptoms of bruxism. They work by relaxing the masseter muscles which are the large muscles near the backs of the cheeks that move the jaw. The injections work by relaxing this muscle to prevent involuntary teeth grinding and clenching.
Procedure: 2 minutes
Last: 4-6 months
Downtime: 0 days
This will gradually soften the jaw and prevent further damage to teeth. Patients will also find that they experience fewer headaches. Facial expressions are not affected by anti-wrinkle injections. As a guide, this simple procedure takes 1-2 minutes to perform. Evaluation and planning take about 5 minutes.
Muscle relaxants typically last 3-6 months & begin to work at 7 to 10 days. While injections are not a cure for bruxism, they can give significant relief for several months. Injections will also soften the jawline, which is important for facial aesthetics.
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What are other treatment options?
If you have medical bruxism, as opposed to aesthetic concerns, the following adjunctive treatments are recommended-
- Splints and mouth guards. These are designed to keep teeth separated to avoid the damage caused by clenching and grinding. They can be constructed of hard acrylic or soft materials and fit over your upper or lower teeth. A dentist can design one for you, alternatively DIY kits are available online.
- Dental correction. In some cases your dentist may need to reshape the chewing surfaces of your teeth or use crowns to repair the damage. This is a relatively simple procedure.
- Stress management. Best see a psychologist for this. I refer all my psych patients to the OCD Clinic in Bulimia. Psychologists can reduce bruxism with biofeedback, CBT & other behavioural changes.
- Tablets. Antianxiety & muscle relaxation BZs may be prescribed by your GP.
What are simple lifestyle changes that may reduce bruxism?
These self-care steps may prevent or help treat bruxism:
- Reduce stress, a good avenue to vent is via exercise. This can help you relax and may reduce your risk of developing bruxism.
- Don’t chew gum! Chewing only strengthens the masseters.
- Avoid stimulating substances in the evening.
- Practice good sleep habits. Getting a good night’s sleep may help reduce bruxism.
- Regular dental visits. Your dentist can spot signs of bruxism in your mouth and jaw during regular visits and exams. They can provide you with advice regarding splints, & if needed sort out the surface of your teeth to ensure a more even bite.
How to evaluate bruxism?
As always, start with a history and examination. Symptoms include headaches & jaw pain.
Signs include strong masseter muscles & in severe cases temporalis muscles. In really severe cases you may have broken teeth or articular surfaces that are worn down. A dentist may take baseline bite profiles, X rays & photos to monitor your condition. A dental examination may reveal other TMJ associated disorders or dental problems.
Can bruxism affect your sleep?
If your bruxism seems to be related to major sleep issues, your doctor may recommend a sleep specialist. A sleep medicine specialist can conduct more tests, such as a sleep study that will assess for episodes of teeth grinding and determine if you have sleep apnea or other sleep disorders.
In fact, the most frequent sleep disturbance is experienced by the partner of the patient suffering from bruxism. Most patients don’t wake up when they grind their teeth, but their partners do!
What is the prognosis of childhood bruxism?
Many kids outgrow of bruxism without treatment, hence intervention is not required. A dental splint may be required if articular surfaces are impacted. The best person to discuss this treatment is a dentist specializing in TMJ dysfunction.
What are the risk factors for bruxism?
Bruxism risk factors include-
- Ethnicity & culture. Overactive masseters are more common in Asian females, especially Chinese. In some cases there maybe a family history of teeth grinding.
- Stress. Increased anxiety can lead to teeth grinding. So can anger and frustration. Having a personality type that’s aggressive, competitive or hyperactive can increase your risk of bruxism (Tom Cruise syndrome).
- Age. Bruxism is common in young children however in some cases it is self-limiting. A proportion will carry on to adulthood.
- Medications and other substances. Bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants.
- Chewing gum is a controversial case. Chewing activates the masseter & temporalis muscles, in turn providing feedback to strengthen these muscles.
What is the cost for injections?
Cost will depend on the amount of injectables I use. As a guide-
- Muscle relaxants $20 per unit, 28 to 36 units per side.
- Splints vary from $30 to a few hundred dollars. Your dentist can guide you.
*My clinical nurses charge less than half of what I charge for injectables. They are excellent injectors.
Davin’s Viewpoint on Bruxism
This common condition can present to GPs, dentists, sleep specialists, & dermatologists. Dentists see the signs of bruxism, namely cracked molars & ground down articular surfaces, whilst GPs & neurologists are often consulted with the symptoms of bruxism- namely headaches.
As for me? I normally see the signs with co-incidental finding of bruxism, namely overtly active masseter muscles causing a boxy or squarish look in females. My bruxism patients come in for facial slimming or V shaping. Treatments to reduce masseter bulk, and hence slim down the face, is with really simple muscle relaxants or ‘anti-wrinkle injections.’ It takes a week or so before symptoms to decrease, whilst the aesthetic effects are seen after 4 weeks. The use of splint at night can prolong the duration of muscle relaxing injections.
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