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Stress and Lack of Sleep may Cause Bruxism

For millions of people, the daily grind may be turning into the nightly grind. And students, along with other stressed-out individuals, are at particular risk.

Stress may be causing millions to unknowingly grind their teeth at night resulting in chronic headaches, earaches and jaw pain; worn enamel; and sometimes flattened, shortened or even broken teeth and fillings.

Medically known as bruxism, nighttime teeth grinding and clenching affects an estimated 10-20 percent of the general population, making it the third most common sleep disorder after sleep talking and snoring, according to the Mayo Clinic Web site. But since this number relies mostly on self-reporting, many doctors and dentists believe that the actual number of bruxers is much higher.

Doctors have yet to discover the exact cause of bruxism, but stress is often cited as a key factor. With all the stresses of college life – moving away from home, exams, heavy course loads – it’s no wonder that some dentists are experiencing a large number of students complaining of symptoms related to bruxism such as toothaches, headaches, facial muscle pain and loose teeth.

Oakland dentist Dr. Kenneth L. Childers sees a lot of college-student bruxers. “We see most of it right around finals,” he said.

Mills student Caroline Cadwell notices a direct correlation between her bruxism and stress levels. Worrying about papers, her health, relationship issues or lack of sleep itself all seem to increase her bruxing. Lately, the transition from living alone to dorm life has been the main contributor.

“I find I rarely get a full night’s sleep,” she said. “I’m always waking up, or being woken up by noisy people.”

According to Childers, the stress created by not sleeping is another common cause of bruxism. After determining whether or not looming deadlines are the source, he asks patients about how they’re sleeping. Many times it turns out that the patient just bought a new mattress that they’re not happy with.

“They’re not sleeping well, so they’re grinding their teeth,” said Childers.

While bruxism is not life-threatening, in some cases there may be a more serious underlying issue. According to Dr. Allison Chan, a fellow at the Stanford Sleep Disorders Clinic, “Obstructive Sleep Apnea [where people stop and start breathing in their sleep] is the number one disorder associated with bruxism.”

Other college-life staples may increase the risk of bruxism, including caffeine and alcohol consumption, especially before sleep; smoking; and anxiety.

On the upside, dorm living may help students discover that they’re bruxing before they’ve done significant dental damage. Since bruxism is an unconscious activity, most people who grind or clinch don’t even know that they’re doing it unless a family member or roommate alerts them to the fact that they’re making horrible noises at night.

“If you’re a back tooth grinder, you sound like a freight train. But if you’re a front tooth grinder, it’s sneaky; it doesn’t make any noise,” said Childers.

After auditory observers, dentists are the most common detectors of bruxism. Dentists look for the visible signs of bruxism mentioned earlier along with chew marks on the inside of the cheeks, swelling or popping of the jaw joint (temporomandibular joint or TMJ), and gum recession.

Said Childers, “We used to think that the gums receded because of brushing too aggressively. But over the last 10 years, studies have shown that a huge majority of the people that have that type of recession also are clenchers or grinders.”

Once it’s established that a patient is bruxing at night, dentists normally recommend a mouth guard (night guard, dental appliance, bite plate, splint). The most common is a piece of hard plastic that fits over your lower or upper set of teeth. Much more comfortable than the mouth guards which boxers and other athletes wear, these are custom made from a mold of the patient’s mouth.

Although there is no cure for bruxism, mouth guards protect the teeth and keep the wearer from putting pressure on any one area.

“The advantage here is that you can’t get at any one particular tooth. You’re sliding over a plastic surface that spreads the load and seems to help a lot,” said Childers. Unlike teeth, “they give the wearer something to grind on that I can easily replace.”

However, because the consequences of Obstructive Sleep Apnea, or OSA, can be so severe, Chan asserts that dentists shouldn’t just give bruxers a night guard and a pat on the back.

“Anyone diagnosed with bruxism should really be investigated for any underlying sleep-disordered breathing by an appropriate physician, somebody who understands sleep disorders very well,” she said.

Along with memory and concentration problems, OSA is associated with increased risk of high blood pressure, heart attack and stroke.

“If there is an underlying sleep disordered breathing, such as OSA, treatment of this breathing problem should resolve the bruxism,” said Chan.

For bruxers without breathing problems to address, the cost of a mouth guard ranges from $450 to $800. Many dental plans will cover at least half the cost. However, the Delta Dental individual plan, recommended on the Student Life webpage, does not cover the cost of mouth guards at all.

Night guards help protect those pearly whites, but they certainly aren’t the sexiest night time accessory. Student Rachel Gordezky said that her friends have told her it looks silly and made fun of the way she talks with it in. “I don’t really like to wear it around other people, but sometimes I just have to,” she said.