Teeth grinding

What grinding and clenching are

Bruxism is the medical name for clenching the teeth together or grinding them against each other.

Sleep bruxism comes from brain activity in the lighter stages of sleep. Nobody can control it, and most people who do it are unaware of it. About 1 in 10 people grind their teeth in their sleep.

Awake bruxism is a habit of clenching during the day, usually without noticing, often when feeling tense, worried or under pressure. Up to 1 in 5 people do it. Because it is a habit, it can be changed with practice.

Signs to look out for

Night-time grinding often comes to light because someone else hears it, or because a dentist sees wear on the teeth. Other signs include:

• a stiff or aching jaw when you wake up;
• headaches, or pain in the face or ear;
• teeth that look worn down, chipped or cracked;
• fillings that break or come out;
• teeth that have become sensitive;
• ridges on the inside of the cheeks, or tooth marks along the sides of the tongue;
• disturbed sleep.

Jaw pain has other causes too, including sinus problems, infection, arthritis and gum disease, so a sore jaw is worth having examined.

What makes it more likely

It is not always clear why someone grinds their teeth. It is most often linked with:

• stress and anxiety, which the NHS describes as the most common cause;
• sleeping badly, for example waking often in the night;
• snoring and sleep apnoea, and some other conditions such as acid reflux;
• caffeine, alcohol and smoking;
• some medicines, including those taken for sleep problems, depression or anxiety.

If you think a medicine may be playing a part, talk to the doctor who prescribed it rather than stopping it on your own.

What can help

Treatment is not always needed. It usually matters only when grinding causes pain or damages the teeth. These steps may help:

1. Find ways to relax. Stress is the most common trigger, so breathing exercises, regular exercise, music or counselling may help. A GP can advise on stress and anxiety.

2. Look after your sleep. Go to bed at the same time every night, wind down beforehand, and keep the bedroom dark and quiet.

3. Cut down on caffeine and alcohol, and do not smoke. One study found that people who smoke, drink alcohol or drink coffee were about twice as likely to grind their teeth.

4. Catch yourself clenching. Your teeth should touch only when you eat. During the day, keep the jaw muscles relaxed and the teeth slightly apart. A phone alarm, stickers at home or work, or family who tell you when they see your jaw clench can remind you while the habit changes.

5. Ease a sore jaw. Paracetamol or ibuprofen can help, as can an ice pack wrapped in a tea towel and held to the jaw for 20 to 30 minutes. Avoid chewing gum and hard foods while it hurts.

Regular dental check-ups matter too, because a dentist often notices the signs of grinding before the person who grinds does.

Mouth guards and splints

For grinding at night, a dentist may suggest a mouth guard, also called a splint or bite guard. It is worn over the upper or lower teeth during sleep, so that the teeth press against the guard instead of against each other. It protects the teeth from wear and fracture, and can help with jaw pain.

A guard should be made by a dentist to fit your mouth, because one that fits poorly can cause problems with the teeth or gums. Guards sold in shops or online may not protect as well. Sports gum shields are designed for impact, with extra cushioning that is unlikely to be comfortable at night. Some people find that a soft guard makes them clench or grind more; hard guards last longer.

What treatment can and cannot do

There is no known way to stop the brain signals that set off grinding during sleep. Treatment therefore usually aims at the harm grinding does, protecting the teeth and easing pain, rather than at stopping it. Medicines are rarely prescribed for it, and injections of botulinum toxin to relax the jaw muscles work only for a short time and do not suit everyone.

Grinding in children

Children often grind their teeth. Because their teeth and jaws are growing quickly, it does not always cause serious damage, and many children grow out of it by adolescence. In children it is not usually caused by stress: irritation inside the mouth, allergies that make breathing difficult, and teeth that do not line up properly can all play a part.

When to see a dentist or a doctor

See a dentist if:

• your teeth look worn, chipped or cracked, a filling has broken, or your teeth have become sensitive;
• you have pain in the jaw, face or ear;
• someone has heard you grinding in your sleep;
• you are worried about your child's grinding.

Damaged teeth may need repair, for example with a new filling or, where much of the tooth is lost, a crown. If a broken tooth hurts, the guide to dental emergencies explains what to do.

See a doctor if:

• someone has noticed your breathing stop and start while you sleep, or that you gasp, snort or choke, especially if you also snore loudly or always feel very tired during the day. These can be signs of sleep apnoea, which is linked with grinding and needs its own assessment;
• you need help with stress, anxiety, smoking or alcohol.

Get medical advice promptly if your jaw locks or you cannot open your mouth fully, or if jaw pain stops you eating or drinking.