Diagnosis initially starts with the patient’s concerns during a dental appointment. The common chief complaint is usually some level of pain, whether it is persistent or inconsistent, from slight sensitivity to intense pain. Patients will usually state generalized or localized hypersensitivity or pain in their teeth and/or jaw. The patient may also become aware of their clenching habits during times of stress or depression. They will sometimes know exactly which tooth. Other times they will know the area but are unable to pinpoint the exact tooth.
After determining decay is not the issue, diagnosing wear facets could be the confirmation of teeth grinding. Symptoms related to the mandible or face are: pain, soreness, tiredness, achiness, popping of the mandible upon opening and closing, tightness or stiffness usually from the pressure and overuse of the masseter muscles or TMJ. Headaches are another common symptom, especially when it is experienced after wakening. These headaches can be dull or intense, sometimes leading to migraines.17
Over the years, the accumulated toll of bruxing can produce a wide range of damage or oral changes. Duration, frequency and intensity of bruxing significantly contributes to the resulting effect.4,16,53
Signs and Symptoms of Bruxism
Enamel appears flat or thin on the incisal and occlusal surfaces (Figures 7‑8). It may be localized, but usually is generalized. Small chips on the incisal edges may show radiographically along with broken teeth or restorations. Radiographically it would show widening of the periodontal ligament and bone resorption due to trauma enforced by the grinding.4 Pulpal necrosis may be visible.
Bruxism is considered the most destructive functional disorder of the dentition. Certain habits can increase the chances of developing and exacerbating bruxism.15