Diagnosis

Diagnosis initially starts with the patient’s concerns during the dental appointment. The common chief complaint with patients 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, noticing any wear facets could be the confirmation of teeth grinding. Symptoms related to the mandible or face are: pain, soreness, tiredness, achiness, 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.4,16,52,53

Signs and Symptoms of Bruxism
  • Micro-cracks and broken restorations, eventually leading to nerve damage.
  • Enamel attrition down to the dentin; removing the rounded edges of teeth and producing sharp edges, causing sensitivity to heat and cold.
  • Abfractions or excessive wear of anterior teeth resulting in esthetic concerns and restorative challenges.
  • Severe wear facets in posterior teeth causing reduction in vertical dimension, mandible overclosure, open contacts and food impactions.
  • Gingival recession, due to pressure on the gingiva.
  • Inflammation of the gingiva.
  • Mobility of the teeth from rocking back and forth on the teeth.
  • Headache and aching jaws due to overuse of muscles.
  • Tongue indentation by constantly pushing the tongue against the teeth when in bruxing mode.
  • Linea alba caused by the pressure exerted by the cheeks on the buccal surfaces of the posterior teeth during bruxing.
  • Earaches or ringing in the ear.
  • Bilateral or unilateral hypertrophy and large muscle tonus of the masticatory muscles depending on if there is a more dominant grinding side.
  • Buccal exotosis, excess bone as a result of the body’s defense to support the teeth.

Radiographic Appearances

Enamel appears flat or thin on the incisal and occlusal surfaces. 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 (Figures 6 and 7).

Figure 6.
radiograph showing thin enamel and bone resportion
Thin enamel, flat cusps and bone resorption.
Figure 7.
radiograph showing widening of the periodontal ligament
Thin enamel and flat mandibular cusps with widening of the periodontal ligament on tooth #13.

Habits

Bruxism is considered the most destructive functional disorder of the dentition. Certain habits can increase the chances of developing and exacerbating bruxism.15

These include:

  • Verbal grinding noise when sleeping
  • Sleep talking
  • Restlessness at night
  • Snoring which can alternate the sleeping arousals increasing the chance of grinding
  • Biting or chewing on the cheeks, lips, fingernails, pencils or other objects. Also, candy sucking or any activity that keeps the mouth busy or on alert regularly, trains the mouth to stay active even when sleeping. These habits make patients more susceptible to grinding their teeth since these habits have a typical cyclic occurrence similar to bruxism.5
  • Chewing gum keeps the cheek muscles tight and tense when the ideally the muscles should be relaxed.
  • Tobacco use
  • Drug use
  • Alcohol use
  • Caffeine consumption