Awake Bruxism Causes & Treatment Options

Evidence Based
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What Is Awake Bruxism? 

Awake bruxism, also called daytime bruxism, is a condition where you grind, gnash, or clench your teeth while awake. This may be unconsciously or consciously. Sleep bruxism is also common, but this condition is when you clench or grind your teeth during sleep.

Bruxism affects at least 20 percent of the population. However, most people grind or clench their teeth at times. Bruxism occurs in adults and children, but it is most common in 25 to 44-year-olds. 

bruxism

Signs and symptoms of awake bruxism can include:

  • Teeth grinding or clenching
  • Flattened, fractured, chipped, or loose teeth
  • Worn tooth enamel
  • Increased tooth pain or sensitivity
  • Tired and tight jaw muscles
  • Jaw pain
  • A locked jaw unable to open or close completely
  • A pain that feels like an earache
  • A dull headache in the temples
  • Chewing on the inside of the cheek

Awake Bruxism vs. Sleep Bruxism

Sleep bruxism is a sleep disorder. Those who grind, gnash, or clench their teeth during sleep are more likely to experience other sleep disorders. This includes snoring and pauses in breathing (sleep apnea).

The symptoms of nocturnal bruxism are similar to those of daytime bruxism. You may not notice if you grind or chew during the night. However, if you sleep with a partner, they may be able to notice or hear your teeth grinding. Since you may be unaware of your sleep bruxism, it’s essential to know the disorder's signs and symptoms to prevent any complications from developing.

Causes of Teeth Grinding During The Day

Doctors still don’t completely understand what causes awake bruxism. However, it may be due to a combination of genetic, physical, psychological, and psychosocial factors.


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Daytime bruxism may be due to the following reasons:

  • Psychosocial factors — Emotions leading to anxiety, stress, anger, frustration, or tension can cause awake bruxism.
  • Age. Bruxism is common in young children. It usually calms by adulthood.
  • Personality type — People who are aggressive, hyperactive, or competitive are more likely to experience bruxism. 
  • Medications and other substances — Daytime bruxism can be an uncommon side effect of some medicines or substances. These can include certain antidepressants, ADHD medications, tobacco, alcohol, caffeinated drinks, and recreational drugs.
  • Genetics — Bruxism tends to occur in families, although this is usually sleeping bruxism. If you have bruxism, your family members may also experience it or have a history of it.
  • Coping mechanism — Awake bruxism may be used as a coping mechanism. Or, it may be a habit during deep concentration.
  • Other disorders Bruxism links to some mental health and medical illnesses. These include Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, attention-deficit (ADHD), or sleep disorders like sleep apnea, parasomnias, night terrors, and wakefulness.

How to Stop Daytime Teeth Grinding and Clenching

There are techniques you can use to help stop or reduce daytime teeth grinding and clenching. Since stress is one of the leading causes of daytime bruxism, reducing stress levels is one of the most effective ways to prevent it.

Some ways to stop awake bruxism include:

  • Acupuncture
  • Yoga
  • Deep breathing
  • Meditation 
  • Exercise
  • Journaling 
  • Avoiding caffeine and alcohol consumption
  • Orthodontic treatment 

Risks of Awake Bruxism 

Mild awake bruxism episodes may not require treatment. In most cases, bruxism doesn’t lead to severe complications. However, bruxism can be severe. If frequent, bruxism can lead to various risk factors and medical conditions, especially if left untreated.

The risk factors and side effects of awake bruxism can include:

  • Jaw disorders
  • Tension-type Headaches
  • Damages to your teeth, crowns, or restorations
  • Severe facial or jaw muscle pain (orofacial pain)
  • Temporomandibular joint disorders (TMJD)
  • Sleep disorders
  • Problems chewing, speaking, and swallowing
  • Ear pain
  • Muscle enlargement 
  • Damage to teeth that requires dental treatment. This includes dental bonding, filling, crowns, or bridges 

Temporomandibular disorders (TMDs) in your joints may sound like clicking noises when you open and close your mouth. The TMJs, or jaw joints, are located just in front of your ears.

Many people don’t realize they have awake bruxism until side effects and symptoms appear. The risks of problems from teeth grinding may increase if you leave bruxing untreated for a significant period.

Treatment Options for Bruxism

If you experience any of the symptoms or side effects of bruxism episodes, or have any other concerns regarding your teeth or jaw, meet with your dentist, doctor, or orthodontist. If you notice that your child is clenching or grinding their teeth, or is displaying any other symptoms of bruxism, mention it at their next dental appointment.

If you experience tooth grinding, there are ways you can stop it. Some remedies may be more effective than others, depending on the underlying cause of your awake bruxism and symptoms. Your doctor, dentist, or orthodontist can help you choose the best solution for your awake bruxism. 

Mouth Guards (Occlusal Splints)

A mouthguard may be helpful for “bruxers.” Occlusal splints work by cushioning your teeth and preventing them from grinding against each other. However, a mouthguard is most useful for those experiencing sleep bruxism as they can be worn during the night.

Occlusal splints can be custom-made by your dentist or orthodontist. Or, you can buy a generic one over the counter.

If you experience chronic sleep bruxing, custom-made mouthguards can help protect your teeth from tooth wear and damage. A mouthguard may also reduce any strain or jaw pain.

Custom-made mouthguards cost more than over the counter options. However, they may be a better choice for some patients. 

Personalized mouthguards come in varying levels of thickness. They fit precisely to your jaw’s exact size and shape. Custom-made mouthguards are usually more comfortable than shop-bought options because they are made of hard acrylic material. Over-the-counter mouthguards are often created from plastic. Plastic mouthguards may not be as comfortable as custom-made options.

If you decide to choose an over-the-counter mouthguard, select one made of soft plastic or an option that can be boiled to soften it. 

Over-the-counter mouthguards may not be as useful for severe bruxism as personalized options. Some people even find that a soft night guard actually increases their muscle clenching or grinding due to the soft, squishy material.  However, they are an affordable and viable treatment for bruxers experiencing minor teeth grinding.

Botox Injections

Injections of botulinum toxin (botox) may reduce the pain and frequency of tooth grinding in otherwise healthy people. However, more research is required to confirm the safety and effectiveness of using botulinum toxin (botox) as a treatment for awake bruxing.

During the treatment of botulinum toxin (botox) for bruxism, a medical professional injects small amounts of the neurotoxic protein into the masseter muscle. This is a large muscle that controls muscle activity. 

Botox won’t cure bruxism. It works as a temporary muscle relaxant. This helps reduce teeth grinding and related side effects and symptoms. Benefits usually last for three to six months. As such, treatment is usually repeated.

If you’re interested in using botulinum toxin (botox) to treat bruxism, discuss the benefits and risks with your doctor. 

Biofeedback Treatment

Biofeedback helps people become aware of and eliminate a behavior. The treatment helps to reduce both awake and sleep bruxing.

During biofeedback treatment, a specialist therapist teaches bruxers how to control jaw muscle activity and movements. This training includes visual, vibratory, or auditory feedback from electromyography. 

Electromyography is an electrodiagnostic medicine technique. The procedure determines and records the electrical activity generated by skeletal muscles.

However, more research is required to understand the long-term advantages and effectiveness of biofeedback treatment.


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Resources

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Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387-1394, https://pubmed.ncbi.nlm.nih.gov/25367475/

Mesko, Mauro Elias et al., Therapies for bruxism: a systematic review and network meta-analysis (protocol)., Systematic reviews vol. 6,1 4. 13 Jan. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237268/

Yap, Adrian U, and Ai Ping Chua., Sleep bruxism: Current knowledge and contemporary management, Journal of conservative dentistry : JCD vol. 19,5 (2016): 383-9, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026093/ 

Guaita, Marc, and Birgit Högl. “Current Treatments of Bruxism.” Current treatment options in neurology vol. 18,2 (2016): 10, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761372

Lal SJ, Weber KK. Bruxism Management. [Updated 2020 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan, https://www.ncbi.nlm.nih.gov/books/NBK482466/ 

Long H, Liao Z, Wang Y, et al. Efficacy of botulinum toxins on bruxism: an evidence-based review. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995, https://www.ncbi.nlm.nih.gov/books/NBK97606/ 

Tinastepe N, Küçük BB, Oral K. Botulinum toxin for the treatment of bruxism. Cranio. 2015;33(4):291-298, https://pubmed.ncbi.nlm.nih.gov/26715152/ 

Jokubauskas L, Baltrušaitytė A. Efficacy of biofeedback therapy on sleep bruxism: A systematic review and meta-analysis. J Oral Rehabil. 2018;45(6):485-495, https://pubmed.ncbi.nlm.nih.gov/29577362/

Updated on: August 28, 2020
Author
Ellie Swain
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Medically Reviewed: August 26, 2020
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Lara Coseo
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