How do I stop grinding my teeth?

Medical Treatment for Teeth Grinding (Bruxism)

A severe case of teeth grinding also know as bruxism will cause progressive dental damage, rendering your teeth structurally damaged, worn out, and extremely sensitive. In addition , excessive grinding of the teeth will leave your jaw so sore that you can not chew properly without causing much discomfort. People with such complaints are usually referred to a dental practitioner to undo the damage to the tooth. The repair typically involves reshaping the teeth's chewing surfaces inserting dental crowns to mend the damage. The most common cause of bruxism is attrition(1). Although there is no widely accepted definition, bruxism has been defined as "the grinding or clenching of teeth at other times than for the mastication of food." Forces produced during an episode of bruxism may be six times greater than during normal chewing. There are two remedies to prevent teeth grinding but both of these are temporary which include medications and use of dental instruments.(2)

Medications:

The medications used include mainly Muscle Relaxant and medications for stress and anxiety relief, both of these act passively in reducing teeth grinding. Muscle relaxant reduces pressure generated on teeth for short term and medications for stress reduce anxiety levels which is the main cause of teeth grinding.(3)

Custom dental night guards:  

Dental devices can avoid this by spreading the force across the masticatory system and reducing the frequency of bruxism, but not the intensity. Muscle activity is likely to return to its previous level once the appliance is removed so it should be constantly worn.(4)  Regardless of this, the devices should cover the occlusal surfaces of all teeth in the arch, because partial covering will lead to any exposed teeth being over erupted.(5) These instruments have many other uses, and are widely used for temporomandibular condition treatment. On the maxillary or mandibular arch, they can be worn and are made of hard or soft materials.

Hard teeth splints:

Strong splints of acrylic are made of poly(methyl methacrylate) (PMMA). Due to higher strength and lower cytotoxicity, heat-polymerized acrylic should be used instead of the auto-polymerised (cold cure) type, especially if the device is intended for long-term usage. This appliance, also known as a Michigan splint or stabilization splint, aims to reduce bruxism by providing a temporary and reversible ideal occlusion that prevents the normal closure by separating the maxillary and mandibular teeth and eliminating the unwelcome guiding effects of cuspal inclines.(6)

In order to establish the interocclusal relationship, a wax bite registration is taken on the retruded axis and a facebow transfer may also be made, although the evidence may suggest that this is not necessary for the construction of occlusal splints. The maxillaire model is mounted on a semi-adjustable joint. The incisal pin is balanced to provide roughly 2 mm of space between the most rear teeth. (7)Using the wax bite registration the mandibular model is then articulated to the maxillary model. The buccal, lingual and proximal undercuts are not blocked excessively, as they are typically used to maintain the splint, while clasps of stainless steel wire, such as Adams clasps, may be used too.(8)

The splint wax pattern is made from two pink modelling wax thicknesses that are hardened and modified over the mold. The wax is trimmed so that it stretches about 5 mm over the palatal soft problem and covers the teeth's incisal edges and buccal cusps by 2-3 mm. The articulator is closed until the pin comes into contact with the incisal table while the wax is still soft which creates the splint 's vertical occlusal dimension (OVD).(9)

The wax is then modified using articulating paper to match the desired occlusion. Contacts are formed between the flat surface of the splint and all the teeth in the opposing arch, and a smooth and shallow concave ramp is made in the anterior region to provide immediate, yet smooth, disclosure of the rear teeth when moving the mandible.(10) Afterwards the maxillary model is separated from the articulator and placed in plaster in a foundation of flasks. The splint 's flat surface is covered, and only the part of the wax pattern that protects the palatal tissue is left exposed to prevent elevated OVD. Once the plaster has been mounted, the plaster is applied with a separating solvent.(11)

A second plaster mix is used to fill the top of the flask to a slight excess, and the base of the flask rests on top of the flask. Once this plaster has been formed, the wax is boiled away, and the mould is filled and treated with transparent poly(methyl methacrylate). Afterwards the appliance is devested, trimmed and polished.(12) The finished splint aims to create immediate and marked relaxation of the masticatory muscles which should contribute to the repositioning and closure of the mandible in the retruded position without disruption of the opposing dentition.(13)

The areas on the polished surface lateral to the canine and anterior to the intercuspal position contacts of the incisor are gently ramped to provide anterior guidance and disclosure of the rear teeth, and the rest of the splint is flat, without indentations, and incorporates at least one central stop per opposing tooth to ensure that the mandible is not held or guided into a predetermined position.(14) When the mandible repositions, the appliance can need to be changed to keep both communications and disclosure.(15)

References:

1 Smith BGN, Knight JK. An index 6 for measuring the wear of teeth.  Br Dent J 1984;156(12):435-438.

2 Holbrook WP, Arnadóttir IB, Kay EJ. Prevention. Part 3: prevention of tooth 7 wear. Br Dent J 2003;195(2):75-81.

3 Grippo JO: Abfractions: a new classification of hard tissue lesions of 8 teeth. J Esthet Dent 1991;3(1):14-19.

4 Lobbezoo F, Van Der Zaag J, Naeije M. Bruxism: its multiple causes and its effects on dental implants - an updated review. J Oral Rehabil 2006;33(4):293-300.

5 Nadler SC. Bruxism, a classification: a critical review. J Am Dent Assoc 1957;54(5): 615-622.  Gibbs CH, Mahan PE, Mauderli A, Lundeen HC, Walsh EK. Limits of human bite strength. J Prosthet Dent 1986;56(2):226-229.  

6 Jagger R. The effectiveness of occlusal splints for sleep bruxism. Evid Based Dent 2008;9(1):23.

7 Holmgren K, Sheikholeslam A. Rüse C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders.

8 J Prosthet Dent 1993;69(3):293-297.

9 Solberg WK, Clark GT, Rugh JD. Nocturnal electromyographic evaluation of bruxism patients undergoing short-term splint therapy. J Oral Rehab 1975;2(3):215-223.

10 Beard CC, Clayton JA. Effects of occlusal splint therapy on TMJ dysfunction. J Prosthet Dent 1980;44(3):324-335.

11 Fricton J, Look JO, Wright E, Alencar FG Jr, Chen H, Lang M, Ouyang W, Velly AM: Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. J Orofac Pain 2010;24(3):237-254.

12 Melilli D, Currò G, Perna AM, Cassaro A. Cytotoxicity of four types of resins used for removable denture bases: in vitro comparative analysis. Minerva Stomatol 2009;58(9): 425-434.

13 Ramfjord SP, Ash MM Jr. Significance of occlusion in the etiology and treatment of early, moderate, and advanced periodontitis. J Periodontol 1981;52(9):511-517.

14 Gray RMJ, Davies SJ, Quayle AA. A clinical approach to temporomandibular disorders. 6 splint therapy. Br Dent J 1994;177(4):135-142.

15 Shodadai SP, Türp JC, Gerds T.