I woke one night with a start, because I heard an awful noise coming from my grandson’s bedroom. I couldn’t figure out what it was until I got closer. It sounded as if someone was grinding rocks together. I quickly realized he was grinding his teeth!
Sleep bruxism, also known as grinding or gnashing of the teeth in sleep, is fairly common in children, affecting approximately 14% to 20% of children. It is one of the few medical problems that improve with age, as it affects only 3% of people aged older than 60 years.
This grinding and gnashing at night can lead to headaches, tooth damage or sensitivity, earache and jaw disorders. Often the patient is unaware this is occurring unless a bed partner complains.
Patients with sleep bruxism may also clench their teeth during the day. There are certain personality types that appear more prone to bruxism. Patients who tend to be more task oriented are afflicted more often.
Sleep bruxism, which is classified as a parasomnia, may be related to various factors including anxiety, misalignment of bite, certain medications including SSRIs and certain illnesses. Performing a polysomnogram to record jaw muscle activity can confirm the diagnosis.
The disorder occurs more often in patients who sleep in the supine position. It has also been observed with other sleep disorders, such as obstructive sleep apnea, restless leg syndrome and periodic limb movements of sleep.
There are no genetic markers for bruxism, but 21 – 50% of patients with bruxism have a direct family member who ground their teeth as a child. Chemical substances that worsen sleep bruxism include alcohol, nicotine, caffeine, and amphetamines, such as methylphenidate, cocaine and calcium channel blockers.
In absence of a medical problem, the cause is considered primary or idiopathic sleep bruxism. Secondary causes would be related to diseases such as Parkinsons, Huntingdon’s, Tourettes and oral tardive dyskinesia.
Treatment is most often with oral appliances, such as a bite guard or bite splint. Alternative treatments can include biofeedback and hypnotherapy. Behavioral strategies may also be beneficial.
For very severe cases, a short course of diazepam or methocarbamol, a muscle relaxer, is helpful. There is some evidence that propranolol may also be helpful.
Consider sleep bruxism when patients complain of jaw pain or headaches when waking. A referral to a sleep specialist or dentist could help improve their sleep health.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.