December 6th, 2011
07:53 AM ET
Zach was a life-long teeth grinder.
“It seemed that as soon as his teeth came in, he started grinding," his mother told me.
It was so loud and frequent that Zach was given his own room because his little brother couldn't get any sleep when they shared. For years he had slept at the end of the hall far from his parents’ and his brother’s room, so one suspected that the grinding was getting worse.
When a dentist noticed a progressive worsening of wear on his patient's teeth, he discussed his concerns about a possible underlying sleep disorder with both Zach and his mother. They then came to me.
Nocturnal grinding can cause not only extensive wear on your teeth, but also jaw and facial pain, headaches, and when it is severe, it can cause sleep disruption that results in daytime drowsiness.
There are two types of bruxism. If there's no clear cause, bruxism is termed "primary." Secondary sleep-related bruxism has been associated with various other disorders, as well as the use of psychoactive medications and recreational drugs.
An overnight sleep test is not always necessary. However, a careful evaluation by a sleep specialist is warranted if, as in this case, the grinding is becoming worse rather than better with age. Bruxism must be distinguished from partial complex seizure, facio-mandibular myoclonus and sleep disordered breathing.
Often, grinding can be an accompanying feature of obstructive sleep apnea and confusional arousals, and it can improve with treatment of the underlying sleep disturbance.
Even in the absence of a clear psychiatric or medical cause, sleep specialists often note heightened stress and anxiety as a predisposing factor. Some specialists have found an association with a Type A personality or someone who is hyper-vigilant and easily aroused from sleep.
In Zach’s case, we figured out that he did have a lot if increased stress due to his busy academic and extra-curricular schedule. He was also worried about getting into a good college and was working around the clock to assure his success. He was stressed in the daytime and it carried over into his sleep. We ruled out any other sleep or medical problems. His dentist made him a bite guard to protect his teeth at night.
He and his parents worked on simplifying his schedule, ensuring adequate time for sleep. They also talked a lot more about his college application process which, Zach admitted, really made him feel less alone and less anxious about the outcome.
If you are - or suspect you are - a grinder, see your dentist to evaluate if there is any damage to your teeth. A visit to a sleep specialist is warranted if there are other symptoms.
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