Bruxism & Sleep Splints
Bruxism & Sleep Splints
Bruxism is the grinding or gnashing of the teeth for no apparent reason during the day time, usually semi-voluntary movement of the lower jaw. Grinding is usually your front teeth and will show signs of wear.
Sleep Bruxism is an involuntary motor activity during sleep associated with tooth grinding and often leads to problems with the jaw, neck and headaches.
Clenching - Everyone does it at night in their sleep and does not show wear on your teeth!!!. When it increases, it becomes a problem (pathology). It is the meeting of the back teeth, in different parts of your sleep cycle, to when you could possibly grind your teeth. Is often done all day long with increased stress or on the start of a new activity. You don't have to clench down hard to start causing problems and over activity of your power muscles (Masseter muscles).
The Masseter muscles over power the endurance muscles and change the activation pattern of your jaw muscles. Just like the rest of the body, your deepest muscles should fire first, then the next layer, then the next layer. By clenching you are stopping your deep endurance muscles from working first and allowing just your top layer of muscles (the power muscles) to work all the time. They get tired and fatigue and cause a poor pattern of jaw opening and closing, causing pain and dysfunction. Leigh has some great ''jaw Pilates'' exercises to reboot your muscles to allow your jaw to open and close properly and reduce the pain and clicking and locking.
Biggest triggers for increased clenching and grinding; High sugar (complex sugars like pasta/rice/milk/alcohol), restricted airways, or OSA = obstructive sleep disorder, hormonal imbalance.
If you answer yes to these questions, you may need a sleep study;
don't wake up refreshed after a nights sleep,
sleep on your back, (not good, best position is on your side, worst position is on your tummy)
sleep with your mouth open (drool on the pillow, or dry mouth in the morning)!!
Normal sleep
Duration is between 6 to 9 hours over a 24 hr circadian rhythm. Non REM sleep is 75-80% of your sleep and associated with body movement and sleep bruxism. (Kato et al 2003a) 74% of cases this bruxism occurs with clients sleeping on their backs, the same position which sleep apnea clients sleep in. (Lavigne et al 2005a).
No sleeping disturbance = Splint Treatment
See a Specialised Dentist or Oral-facial doctor for an occlusion splint (night guard) if no sleeping problems. Occlusion Splints - are much better as a lower jaw appliance (if you have TMJ symptoms or scan changes), they come as either a: - decompressive splint, or - neutral splint. The acrylic splints take longer to mould, however they are more comfortable and sit lower in the mouth. Proxy splints are cheaper/quicker to mould, however they are bulkier and affect the tongue position in the mouth, which we know will then affect sleeping (ie. oxygen uptake or degree of bruxism).
Sleep disturbance = snoring, tired in the day, partner reports teeth/jaw noises.
See a sleep study clinic. Mandibular advancement devices and be made, or CPAP therapy (continuous positive airway pressure device).
Hormones and Breathing and thus more clenching
For Women; Evidence shows that progesterone (in women) and thyroxine (women and men) support upper respiratory tone (open airways). Thus less clenching, possibly grinding in sleep. Reference; Tarja Saaresranta 1, Olli Polo. Hormones and Breathing, Chest. 2002 Dec;122(6):2165-82. doi: 10.1378/chest.122.6.2165.
It’s important that your doctor knows the different levels of hormones for the different ages and when to test. The nurse practitioner I refer to likes the blood test taken on day 21 of your cycle. If you are 18yrs - 40yrs the Luteal phase of your progesterone should be > 30. Over 40yrs it is a lot more complex and you need to talk it over with your nurse practitioner or endocrinologist.
For Men; Evidence is very poor with measuring whether hormone therapy in men with sleep apnoea helps, as many other conditions will also occur, like obesity, high cholesterol. (Also the studies are only done on older men, ie >50yrs???).
Many younger men are experiencing fatigue, clenching, headaches, poor sleep. We know, poor sleep leads to lower testosterone. Being overweight significantly decreases testosterone. Thus men need to lose weight before hormone therapy if over 50yrs (from one article that has low subject numbers????).
But wouldn’t it be better to catch this before it becomes a chronic condition!!!?? Surely seeing an earlier pattern in younger men, will dramatically decrease the developing respiratory and cardiovascular risk. Thus stop them becoming grossly overweight before they reach 40-50 yrs of age.
Dr Dan Purser describes the benefits of normalising testosterone levels in men (levels should be 30-35) naturally (i.e finding out the vitamin deficiencies responsible) to allow for weight reduction, reducing cardiovascular risk, optimising energy levels etc. Reference: substack, Dr Dan Purser, 50+ Referenced Benefits Of Normalizing Testosterone Levels Naturally in MEN!
His online program (and in videos on facebook), are extremely systematic and thorough.
Triggers for clenching / grinding / bruxism
Changes in hormone levels, eg adolescence, menopause, etc
Gut disorders or small bleeds in the GI tract
Respiratory disorders, and a lack of oxygen due to nose/airway obstruction - sinusitis, deviated septum's in the nose, broken nose etc
Anti depressant medication
Research is starting to show up to 3 months of taking this medication can trigger bruxism (day or night or both)
Pain specialists are finding links between some anti depressant medication and early onset Alzheimer's, make sure you are informed of your medication
Evidence suggests that exercise and psychological counselling is just as effective as anti depressants.
Large meals and alcohol (just have alcohol on the weekends)
Irregular sleep patterns - Go to sleep at the same time, wake at the same time, routine to wind down at night before bed (the body remembers and will help you fall into a deeper sleep). Good temperature, little light or noise
Disorganisation and worry;
Write down all your chores for tomorrow so your brain doesn’t have to remember them that night
Sync your diary and phone diary with all appointments / to do lists / reminders
Mondays – spend some time planning your week – write it down
Each morning – plan your day, write down your chores / ideas in your diary (maybe on your email calendar).
Analyse your life – do you need more balance
Don’t make other peoples issues your issues, you can help but don’t own those issues.