bruxism

What are teeth?

Your teeth are made of a hard, bonelike material. There are four parts:

• Enamel, your tooth's hard surface
• Dentin, the hard yellow part under the enamel
• Cementum, the hard tissue that covers the root and keeps your teeth in place
• Pulp, the soft connective tissue in the center of your tooth. It contains nerves and blood vessels.

You need your teeth for many activities that you may take for granted. These include eating, speaking and even smiling.

What are tooth disorders?

There are many different problems that can affect your teeth, including:

• Tooth decay - damage to a tooth's surface, which can lead to cavities
• Abscess - a pocket of pus, caused by a tooth infection
• Impacted tooth - a tooth did not erupt (break through the gum) when it should have. It is usually wisdom teeth that are impacted, but it can sometimes happen to other teeth.
• Misaligned teeth (malocclusion)
• Tooth injuries such as broken or chipped teeth

What causes tooth disorders?

The causes of tooth disorders varies, depending on the problem. Sometimes the cause is not taking good care of your teeth. In other cases, you may have been born with the problem or the cause is an accident.

What are the symptoms of tooth disorders?

The symptoms can vary, depending on the problem. Some of the more common symptoms include:

• Abnormal color or shape of the tooth
• Tooth pain
• Worn-down teeth

How are tooth disorders diagnosed?

Your dentist will ask about your symptoms, look at your teeth, and probe them with dental instruments. In some cases, you may need dental x-rays.

What are the treatments for tooth disorders?

The treatment will depend on the problem. Some common treatments are:

• Fillings for cavities
• Root canals for cavities or infections that affect the pulp (inside of the tooth)
• Extractions (pulling teeth) for teeth that are impacted and causing problems or are too damaged to be fixed. You may also have a tooth or teeth pulled because of overcrowding in your mouth.

Can tooth disorders be prevented?

The main thing that you can do to prevent tooth disorders is to take good care of your teeth:

• Brush your teeth twice a day with a fluoride toothpaste
• Clean between your teeth every day with floss or another type of between-the-teeth cleaner
• Limit sugary snacks and drinks
• Don't smoke or chew tobacco
• See your dentist or oral health professional regularly

What is sleep?

Sleep is a complex biological process. While you are sleeping, you are unconscious, but your brain and body functions are still active. They are doing a number of important jobs that help you stay healthy and function at your best. So when you don't get enough quality sleep, it does more than just make you feel tired. It can affect your physical and mental health, thinking, and daily functioning.

What are sleep disorders?

Sleep disorders are conditions that disturb your normal sleep patterns. There are more than 80 different sleep disorders. Some major types include:

• Insomnia - being unable to fall asleep and stay asleep. This is the most common sleep disorder.
• Sleep apnea - a breathing disorder in which you stop breathing for 10 seconds or more during sleep
• Restless leg syndrome (RLS) - a tingling or prickly sensation in your legs, along with a powerful urge to move them
• Hypersomnia - being unable to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness.
• Circadian rhythm disorders - problems with the sleep-wake cycle. They make you unable to sleep and wake at the right times.
• Parasomnia - acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating

Some people who feel tired during the day have a true sleep disorder. But for others, the real problem is not allowing enough time for sleep. It's important to get enough sleep every night. The amount of sleep you need depends on several factors, including your age, lifestyle, health, and whether you have been getting enough sleep recently. Most adults need about 7-8 hours each night.

What causes sleep disorders?

There are different causes for different sleep disorders, including:

• Other conditions, such as heart disease, lung disease, nerve disorders, and pain
• Mental illnesses, including depression and anxiety
• Medicines
• Genetics

Sometimes the cause is unknown.

There are also some factors that can contribute to sleep problems, including:

• Caffeine and alcohol
• An irregular schedule, such as working the night shift
• Aging. As people age, they often get less sleep or spend less time in the deep, restful stage of sleep. They are also more easily awakened.

What are the symptoms of sleep disorders?

The symptoms of sleep disorders depend on the specific disorder. Some signs that you may have a sleep disorder include that:

• You regularly take more than 30 minutes each night to fall asleep
• You regularly wake up several times each night and then have trouble falling back to sleep, or you wake up too early in the morning
• You often feel sleepy during the day, take frequent naps, or fall asleep at the wrong times during the day
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep
• Your bed partner notices that your legs or arms jerk often during sleep
• You have vivid, dreamlike experiences while falling asleep or dozing
• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh
• You feel as though you cannot move when you first wake up

How are sleep disorders diagnosed?

To make a diagnosis, your health care provider will use your medical history, your sleep history, and a physical exam. You may also have a sleep study (polysomnogram). The most common types of sleep studies monitor and record data about your body during a full night of sleep. The data includes:

• Brain wave changes
• Eye movements
• Breathing rate
• Blood pressure
• Heart rate and electrical activity of the heart and other muscles

Other types of sleep studies may check how quickly you fall asleep during daytime naps or whether you are able to stay awake and alert during the day.

What are the treatments for sleep disorders?

Treatments for sleep disorders depend on which disorder you have. They may include:

• Good sleep habits and other lifestyle changes, such as a healthy diet and exercise
• Cognitive behavioral therapy or relaxation techniques to reduce anxiety about getting enough sleep
• CPAP (continuous positive airway pressure) machine for sleep apnea
• Bright light therapy (in the morning)
• Medicines, including sleeping pills. Usually, providers recommend that you use sleeping pills for a short period of time.
• Natural products, such as melatonin. These products may help some people but are generally for short-term use. Make sure to check with your health care provider before you take any of them.

What are temporomandibular disorders (TMDs)?

Temporomandibular disorders (TMDs) are a group of more than 30 conditions that affect your temporomandibular joints (TMJs). You have two TMJs; one on each side of your jaw. They connect your lower jaw to your skull.

TMDs can cause problems in your jaw joint and your muscles that control jaw movement. These problems can include pain, stiffness, and trouble chewing.

There are three main types of TMDs:

• Disorders of your jaw joints
• Disorders of the muscles you use for chewing
• Headaches from a TMD

Many TMDs last only a short time and go away on their own. However, in some cases they can become chronic (long lasting)

What causes temporomandibular disorders (TMDs)?

Sometimes an injury to the jaw or TMJ can cause a TMD. But in most cases, the cause is not known.

Research suggests that certain factors may play a role in why a TMD starts and whether it will be long lasting:

• Genetics
• Psychological and life stressors
• How someone perceives pain

Who is more likely to develop a temporomandibular disorder (TMD)?

Anyone can develop a TMD, but it is more common in women than in men. It is most common in women between 35 and 44 years old.

What are the symptoms of temporomandibular disorders (TMDs)?

The symptoms of TMDs may include:

• Pain in the chewing muscles and/or jaw joint. This is the most common symptom.
• Pain that spreads to the face or neck.
• Jaw stiffness.
• Limited movement or locking of the jaw.
• Painful clicking or popping in your jaw joint when you open or close your mouth. However, clicking or popping without pain is common and is not a sign of a TMD.
• Tinnitus (ringing in the ears), hearing loss, or dizziness.
• A change in the way the upper and lower teeth fit together.

How are temporomandibular disorders (TMDs) diagnosed?

There is no standard test used to diagnose TMDs, and some other conditions can cause some similar symptoms. This can make TMDs hard to diagnose.

To find out if you have a TMD, your health care provider or dentist:

• Will take a detailed medical history, which includes asking about your symptoms. They will want to know:
  • Where the pain is
  • When you have it
  • What makes it better or worse
  • If it stays in one area or spreads to other parts of your body
  • If you have any other pain conditions such as headache or back pain
• Will examine your head, neck, face, and jaw for:
  • Tenderness
  • Jaw clicking or popping
  • Problems moving your jaw
• May order imaging studies such as an x-ray, MRI, or CT

What are the treatments for temporomandibular disorders (TMDs)?

For many people, the symptoms of TMD are temporary. To help you feel better, your provider or dentist may suggest that you:

• Eat soft foods.
• Apply heat or cold to the face and do some exercises to gently stretch and strengthen your jaw muscles.
• Take over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
• Stop clenching your jaw, chewing gum, and biting your nails.

If those do not help, your provider or dentist may suggest other treatments such as:

• Physical therapy
• Self-management and behavioral health approaches, which can include:
  • Cognitive behavioral therapy (CBT), a type of psychotherapy. It can help you identify negative thoughts and change them. It can also teach you coping skills.
  • Biofeedback, which involves using electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension. For example, it can detect when you tighten your jaw muscles. You can learn how to recognize when this happens and then relax your muscles.
• Medicines such as:
  • Anti-anxiety medicines
  • Antidepressants
  • Anti-seizure medicines
  • Prescription pain relievers
• An intraoral appliance, which is a device that fits over your teeth. Types of intraoral appliances include oral splints and mouth guards. If you are going to use one, it's important to:
  • Know that there is not a lot of evidence that they improve TMD pain.
  • Make sure that the appliance you have is not designed to permanently change your bite.
  • Let your provider or dentist know if it makes your pain worse.
• Complementary treatments, which are treatments that are used along with mainstream medical care. There is limited evidence showing that they help with TMD symptoms. But some providers and dentists may recommend acupuncture and transcutaneous electrical stimulation (TENS). TENS involves using a device to send a gentle electric current to your nerves or muscles. It may help treat pain by interrupting or blocking the pain signals.

If you are still having severe symptoms from a TMD, your provider or dentist may suggest surgery, including implant surgery, or another procedure.

It's important to be careful, because sometimes surgery or another procedure may not work or may even make your symptoms worse. Before any surgery or other procedure, it is very important to get opinions from more than one provider and to completely understand the risks. If possible, get an opinion from a surgeon who specializes in treating TMDs.

NIH: National Institute of Dental and Craniofacial Research