Bruxism (Teeth Grinding), Bite Guards and TMJ Dysfunction
Bruxism has been defined as the complex, unconscious grinding or clenching of teeth during sleep, or as a mechanism for combatting stress in waking hours. It has also been called the most prevalent, complex and destructive of all oral disorders. The amount of destruction of teeth can be so severe resulting in cracked teeth and nerve exposure leading to root canal therapy.
There is extensive literature on bruxism, offering a wide spectrum of opinions. Some studies say that it is the body's way of releasing stress. From a physical aspect, Michael Messing, DDS, a practicing dentist in Short Hills, NJ, did an extensive review of articles which consider bruxism as an attempt to remove interferences of a misaligned bite.
The review found that, even though there is a strong association between bruxism and temporo-mandibular joint (TMJ) dysfunction, one can be found without the other. When initial treatment is given to control the symptoms of TMJ dysfunction, bruxing may stop, but this does not necessarily mean that a permanent solution for bruxing has been achieved.
Take, for example, this bruxism patient.
Case History This female patient presented with a history of bruxism, TMJ dysfunction and difficulty making her teeth fit together. She had Invisalign treatment and veneers on the upper front teeth. Due to her grinding, the veneers were replaced twice because they kept breaking.
Photograph A shows that her upper and lower dental midlines were not aligned. This is not really a teeth problem. This is a jaw misalignment problem. The upper jaw was deviated to the right, while the lower jaw was deviated to the left.
Photograph B shows the severe destruction of tooth structure due to bruxing. Also, notice what the patient did when she attempted to get the dental midlines to coincide. This was the reason for her bruxing.
The body will try to find a way to achieve balance, and in doing so, this patient had to get her upper and lower jaw in the proper position by constantly sliding her jaw forward.
Bruxism is a physiological response to the presence of interference in the occlusal (bite) scheme.
Unless the jaw misalignment is addressed and treated, bruxism will continue even with the use of a bite guard.