Do You Grind, Clench or Gnash Your Teeth?

I'm Dr. Michelle Hucke, owner and operator of Jax Beaches Family Dentistry, with my partner, Dr. Liz Alfuente and with my associate dentist, Dr. Kelly Carrothers. We are also very blessed to have an amazing team that makes us look good and makes our patients feel welcome and cared for each and every day. Thank you so much for joining us today. This is a very timely topic, especially during the pandemic where people are under a lot of stress and pressure. At Jax Speeches Family Dentistry, we're seeing a lot of patients that have a lot of extreme stress, related to all different things, especially now with kids going back to school, a lot of daytime sleepiness, and what we're seeing in the office, in our dental office are emergencies related to clenching and grinding like tooth fracturing, lots of jaw pain, people that have a history of clenching and grinding are ending up with their jaws locked and just situations that they normally wouldn't come in for are now really becoming symptomatic because of the stress and pressure that we're under.

And honestly, we're generally just not taking very good care of ourselves. We have been dealing with something that we thought was temporary and it's dragging on, and our bodies are starting to show the signs and symptoms of that stress. Here at Jax Beaches Family Dentistry, we are very passionate about helping people find natural alternatives for treatment. Anybody that knows me knows that even though I was trained in and I’m and involved in Western medicine as a dentist, I'm more of a natural remedy kind of girl, not really a hippie, but I definitely like to find a natural remedy instead of popping a pill for your next ill. If you have any questions while you're watching this webinar, please feel free to email me. A couple of different times throughout the webinar, you will see my email address. This is my beautiful partner, Dr. Liz Alfuente. Here's my amazing hygiene team. And we're going to start off talking about grinding, which is also known as bruxism. It's a condition that includes clenching, grinding, gnashing, all of that. So it's the formal term for grinding your teeth. It's often done unconsciously, mostly when you sleep, but it also can be done when you're awake. And I did a lot of extensive training about bruxism at an Institute called the Pankey Institute. And when I did my training, most of the time, and most of what we were talking about was your bite and the way that your teeth fit together. And the feeling back then was that was the main reason why you did grinding and the treatment for it, especially from the dental side, was all revolving around making your bite better and protecting it with a traditional bite guard or night appliance.

So if any of you are watching this because you have been a clincher and grinder, or you are, I'm sure you've talked about that with a dentist, or you've been tempted to use an over-the-counter mouth guard, please don't do that from CVS. And that's because that was as dentists, what we mostly talked about, that was how we were trained, that was what we knew. And now what we're aware of, which is really kind of new, breaking information about grinding is that most of the time, up to 70% of the time, if you're grinding your teeth, it's because you have some sort of sleep issue. And we always used to say to people, well, during the day, there are different things that we can do to try to break that daytime habit because that daytime habit is usually stress-related and can actually be broken.

So at night, what it is is it's usually some sort of sleep issue or an airway restriction, which we will talk about. So the symptoms are important to know about the symptoms of bruxism because if you aren't aware that you're doing it, there are some really detrimental things that can happen. So it's good for us to all know what the symptoms are because a lot of times, the activity itself can actually be silent. So people think, Oh, well, I would know if I was grinding because my spouse or my dog, or, it would be noisy so, they would know that I'm grinding my teeth, but actually clenching, which is just kind of holding your teeth together is very silent. And also a lot of people say, Oh, well, I know that I don't snore because my bed partner doesn't hear me.

But even mouth breathing with quiet snoring is actually not good for your health at all. So a lot of the symptoms are very subtle, your teeth can be flattened or chipped. Your teeth can be worn. You could also end up with tooth sensitivity that kind of comes and goes like there was a tooth over here, that's sensitive. And then, a couple months later you have a tooth down here that sensitive. You could also have jaw soreness, pain that feels like an earache because your jaw joint is right near your ear. So a lot of times people think they have an earache or they have a sinus infection and it's really a jaw pain. You can also have pain in your temples because if you put your hand on your temples and you clench your teeth together, you can feel that that muscle moves.

And so that muscle will actually, become sore. And then also you can develop a, if you're a clincher grinding, or a lot of times you have a cheek biting habit. And again, like I was mentioning before, it’s related to sleep issues. So a lot of times clincher and grinder people that are having all these other symptoms also have sleep disruptions. So if any of these things ring true to you, it's really important to mention that when you go to the dentist, so no matter where you go as your primary dentist, if you have any of these symptoms, you want to bring them to our attention. Not because anything drastic, maybe needs to be done, but it is good to have, mention of that in your charge.

Like we were talking about before, what are the causes of bruxism? So it used to be, we really believed that it was causally related to your bite, but the bruxism association came out with a report and the report says the research concludes that neither occlusal interference, and that means a bad bite nor factors related to the oral facial skeleton have a role in the etiology of bruxism. So all that really means is that's really not what causes it. And then awake bruxism like I talked about before, so that would be holding your teeth together instead of having them be relaxed and apart that's really associated with emotional stress and tension. And then the research on sleep bruxism, which is what I was talking about before is that it's a secondary etiology related to arousals. So when you have an airway restriction that generally causes you to wake up and brings you out of your deeper level of sleep, and that is what then causes you to grind your teeth? And a lot of people's theory with that too, is that you wake up because your airway is restricted, when you lay back and you're sleeping, your tongue blocks your airway, you bring your jaw forward and you start to grind in order to then open up your airway. And so that's where the grinding comes from.

So that brings us to sleep disorders. So there are all kinds of sleep disorders and research really consistently without any doubt at this point, we know that grinding your teeth really, isn't a solo thing. You don't just grind your teeth. And it's something that we put an appliance in and we're going to protect your teeth. We really, at this point, it is our obligation as dentists to kind of get to the bottom of where's the grinding coming from. Again, it's that whole root cause medicine feeling of, we could just put something into protect your teeth, but it's important to figure out, where's the issue coming from, especially if you might just be a snore, but snoring is not good for you. And you also may have obstructive sleep apnea, which is a serious medical issue. So it's our obligation as dentists now, to be sure that you don't have obstructive sleep apnea if you're grinding your teeth. First of all, because if you do, you're not ever going to stop grinding, which isn't good for your teeth. And if you have obstructive sleep apnea, it's important for us to uncover that.

And then another thing that's interesting is, what is the prevalence of bruxism, how many people clench and grind and just like a lot of things, right? It's a really wide range. And what I noticed is they're saying that it's between 8% and 31% of the general population and that big range has to do with the fact that a lot of times kids are clenching and grinding. And then as they get older, that goes away. There are some contributing factors, which I thought were interesting, actually, smoking and caffeine and take alcohol consumption. Isn't a surprise, right? Because those things cause you to do everything. But then the other thing was that the higher education that you had, the more you have a tendency to brucks, which I guess maybe in hand with your stress level and lifestyle stuff, and everything. If you eat better and you have better sleep habits then you have less of a tendency to bruck.

Next slide. So stress, right? Research shows that 70% of grinding occurs as a result of stress or anxiety, which we just talked about. Right? And the most significant thing again has to do with sleep. So the bruxism association again said stress levels and personality characteristics are often considered as initiating and predisposition for several diseases and your personality. And whether you have the ability to cope really determines whether or not you can stop grinding. And they also say this is not a surprise, right? Some of us are less resilient to stress and suffer more from the consequences of that. And we grind our teeth more. One of the most common things, and this isn't a surprise to anybody is the more you grind, the more your jaw joint is painful and also can cause movements and disruptions in those movements. So it can make it painful, which we already talked about.

It also can make it so that it hurts to open wide. So what I tell people is, if your jaw joint is popping and clicking, that is something that potentially has happened as a result of damage that you've already done. It doesn't matter that much, just like some people have a knee that pops and click. It doesn't matter that much, unless it, progress where it starts to be painful. It does not matter that much, unless you have a history of it clicking, popping, and getting stuck. And then at that point, we may want to take a look at some treatments. Now my feeling about treatments are, we don't do surgery as much as we used to anymore. Most of the time what we're doing are supportive treatments, which I'm going to talk to talk about in a minute. And that is massage, chiropractic, acupuncture, things like that, that are non-invasive.

And we also sometimes still make certain appliances that help relieve that pain. So you might have trouble chewing you definitely, if your bite significantly changes, that's something that we want immediate attention to. The other thing that is actually an emergency and an urgent need to address is if your jaw is getting stuck or you feel like you can't close. If those things remain for too long, they actually become chronic. And we definitely don't want to get to the point where something that's popping and clicking is painful and it's staying painful, very important to address that. So natural relief, I'm all about, because I do not like drugs or medications whenever possible. So our strategy really is dentistry. Obviously, taking a look at it, seeing if we need to make an appliance, functional medicine, which helps us get to the root cause of it, physical therapy, acupuncture, and chiropractic care.

And I am super blessed. We are super blessed in the Jacksonville area to have a whole team of people that have a lot of experience with that. And there are people that I trust they're not going to do treatment just because that you came to their office. They are very experienced in that. So I'm super blessed to be able to be surrounded with people that I trust. Also very important, like we talked about earlier to limit things like caffeine and alcohol, you definitely also do not want to be a gum chewer if you have a tendency to have a sore jaw, and there are some sort of, if you have a flare up, there are things that you can do at home that are like home remedies. You can put heat. So heat on your joint can really help obviously reducing your stress and anxiety, being sure that you have a bedtime routine and then getting really good exercise and eating well. Here are my people that I love and trust. If you want to take a picture or screenshot of this. Dr. Ellen Duke is my functional medicine specialist. Dr. Nick Scotto is an incredible physical therapist who only works one-on-one with patients and loves challenging patients and it's river city physical therapy. Dr. McGuffin has a lot of experience with jaw issues. She's a chiropractor. She's amazing. And then Andrea is an acupuncturist. So not only does she do acupuncture, but she also does massage on the joint. She's amazing. So since I'm a dentist, let's talk about dentistry. If I can figure out how to talk again, we're going to talk to you as dentists about your stress and try to figure out what things in your life might be causing you to have those disruptions in sleep. And then also we're going to take a look at the wear and tear on your teeth. Your bite can be something that's going to exacerbate if you are clenching and grinding, we now know that it doesn't necessarily cause it, but if you've worn your teeth down, then it can make things like your jaw pain worse. So we're going to look at that and see whether we need to do some dentistry to make your bite better, or whether we need to consider moving some teeth to get your bite better.

So that the system works better because your teeth are like little years and they have to work together in order to alleviate the stress in your jaw. So the alignment is really important. And then, as I mentioned before, if you're clenching and grinding, you've got a night appliance and that was going to protect your teeth. A lot of people couldn't wear those night appliances. And we now know that the reason that they couldn't wear them is because their airway is restricted and that the particular standard night appliance just made the airway even much more restricted. So we don't do that anymore. What we do is we do a home sleep test before we decide what kind of appliance that you need. A lot of times you need an appliance to help with snoring, or you need an appliance that helps open up the airway, which then will also obviously protect the teeth.

And then some people, need medical care. They need a C-PAP machine, or they need to take a look at, losing weight, eating different foods, modifying what they're drinking and when they're drinking it in order to get some better sleep so they can stop grinding. Functional medicine like I mentioned before, with someone like Dr. Duke, Duke is super helpful. A lot of times, honestly, you're just eating something that doesn't serve your body well. It creates inflammation, it causes pain and sometimes that jaw pain is just the area in your body that gets inflamed when you eat the wrong foods. So it's amazing when you go to see someone like Dr. Duke, she helps me decide like, what things do I eat and what things do I do that are going to serve my body well, and make me feel good so that I have a better chance of sleeping better and not grinding my teeth as much because my job can really kill me if I'm not behaving myself.

And none of us behave ourselves all the time, that's just part of life, right? Physical therapy and chiropractic therapy can be a huge help. Again, I'm really blessed. I have a chiropractor, Dr. Suzy McGuffin, she's right in Jacksonville Beach. She has a lot of expertise and helping people with their jaw issues. She's not going to snap your jar around, cause certainly, that's not something that you want to have done. If your jaw is sore, she does really gentle adjustments. And that allows the pain to be relieved and then physical therapy is the same thing, they work hand in hand and they co-manage patients. They also give you advice about different exercises to do. I will say that the webinar and research that was associated with this webinar was really good, but I would really urge you not to, if you're having jaw pain, to look up different things online in terms of exercises, I think it's really important to actually go see one of these therapists and make sure that whatever exercises you're doing is what's best for you because you really can aggravate and make them make it worse.

Acupuncture is also amazing. Acupuncture is, it's thousands and thousands of years of therapy. They can tell which areas of your body are overactive. It's treated as with the needles and they correct and help with organs that are over-functioning, which caused inflammation and pain. The great thing about Andrea at acupuncture by Andrea is that she's also really experienced with jaw issues and she's very experienced with massage. So she can do both modalities and helps a lot with my patients that are having jaw pain.

We already talked a lot about sleep. The most important thing about sleep is figuring out if you have an airway restriction, we do that with our home sleep test, or are you going to have a home sleep test done by your physician? Or you can obviously do the hospital-based sleep tests. It really doesn't matter to me. I just want to make sure I see the results. One of the things with hospital-based sleep tests, and depending on what physician you see is a lot of times, if your score sort of like being grade when you're in school, you can either have a good grade or a bad grade, right? So if your score, which is called an AHI is above 30, then physicians say, Oh yeah, look at that. You have sleep apnea. You need a C-PAP machine.

And some, some physicians, if they don't know about the different levels of sleep and airway restrictions, will look at a lower score and feel like, Oh, well, that's not a big deal. Or it's something that doesn't really require treatment because your score is low. The thing with that is that even if your overall score is low, you may be grinding your teeth because when you're in a certain position, for most people, that's on your back, your airway is in fact highly restricted, and that causes you to grind your teeth. So it's important to me, if people are going to get their sleep tests done at a hospital, or if they're going to get the sleep test done by a physician that I still see that, so that we can be sure that we figure out where that grinding is coming from.

There are things like positioning yourself that you can do once we see the results of your sleep test. If you're only having an airway blockage when you're on your back, some people can effectively position themselves on their side and then they don't have an airway restriction. So they'd become a perfectly normal sleeper. They were just on their side. And then the other thing, and this is something that you can Google, you just Google sleep hygiene. When you Google that term, because it's kind of a very common term, you will see all kinds of tips about things to do, especially now that we have screens everywhere in our house, including in our hand, we have pretty bad what's called sleep hygiene. So sleep.org has a list of recommendations, I think are really good. And that is to keep a schedule, right?

And now we had our Fit bit, so you can program yourself to start going to sleep at a certain time and the screen that you're not supposed to be looking at right before bed reminds you go to sleep. So keep a schedule, be mindful of what you eat and drink, which we already talked about. You don't want to be drinking coffee at 10 o'clock at night. You want to have a quiet, cozy, welcoming, sleep-inducing space. You want to start with a ritual. So, if you always read before bed, then that will help you put, go to sleep. And then if you wake up, you don't want to watch the clock and be panicking that you're not going to get enough sleep. If you have a tendency to wake up in the night, first of all, it's a sign that there might be something going on with your sleep.

So, but if you do wake up, it's good to have a, Oh no, I woke up in the middle of the night ritual so that you don't start to panic and get anxious about being awake. So those are good things to know. And then there's classic stress management techniques. Yoga, working out, running, meditating because grinding just gets worse during stress. Now, again, in the past, we always thought that that was because of your bite. And when you were stressed, you just noticed your bite more. And so you were grinding. But I really think that it's related because it's so related to sleep. Stress management is important because that allows you to get better sleep. Essential oils can be helpful. In fact, now in dentistry, because we're so linked to sleeping in terms of trying to keep people's teeth healthy, there's actually classes now, which never was a thing.

But now in dentistry, we have essential oil classes. So one of them, the whole list of them, which are great. So peppermint oil is helpful because it helps reduce anxiety. Frankincense reduces inflammation, lavender, as we all know is calming. So that's something that you can put in the room or put on your pillow. Chamomile oil can be also put in the room. It's that's something that I drink at my tea at night, which helps me to relax. Rosemary oil has always been known as an anti-inflammatory, so that can help with your sore jaw and then turmeric oil is a strong, relaxing, and anti-stress oil. Well, that's good to know. And then this is something that I'm learning more and more about because I'm 55 years old and I am twin 12-year-old. So I'm trying to live a long, healthy life.

And I've gotten very assertive and aggressive about it, especially too, because I found out that I have osteopenia. So none of these things are things that I want to deal with long-term so supplements have become a thing for me. And then the more that I read about how important it is not to just pop a bunch of pills, first of all, because I hate popping pills. And then it's also been shown and proven over and over again, some of which I've read about because of my webinars that I do, that you live a much longer and healthier life if you actually eat things that you would normally take a supplement for. So if you're trying to improve your levels of vitamin C, it's really tempting to just take vitamin C, but it is much better for your long-term health and wellness to eat foods that have vitamin C in them.

So that's something I'm just learning, as part of my life. So vitamin C complements stress management, because it helps with your fatigue, adrenal glands, which happens, as a natural part of aging, but also as a natural part of not sleeping well. So vitamin C rich foods are things like red peppers, Kiwis, green peppers, oranges, papaya, broccoli, et cetera. Magnesium deficiency, I've learned a lot about this recently. It's associated with anxiety, irritability, insomnia, restlessness, and hyperactivity. And so you can imagine if you're clenching and grinding your teeth and you're not sleeping well, that you certainly could use some magnesium. So there are a lot of supplements like I just found one that I can put in my drink that's a magnesium calming supplement and having a little boost of magnesium is great for you in terms of your ability to sleep right later in the day.

And magnesium-rich foods include spinach, chard, pumpkin seeds, Kiefer, Yogurt, almonds, black beans, avocados, figs, dark chocolate, for you chocolate lovers and bananas. Yeah. I have been eating a lot of that. The role of vitamin B vitamins in your overall health and wellness is well known. Everyone knows you can go get a vitamin B shot and vitamin B is super important on all different levels. And it really helps with stress, depression and even panic attacks. So super important to be sure that not only are you taking vitamin B, now it has to be taken a certain way, which is why people get injections, vitamin B, B12 injections, but also it's an important level to be checking when you're having your physicals and your checkups and things. Valerian root. This is something I'm actually going to look up after I get off this webinar because I learned about this while I was doing my research for this webinar.

It's a natural sedative and anti-anxiety treatment shown to improve the quality of sleep, which we all want, right? With no reported side effects and since bruxism or grinding is a sleep disorder, then we all need to have some more of that. So as we wind down as always, I have all kinds of references, lists and lists and lists that are related to this webinar. So if you heard something that you thought was kind of odd, or you heard something that you thought was sort of interesting, please feel free to email me as always, and I can pull up the article for you and send it to you. And then I want to thank you guys for taking the time to watch this. I appreciate your support. And I love that people are interested enough to watch me share information. That's interesting to me. Please go to our website, which is Jacksonvillebeachdentists.com. This is me. This is our phone number at the office. And I just want you to know that I hope that you've learned something. I hope the information was useful. And if anything was interesting or I can support you in any way, or if you're a dentist and you think what I'm talking about is interesting, please just shoot me an email and I am happy to answer those.


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