Clenching your teeth at night? So what’s the big deal?

For over three decades I’ve evaluated patients with Temporomandibular Dysfunction (sometimes simply called “TMJ”). Specifically, I’ve treated thousands of patients that come to me with all kinds of problems caused by sleep bruxism, defined as grinding or clenching your teeth at night while sleeping. These activities are often linked to neck pain, jaw pain, ear pain, headaches and toothaches that don’t respond to traditional dental treatment.

Millions of Americans clench (or grind) their teeth at night, so it shouldn’t come as too much of a surprise that the consequences can be extremely varied. Here is the story of a good friend of mine.

To protect his teeth while sleeping he has worn a night guard for many years.

Every now and then he would wake up and notice that his lower teeth were pressing against the top night guard very fiercely. He would do some relaxation breathing that I taught him and that usually was all he needed to get back to sleep. He, however, never had jaw stiffness, headaches, or tooth pain due to his clenching.

That all changed last week.

It was a Friday night and he apparently tossed and turned for hours before finally getting into a deep sleep around 2 am. The cause of his edginess was likely a combination of a large dinner with wine at an hour later than what’s normal for him and then watching a late movie. On top of that, his ears were straining to hear his daughter arrive home from a party (I’m sure all parents can relate to that!). It added up to a very restless night.

So, finally he fell asleep but two hours later was suddenly awakened by an extreme soreness in his lower left second molar that was braced into his night guard. After taking out the night guard he fell asleep but a couple of hours later woke up to a screaming molar (that’s the only way he could describe it!). To make matters worse, his ear throbbed and jaw ached. Even the gums around this tooth were apparently in crisis.

As it was Saturday he went to play a round of golf but by the second hole was rummaging through his bag for some Aleve. Not only was his mouth freaking out, but also his entire body had begun to tighten up as a result of that aching molar.

The Aleve did work after an hour or so and the pain, stiffness and body tightness began to ease. He was able to finish the full eighteen holes but apparently, it was a forgettable round.

So how does something like this happen? Here’s the blow-by-blow:

• The force of my friend’s clenching was so great that it traumatized the ligament that binds the molar to the supporting bone.
• Then the tooth’s nerve fibers started to react and the area “lit-up”.
• Pain spread from the tooth site to his jaw, ear and the gum tissues adjacent to the traumatized molar (all these areas receive the same nerve supply as the tooth).
• Finally, the side of his neck and left shoulder started to tighten and lock-up (this is called referred pain).

In actuality, my friend had sprained the tooth ligament by so fiercely clenching his teeth, initiating the pain scenario he described! Treatment was put into place to address this ligament sprain and I’m happy to report that since he came to my office there has been significant improvement in his condition. My friend has also made it his business to go to bed at a decent hour, avoid computer work just prior to going to bed and limit daily caffeine and late night alcohol (known risk factors that can drive teeth clenching and grinding while sleeping).

So…if you are a clencher, even if you use a night guard this could happen to you! If so here’s my advice:

After seeing your dentist to assess the damage, stop and take a good look at your lifestyle. Are you getting enough sleep? Too many glasses of wine at late night dinners? Evening hours doing paperwork or at the computer? Stress at a high level? Dwindling exercise and relaxation time? If so, make some changes and see how you feel. You may find that the aggressive clenching will ease reducing the potential for this scenario to be a common part of your life.

And here’s something you probably don’t know: night guards lose their effectiveness over time and can only do so much to protect your teeth and jaws; so injuries can still occur. Keep an eye on your daily world and do your best.