If you are suffering from headaches, jaw soreness, or tooth pain you may be grinding or clenching at night and not even know it.

Many people grind and /or clench their teeth during the day and at night. This can be just out of habit or possibly from a change in your daily stress level. This problem is widespread and is common in both women and men. I call it the “silent killer” in dentistry because people are generally not aware of the long-term negative consequences from their daily stress.

You may have this problem and it could go undetected or undiagnosed for years. The symptoms vary widely from patient to patient. Many times, it will present as tooth pain from two or three teeth in one area of the mouth. It can range from a vague soreness to a very debilitating severe pain in one tooth. Other generalized symptoms could be frequent or constant headaches, shoulder soreness, and jaw soreness located just under the ear on one or both sides. This condition is sometimes difficult to diagnose because the symptoms may come and go. The symptoms can also widely range from mild to severe.

I usually see multiple patients a month who are grinding or clenching so intensely that they come to the dentist with what they report as a severe toothache. The treatment for these patients is usually easy, and with patience and proper care, their symptoms will resolve. Initially, I will do an examination to determine the underlying cause of the pain. If it is probable that you grind your teeth, I will usually prescribe a bite guard to be worn at night and/or during the day. This is used in conjunction with non-steroidal anti-inflammatory drugs, warm compresses, massage therapy, and most importantly recognizing and minimizing the stress triggers that may be the root cause. A bite guard is an acrylic mouthpiece that is worn much like an orthodontic retainer. This stabilizes your bite and your jaw joint. It allows the teeth to fit together in a more favorable way and places your jaw joint in a more relaxed position.

One very common and very important subgroup of this condition is patients that grind but have no symptoms. They will usually report no pain, but upon clinical examination it is noticed that they are causing significant damage and excessive wear to their enamel (the first layer of the tooth). These tend to be males and as they grind their teeth over the years, their teeth they become shorter, fractured, and can even expose the nerve once the wear exceeds the thickness of the dentin (the second layer of the tooth). Fortunately, if this condition is diagnosed early, you can wear a bite guard and prevent the damage from occurring. However, if the wear goes unchecked, the treatment can be extensive and expensive and involve placing crowns on some or all of your teeth. If you have porcelain crowns in your mouth, a bite guard can even be used solely as a protective device to prevent fracture of the surface porcelain.

I often receive questions about using over-the-counter bite guards from the drug store. I do not recommend using these, as their consistency is soft, and this seems to stimulate clenching at night. Most of the over-the-counter guards (or “boil and bite” mouth guards) are made this way and seem to worsen the problem.


M. Scott Smith, DMD