Stress has always been one of the main focuses when looking for a source of a patient’s teeth grinding and clenching problems, so it shouldn’t be completely surprising that a disorder that’s known for being the result of trauma and stress could also coexist in a person with teeth grinding problems.
Recent research suggests that chronic stress, a common symptom of PTSD, may indeed increase the likelihood of bruxism episodes. By understanding this relationship, healthcare professionals can better assist patients with PTSD in managing both their psychological well-being and oral health.
In today’s blog post, we want to talk about how this knowledge has helped in the development of effective strategies to mitigate the occurrence of bruxism caused by PTSD or severe stress.
What is Teeth Grinding or Bruxism?
Bruxism is a condition characterized by the involuntary grinding, gnashing, or clenching of teeth. It can be both a movement disorder and sleep disorder, as it can occur during the day, known as awake bruxism, or during sleep, known as sleep bruxism.
Awake bruxism is often associated with stress, anxiety, or tension, and individuals may not even realize they are doing it until acute signs and symptoms appear, which are jaw pain, headaches, and tooth sensitivity.
Sleep bruxism, on the other hand, is a sleep-related movement disorder. It is thought to be caused by factors such as misalignment of the teeth or jaws, sleep apnea, or certain medications taken before sleep, along with chronic stress and anxiety in one’s life.
Also known as nocturnal bruxism, sleep-related bruxism (some people sleep during the day) is typically characterized by loud, rhythmic grinding sounds during sleep, and it can have negative consequences. These include tooth damage, jaw muscle discomfort, headaches upon waking, and disrupted sleep for both the sufferer and their sleep partner.
Of the two, awake bruxism is a bit more common in the general population, with awake bruxism being present in somewhere around 22.1–31% of the population and bruxism during sleep in 9.7–15.9%. However, there have always been questions about the difficulties of diagnosing sleep bruxism, as it occurs when both the patient and people around them are asleep and, therefore, likely underreported.
Overall, teeth grinding is a common condition that can affect up to 90% of the population, according to some studies, and can occur during both wakefulness and sleep.
Bruxism can either be the result of another condition or itself being the primary condition that needs to be treated. When bruxism is a secondary condition, then the primary condition needs to be resolved first as a way to treat the grinding of the teeth.
It is important to identify and manage bruxism, either as a primary or secondary condition, to prevent further dental complications and improve overall oral health.
Symptoms and Risk Factors for Teeth Grinding
Not all cases of bruxism can lead to severe or even pronounced symptoms or signs in sufferers, with some probably going through a period of teeth grinding that goes away without much notice.
But even people with moderate teeth-grinding sufferers will likely feel the most common bruxism symptom, which is muscle tension in the jaw and face. People who grind their teeth often experience tightness and discomfort in their jaw muscles, which can contribute to chronic grinding.
They or their sleep partners might also hear the grinding sounds or notice their jaw clenching.
Other symptoms of teeth grinding include headaches (morning headaches in the case of sleep bruxism,) earaches, tooth pain from teeth damage, orofacial pain, joint pain, neck pain, and eventually, in extreme cases, tooth loss.
Bruxism and jaw clenching can also lead to the development of temporomandibular joint disorder (TMJ or TMD), which is damage to and inflammation of the jaw joint, leading to problems with chewing, chronic pain in the jaw muscles, and other potentially serious complications.
Bruxism and TMJ or TMD are not the same. Most sufferers with TMJ also brux, and there may even be a causal relationship between the two disorders. Bruxism can either be a secondary condition from TMJ/TMD, or it can even be primary; the connection between the two is unclear.
The risk factors commonly present in most cases of bruxism include psychosocial factors like anger, stress, and anxiety, as these emotions can lead to increased muscle tension in the jaw. Teeth grinding and clenching can also result from having an abnormal bite or misaligned teeth, as problems with properly speaking, chewing, or biting can accumulate and lead to habits that make teeth grinding inevitable.
Certain lifestyle choices like excessive alcohol consumption or tobacco use can also contribute to the development of bruxism, as they disrupt sleep, increase stress and anxiety, and affect muscle tension and movement.
Definition Of Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, and it can lead to constant intrusive thoughts or memories, nightmares, flashbacks, and heightened anxiety or irritability.
While most people who lived through a traumatic event won’t necessarily develop this disorder, anyone is susceptible and isn’t limited to an amount of trauma or type. PTSD is less common in children (but still possible) than in adults.
The link between bruxism and PTSD begins with remembering that bruxism can be a secondary condition of chronic stress. In fact, stress is the number one risk factor involved with teeth grinding and plays an important part in our understanding of the relationship between the two conditions.
Common post-traumatic stress disorder symptoms include intrusive thoughts or memories of the traumatic event, which can manifest as distressing nightmares or flashbacks. These intrusive thoughts can cause significant anguish and often lead to avoidance of reminders of the trauma, which in turn affects the patient’s normal way of life.
Individuals with PTSD can also experience sudden negative changes in their mood and thinking patterns. This can include persistent feelings of guilt, shame, or fear, as well as distorted beliefs about oneself or the world.
Other post-traumatic stress disorder symptoms can also include heightened arousal and reactivity, such as being easily startled, having difficulty concentrating, or experiencing irritability and anger.
As we’ll explore further, temporomandibular disorders, awake bruxism, and sleep bruxism have also been found to be common symptoms and present at higher rates among people with this condition.
Diagnosing this Condition
The diagnosis of post-traumatic stress disorder (PTSD) involves a comprehensive evaluation of a person’s symptoms, medical history, and exposure to traumatic events. PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event.
Firstly, the individual must have been exposed to a traumatic event, such as a life-threatening situation, serious injury, or witnessing a traumatic event.
Secondly, they must experience a set of symptoms that include intrusive thoughts or memories of the event, nightmares, flashbacks, intense distress or physiological reactions when exposed to triggers associated with the trauma, avoidance of reminders of the event, negative changes in mood or thoughts, and increased arousal or hypervigilance.
To be diagnosed, these post-traumatic stress disorder symptoms must persist for at least one month and cause significant distress or impairment in daily functioning. Diagnosing this condition requires a careful assessment by a qualified healthcare professional, such as a psychiatrist or psychologist, who will use standardized diagnostic criteria, such as those outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Research studies have shown that PTSD affects a significant portion of the population, with various studies estimating prevalence rates ranging from 3.9% to 9.2% in the general population worldwide.
Those Most at Risk of PTSD
Some of the people who are most at risk of developing post-traumatic stress disorder (PTSD) include:
- Military personnel and veterans: Individuals who have been exposed to combat situations, witnessed or experienced violence, or faced life-threatening situations during their military service are at high risk for severe PTSD. In 2020 alone, almost 50% of active-duty personnel were diagnosed with the disorder, and almost 20% of all veterans suffer from it. Military personnel are among the populations with the highest rates of PTSD.
- Survivors of physical or sexual assault: People who have experienced rape, physical abuse, or other forms of violent attacks.
- Emergency service workers: Firefighters, police officers, paramedics, and other first responders often witness traumatic events and face ongoing exposure to highly stressful situations, increasing their risk.
- Survivors of natural disasters: Individuals who have lived through earthquakes, hurricanes, floods, tsunamis, or other catastrophic events may develop the disorder due to the trauma and loss they experienced.
- Refugees and asylum seekers: People who have fled their countries due to persecution, war, or violence often have a higher risk of developing it, as they have been exposed to multiple traumatic events.
- Survivors of accidents or serious injuries: Those who have been involved in severe car accidents, plane crashes, or other traumatic incidents resulting in significant injuries may develop PTSD.
- Individuals who have experienced a sudden loss: Losing a loved one unexpectedly, such as in cases of homicide, suicide, or accidents, can be highly traumatic.
- Children who have experienced abuse or neglect: Children who have been exposed to physical, emotional, or sexual abuse, as well as neglect, are particularly vulnerable to developing PTSD and many other mental health disorders.
It’s important to note that while these groups are at higher risk, anyone who has experienced or witnessed a traumatic event can potentially develop PTSD.
Possible Link Between PTSD and Bruxism
Research suggests a potential association between post-traumatic stress disorder (PTSD) and bruxism.
While the exact mechanism linking these two conditions is not fully understood, it is believed that stress plays a key role, as it does with most bruxism cases.
One study from the UK and The Netherlands found that temporomandibular disorders (28.4%,) awake bruxism (48.3%,) and sleep bruxism (40.1%) were all more prevalent among PTSD patients than in the population at large.
People with PTSD are more likely to experience chronic stress, which can increase the likelihood of bruxism episodes. A study from 2001 that involved 40 patients with 100% disability claims because of PTSD at the Buffalo VA Medical Center found that those with the disorder were more than 10 times more likely to show signs of bruxism on their tooth surfaces and gum lines.
Bruxism in veterans with PTSD has become such a common issue that it’s now considered a “secondary service-connected condition” in most VA systems in order to qualify for disability benefits and treatment. This means it’s considered a secondary condition to those primary conditions they acquired because of their military service.
Furthermore, the physical act of teeth grinding and clenching may serve as a coping mechanism for individuals with PTSD, allowing them to release some of the tension and anxiety associated with their condition.
Although more research is needed to fully establish the link between PTSD and bruxism, recognizing this possible association can help healthcare providers better understand and address the oral health needs of individuals with PTSD.
Common Treatment Options for Teeth Grinding Caused by PTSD or Severe Stress
Treatment options for teeth grinding caused by post-traumatic stress disorder or severe stress include various therapeutic interventions to combat either the secondary condition of bruxism or the root cause, which is PTSD itself. These interventions aim to alleviate the pain and discomfort that individuals with severe bruxism may experience and address the underlying causes of their condition.
Night Guards and Occlusal Splints
In some cases, dental appliances such as night guards and mouth guards may be recommended to protect the teeth from the damage caused by grinding. Mouth guards and splints are used mostly for treating daytime teeth grinding, while nocturnal bruxism is treated with night guards. These can be custom night guards fitted for every patient by their dentists or oral healthcare provider or over-the-counter guards that are available in pharmacies or stores that come in predetermined sizes or molded to a certain degree when boiling at home.
One effective treatment option is cognitive behavioral therapy (CBT), which helps individuals identify and modify negative thought patterns and behaviors that contribute to teeth grinding. CBT can also help individuals develop coping strategies to manage stress and anxiety.
Another therapy that may be beneficial is biofeedback, which uses sensors to monitor the activity of the muscles of mastication (chewing) and provides real-time feedback to help individuals become more aware of their grinding habits.
Relaxation techniques such as deep breathing exercises, meditation, and yoga can help reduce stress levels and promote overall well-being.
Most physicians and therapists will request the patient eliminate caffeine, alcohol, tobacco, drugs, and even some medications from their diet and lifestyle because of the propensity of these substances to increase stress, anxiety, and muscle tension that aggravates bruxism.
Drinking more water daily is also a common part of any treatment plan for PTSD, as it helps muscle relaxation and keeps the patient from feeling the need to drink something other than plain water.
It is important for individuals experiencing teeth grinding due to PTSD or severe stress to seek professional help and explore these treatment options to find relief.
Other Mental Health Disorders That Can Lead to Bruxism
While post-traumatic stress disorder (PTSD) has been extensively studied in relation to teeth grinding, there are other mental health conditions that can also lead to this behavior.
- Anxiety disorders: Generalized anxiety disorder and panic disorder can cause chronic stress and increase the risk of bruxism.
- Depression: Characterized by persistent feelings of sadness and hopelessness, depression has been associated with teeth grinding.
- OCD: People with obsessive-compulsive disorder (OCD) may experience heightened stress levels that can lead to bruxism.
It is important to note that these mental health disorders are complex and multifaceted, and the link between them and bruxism requires further research.
However, recognizing the potential connection can help healthcare professionals provide comprehensive care to individuals experiencing teeth grinding as a result of these conditions.
Look to Any Possible Avenue as a Source for Your Teeth Grinding
Understanding this connection is crucial for effectively managing and treating both PTSD and bruxism so that your healthcare provider can address the needs of patients with PTSD by offering strategies to mitigate the occurrence of bruxism. Don’t be afraid of suggesting your diagnosed PTSD might be responsible for your bruxism.
This knowledge contributes to a broader understanding of the interplay between psychological well-being and oral health and thus plays a crucial role in treating it.