Grinding (Bruxism)

Teeth grinding (bruxism) is involuntary clenching, grinding and gnashing of the teeth. It is thought that about half of the population bruxes from time to time, while around five per cent are habitual and forceful tooth grinders. It generally happens during sleep, but some people experience it when they are awake.

Bruxism can be a physical expression of stress; for example, susceptible people may tend to grind their teeth when they are angry, concentrating hard on a particular task or feeling anxious.  Generally, the person doesn’t realise that they grind their teeth in their sleep as it is an unconscious behaviour. The spouse or partner who shares their bed (and hears the grinding noises at night) is often the first to notice the problem.

Dentists also reported a 69 percent jump in patients who clench or grind their teeth during the COVID-19 pandemic, according to the Australian Dental Association (ADA).

Signs & Symptoms

• Audible grinding sounds while the person is asleep
• Headache, jaw joint and/or ear pain
• Aching teeth, particularly upon waking
• Aching and/or stiffness of the face and temples upon waking
• Aching or stiffness in the jaws while chewing, particularly during breakfast
• Clenching the jaw when angry, anxious or concentrating
• Temperature-sensitive teeth
• Cracked or chipped tooth enamel
• Tooth indentations on the tongue
• Raised tissue on the cheek mucosa caused by cheek biting (linea alba)
• Mobile teeth

Causes of Bruxism

• Stress
• Alchol and tobacco
• Medications: anti-depressants and anti-psychotic
• Medical conditions: dementia, Parkinsons’ disease, or stroke
• Existing temporomandibular joint (TMJ) disorders
• Sleep apnoea

Bruxism Treatment Options 

• Occlusal splint: a plastic mouth guard that puts puts space between the upper and lower teeth to protect them and allows the jaw muscles to relax. A guard customized for you by your dentist is usually more effective than an over-the-counter product, and is sometimes covered by insurance. Neither breaks the habit but will prevent further tooth damage.
• Botox: Botulinum toxin injections into the jaw muscles that control chewing may reduce the pressure you exert on teeth and relieve any TMJ related problems.
• Stress reduction: relaxing activities (like yoga and meditation) may help. So can increasing your awareness of the behavior. A tip: “If, during a stressful moment, you feel your teeth touching, gently allow your jaw to open and the teeth to float away from each other,”.
• Physical therapy: A physical therapist trained to treat bruxism can teach you exercises to stretch, strengthen, and relax neck and jaw muscles, which can reduce the muscle tension that may lead to clenching and grinding.
• Sleep study and CPAP machine

Periodontitis

Periodontitis, also known as pyorrhea, is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth.

Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth.

Periodontitis is caused by microorganisms that adhere to and grow on the tooth’s surfaces, along with an over-aggressive immune response against these microorganisms.

A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe (i.e., a clinical examination) and by evaluating the patient’s X-ray films (i.e., a radiographic examination), to determine the amount of bone loss around the teeth.

Symptoms may include

• Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g., apples) (though this may occur even in gingivitis, where there is no attachment loss)
• Gum swelling that recurs
• Spitting out blood after brushing teeth
• Halitosis, or bad breath, and a persistent metallic taste in the mouth
• Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy-handed brushing or with a stiff tooth brush.)
• Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
• Loose teeth, in the later stages (though this may occur for other reasons, as well)

Prevention

Daily oral hygiene measures to prevent periodontal disease include:

• Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, helps disrupt the bacterial-mycotic growth and formation of subgingival plaque.
• Flossing daily and using interdental brushes (if the space between teeth is large enough), as well as cleaning behind the last tooth, the third molar, in each quarter
• Using an antiseptic mouthwash: Chlorhexidine gluconate-based mouthwash in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontitis.
• Using periodontal trays to maintain dentist-prescribed medications at the source of the disease: The use of trays allows the medication to stay in place long enough to penetrate the biofilms where the micro-organism are found.
• Regular dental check-ups and professional teeth cleaning as required: Dental check-ups serve to monitor the person’s oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontitis, and monitor response to treatment.
• Microscopic evaluation of biofilm may serve as a guide to regain commensal health flora.

Missing Teeth

Replacement options for missing teeth

Following dental extraction, a gap is left. The options to fill this gap are commonly recorded as “BIND”, and the exact choice is agreed between dentist and patient based upon several factors.

Bad Taste In Mouth

There are a couple of different reasons why you might get a bad taste in your mouth.

Infection can cause a bad taste or breath

The most common one is from an infection. Whether it is pus draining into your mouth, or there is an infection in the gum or jawbone, you will also get a bad taste from that. The problem with these is that quite often there is no pain associated with the early stages, so you can have this infection for quite a while, weeks or even months, before you start to get any pain from it.

The down side of this is, all that time that the infection is festering away the bacteria is going into your bloodstream and can cause damage to other organs: your heart in particular or your pancreas. This means you are at a much higher risk of heart disease, stroke or diabetes.

The bad tastes that you might experience can really vary, so it is hard to pin it down whether it is a ‘bitter’ or ‘sour’ taste – it is most easily described as a very unpleasant taste.

“Bad breath is usually picked up first by other people before the person who has bad breath.”

Investigate potential infection as soon as you can

If you have any kind of bad taste you should get it investigated as soon as possible because it can blow up very quickly. Thousands of people do end up in hospital in Brisbane every year having major surgery from dental infections causes.

Deteriorating fillings can cause a bad taste or breath

The second thing it could be is if your dental fillings are deteriorating it can give a metallic taste. Over time everything breaks down so the old silver mercury fillings can corrode or break down where they seal against the tooth and this will let in bacteria into the tooth so that decay can produce a bad taste too.

Deteriorating fillings can cause bad breath

I have been asked about the effects of ingesting or swallowing the filling materials, in particular the old mercury fillings. The actual amount of filling you could digest and is contained in your body is quite small. Current research suggests that most of what you ingest is passed through the body and not retained, so no measurable health risk could come from that.

The main risk of deteriorating fillings

The main risk with deteriorating fillings is the damage to the tissues, further decay to the tooth and that you are potentially heading down the path to an abscess.

If caught early then the filling can simply be replaced, however if left longer more work will need to be done to save the tooth.

Like everything, the earlier and smaller the problem is caught the better – which is also reflected in time and cost at the dentist.

Other potential reasons for a bad taste or breath

There are a couple of other reasons, including:

Gases coming up from your stomach: sometimes acid can come up as well and cause damage to the esophagus.

Bacteria in the mouth that can cause a ‘rotten egg’ gas: this is not so much bad taste but more bad breath. This bacteria usually lives on the side of the tongue and usually don’t cause any damage to the teeth. These can usually be dealt with by a particular kind of mouthwash. The supermarket variety mouthwashes usually won’t be able to neutralise this kind of bacteria.

Food caught in between the teeth: this can smell or taste bad and will eventually lead to decay and potential infection.

There are complex machines that can measure the strength of ‘rotten egg’ sulphur gases, but the best machine to test with is the nose!

Cracked Tooth Syndrome

Cracked Tooth Syndrome is a dental condition characterized by symptoms of sharp pain on chewing without any visible reason, which is actually caused by a ‘hidden’ crack of the tooth.

Teeth that cause cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome is a condition that has to be identified and treated early enough before the damage puts the tooth at risk. If the crack reaches the pulp chamber of the cracked tooth, the pulp tissue becomes exposed to bacteria and bacterial toxins, and gets inflamed, developing a tooth infection. 

An untreated cracked tooth can result in pulpal necrosis (death of the nerve), and tooth abscess (infection) requiring root canal treatment. In severe cases the tooth can split in two reducing the chances to fix the cracked tooth and usually tooth extraction is necessary.

Causes of cracked tooth syndrome

• Natural wear: Over the years, the repetitive everyday use of the teeth for biting and chewing may cause cracks on teeth.
• Clenching or grinding teeth (bruxism) is one of the major causes of fractured tooth syndrome. Grinding and clenching puts teeth under excessive pressure making them more susceptible to cracks.
• Bad chewing habits such as biting pencils or chewing on hard foods.
• Trauma to the mouth.
• Large fillings can weaken the teeth resulting in tooth fracture.
• Untreated extensive tooth decay.
• Complications during/after endodontic therapy. Sometimes the pressure applied on a tooth during root canal treatment may cause a crack. After a root canal treatment teeth become brittle and they are more susceptible to cracked tooth syndrome.

Symptoms of cracked tooth syndrome

• Tooth sensitivity to hot and cold temperatures.
• Pain in the tooth upon biting or chewing. Pain is not constant as that in case of tooth decay or tooth abscess. The tooth may be painful only when eating certain foods or when chewing in a specific way. If the pain is usually experienced upon release of biting pressure, it is a sign that it is a case of cracked tooth syndrome.
• If the crack is severe, there may be signs of increased tooth mobility.

Why does a cracked tooth hurt?

The crack will expose the inside of the tooth (the ‘dentine’) that has very small fluid filled tubes that lead to the nerve (‘pulp’). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain.

How can I prevent my teeth from fracturing?

Most fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by:

1. Trying to eliminate clenching habits during waking hours,
2. Avoiding chewing hard objects (eg bones, pencils, ice),
3. Avoiding chewing hard foods such as pork crackling and hard-grain bread

If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you. It is very important to preserve the strength of your teeth so they are not as susceptible to fracture. Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled. Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces. Relaxation exercises may be beneficial.

How does the dentist treat a cracked tooth?

It depends on the direction and severity of the crack. If the crack is small enough, it may be removed by replacing the filling. Bonded white fillings and bonded amalgam fillings will hold the tooth together making it less likely to crack. Sometimes the cracked part of the tooth fractures off during the removal of the filling and this can be replaced with a new filling. Your dentist may first place an orthodontic band around the tooth to keep it together.

If the pain settles, the band is replaced with a filling that covers the fractured portion of tooth (or the whole biting surface). Other options include the placement of gold or porcelain fillings or even a crown. If the crack goes too far vertically, there is a possibility the tooth may need to be removed and replaced with an artificial one. (See bridgework, denture, and implant). The nerve may sometimes be affected so badly that it dies. Root canal treatment will be required if the tooth is to be saved.

Will my tooth become better?

Unlike fractures elsewhere in the body, this crack will never heal. There is a small chance that the crack will get worse even with a crown placed. This may lead to the need for root canal treatment, or even removal of the tooth. However, many cracks can be fixed without root canal or tooth removal.

What type of forces cause teeth to crack?

Front teeth usually break due to a knock, an accident or during biting. Back teeth can also be fractured from a knock. They are much more likely than front teeth, to crack from forces applied by the jaws slamming together rapidly. This is why sportspeople wear mouthguards to cushion the blow. 

Other forces occur during sleep because people grind their teeth with a much greater force than they would ever do while awake. The first sign of problems may be what we call “cracked tooth syndrome” – a sore or sensitive tooth somewhere in the mouth that is often hard for even the dentist to find. In some individuals the grinding, called bruxism, causes tooth wear rather than fracture.

Dental Erosion

Causes of Dental Erosion

• The acidity of food/fluids: tooth enamel is composed of minerals, such as calcium and phosphate. Both enamel and dentine are weakened and dissolved by acid (pH less than 5.5). The enamel layer in primary teeth (the first set of teeth in children) is thinner making them particularly vulnerable. In commercially available sports drinks, the pH is 2.4 – 4.5 and hence the concern about damage to teeth.
• The frequency and duration of exposure to acidic products: salivary flow neutralises acids and provides calcium and phosphate to remineralise tooth enamel within a 20-30min “recovery” phase. Frequent sipping of sports drinks/soft drinks increases the length of this recovery phase extending the time in which teeth are ‘vulnerable’ to erosion.
• The sugar content: Cola drinks, sports drinks, gels and energy drinks (and any other type of food which may be “sticky” e.g. honey, glucose syrup, etc) are sources of carbohydrate in the form of sugar for the purpose of easy-digestibility and delivery to working muscles. However, these foods provide sugar in a form that adheres to teeth more than saliva and provide a substrate for additional acid production by oral bacteria.
• Decreased salivary flow: Saliva plays a vital role in protecting teeth. It dilutes and clears liquids at the tooth surface. It neutralises acids in the mouth and provides a mineral source including calcium and phosphate for remineralisation (enamel hardening). Dehydration is a real issue for many athletes, particularly when exercising in the heat, for extended periods and especially for those with a higher-than-average sweat rate. Dehydration causes the mouth to become dry, reducing salivary flow which increases the time of tooth surface damage.

Signs of Dental Erosion

• Hollow defects on the cusp tips/loss of surface detail on the chewing surfaces of posterior teeth
• Fillings in affected teeth appear to “stick out” of the tooth surface due to surrounding tooth structure being dissolved
• Thinning/chipping of the biting (incisal) edges of the anterior teeth
• Thinned outer enamel layer of affected teeth so underlying grey/brown tooth colour is more noticeable
• Tooth sensitivity to hot/cold or sweet for duration of contact with affected tooth surface

Dry Mouth

Dry mouth syndrome is when there is not enough saliva (spit) in the mouth. A dry mouth is a symptom of an underlying problem, rather than a disease in itself. Causes may include drugs or medication, dehydration, Sjogren’s syndrome, infection, nerve problems and some cancer treatments. Dry mouth syndrome is also called xerostomia.

Causes of reduced salivary flow

• Medications: anti-hypertensives, sedatives, anti-histamines, respiratory inhalers, etc
• Systemic disease: Sjogren’s syndrome, diabetes, rheumatoid, etc
• Radiation therapy
• Radioactive iodine therapy
• Electrolyte loss: dehydration, vomiting, diarrhea
• Lifestyle factors: smoking, excessive caffeine intake, alcohol abuse, etc

Symptoms of dry mouth

• Saliva that feels thick or stringy
• Rough, dry tongue
• The tongue tending to stick against the roof of the mouth
• Problems with chewing or swallowing (particularly dry foods such as biscuits)
• Bad breath
• Mouth ulcers
• Dry and cracked lips
• Susceptibility to oral thrush infections
• High rate of tooth decay
• A prickly burning sensation in the mouth

Tooth Wear

Attrition

It is defined as physiologic wearing away of tooth as a result of tooth to tooth contact a as in mastication. Everyone wears down their teeth in one way or another during a lifetime, thus everyone suffers at least some attrition.

Abrasion

It is defined as pathological wearing of tooth substance, through some abnormal mechanical process, like from misuse of toothpaste on virtually any surface exposed to toothbrush bristles or toothpaste.

Abfraction

It is a wedge shaped defect limited to cervical area of teeth. It may resemble cervical abrasion or erosion. There is loss of cervical tooth structure secondary to repeated flexure of tooth caused by occlusal stress. It is thought that lateral occlusal forces bend the tooth with tensile stress concentrated in cervical fulcrum area, leading to disruption of enamel and dentin bonds. Once damaged the area may be enlarged secondary by abrasion, attrition, erosion.

Temporomandibular Joint Disorder (TMD) & Bruxism

TMD/TMJ describes a group of diseases that can involve the jaw joints, the muscles that control jaw movement and the dental occlusion. TMJ / TMDs are physical disorders arising from an imbalance in the delicate working relationship of the jaw and skull with the muscles that move the jaw, as well as the nervous system associated with these systems.

This imbalance results in muscle fatigue, spasm and/or joint dysfunction, and even changes in the teeth, which in turn cause a variety of symptoms, unique to each person. Temporomandibular disorders (TMJ / TMDs)

Causes of TMJ/TMD

The symptoms of TMJ / TMD, which affect millions of adults and children, can gradually appear with no apparent, specific cause. They also can occur after a trauma, such as a traffic accident or a blow to the face. Even subtle repeated traumas, like clenching the teeth or excessive gum chewing, nail biting or cradling a phone between your shoulder and the side of your head can cause TMJ / TMD . These conditions can also be caused by a bad bite (dental malocclusion), which is not synchronized with healthy muscle and joint function. Systemic diseases and developmental abnormalities also can cause TMJ / TMD.

Bruxism 

Bruxism is an oral parafunctional activity which commonly occurs with most people at some point in their lives. The two main characteristics of this condition are grinding the teeth and clenching of the jaw. These actions usually occur during a person’s sleeping hours, but occasionally they occur during the day.

Bruxism is one of the most common known sleep disorders. Chewing is a neuromuscular activity controlled by a subconscious process, but more highly controlled by the brain. During sleep, the subconscious process may become active while the higher control is inactive (asleep), resulting in bruxism. The most common symptoms are earaches and headaches, depression, eating disorders, anxiety, and chronic stress.

Treatment Options for Bruxism

1. Botulinum toxin 
2. Occlusal splint
3. Management for sleep apnoea
4. Relaxation therapy
5. Physiotherapy

Why should I seek treatment for Bruxism?

1. Gum Recession — Bruxism is a leading cause of gum recession and tooth loss. Grinding teeth can damage the soft tissue directly and lead to loose teeth and deep pockets where bacteria are able to colonize and decay the supporting bone.
2. Facial Pain — Grinding can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and, in severe cases, incapacitating headaches.
3. Occlusal Trauma — The abnormal wear patterns on the occlusal (chewing) surfaces of the teeth can lead to fractures, which if left untreated, may require restorative treatment at a later time.
4. Arthritis  — In the most severe cases, bruxism can eventually lead to painful arthritis in the temporomandibular (TMJ) joints that allow the jaw to open and close smoothly.

Wisdom Teeth

Wisdom teeth usually do not push through the gums until people reach 18 years of age or even older. Most people have 4 wisdom teeth. Some people have no wisdom teeth.

Often there is little space at the rear of the jaws for wisdom teeth to come easily through the gums. If the jaw does not have enough room for the wisdom tooth, the tooth will become wedged in or “impacted”. Some impacted wisdom teeth remain buried and cause no trouble, other may cause severe problems. Often one or more wisdom teeth will cause problems and must be removed.

Removal of wisdom teeth is a very common procedure. Removal of troublesome wisdom teeth should be done as soon as possible before it gets worse. If your wisdom teeth are likely to be difficult or complicated to remove, we may refer you to an oral and maxillofacial surgeon.

Problems Caused

Impacted wisdom teeth can cause a lot of problem:

• Infection
• Inflammation (swollen, red gums)
• Pain
• Swell and stiffness of jaw
• Bad breath and unpleasant taste
• Push the nearby tooth out of their correct position and cause crowding of the front teeth
• Cyst inside the jaw bone
• Damage to nearby molars, cause cavity formed and often removal of both teeth is needed
• Ulcer of the gum
• Food trapped and cause decays

Treatment of Wisdom Tooth Infection

We suggest:

• General dental cleaning
• Rinse with saltwater or disinfectant mouthwash
• Pain killer and antibiotics
• Extraction

It’s recommended to remove the troublesome wisdom tooth when the person is young. In young people, a tooth’s roots have not formed totally, and the surrounding bone is softer. This allows easier removal of the tooth, and there is less risk of damage to nerves, bone or other teeth.

Removal of the Wisdom Teeth

A small portion of gums and/or bones need to be removed so we can get access to the tooth, or the tooth may have to be divided into segments so it can be removed easily and safely. After the tooth has been removed, you may need stitches to close up the open gum depends on the degree of opening, stitches could be self-dissolvable or to be removed by us after a few days.

Possible Side Effects of the Surgery

Complications can occur though not often:

• Numbness or altered sensation
• Dry socket (bone infection)
• Gum infection
• Difficulty in opening mouth
• Fever
• Excessive bleeding
• Lip sores
• Damage to the nearby tooth or filling
• Vomiting
• Sinus problems
• Weak jaw

More About Wisdom Tooth Removals