How to diagnose teeth grinding and clenching? When to seek help.

Medically reviewed by Brittany Ferri, PhD

Teeth grinding and jaw clenching during sleep, known medically as sleep bruxism, often conjures up worrying images of teeth being worn down night after night. Given that teeth cannot regenerate, the prospect of such damage is understandably alarming.

Unfortunately diagnosing sleep bruxism is quite tricky because it occurs subconsciously in our sleep which makes it difficult to detect and assess accurately. And current diagnostic tools lack accuracy, leading to scenarios where some people might end up getting treatments they don’t need while others with severe issues remain undetected.

Furthermore, the impact of grinding and clenching can vary a lot between individuals. Not everyone experiences detrimental health effects or needs intervention.

So, how can you diagnose teeth grinding or clenching at night? When should it be a cause for concern? This article delves into the complexities of identifying sleep bruxism, offering insights into when intervention is necessary.

💡 Different forms of jaw movement during bruxism

Teeth Grinding: This is when your teeth rub against each other, usually moving back and forth or side to side, or in a (semi)circular motion.

Jaw Clenching: This is when you tightly squeeze your teeth together, holding them in a firm bite without moving them. Imagine biting down hard without chewing.

Bracing: This is when you keep your jaw muscles tense without your teeth touching each other, almost like you’re getting ready for a heavy lift or a sudden impact. It might also involve contraction of other muscles (for example, neck and back)

Thrusting: This is when you push your lower jaw forward (sticking your jaw out)

How to identify teeth grinding or clenching

1. Self-Report

Often, people learn about their grinding or clenching habits from a partner or family member who hears it at night, or they might have caught themselves doing it when they wake up briefly from their sleep.

❓In the last two weeks, have you noticed (or been told) that you grind your teeth, keep your teeth together, or brace your jaw while sleeping?

A “yes” response likely indicates that you have sleep bruxism, but a “no” doesn’t rule it out, especially if you or your partner are heavy sleepers. It’s also hard to gauge the severity this way. As mentioned earlier, not all sleep bruxism has to be treated. If there’s no symptoms or issue to your dental health, no pain, headaches, etc. then it might be mild and not require intervention.

2. Symptom Check

Bruxism can manifest through various symptoms, including:

• Jaw muscle pain, fatigue, or stiffness, especially in the morning
• Frequent morning headaches (often tension-type, different from migraines)
• Clicking, popping, or grating sounds in the jaw joint
• Jaw locking or catching such that the mouth doesn’t open all the way
• Increased tooth sensitivity or visible tooth wear

Bruxism pain has been described as a sore muscle feeling, similar to what you experience after working out. The soreness, fatigue and stiffness most often affect two major chewing muscles in charge of opening and closing the jaw: the masseter and temporalis muscles.

The masseter is located on the side of your face, just below your cheekbone and in front of your ear, while the temporalis is a muscle located on the side of your forehead (temples), above your ear. When you press your back teeth together, you can feel these muscles bulking up by placing your fingers on the sides of your jaw or the sides of your forehead.

One study has shown that it’s not only the jaw muscles that contract during sleep bruxism episodes. Sometimes the neck muscles (sternocleidomastoid, trapezius muscles) are also involved, which is why some people also experience pain and stiffness in the back of their neck.

While the muscle activity during sleep bruxism, as measured by electromyography (EMG), typically does not generate enough force to overload the muscles, the continuous, low-intensity activity can lead to muscle pain through metabolic exhaustion. This phenomenon is akin to the fatigue felt when holding a simple pose for an extended period—easy to maintain initially but increasingly uncomfortable over time.

The symptoms for sleep bruxism (e.g., jaw pain / tightness and headaches) are usually more noticeable upon waking. If these symptoms are more prominent at the end of the day, you might have awake bruxism instead (grinding, clenching during the day).

3. Medical Diagnosis

The gold standard for diagnosing sleep bruxism is a polysomnography sleep study, which monitors various bodily functions overnight. However, this is complex and costly, so dentists or doctors often use questionnaires and clinical signs instead, including:

• Abnormal Tooth Wear: More wear than expected for someone your age. Tooth wear accumulates gradually and is influenced by other factors like gender, bite alignment, and diet. It could be a result of past teeth grinding behaviors and does not always mean that you are still grinding your teeth now, especially if you’re older.

This is why experts caution against relying solely on tooth wear for diagnosis due to the risk of misdiagnosis and unnecessary treatment with mouth guards, which can potentially worsen sleep quality.

• Hypertrophy of the Masseter Muscle: Bulky jaw muscles that can create a square jaw appearance

• Dental Impressions on the Tongue and Cheeks: Marks from grinding or clenching. White line on the inside of the cheek. Often called “cheek biting marks” or linea alba.

What can I do if I suspect I grind my teeth at night?

In otherwise healthy individuals, sleep bruxism is often not considered a disorder that requires immediate intervention or treatment. Therefore, if you are experiencing no health symptoms such as pain or headaches, and your teeth show minimal wear without predisposing factors like an acidic diet or acid reflux, intervention may not be necessary.

However, if symptoms persist and are bothersome, it’s important to rule out other potential causes. And if symptoms continue to affect you or if you’re worried about whether you have bruxism and the impact it might be having on your health or your teeth, there are some steps you can take:

Seek professional advice – ask your healthcare provider to ensure that it doesn’t stem from a serious, underlying medical condition.

Find out if you’re still actively bruxing – there are apps that can record the sounds you making during sleep, or if you sleep in the same room as someone, you can ask them if they’ve heard you grinding recently. However, this is not a foolproof method as clenching tend to be silent.

Tackle awake bruxism – although sleep and awake bruxism are considered different behaviors with different etiologies, studies indicate that there’s a carryover effect: what you do during the day carries into the night. So check if you frequently clench or tense your jaw during the day: set random timers (every 5-15 minutes) during the day and when it goes off, check if you are clenching or tensing your jaw muscles. The positive side of the carryover effect means that if you’re able to unlearn clenching habits during the day, it will also help with reducing bruxism at night.

Review your sleep hygiene – fragmented sleep with frequent awakenings can increase the likelihood of sleep bruxism activities, so taking stock of your sleep hygiene factors can help. Ensure that you sleep in a quiet, dark bedroom with comfortable temperature, free from disruption from your electronic devices and avoid large meals, caffeine or alcohol close to bedtime.

Reflect on your diet and dental care habits – acidic foods (like citrus fruit and tomatoes) and sugary and carbonated drinks are prime culprits when it comes to tooth wear. Avoid where you can, and rinse your mouth with water after meals.