Bruxism (Teeth Grinding) & Sleep Apnea
Our clinic does not endorse night guards for bruxism. Why? Because our practice attracts individuals with chronic stress, fatigue, and hard-hitting illness in both kids and adults, it is not uncommon to identify teeth grinding and other types of sleep tension symptoms as part of our patient’s overall presentation.
From our perspective this is not just an aside, but a huge clue to something much more concerning. If you have a night guard for grinding, or you have “grinded through” all the night appliances you’ve been given, this message for you.
Get rid of it! Unless you are absolutely sure it fits properly and accounts for any sleep apnea, disordered sleep, or the more subtle upper airway resistance syndromes (UARS) that worsen during the deepest stages of sleep, your night guard may be causing more harm than good.
I understand that the traditional approach to treating bruxism is to protect what is left of your teeth from the harsh vertical forces that occur during sleep and, in some cases, during your workday life (if you wear a daytime version). However, the problem is that your oral guard doesn’t address the root cause, and in fact, often makes grinding worse over time.
The new paradigm is that the incessant grinding may be the brain’s instinctive (and subconscious) way of trying to move the lower jaw or mandible forward to clear your airway so you can get more oxygen when you are deeply asleep.
You of course don’t know this because you are sleeping, but airway and tongue muscle sometimes cause trouble during the deepest stages of sleep. At any point when the airway obstructs, your brain has no other choice than to arouse you back into lighter, less restorative, stages of sleep.
The grinding motion your brain initiates pushes the lower jaw forward, manipulating the tongue and other soft tissue just enough to assist with compromised airflow. If your protective brain stops calling for grinding, less oxygen reaches your lungs, body, and brain.
Brilliant, right? The brain first tries to reposition the jaw and soft tissue. If that doesn’t work, you arouse out of deep, healing, and restorative sleep and feel unrested in the morning. Sound familiar?
Gone are the days where our only options are forced-air machines like CPAP or AutoPAP. There are now many options to choose from, but a sleep diagnostic test is always required to determine the best course of action.
Take home message: A history of teeth grinding is a red flag for our clinic to order a sleep study to evaluate for sleep apnea, disordered sleep, or an upper airway resistance syndrome (UARS).
Yes, the right device for the right person can be the solution, and we do sometimes suggest these to patients if a sleep diagnostic test indicates this is a viable answer. However, take note of the fact that I said, “right device” for the “right person.”
A poorly designed apnea appliance can be disastrous. So, one needs to work with a qualified dentist that really cares about the device they are making and ensures it will keep your lower jaw forward and minimize pressure on the TMJ joint and dynamic muscle masses that act on the jaw.
A poorly fitting appliance can also dramatically interfere with the vital response that you use every night to prevent arousing out of deep, restorative stage 4 and REM sleep.
The standard for our practice is treating the root cause of our patients’ conditions using precision diagnostics and careful, conscious decision making for those who have entrusted us with their health issues. We do not recommend night guards for grinding unless they are designed by an expert dentist familiar with how grinding relates to sleep apnea.
As I mentioned, grinding may be happening to clear your airway during the deepest stages of sleep. Our primary concerns in such cases are 1) to protect your teeth from the strong vertical forces without damaging the jaw joints and muscles; and 2) either diagnose or rule out sleep apnea using sleep diagnostics that can determine if there is clinically relevant apnea and whether or not this is due to central (i.e. brain) or obstructive mechanisms. A sleep diagnostic test needs to be order and interpreted by a medical clinic, such as ours, to determine the best course of action.
Remember, a night guard that does not take into consideration airway clearing can make grinding worse and prevent you from being able to push out your lower jaw, thereby preventing the airway from remaining open, effectively causing the vicious cycle of grinding worse and more often which is ultimately negative for your teeth, your brain, and your overall health and wellbeing.
Treating sleep apnea and disordered breathing IS the best treatment for bruxism. I can’t treat my patients’ grinding without treating the root cause of their grinding. And I can’t treat the root cause without diagnostic testing such as a home or in-lab sleep test.
Be aware, not everyone in the dental and medical field is aware of this paradigm, so just ask yourself this question…Does it make sense? It sure does and it also has proven itself in the trenches with patients in our clinic with all types of medical issues where the relative lack of oxygen during the deepest stages of sleep was one of the primary culprits fueling their chronic health problems in the first place.