Dentists often call it bruxism. To the layman it is "teethgrinding", although it may only be clenching rather than grinding. A lot of it happens at night, but there can be clenching during the day. I bit into this soft sandwich and heard this crack Juliet Conner.

Some people may suffer headaches as a result, or shooting pains in their jaw. But many may not realise they are doing it until the dentist spots it. Dentists look for particular patterns of wear, which can involve flaking of the enamel, although in more serious cases the "cusps" at the corners of molars may snap off, or they may be a total fracture of a tooth.

Often, irate sleeping partners are the first to discover the activity. It is not a pleasant thing to be woken by. "It is the most horrendous noise," says dentist Andre Hedger, who has a dental practice in Great Bookham, Surrey, and saw a 20% rise in cases in 2008 and 2009. "It is like a concrete mixer running down a blackboard." A full explanation for why we grind our teeth is yet to be established, but it is believed that stress and anxiety are at least exacerbating factors. "Often the reason they are doing the grinding or clenching is stress, the recession", says Dr Hedger. "We have never seen so many stressed patients. They all say things have changed in the workplace - they are working longer hours."

TELL-TALE SIGNS OF BRUXISM

  • Enamel is worn away and softer, orange coloured dentine is exposed 
  • The lower incisors are worn flat
  • Upper teeth become more angled, thin, and translucent, also putting them at-risk for chips
  • The roof of the nerve chamber is visible in the tooth's centre

A paucity of studies means it is not easy to establish the numbers of sufferers in the UK. The advisers who man the helpline at the British Dental Health Foundation anecdotally report an increase in calls. And an unscientific straw poll by the British Dental Association identifies a number of dentists who think it is on the rise.

One reports: "I have definitely seen a huge interest in grinding-related problems since the start of the recession… I would say that I am probably seeing about five times as many cases as usual." Another suggests: "We have seen a lot of grinding and clenching of late. Because grinding can take a long time to show up as tooth wear it would be difficult to say that clinically obvious examples have started within the last twelve months or so." Yet another notes: "Whilst I haven't noted a particular increase of signs and symptoms associated with parafunctional [not to do with normal actions] clenching and grinding during the period of the recession, this is generally a phenomenon that is slowly increasing in prevalence." Colchester dentist Francois Roussouw has noted a marked rise in people suffering the effects of teethgrinding. Dentists have developed treatments for bruxism "Over the last six-to-nine months there has been a 30% increase," he says. "We see fracturing teeth without any decay being present. People who fractured a healthy tooth in the past - that was very rare. In the past two months I've seen three patients where a perfectly healthy virgin tooth has been fractured into the root." Juliet Conner is one such patient. "I bit into this soft sandwich and heard this crack. There was pain and I thought 'what was that'." Mrs Conner suffered a broken tooth in October. And then another one in December. But she doesn't fit the pattern of stressed, recession-fixated business people.

SOME SYMPTOMS

  • Abnormal wear on teeth 
  • Fractures in healthy teeth 
  • Headaches 
  • Migraines
  • Pain in jaw and jaw joint

"I lost my husband six-and-a-half years ago - whether it's subconscious worry over that I don't know. "I'm not a particularly stressed person." Yann Maidment, who is part of a three-dentist-practice in central Edinburgh, can't be sure that the recession is to blame for the increase in patients with bruxism at his dental practice. "We are sitting right in the middle of a financial district. We have seen a higher instance of clenching and grinding of the teeth. You ask them about stress - they are under more pressure "We know that stress is involved in the process but there can be other factors. When we take histories from people they will often describe an increase in stress levels that have accompanied the onset." But while stress is a big factor, it's certainly not the only thing causing teethgrinding. "There are other factors for example the anatomy of the jaw, the shape of the jawbone, the position of the teeth in respect of each other," says Dr Maidment.

Something more fundamental in Western lifestyle could be to blame, says Dr Hedger. Soft foods could be leading to underdeveloped jaws, Dr Hedger says "It is common in the West because we have underdeveloped upper jaws. We have a very soft diet - our jaws are getting smaller and more crowded."

Dr Hedger also works on patients who have Temporo Mandibular Joint Dysfunction, a group of conditions related to bruxism. Some are terribly affected, he says, reduced to crawling at the start of the day and afflicted by a range of unpleasant conditions. "They are very ill with it. They have chronic fatigue, headaches, migraines and tinnitus." When given questionnaires many patients say they have been accused of imagining or faking symptoms, and a fifth have considered suicide. Opening bite For those with run-of-the-mill bruxism, a nightguard is often offered by the dentist. In the UK this can cost anything from £100 to a few hundred pounds. Typically this resembles a sport gumshield and is custom-fitted to the lower teeth. It is to be worn every night. But the use of the one of these nightguards can sometimes fall short, says Dr Hedger. We have a very soft diet - our jaws are getting smaller and more crowded Andre Hedger "They actually can increase the clenching activity. Where they win is they slightly open the bite by a number of millimetres, which often relieves the jaw joint." But he is one of the dentists promoting an alternative, the catchily-named nociceptive trigeminal inhibitor.

The NTI is a small occlusal splint that just fits over the front teeth.

"They are designed to put pressure on the front teeth. When the grinding starts in the night the pressure is applied to the two front teeth… they send quite a strong signal to the brain saying 'what are you doing?'." The aim is to stop the grinding rather than, as with a basic nightguard, mainly to protect the teeth from damage by covering them. Other treatments range from muscle massage to relieve symptoms, counselling to reduce stress, and even hypnosis. But the important thing, the dentists say, is getting early treatment. Otherwise bigger dental problems may beckon.

Comment