How the Teeth are Affected by Sleep-Related Bruxism

Sleep-related bruxism is one of the most common dental conditions and has a profound effect on the teeth. The following section will illustrate some of the more common and significant effects.

Sensitive Teeth:

Figure 1: Sensitive Teeth

Sensitive teeth are a direct result of the excessive forces placed on the teeth with SRB. The sensitivity is to temperature extremes such as ice water or hot coffee as well as to sweet foods and drinks and can be quite intense. This is one of the most commonly reported symptoms of SRB in all age groups.

Excessively Worn Teeth:

Figure 2: Excessive Tooth Wear

With the nightly forces of SRB acting directly on the teeth, they wear down becoming shorter. This disfigures the teeth and exposes the softer underlying dentin of the teeth contributing to tooth sensitivity. GERD (gastro-esophageal reflux disorder or acid reflux) commonly occurs in sleep-related bruxism and the strong stomach acids soften the enamel of the teeth resulting in accelerated tooth wear in some.

Abfraction Lesions:

Figure 3: Abfraction Lesions

Abfraction lesions are notches that form at the gum line. It was believed that this was due to aggressive tooth brushing but this has now been shown not to be the case. The side-to-side grinding seen in phasic SRB rocks the teeth and the enamel at the gum line begins chipped off. A notch forces thinning the tooth where it exits the jaw bone. The sensitive dentin is exposed. These abfraction lesions can be extremely sensitive to temperatures, sweet foods, cold drinks, as well as to touch. These are a common finding of SRB and can occur in upper and lower teeth on the outside of the teeth and less commonly, on the inside of the teeth.

Cracked Fillings:

Figure 4: Cracked Fillings

With the excessive forces of SRB on the teeth, fillings can break often shortly after being placed. This can be costly and frustrating for both the patient and the dentist who placed the filling. Most filling materials have a compressive strength of less than the forces that SRB can generate.

Cracked Teeth:

Figure 5: Cracked Teeth

With the excessive compressive forces of SRB, the teeth themselves can crack or split. This is extremely painful when it happens as in figure 5. Often there is simply a small crack in the tooth that opens only when biting hard foods (resulting in a sharp pain that resolves immediately once the crack closes). Cracked teeth are very common. If caught early, a crown placed over the crack tooth can save it. Otherwise, the crack can deepen until the tooth splits and must be removed. Research has shown that the earlier a crown is placed on a cracked tooth, the better the long term prognosis.

Cracked Roots of Teeth:

Figure 6: Cracked Roots of the Teeth

Sometimes we see that the root of the tooth cracks. This requires a radiograph (x-ray) to identify. The tooth may feel loose and, if no previous root canal as in the image, are usually extremely painful. There is usually pain and swelling in the gum tissue around cracked roots and a deep periodontal pocket often forms around the crack. In most cases, the affected tooth must be removed.

Fractured Dental Implants and Peri-Implantitis:

Figure 7: Fractured Dental Implants

Dental implants are often placed to replace missing teeth or teeth badly damaged that cannot be saved. They are used as an anchor for fixed bridges as well. With the extreme forces of sleep-related bruxism, implants can be fractured during sleep.

Additionally, excessive side-to-side forces can result in peri-implantitis or bone loss around the implant similar to gum disease. This is due to overloading of the implant and side-to-side rocking of it.

Figure 8: Peri-Implantitis

As you can see, untreated sleep-related bruxism can be very damaging to your teeth. The Luco Hybrid device is the only FDA treatment of any type, for sleep-related bruxism and associated tension/migraine type headaches.