Bruxism and stress: grinding, clenching and what to do about it

Bruxism is grinding or clenching the teeth, usually without being aware of it. Most people do it at night; some do it through the day at a desk or in traffic. It is common, it is strongly linked to stress, and left alone it does slow, permanent damage that is expensive to repair.

How you might know

Most people find out from their dentist, because the signs are on the teeth before they are felt:

• Flattened, worn or chipped teeth, particularly the tips of the front teeth and the cusps of the back ones
• Notches at the gumline
• Fractured fillings or crowns, or a tooth that cracks without an obvious cause
• Waking with a sore or tight jaw, temples or face
• Morning headaches, often across the temples
• Sensitivity to hot and cold, from worn enamel
• Clicking, locking or pain in the jaw joint
• A partner who hears it at night
• Indentations along the edge of the tongue or a ridge inside the cheeks, from pressing against the teeth

A quick self-check

None of this is a diagnosis, but it is worth knowing before an appointment.

• Look at your lower front teeth in good light. Are the edges flat and level, rather than slightly scalloped?
• Do your upper and lower front teeth meet edge to edge in a way that matches, like two worn surfaces?
• Press your fingers on your temples and on the muscle at the angle of the jaw, then clench. Are those muscles tender afterwards?
• Is there a ridged white line along the inside of your cheeks, level with where your teeth meet?
• Do you catch yourself with your teeth touching when you are concentrating? At rest, they should be slightly apart.

Day grinding and night grinding are different

They are treated differently, which is why it is worth knowing which you have.

Plenty of people do both.

What causes it

Stress and anxiety are the most consistent association. Grinding often rises during difficult periods and eases when they pass.

Sleep disorders, particularly obstructive sleep apnoea, are strongly linked to night-time grinding. Grinding can be the body's response to a partially blocked airway. If you snore heavily, wake unrefreshed, or someone has noticed pauses in your breathing, that needs assessing by a GP or sleep physician, not just a splint.

Stimulants — caffeine late in the day, alcohol, tobacco, and recreational stimulants all increase grinding.

Some medications, notably certain antidepressants (SSRIs), can cause or worsen clenching. Do not stop medication on that account; raise it with your prescriber.

Reflux is associated with sleep bruxism in some people, possibly through the same sleep arousals.

Bite and tooth position play a smaller role than once thought. Grinding is largely a nervous-system behaviour, not a mechanical one. This matters practically: adjusting or rebuilding teeth in the hope of stopping bruxism is rarely the right first move.

Why it matters

Enamel does not regenerate. Years of grinding wear teeth shorter, expose the softer dentine beneath, and crack fillings and crowns. The jaw joint and muscles take the load too, which is where headaches and jaw pain come from. Severe long-term wear can change the bite and the face, and rebuilding worn teeth is a major undertaking — see full mouth rehabilitation.

Roughly how it progresses

The honest point of that table: the cheap intervention is available at the top and nowhere else. A splint is a fraction of the cost of the restorative work it defers.

What helps

An occlusal splint. A custom-made acrylic guard worn at night. It does not stop you grinding — nothing reliably does — but it takes the wear, so your teeth do not. It also reduces load on the jaw muscles and joint, which often eases morning symptoms. It is the single most effective step for protecting the teeth. See occlusal splints.

A splint is custom-fitted to your teeth. Cheap boil-and-bite guards from a chemist are soft, encourage chewing, and can make clenching worse.

Addressing stress. This is the part dentistry cannot do for you. Exercise, sleep, reducing caffeine and alcohol, and — where anxiety is persistent — talking to your GP about psychological support. Cognitive behavioural therapy has evidence for stress-related bruxism.

Daytime awareness. Clenching during the day is a habit you can interrupt once you notice it. Teeth apart, lips together, tongue resting on the palate. A reminder on your screen helps more than it sounds.

Sleep assessment where apnoea is suspected. Treating the airway often reduces the grinding.

Physiotherapy for the jaw muscles, and heat, gentle stretching and a soft diet during a flare.

Repairing damage — worn or cracked teeth are restored once the grinding is being managed, otherwise the new restorations wear out the same way. See TMD and jaw treatment.

Types of splint

A splint is normally made for the upper arch, from a scan or impression, and fitted a week or two later. It is adjusted at the fitting so it meets evenly, and checked at your regular visits.

Living with a splint

• The first few nights are the worst. Most people adapt within a week or two. If you are taking it out in your sleep, persist — put it back in when you wake and notice
• Extra saliva at first, then it settles
• Rinse and brush it with a soft brush and cold water each morning — no toothpaste, which scratches it, and no hot water, which distorts it
• Store it dry, in its case, away from pets. Dogs destroy more splints than grinding does
• Bring it to every check-up. We check the fit and the wear pattern, which is also the best record of whether the grinding is getting worse
• A splint lasts years, but not forever. A heavy grinder may wear through one in two to three years, which is exactly what it is for

A splint should not be worn without dental supervision. If your bite feels different when you take it out, or the splint stops meeting evenly, get it checked rather than adjusting it yourself.

Children who grind

Grinding is common in children, often noisy, and usually resolves by itself as the adult teeth come through. It is rarely damaging at that age, and a splint is generally not made for a growing mouth because it interferes with development.

Worth mentioning at a check-up so the wear can be looked at. Worth investigating further if it comes with snoring, mouth breathing, restless sleep or daytime tiredness — the airway question applies to children too, and often more so.

Treatments you may read about

Botulinum toxin injections into the jaw muscles are used by some practitioners for severe bruxism and jaw muscle pain. The evidence is developing rather than settled, the effect wears off after months, and repeated use can weaken the muscles. It is a prescription medical treatment that must be provided by an appropriately qualified registered practitioner. We do not provide it here, and would want a splint and a sleep assessment considered first.

Bite adjustment (occlusal equilibration) — permanently reshaping tooth surfaces to "balance" the bite — is irreversible and has weak evidence as a treatment for bruxism. Be cautious about agreeing to it for that reason alone.

Orthodontics straightens teeth. It does not reliably stop grinding.

Supplements — magnesium is widely recommended online. The evidence for it in bruxism specifically is thin. It is unlikely to harm you and unlikely to be the answer.

What we would not claim

No splint, exercise or treatment reliably stops bruxism. The honest goal is protecting the teeth and reducing symptoms, while the causes — stress, sleep, medication — are addressed where they can be. Anyone promising a cure is overstating it.

Questions we are asked

Will a splint stop my headaches? Often it helps, sometimes considerably. It is not guaranteed, and persistent headaches deserve a GP's opinion as well.

Does health insurance cover a splint? Most extras policies contribute under major dental, often with a waiting period. We can check your cover with a quote before you commit. See private health insurance.

Can I wear a splint with braces or Invisalign? Not usually during treatment — the aligners or the orthodontic plan take precedence. Raise it with the treating practitioner.

I have a splint and I am still grinding. Expected. The splint protects; it does not stop the behaviour. If the splint is being worn through quickly, or your jaw is still sore, tell us — the design may need changing, or the airway question may be the one to pursue.

Will my worn teeth be repaired to how they were? They can be rebuilt, and the result can be very good, but it is restorative work with a lifespan rather than a restoration of the original tooth. Which is the argument for the splint, early.

My jaw clicks. Is that bruxism? Not necessarily. Clicking without pain is common and often needs nothing. Clicking with pain, locking, or a jaw that will not open fully should be assessed.

When to see us

If you have any of the signs above, or your partner has mentioned the noise, book an examination. Wear is measured and photographed so there is a baseline to compare against, and a splint can be made from an impression or scan in a couple of weeks.

Who provides this here

Victorian Dental Group is a general dental practice in Malvern East and holds no specialist registration. Our dentists assess wear, make and adjust occlusal splints, and restore damaged teeth. Where the picture points to a sleep disorder we will say so and ask you to see your GP; where jaw joint problems are complex, or extensive rebuilding is needed, we refer to a registered specialist.

Victorian Dental Group — 291 Wattletree Road, Malvern East VIC 3145 · (03) 9088 5808 · Monday to Friday, 8:00am–5:00pm · book online

Read more about how stress affects oral health or occlusal splints.

General information only, not personal dental or medical advice. If you suspect a sleep disorder, see your GP. See our disclaimer.