Are you a Bruxer or a Clencher ?

Sometimes people only know that they grinding or clenching their teeth because their dentist says they do.

Why is this ? It is because you are asleep and not aware of what you are doing.

Dr David Stephenson of Albany Creek Brisbane writes :-

The truth is that everyone swallows during their sleep, and when they do, their teeth go together for a short period of time. Everyone clenches to some degree ( even people without teeth who have dentures and wear them when asleep ). Most people just have static clenching. Bruxing is clenching in motion. The force of the clenching and the extent and duration of the muscle activity is what varies.

Some people clench/brux excessively and it can cause health problems, not just dental problems. Bruxers are often completely unaware of the unnerving tooth gritting noise which is enough to set a bedpartner on edge.

So is bruxing and clenching caused by stress?

It is a little more complex than that. It relies on your brain's capacity to process and deal with stress adequately enough that it can get to sleep and rest fully, heal and recover from the day. The upper brain needs to shut down and go to sleep and let the autonomic nervous system (lower brain ) also go into autopilot mode. Stress will prevent lower brain going into autopilot mode. Instead it remains in sympathetic mode. In other words, it is primed or charged and isnt as quiet during sleep.

Stress might be from life events, emotional issues, worry , anxiety, chronic pain, hunger, cold, illness, or behaviours like too much food, alcohol and stimulants.

But stress doesnt have to be negative. If you have a lot of physical or mental stimulation like cardiovascular exercise or thinking, study, audiovisual stimulation just before bed, the lower brain is not as quiet during sleep.

The lower brain gives input to the upper brain in such a way that you are aroused from deep sleep more often. Aroused doesnt mean awake but rather a lighter level of sleep. If someone is talking to you, you wont register that they are doing so.You stay asleep but your body isnt in deep restful sleep.Your higher brain turns on and filters the external information like familiar or unfamiliar noises, body position comfort, breathing ok, too hot or too cold, dog not barking, bed partner not making too much noise snoring. If everything is ok, your higher brain goes back to sleep.

If not you will stay aroused or even wake up. When your body is stressed, you will be in repetitive periods of arousal. Your heart rate increases, your brain activity increases and muscle activity is stimulated. Bruxism occurs during these periods of arousal, including during REM or dreaming sleep. If the bruxing causes damage to the jawjoint or overworks the msucles, the body registers this as stress.

But if you have been pushed too much out of autopilot mode by stress, maybe drinking too much caffeine, smoking, drinking too much wine, or you suffer chronic pain, or by too much physical stimulation from exercise, or intense audiovisual stimulation, you will be in the aroused state for longer periods of time.This broken unrefreshing sleep can itself become a major stress.

When you have sleep apnoea, you will stop breathing for a period ranging from a few seconds to a couple of minutes. This will arouse you out of deep sleep. Even limited airflow causing a drop in oxygen in blood and brain will arouse you from deep sleep.

Sometimes the only symptom is a dull morning headache and maybe a stiff neck on waking. People say "Oh, I must have just slept badly or slept the wrong way" as if it is no big deal. These people are usually having a problem with airflow/breathing or/and bruxism/clenching muscle activity. Because it affects the quality of their sleep, sooner or later it will affect their health. After all you spend a third of your life asleep.

Some people say they cannot be bruxing or clenching because they go to sleep with their teeth apart and mouth open. This is all very well but once you fall asleep, your higher brain shuts down and your autonomic nervous system takes over and your muscle activity is out of your control. Similarly, people say they can't be bruxing and clenching because their partner says they snore. Every time you swallow, your jaw muscles contract and your teeth go together for anything from a second to a couple of minutes before relaxing again.

During this time, breathing stops! Usually a snorer cycles between snoring, swallowing, clenching, stopping breathing, opening mouth, gasping and starting snoring again.

People do this because they cannot breathe through their nose adequately so that enough oxygen gets in the blood and into the brain. The brain then switches to mouth breathing. Mouth breathing arouses the autonomic nervous system out of autopilot into primed mode.

Some people brux and dont wear away their teeth much. Other people dont put much force on their teeth but their teeth wear quickly. This is partly due to differences in enamel hardness but also, this is because of saliva quality.If the saliva is a bit acidic, the teeth will wear more easily.

People may be surprised to know that the mouth should always be alkaline. Eating and swallowing stimulates saliva, which quickly neutralises any acid food or drink and returns the mouth to alkaline. When dentists actually test the pH of a person's saliva, it is often acidic. This is not normal or healthy. Acidic saliva usually means a person is poorly hydrated, low in minerals, has poor nutrition or suffering chronic inflammation or illness.

Dentists are orofacial health care professionals. Their field of training and professional care covers the mouth ( tongue , teeth , gums, throat), the jaws and lower face bones ( including the maxilla that forms the nose and sinuses), the jawjoint and muscles attached to the jaws and skull, and the nerves and blood vessels that come from the brain and cervical spine to service these structures.

Thus dentists care about breathing, eating, speaking, swallowing, lip support, facial appearance and expression, nutrition, jaw and neck posture. As care givers their role is to protect the health of all these structures and functions during waking hours and during sleep. Suffice to say, dentistry is not just about teeth. The mouth is the doorway to body and offers a valuable window to the status of whole body health.

The problem with ignoring poor sleep, bruxing, clenching and breathing disorders is that the constant longterm stress stimulates the adrenal and pituitary glands to secrete stressor hormones which keep the body primed in sympathetic mode. Lack of deep restful sleep prevents the brain from producing enough serotonin and growth hormones needed for repair and recovery. Chronic inflammation builds acidic wastes and muscle tension prevents proper lymph flow. Chronic pain or neurological symptoms can start. Eventually general symptoms can start to appear with metabolism and thyroid trouble, clinical depression, fibromyalgia and sympathetic dystrophy in various forms.

Dr Stephenson feels that the first point of diagnostic information required should be a Home sleep study with a monitor on jaw muscles. The study should happen in your own bed under normal conditions so that changes in sleep position can be analysed not just when you are on your back in a hospital bed.

Other diagnostic examinations include physical and radiological assessment of the jawjoints and airway, and analysis of the occlusion and function of the bite.

Dr Stephenson has a special interest in this complex and fascinating way of restoring and maintaining health., and is the provider for Home Sleep Studies Australia in North Brisbane and Pine Shire.

Dr David Stephenson 725 Albany Creek Rd Albany Creek Q 4035 PH 07 3264 5698

for more information on Home Sleep Studies please go to www.homesleep.com.au

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