What is bruxism?

Bruxism is the involuntary grinding, clenching, or gnashing of the teeth. It can occur during sleep (sleep bruxism – the more damaging type, because the jaw muscles exert forces several times stronger than during conscious chewing) or while awake (awake bruxism – usually clenching rather than grinding, often linked to concentration or stress).

Bruxism affects an estimated 8–13% of adults and is even more common in children (up to 40% during the mixed-dentition years). Many people are unaware they grind – the damage is often first identified by a dentist during a routine check-up.

Signs you might be grinding your teeth

Because sleep bruxism happens unconsciously, the signs are often indirect:

• Morning jaw pain or stiffness – the masseter (jaw) muscles are fatigued from clenching overnight
• Temple headaches on waking – tension headaches caused by sustained jaw muscle contraction; often misdiagnosed as migraines
• Tooth sensitivity – worn enamel exposes the underlying dentine, which is sensitive to hot, cold, and sweet
• Audible grinding at night – a partner or family member hears the characteristic sound
• Flat, chipped, or worn teeth – the biting edges of the front teeth lose their natural shape; the cusps of the back teeth flatten
• Scalloped tongue – indentations along the sides of the tongue from pressing it against the teeth during clenching
• Cheek biting – the inner cheek shows ridges or bite marks
• Cracked or fractured fillings – existing restorations break under grinding forces before the natural tooth does

Your dentist can confirm bruxism by examining specific wear facets on the enamel – these polished, flattened surfaces are characteristic of grinding and are easy to spot under magnification.

What causes bruxism?

Bruxism is rarely caused by a single factor. The most common contributors are:

Stress and anxiety

This is the dominant factor in adult bruxism. Elevated cortisol increases jaw muscle activity during sleep. If you notice your grinding worsens during stressful periods (work deadlines, financial pressure, relationship difficulties), the link is likely causal. Stress management – exercise, sleep hygiene, counselling – can reduce but rarely eliminates grinding.

Sleep disorders

Obstructive sleep apnoea (OSA) is strongly associated with bruxism. The jaw clenches as part of the arousal response when the airway partially obstructs. If you grind your teeth, snore heavily, and feel unrested despite adequate sleep hours, discuss a sleep study with your GP – treating the apnoea often reduces the grinding.

Medications

SSRIs (selective serotonin reuptake inhibitors) and other antidepressants are a well-documented cause of bruxism. Stimulant medications (for ADHD) and recreational stimulants also increase grinding. If bruxism onset coincided with starting a new medication, discuss this with the prescribing doctor.

Bite and jaw alignment

Malocclusion (teeth that do not meet evenly) can predispose to grinding, but is rarely the sole cause. Orthodontic correction of a significant malocclusion may reduce bruxism in some patients.

Alcohol and caffeine

Both increase the frequency and intensity of bruxism episodes during sleep. Reducing evening alcohol and afternoon caffeine is a simple first step.

Genetics

Bruxism tends to run in families. If a parent grinds, their children are more likely to grind as well.

What damage can grinding do?

The forces generated during sleep bruxism can exceed 250 pounds of pressure per square centimetre – far more than normal chewing. Over months and years, this causes:

• Enamel wear: The protective enamel layer is ground away, exposing yellow dentine underneath. Enamel does not regenerate
• Tooth fractures: Teeth can crack vertically under grinding forces, sometimes requiring extraction if the crack extends below the gum line
• Restoration failure: Fillings, crowns, veneers, and even implant crowns can fracture or debond
• TMJ damage: The temporomandibular joint (jaw joint) can develop clicking, locking, disc displacement, and degenerative arthritis from chronic overloading
• Gum recession: Excessive lateral forces on the teeth can cause the gum to pull away from the tooth root
• Tooth loosening: Sustained force on the periodontal ligament can cause teeth to become mobile

The damage is cumulative and often painless until advanced. Many patients first discover bruxism only when a tooth fractures or a crown breaks.

When do you need a night guard?

A night guard (occlusal splint) is a custom-fitted acrylic or hard resin appliance worn over the upper or lower teeth during sleep. It does not stop the grinding – it prevents the teeth from making direct contact, distributes the forces evenly across the arch, and protects enamel, restorations, and the TMJ.

Your dentist will recommend a night guard if:

• Visible wear patterns are present on the teeth
• You have symptoms – jaw pain, headaches, tooth sensitivity – consistent with bruxism
• You have expensive dental restorations (crowns, veneers, implants, bridges) that need protection
• You have a history of cracked teeth or fractured restorations
• TMJ clicking, locking, or pain is present

In some cases, your dentist may identify wear patterns at a routine check-up even though you have no symptoms. A splint is still worthwhile – preventing further damage is far cheaper than restoring teeth that have been ground down.

Custom night guard vs pharmacy boil-and-bite

Custom-fitted night guard (from your dentist)

• Made from precise impressions or digital scans of your teeth
• Fabricated in a dental laboratory from hard acrylic or dual-layer material
• Fits precisely – stays in place, comfortable to wear, does not trigger gagging
• Distributes bite forces evenly across the full arch
• Adjusted by the dentist to ensure your bite is balanced when the splint is in place
• Lasts 3–5+ years with proper care
• Cost: approximately $500–$700

Pharmacy boil-and-bite guard

• Generic thermoplastic tray softened in hot water and moulded to the teeth by biting
• Loose, bulky fit – shifts during sleep, can obstruct breathing
• Soft material may actually increase clenching (the jaw muscles work to “chew” the soft surface)
• Does not distribute forces evenly – may concentrate force on specific teeth
• Wears out in weeks to months
• Cost: $20–$50

Dentists do not recommend boil-and-bite guards for diagnosed bruxism. They are designed as short-term sports mouthguards, not therapeutic splints. The difference in fit, force distribution, and durability is significant.

How much does a custom night guard cost in Pakenham?

• Custom occlusal splint: approximately $500–$700 (includes examination, impressions/scan, lab fabrication, fitting, and adjustments)
• Sports mouthguard (custom): approximately $200–$350

Most major Australian private health funds provide a partial rebate under the “Major Dental” or “Mouthguards/Splints” benefit category. With HICAPS on-the-spot claiming at Pakenham Creek Family Dentist, the typical out-of-pocket cost is $200–$300 after the health fund rebate.

Payment plans are available via Afterpay, Zip Pay, SuperCare, and NDP for patients without health fund cover.

What else can help alongside a night guard?

A night guard protects the teeth but does not address the underlying cause. Depending on what is driving your bruxism, your dentist or GP may recommend:

• Stress management: Exercise, meditation, counselling, or CBT (cognitive behavioural therapy) if stress or anxiety is the primary driver
• Sleep study: If sleep apnoea is suspected (snoring, daytime fatigue, witnessed apnoeas), a polysomnography can diagnose it and CPAP treatment often reduces grinding
• Medication review: If bruxism began after starting an SSRI or stimulant, your prescribing doctor may adjust the dose or switch medications
• Limit caffeine and alcohol: Particularly after midday (caffeine) and in the evening (alcohol)
• Jaw muscle stretches: Gentle masseter stretches and warm compresses before bed can reduce overnight muscle tension
• Physiotherapy: For patients with TMJ pain, a physiotherapist specialising in the jaw can provide manual therapy and exercise programs

Bruxism in children

Teeth grinding is very common in children, particularly during the mixed-dentition phase (ages 6–12) when baby teeth are being replaced by permanent teeth. In most cases, childhood bruxism resolves on its own as the adult bite develops and is not a cause for concern.

A night guard is only considered for a child if:

• The grinding is causing pain or headaches
• Significant wear is visible on the permanent teeth (not baby teeth – those will be lost anyway)
• Sleep is being disrupted

If your child grinds, mention it at their next check-up so the dentist can monitor for any wear on the permanent teeth.