Clenching and Grinding

Teeth clenching and grinding is caused by a bite imbalance where the teeth don’t line up with the jaw joints. Most people grind their teeth during their sleep and don’t even realize it. Bite guards and bite splints can help protect the teeth during sleep.

What are some reasons that people clench or grind their teeth?

Dr. Darren McKeever: There’s really only a few reasons why people actually clench and/or grind their teeth. Everybody thinks they clench or grind their teeth because of their stress level. Stress does not make people clench their teeth. Stress exacerbates a tendency for people who do clench their teeth. It makes it worse but it is not the initiator.

Most clenching and grinding, and I’m talking within the mid 90% of people who do it, is caused because of some type of bite imbalance. The teeth, when they close, just don’t mesh properly with what the jaw joints and the muscles that work the jaw would like the teeth to close in some type of different position. What happens? The muscles feel the discrepancy of teeth coming together and they try and obliterate how the teeth are hitting improperly and that is what causes clenching and grinding in most people.

There is also a very small amount of people who actually clench and grind their teeth in order to literally save their lives. People who have sleep apnea literally go into some kind of biofeedback mechanism where they set their teeth as hard as they can in order to keep their tongue from dropping backwards while they’re sleeping, which causes them to go into an episode where they’re literally choking on their own tongue and they can’t breathe. Those people we see tremendous grinding, but there’s such a very small part of the population that does that. In essence, most clenching and grinding is literally caused because people’s teeth don’t mesh properly.

When people grind their teeth during their sleep, do they even realize what they are doing?

Dr. Darren McKeever: It is amazing how many people will say, “I don’t clench or grind my teeth …” yet they have all the signs, they have all the symptoms. Usually it’s because they’re doing it at a time in their day when they don’t realize it. More often than not, it’s when they’re sleeping. We see it also in people who are very involved with a computer and they’re sort of into the computer or people who are … I don’t want to say absent-minded but they’re doing something that seems to be so involved, they sort of lose biofeedback and they don’t realize they’re clenching their teeth.

It’s no different than watching a movie and you realize after a while, “Wow, my leg is asleep and I didn’t even realize I was sitting on it in such a funny way.” During certain periods of the brain patterns when people are focusing on some things, like even driving, they will actually lose the biofeedback that would stop you from clenching your teeth and noticing it and they do it, but more often than not when people are doing it during their sleep, they’re asleep, they don’t realize they’re doing it. People who go for sleep studies, for apnea or for whatever, those people usually are hooked up to a process called a myomonitor analysis and they’re clenching their teeth periodically. It’s amazing how often people do it, but it’s also amazing how many people just don’t want to believe they do it because they’re not present at the time they’re doing it.

What are the side effects of teeth grinding and clenching?

Dr. Darren McKeever: More often than not, what we start to see is discomfort in the teeth. Small hairline fractures in the enamel. Eventually the enamel can become so worn off that the inner dentin, which is much more sensitive, becomes exposed. We also start to see notches at the gumline in teeth. You don’t necessarily see that on all the teeth. Sometimes you may see it only on one tooth.

Years ago, we would tell people they were brushing too hard and then somebody asked the question, “Well if they’re brushing too hard how come you can only see it sometimes on one tooth? Can you really brush one tooth harder than the two neighbor teeth?” You really can’t when you think about it. More often than not, we see some kind of low level discomfort. We see changes in the aesthetics of the teeth where they start to get shorter. We may even start to see pain in the temporomandibular joints or in the muscles. All of those are side effects usually of grinding or clenching.

Can teeth grinding cause TMJ?

Dr. Darren McKeever: When we talk about TMJ, TMJ being the temporomandibular joints, that’s sort of a catch-all term. Nowadays we refer to it really as TMD, temporomandibular dysfunction. Clenching and grinding is one of the biggest reasons by far for why people get a dysfunction in their temporomandibular joints. TMD doesn’t necessarily always involve just the joint, it can be just the muscles that work the jaw. It can be the ligaments or the attachments that hold the disc that is part of the temporomandibular joint. More often than not, TMJ disease is caused by usually clenching and grinding over a long period of time.

Are bite guards the best protection against teeth grinding?

Dr. Darren McKeever: Usually a bite guard is the number one thing that we go to first because you really can’t stop somebody from clenching their teeth completely. Even if you do balance their bite, there are people who will still clench and/or grind. It depends on the cause. It depends on the person as well.

More often than not, a bite guard or a bite splint, which is slightly different, is usually the best protection against grinding your teeth because it keeps your teeth from touching while you’re asleep. If your teeth don’t touch, usually the muscles will not have that interference that they’re trying to obliterate and they’ll relax. People tend to get better sleep once they commit to the bite guard. More often than not, bite guards, bite splints, are the number one treatment that we use.

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If you are interested in speaking with Dr. Darren McKeever, visit or call 973-839-8180 to schedule an appointment.

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