After repeatedly waking up with throbbing, overwhelming headaches accompanied by a tight jaw, sore neck, and feeling like I’d barely slept, I discovered a culprit: I was grinding my teeth, what’s medically referred to as bruxism. This clenching of teeth most often happens overnight in the early stages of sleep, according to the American Sleep Association, which reports that about 10 percent of Americans have it.
“Bruxism is basically when your muscles that you chew with, they go into a cycle where they just keep grinding on each other constantly due to the fact that the muscles are hyperactive,” dentist Moris Ayenechi told The Daily Beast.
Ogbonna Bowden, a dentist in Chicago, told The Daily Beast that the jaw’s masseter muscle, responsible for chewing, is the strongest muscle in the body based on weight. It can generate 600 pounds of force per square inch of your teeth. This can cause microfractures in your teeth that can get worse over time, causing sensitivity in the teeth and leading to more dental work, like crowns, to protect the nerve endings of the teeth. Bruxism can also change your bite and cause headaches, aching behind the eyes, discomfort of the jaw and mouth, stiffness in the neck and shoulders, earaches and jaw clicking or popping
But a surprising, newer treatment for bruxism is Botox, where the neurotoxic protein is injected into the temporal and masseter muscles in the jaw. A report based off a small sample in the journal Neurology found that subjects given Botox versus a placebo for bruxism found their symptoms “very much improved” or “much improved.”
Botox blocks nerve signals to the muscle where it’s injected, so the muscle relaxes or, depending on how much botox is used, stops contracting. Ayenechi, who treats hundreds of bruxism patients with Botox, said he uses small doses of botox in the temporal and masseter muscles, which help relax them.
“Patients benefit a tremendous amount from all the discomfort, but the drawback for the Botox is that it wears out in about 3 or 4 months,” Ayenechi said. This is because botox doesn’t kill nerve signals, it just blocks them temporarily.
Ayenechi recommends patients get the Botox treatment every few months for a year, to get a cumulative picture of how well the Botox is working. After a year, he’ll have them take time off the treatment to see if their jaw muscles have adjusted to not grinding.
Bruxism is often caused by stress, both Ayenechi and Bowden said, though it can also be caused by sleep apnea. It’s most commonly thought of as affecting people going through stressful times or dealing with anxiety disorders. In fact, researchers have found a stronglink between bruxism and symptoms of anxiety and depression.The American Psychological Association reports that stress in America is on the rise, with nearly half of people reporting it affecting their sleep, when bruxism is most likely to happen.
Treating bruxism can be difficult, namely because the most common causes of it, stress and anxiety, aren’t as easy to treat as a dental cavity. “Stress and anxiety are the bigger causes for grinding your teeth, if you’re high strung or have a hyperactive personality, are the go-getter,” Bowden said. Ayenechi agreed, adding that he’d seen bruxism diagnoses follow the news. During the 2009 financial crisis, for example, his practice saw a spike in cases.
But dentists don’t often refer patients to mental health professionals at the first sign of bruxism. Neither Bowden or Ayenechi do. Instead, treatment for teeth grinding is often found in the form of night guards, plastic devices patients can buy over the counter or get custom-made from their dentist.
Night guards protect the teeth from grinding against each other and wearing down. In some cases, they can ease joints from working overtime.
But, essentially, they’re just a Band-Aid on the problem, only temporarily relieving patients from the discomfort of bruxism. “It’s a necessary part of treatment, but it doesn’t address the root of the issue,” Ayenechi said.
This is why botox is so groundbreaking for bruxism: it could essentially train the muscles to stay relaxed. Other treatments include muscle relaxers, physical therapy, acupuncture and even jaw-specific massage.
Luke Greenberg, a physical therapist and co-owner of MotivNY, told The Daily Beast that neck and shoulder muscles share connective tissue with the jaw, so it’s a painful chain reaction of tightness if the jaw is tight.
“Teeth grinding more of a stress mechanism than a muscular mechanism and the muscular mechanism is secondary, so if you never remove the stress then you’ll never remove the muscular tension,” he said.
Postural stress, how the body carries stress in the shoulders and back from poor posture often linked to sitting at a desk and stressful work environments, combined with general stress and anxiety can be a double whammy in the muscular department, Greenberg saws, creating a cyclical issue that includes the jaw.
Still, the most common treatments are tackling the pain from the problem, not the problem itself.
Botox also has something else going for it: a 2016 study found that botox might be affecting the central nervous system in addition to relaxing muscles. As a result, it’s being researched as a drug for depression and migraines.
A drawback for Botox is the price, which varies depending on how many units patient needs but has been reported to start at $500 a session in New York City, and is rarely if ever covered by insurance. The cost of a custom night guard can also be steep, ranging from $300 to $500, which is not always covered by insurance.
Teresa Duncan, President of Odyssey Management Inc, a speaker and lecturer on insurance and management issues in the dental industry, told The Daily Beast that what typically happens is that most patients will go see a physician for headaches, who will see that they’re experiencing bruxism and will send them to a dentist.
“It’d be helpful if a doctor wrote a diagnosis for stress or a referral form then the dentist can write a good narrative or appeal to the insurance,” she said.
Bruxism, when it is covered by insurance, is well covered, Duncan said, meaning it’ll cover between 50 and 80 percent of a night guard cost. But beyond that, the responsibility typically lies with the patient. To combat this, Duncan said to investigate all your coverage on a medical, behavioral and dental level to understand what is covered, what’s not and why. If your doctor can make a case for how bruxism is interfering with quality of life, there could be a chance it’s covered.
Until then, over-the-counter night guards cost just shy of $20,there’s always a weighted blanket to help destress before bed and the hope that dentists will do everything they can to find a way to help patients.
“The problem is not that easy, how do you tell someone: decrease your stress?” Ayenechi said. “I’m open to any avenues that are helping these patients.”