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Welcome to this webinar entitled, “Relief from Bruxism.” I’m Dr. Trish Murray – physician, best-selling author, and the Health Catalyst Speaker. Here at Discover Health Functional Medicine Center, we provide patients with natural alternatives to take control of their health and transform their lives. Above all, I am motivated to help you achieve better health and wellness with effective and holistic treatments.
If you have questions during our time together, please feel free to post them in the chat, and I will be happy to address them at the end of the presentation. Bruxism is pronounced exactly that: BRUK-siz-um. It is a condition associated with teeth grinding, gnashing, or clenching.
The process is usually done unconsciously and can occur while awake (awake bruxism) or it could happen at rest (sleep bruxism). Sleep bruxism is a sleep-related movement disorder and is usually associated with other sleep disorders such as snoring or possibly sleep apnea.
Because sleep bruxism occurs when we are unaware, it may not be identified until complications develop. Knowing the signs and symptoms is crucial to getting care. So, when bruxism is considered severe, jaw disorders, headaches, and tooth damage are the primary issues that are of concern.
Now, the Mayo Clinic has identified the following symptoms to be associated with bruxism:
- Teeth grinding or clenching, which might be loud enough to wake up your sleep partner
- Teeth that are flattened, fractured, chipped, or loose
- Worn tooth enamel, exposing deeper layers of your tooth
- Increased tooth pain or sensitivity
- Tired or tight jaw muscles, or a locked jaw that won’t either open or won’t close completely
- Jaw, neck, or face pain or soreness
- Pain that feels like an earache, though it’s not a problem with your ear
- Dull headache starting with the temples
- Damage from chewing on the inside of your cheek
- Sleep disruption
If you or your child experience any of the symptoms that I’ve just listed off, be sure to talk with your doctor or dentist as soon as possible.
The cause of bruxism is not yet completely understood. Research points to a combination of physical, psychological, and genetic factors as potential causes.
It was once thought that the dental occlusion was causally related; however, the Bruxism Association reports, “Research concludes that neither occlusal interference nor factors related to the oral-facial skeleton have a role in the etiology of bruxism.”
Awake bruxism is thought to have an association with emotional stress such as anxiety, anger, frustration, or tension. It may also be a coping strategy or a habit of deep concentration.
Research on sleep bruxism suggests the condition is secondary to sleep-related arousals. Sleep arousals are defined by a rise in autonomic cardiac and respiratory activity during sleep. These can occur anywhere from eight to fourteen times per hour of our sleep cycle and peaks in the minutes before rapid eye movement sleep, which suggests that there is some mechanism related to sleep stage transitions that influence the motor neurons of bruxism.
Research consistently reports bruxism rarely occurs alone. In other words, bruxism is commonly associated with an existing sleep disorder such as snoring, sleep talking, violent or harmful behaviors during sleep, sleep paralysis, breathing pauses during sleep, obstructive sleep apnea, and hypnagogic or hypnopompic hallucinations. What the heck are they? Well, hypnagogic or hypnopompic hallucinations are visual, tactile, auditory, or other sensory events, usually brief but can be prolonged, that occur at the transition from wakefulness to sleep. When you’re going from awake to asleep it is called hypnagogic or from sleep to wakefulness is called hypnopompic.
Bruxism is a common behavior prevalent in 8–31% of the general population. The prevalence of bruxism during sleep peaks in childhood actually and progressively declines with age. A literature review of cross-sectional survey studies and self-reporting show sleep-related bruxism affects 15-40% of children and 8-10% of adults. It’s actually significantly more common in children. This varies, however. Higher educational status, smoking, caffeine intake, and heavy alcohol consumption are all associated cofactors for bruxism.
Bruxism is significantly higher in individuals whose lifestyle includes the use of psychoactive substances such as tobacco, alcohol, caffeine, and medications for sleep or depression and anxiety. Psychoactive substances increase arousal and lead to problems such as daytime sleepiness.
Research shows nearly 70% of bruxism occurs as a result of stress or anxiety. Job-related stress is well documented as the most significant factor associated with bruxism due to being detrimental to good sleep and as a consequence can be responsible for daytime sleepiness.
The Bruxism Association reports, “Stress levels and personality characteristics are often considered as initiating, predisposing, and perpetuating factors for several diseases. Personality variables include the individual’s coping style both in perception and coping techniques. Some people are less resilient to stress and therefore suffer more from the physical and psychological consequences.”
Research findings point to a link between bruxism and high levels of stress which can include stress in the work environment, especially the coping strategies for work-related stressful demands.
Now, the top complications of bruxism include the following:
- Damage to teeth, restorations, crowns, or your jaw
- Disrupted sleep
- Tension-type headaches
- Facial or jaw pain
- Disorders that occur in the temporomandibular joints which are located in front of your ears and which may sound like clicking when you open and close your mouth
The temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull located in front of your ears. The temporomandibular joint allows you to move your jaw up and down and side to side, so you can talk, chew, and yawn. You can see in the slide here that the pen is pointing right to the socket with the ball of the temporomandibular joint visible in the skull on the picture.
Pressure on the joint from grinding or clenching teeth can cause temporomandibular joint problems, and when movements are disrupted causing problems with the jaw and facial muscles this is referred to as temporomandibular disorders (TMD). Now, the common symptoms of temporomandibular disorders include:
- Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when the mouth is moved
- Problems when the mouth is open wide
- The jaw that gets “stuck” or “locked” either in the open or the closed mouth position
- Painful clicking, popping, or grating sounds in the jaw joint with movement of the mouth
- A tired feeling in the face
- Trouble chewing or a sudden uncomfortable bite (for example, the upper and lower teeth suddenly feel misaligned)
- Swelling on one side of the face
Let’s take a moment and help you to feel where this is and see how you can actually palpate and feel the motion of your own temporomandibular joints. What I want you to do is take your index fingers on both hands and put them in the circular opening of your ears on either side. Put your index finger basically in your ear socket there. Don’t do it so hard that you can’t hear anything! Gently put your index fingers inside the holes of your ears. Then, right in front of the ear use your middle fingers and thumbs and feel for the ball or the bump right in front of your ears. Put your middle fingers on the top of the bump and your thumbs underneath on the bottom or just below. Don’t squeeze hard or anything. We’re just trying to palpate and feel it. Now, what I want you to do, if you think you’re in the right place with your index fingers in your ears and your middle finger on the top of the joint and your thumbs below the joint, simply open and close your mouth. Do it multiple times.
Ask yourself, first of all, can you feel the joint move? Does it move smoothly or not? Do you feel clicking or grating? Do both sides move symmetrically or not? If you actually, at the very end here poke around a little more firmly…is the area tender as you palpate around the joint? Now, if you answered yes to these clicking or asymmetry or tenderness, then this is a sign that you have temporomandibular joint dysfunction.
What do we do about it? Treatment will depend on the cause of bruxism. While there is no cure for bruxism, natural options are available to relieve symptoms, and an underlying cause can be addressed. Strategy options for addressing for improving bruxism include things like:
- functional medicine
- physical therapy
- osteopathic manipulation
Because certain lifestyle factors have been associated with worsening symptoms, such as high concentrations of caffeine or alcohol, these too should be avoided. Additionally, chewing gum may embed the process of clenching and grinding into the muscle memory around your jaw thus should be avoided. Chewing gum is not a good idea for folks with bruxism.
Other methods for relief include:
- The use of a warm washcloth or a heating pad at least once a day on the areas of discomfort.
- Reducing stress and anxiety in whatever way works best for you or some of the ways I’ll suggest tonight if you’re not already doing them.
- Implementing a soothing bedtime routine to promote restful and relaxing sleep.
- Prioritizing regular physical activity for sleep health and stress management.
Now, your dentist will ask about lifestyle stress and general dental health to help determine if you may be suffering from bruxism. Additionally, your dentist will check for tenderness in your jaw muscles, as well as for any obvious dental abnormalities, such as broken teeth, missing teeth, or poor tooth alignment.
If problems are thought to be caused by improper alignment of the teeth, correcting the alignment before too much damage is done may be recommended. Methods might include things like braces, crowns, oral surgery, or reshaping the chewing surface of the teeth to make the teeth align properly. But mouth guards, or what are called night guards, are the most common conventional treatment for bruxism. Mouth guards are specially designed most of the time to keep your teeth separated to prevent the top teeth from meeting the bottom teeth and clenching and grinding in order to prevent further damage due to the grinding or clenching.
As you know many people listening that have bruxism may have been to the dentist and had a special night guard made, and you know that they’re not inexpensive. You may not have done that yet. You can go to the dentist and they absolutely can make a very specific dental night guard fitted for you; however, there are over-the-counter options.
I have been to either pharmacies or other stores that if you go to the pharmacy section, they may have bruxism or teeth grinding related over-the-counter products. You also could go to the sports section and buy one of the make your own mouth guards.
Because I have bruxism myself, I tend to cut the mouth guard down so it’s not so bulky. I put it in the hot boiling water and bring it out and then I put it in my mouth. As you make those mouth guards yourself, you’re told to put them in boiling water, take them out of the boiling water, wait ten seconds or so so you don’t burn your mouth of course, and then put the mouth guard in and bite down and sort of suck in to get the melted or now soft plastic, if you will, to form around your jawline and your teeth.
The one thing I would say, if you’re making your own mouth guard, I would not bite down very hard. I would bite down only gently and suck in only slightly. Again, you want it to form so that while you’re sleeping it’s not uncomfortable, but you also don’t want to bite down too hard because the whole point is to keep the thickness in the plastic so that it separates your bottom teeth from your top teeth and you’re not able to grind. These are options for the whole mouth guard/night guard concept.
Functional medicine and functional dentistry utilize holistic techniques to determine the root cause of conditions. There is new research that bruxism and clenching are not always benign. We know that it leads to dental and temporomandibular joint dysfunctions, and now there are several independent sources that possibly link bruxism with neurodegenerative conditions which functional medicine can help identify.
A functional medicine professional will work to create a partnership with a patient in order to develop a personalized care plan using lifestyle techniques to reduce underlying conditions related to diet, inactivity, and associated mental issues, such as stress.
This is why at Discover Health Functional Medicine Center we start out with doing a full history of someone’s entire life and actually create, together with you, a timeline so that no rock is left unturned in trying to identify what has brought each individual to the place they are and the symptoms they are experiencing.
Daily jaw exercises can help with teeth grinding. An osteopath or physical therapist can work with you to recommend further functional exercises. Let’s go over a few simple jaw exercises to get you started. Remember, the goal is to help relax and strengthen your jaw. Let’s try a few things. First of all, the first one is to actually…you may not have this around, don’t worry about this one. Apply a warm compress to the jaw by using a warm, wet washcloth. If you haven’t done that, it can be very relaxing in the evening to do that.
The exercises themselves are place your thumb or even your whole fist underneath your chin, you’re going to go under your chin, to create resistance when opening and then even while closing your mouth. What you would do is put your fingers, your thumbs, or even your whole fist, under your chin. Now, you’re going to try to open your mouth but use your hand to add some resistance, not so much that you can’t even open your mouth, but just some resistance. You’re going to do these three or four times. Open and then close, then resist and open again and close, and then resist and open again and close. You would do that repetitively maybe from, like I say, anywhere from three to six times.
The next exercise is to put your thumb and forefingers on the front now of your chin to create resistance as you actually push your jaw outward, away from your body. The hand will move forward, the jaw’s moving forward and protruding, but the fingers in the front of your chin are adding some resistance. Go ahead and do that multiple times, anywhere from three to five times. Again, you’re not adding so much resistance that you can’t move your jaw at all, you’re just gently resisting to make your jaw work and the muscles of your jaw work and be more aware of what they’re doing.
The third one is to put your tongue and attach it and just put it up on the roof of your mouth. Put your tongue on the roof of your mouth and then keep it there while you open and close your mouth. Again, put your tongue and attach it to the roof of your mouth and just try to open and close your mouth without releasing your tongue from the top of your mouth. Do that three, five times.
Again, for best results, perform each of these three exercises three to six times. You would do it repetitively. You would do these exercises two or three times a day as you’re trying to really focus to see if they’re going to make a difference over time.
Now, also in just a few minutes towards the end of the program I will share with you a video on how to do your own self-myofascial facial. This video that I’ll share was created by Lisa Buerk who is our Discover Health Movement Membership self-myofascial release instructor.
Discover Health Movement Membership is an online movement program that we have created to give you the tools you need to take control of your pain. It offers three different classes: Self-Myofascial Release, Movement for Longevity, and Discover Yoga. To learn more and to sign up, go to discoverhealthfmc.com/#Movement.
Many report to finding relief from teeth grinding associated with bruxism with regular acupuncture sessions. Acupuncture is a form of Traditional Chinese Medicine which has identified a number of patterns associated with bruxism. Traditional Chinese Medicine links bruxism to organs that are functioning at an excessive or hyperactive rate, commonly the heart, stomach, and/or the liver.
Acupuncture improves bruxism by correcting the functioning of the organs that are considered either excessive or what’s called deficient in the acupuncture realm. Pressure points, or acupoints, are said to lie along channels of energy in the body and typically are found within the fascia or connective tissue that surrounds everything in your body. These points are in the tissues that connect and surround every organ and can be stimulated to restore function to the associated organ.
Once the condition is identified, tiny needles are inserted into the fascia to stimulate and improve circulation. The whole process is typically painless, and many report feeling immediate relief.
Now, designing a good bedtime routine can have a significant influence on getting better night’s sleep and on reducing your bruxism. Sleep.org recommends the following habits for a healthy night’s sleep:
- Keep a schedule. Going to sleep and waking up at the same time every day is crucial for setting your body’s internal clock.
- Be mindful of what you eat and drink, and when. Nicotine and caffeine are stimulants that can take hours to wear off, so they’ll make it harder to fall—and stay—asleep and should be avoided for at least six hours before bedtime. Alcohol also disrupts your quality of sleep.
- Create a welcoming, cozy sleep space. Your bedroom should be peaceful and conducive to sleep. Try keeping it quiet, cool, and dark. Earplugs can help block out noise, and room-darkening shades can help block the light.
- Start an evening ritual. Try curling up with a good book, listening to calming music, or taking a warm bath at the same time each night to signal and prepare your body for sleep. Avoid watching TV or looking at any laptop, tablet, or smartphone screens because they can interfere with the release of your appropriate sleep hormones.
- Avoid clock watching. Constantly looking at the time will cause more stress and make it more difficult to sleep. If you are having trouble falling asleep simply get out of bed for fifteen minutes. Try reading or stretching before returning to bed.
In the past, I’ve done a webinar that focused completely, the whole webinar, on sleep and how to optimize it. Be sure to check out my podcast, Discover Health Podcast, or go to our Discover Health Functional Medicine Center YouTube channel to listen to that webinar.
Managing stress is crucial for reducing teeth grinding caused by bruxism. Grinding is often worse when suffering from stress or anxiety. Learning techniques to manage and release stress will help reduce your bruxism. Meditation, physical activity, and essential oils are all beneficial techniques. There are a wide variety of meditation techniques available including, but not limited to:
- concentration meditation
- mindfulness meditation
- guided meditation
- mantra meditation
- visual meditation
- observation meditation
Physical activity also offers a variety of options, such as:
- circuit training
- weight training
- and many other options, the list is limitless!
A number of essential oils help promote calming and relaxation through various application methods, as well.
What is your go-to stress management technique?
Various studies link meditation and the relaxation response and have documented the following short-term benefits to the nervous system. Meditation and relaxation:
- Lower blood pressure
- Improve blood circulation
- Lower heart rate
- Decrease perspiration
- Slow respiratory rate
- Less anxiety
- Lower blood cortisol levels
- Decrease stress
- Deeper relaxation response
Now, a number of yoga postures have been shown to help release tension thus benefit bruxism sufferers. Postures to relieve stress and tension in the neck, upper shoulders, and trapezius muscles are particularly helpful.
Some specific postures that will do this include one called eagle arms to help to relieve any built-up tension in the shoulder blades and postures that are related to stretching the chest help reduce tightness from your clenched muscles surrounding your jaw.
A regular full yoga practice is also associated with overall stress relief. Meghan, who you see in the slide on this picture, our Discover Health Movement Membership Discover Yoga instructor teaches a beginner or basic yoga class that helps to quiet and focus the mind and relax the tissues. Remember, our Discover Health Movement Membership is available completely online and can be done from anywhere in the world as long as you, of course, have internet!
Essential oils offer natural ways to reduce pain and reduce stress. Essential oils can be taken in many different ways. They can be taken orally, they can be taken topically, or they can be inhaled. Be sure, however, to ensure the quality of the oils and also be sure to research which avenue you are supposed to use any particular oil. Some oils would not be taken orally because they could be toxic! Make sure you research these things.
Peppermint oil is great for teeth grinding. A small dose before bed helps reduce anxiety and provide headache relief. Frankincense oil is a natural inflammation reducer and reduces anxiety as well. Lavender oil is very calming. Try sprinkling a few drops on your pillow to calm your muscles. Lavender oil can also be mixed with coconut oil and massaged into the jaw and neck for relaxation. Chamomile oil can be used aromatically which means just by breathing it with a diffuser to decrease anxiety and lessen teeth grinding. Rosemary oil is perfect for relieving the sore jaw caused by grinding your teeth. And turmeric oil is a strong relaxant to reduce anxiety and stress all day long.
Let’s talk a minute about supplements. A number of supplements can be used in combination with the aforementioned techniques to help reduce stress and anxiety.
Vitamin C complements stress management because it is used by your adrenal glands in the stress response. Vitamin C is essential in the making of dopamine, which helps to regulate moods. Vitamin C rich foods include guava, black currants, red peppers, kiwi, green peppers, oranges, strawberries, papaya, broccoli, and kale.
Next, magnesium. Magnesium deficiency is associated with anxiety, irritability, insomnia, restlessness, and hyperactivity. A high-quality magnesium supplement before bed helps to improve the quality of one’s sleep. Magnesium-rich foods include spinach, chard, pumpkin seeds, kefir or yogurt, almonds, black beans, avocado, figs, dark chocolate, and bananas.
Next, the role of the B vitamins in the overall health and wellness is well-documented. Deficiency in B vitamins may cause psychological stress, depression, and even panic disorder. Vitamin B5, called pantothenic acid, may be especially useful when you are trying to overcome bruxism to help balance mood.
Next, valerian root is a natural sedative and an anti-anxiety treatment shown to improve the quality of one’s sleep. Since bruxism is classified as a sleep-related movement disorder, valerian root might be something that can be ideal to be tried.
This is Lisa Buerk, again our Discover Health Movement Membership Self-Myofascial Release instructor…the video demonstration of how to do a self-myofascial facial with Lisa, begins 35 minutes into the YouTube video, Relief from Bruxism.
I hope you enjoyed that. If you did, as I said, self-myofascial release is a modality that you can be learning how to use not only for your jaw and your face as a self-myofascial facial like we just did, but you could be learning how to do that modality for your entire body through our Discover Health Movement Membership, an online program. Lisa is the instructor for one of the three classes called Self-Myofascial Release.
There are numerous resources used to create this presentation. As usual, we will post all of them for you in our Discover Health Facebook Group tomorrow. So, if you want to get access to these resources and do further learning for yourself and are not already a member of our Discover Health Facebook Group then simply do this: go to Facebook, go to our Discover Health Functional Medicine Center business page, and simply request (there will be a button to link) to join our focus group called our Discover Health Facebook Group. Tomorrow we will post all of the resources for you, and we will also post the video that Lisa just did.
We will also post the video on our Discover Health Functional Medicine Center YouTube channel. That’s another place to watch for it if you would like to watch that entire video. And, of course, if you’re here tonight or you’re someone who’s registered for tonight’s presentation we will send you the link to the recording of the talk that you can share with anyone you’d like!
Thank you all for taking the time to experience our class today! We hope everyone learned something new and is now better equipped to improve their bout of bruxism. If you have any further questions, just email us at [email protected] or your can also post questions in our focus group, our Discover Health Facebook Group.
Thanks everyone! Have a fantastic evening. Here locally it’s absolutely gorgeous so I’m going to get outside and also, it’s staying light out much later. Let’s go enjoy some sun!
Watch this full webinar on our YouTube channel: https://youtu.be/DjcGpahrQi8
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