Dentists and patients have been told for years ‘why’ they grind their teeth at night. I’ve heard from occlusion specialists that it has to be because of imperfections in the bite, from myofacial pain specialists that it’s because of dis-coordination of the function due to inflammation in the muscles, from behavioral specialists it’s because of stress, and from neurologists claiming it is from brain dysfunction. Nutritionists, massage therapists, acupuncturists, psychiatrists, and kinesiologists all claim to have the answers. There seem to be as many theories for ‘why’ as there are theorists and just as many solutions.
Research in this area often leads to confusion but the deepest research yields a firm understanding that there is no firm understanding of sleep bruxism. The best resource I have found, ‘Bruxism – Theory and Practice’ edited by Daniel Paesani (Quintessence, 2010) concludes many of its 25 chapters and 524 pages by noting that ‘more research is needed’ or ‘multiple explanations are likely’ for what it presents.
What does the practitioner do with this body of data? I think we should treat our patients according to the best research we have available all the while sharing that we don’t know everything we wish we knew. Those patients who claim that ‘stress’ is causing their sleep bruxism and those who are sure that it’s “because everyone in their family does it” could both be right. There’s no reason for you to assert any other theory (and try to be ‘right’) because you can’t say with any more certainty than they can.
Treat the symptoms in the least invasive way possible. Keep in mind that many of your sleep bruxism patients may be suffering with sleep disordered breathing and before you make that ‘nightguard’ – whatever design that means to you – be sure to screen for the medical condition. You may just help the patient discover that there is more to what she/he is feeling than just sensitive teeth.
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