A unifying characteristic of all rodents is that their teeth—specifically, their top and bottom incisors—never stop growing. To prevent them from extending into their brains, rodents have to constantly grind these two pairs of teeth against one another. Human teeth, by contrast, emerge from the upper and lower jaw fully formed. As such, there’s no need for us to spend our time whittling them down. But that doesn’t mean that teeth grinding—also known as bruxism—isn’t surprisingly common among people. In fact, some studies show that almost a third (31%) of us do it.
Typically, bruxism occurs during sleep or unconsciously while we’re awake. That means most people with bruxism may not know they are grinding their teeth unless they’re informed by a partner or tipped off by jaw pain, headaches, or tooth damage.
In some cases, however, bruxism can belong to a category of mental health conditions known as body-focused repetitive behaviors (BFRBs)—a category that also includes hair pulling (trichotillomania), skin picking (excoriation disorder), and nail-biting (onychophagia). BFRBs are repetitive behaviors that are consciously performed in order to soothe oneself or relieve tension. As the name suggests, BFRBs involve focused attention on the body and often damage the body part in question.
In this article, we’ll take a closer look at the type of issues teeth-grinding can cause, how those issues can be mitigated, and how the various underlying causes of bruxism can be addressed by an evidence-based form of therapy.
Issues related to bruxism
Whether you’re doing it consciously or not, grinding your teeth will ultimately cause you problems, the most obvious being damage to the teeth themselves. Despite being the hardest substance in the human body, tooth enamel can be worn down by bruxism over time, leading to tooth sensitivity, chipped teeth, and fractures, to say nothing of the damage it can do to fillings, crowns, and bridges.
In some cases, chronic teeth grinding can alter the actual alignment of the teeth, causing a misaligned bite (malocclusion), which can undo the progress of orthodontic work and even require more. The strain bruxism causes the muscles can also cause temporomandibular joint (TMJ) disorders and headaches, and negatively impact people’s gum health.
Additionally, if you grind your teeth while sleeping, the sounds can disrupt your sleep and the sleep of those you share space with, resulting in poor sleep quality, daytime drowsiness, and fatigue. Wearing a mouthguard while sleeping can reduce or prevent tooth damage, headaches, or a misaligned bite, but that’s mostly feasible during the nighttime—to stop grinding our teeth altogether, we must treat what’s causing it.
What causes teeth grinding/clenching?
Teeth grinding is symptomatic of several common phenomena. Among them are:
Anxiety: For many people, bruxism is a symptom of anxiety, stress, or frustration. As such, meditation, breathing exercises, and other relaxation techniques can be employed to mitigate its impact.
Sleep disorders: While the relationship between bruxism and sleep disorders is complex and not fully understood, sleep apnea and snoring have been associated with an increased likelihood of bruxism.
Malocclusion: In addition to being an effect of bruxism, a misaligned bite can also cause teeth clenching and grinding in some people. An orthodontist or maxillofacial specialist may be able to offer interventions for people who grind their teeth for this reason.
Recreational substance use: For those with bruxism caused or exacerbated by nicotine, alcohol, or the use of recreational drugs such as cocaine or amphetamines, the best response is to quit or significantly reduce using them.
Body-focused repetitive behavior (BFRB): In addition to hair pulling and skin picking, teeth grinding is one of the officially recognized forms of BFRB. In these cases, it’s different from the other causes of bruxism in that it’s engaged in consciously and is aimed at self-soothing or relieving tension.
“What really separates teeth grinding from other BFRBs is that it’s much more difficult to notice,” says therapist Aaron Hensley, MSW, LCSW. “Not only can we see when a person is plucking hairs or picking at their skin, but we can also see the results—bald patches, scabs, etc. Teeth grinding happens where we can’t see it and, oftentimes, only a dental exam will reveal that it’s been taking place.”
Hensley explains that he primarily sees teeth grinding as a BFRB when working with children, and has successfully reduced it with a type of evidence-based therapy that’s been shown to be effective for all BFRBs: habit reversal training (HRT).
What is habit reversal training (HRT)?
Habit reversal training (HRT) has been widely studied and shown to be an effective treatment approach for reducing all body-focused repetitive behaviors (BFRBs). It involves five stages that a therapist trained in this approach will work through with you.
First, the therapist will teach you techniques to notice when you are performing the behavior and, more importantly, the feelings that precede that behavior. They’ll also help you identify the specific situations in your life that trigger it.
The therapist will then help you institute a competing response that will replace the behavior that’s causing problems. This is the core component of HRT, and competing responses tend to occupy the same part of the body as the original behavior or even physically prevent it from being possible. For teeth grinding, this might include breathing exercises, jaw stretching, or tongue placement.
Another element of HRT is called motivation and compliance: This could involve making a list of all the problems that were caused by the behavior to remind you of the importance of sticking with it. This stage can be bolstered by asking friends and family to acknowledge your progress.
The fourth aspect of HRT is the adoption of relaxation skills. These may include deep breathing, mental imaging, mindfulness, and progressive muscle relaxation to keep urges at bay, particularly as the thoughts and feelings that precede the teeth-grinding arise.
Generalization training, the fifth and final stage of HRT, involves practicing your new skills in several different situations so the competing response becomes automatic. Between sessions, your therapist will ask you to fill out something called a target behavior monitoring form. It will enable you to keep track of your teeth grinding and provide you with reference data about when it happened, where you were, how you felt, what you were thinking, how you tried to prevent the behavior, and the outcome of the situation. By having this record on hand, you and your therapist will be able to chart your progress and, if necessary, make adjustments to what you do in and outside of sessions.
How to find help for teeth grinding and other BFRBs
While not the same as having Obsessive-Compulsive Disorder (OCD), BFRBs are classed as OCD-related disorders. The close relationship between these conditions—and the high rates of co-occurrence between them—is why the over 300 licensed therapists in the NOCD Therapy network are all specialty-trained in HRT for BFRBs.
Like the gold standard treatment for OCD—exposure and prevention response therapy (ERP)—HRT can be delivered remotely with great success, and a marked improvement is typically seen in a matter of weeks. If you or someone you know is struggling with conscious teeth grinding— or any other BFRB—you can schedule a free call today with the NOCD Care Team to learn more about how a licensed therapist can help.