Andrea Wise was fresh out of graduate school and working for an early-stage startup when she started waking up with an aching jaw. She had found ways to manage her chronic anxiety—a blend of medication, exercise, solid sleep, and a quiet, tree-lined neighborhood—but her healthy habits went out the window when she started working 70 to 80 hours per week.
Then 25, Wise found out she had high blood pressure and had started grinding her teeth in her sleep, which was causing that serious morning jaw pain. She tried an over-the-counter night guard—briefly. "It was bulky and annoying, and even though it was probably protecting my teeth, I was still clenching my jaw intensely overnight so it didn't help the jaw pain," she says. Feeling powerless to reduce her hours at work and too busy to start exercising again, she asked her doctor to up the dosage of her medication.
She saw short-term benefits: Wise felt less anxious and stopped grinding her teeth. But the meds didn't fix the problems, just made them manageable. "It wasn't until I finally left that job and got back to making lifestyle decisions that prioritized my physical and mental health that I was able to reduce my meds without those symptoms, like the teeth grinding, coming back," says Wise, now 28.
Bruxing—excessively grinding your teeth or clenching your jaws—is an oral parafunctional activity, meaning it's completely unrelated to your mouth's primary functions like eating or talking. It can be diagnosed in three ways: self-report questionnaires, clinical exams, and polysomnography exams. "Self-report questionnaires are not the most accurate way of determining any condition," says Gary Klasser, an expert on orofacial pain and a professor at Louisiana State University's School of Dentistry. "A sleep study that has audio-visual recording—that's probably the most accurate means." People can brux in their sleep or during the day, but we know a lot more about sleep bruxism because it's easier to stick wires on people, hook them up to machines, and observe their behaviors when they're snoozing.
Brazilian researchers recruited 1,042 people to fill out questionnaires and undergo polysomnography exams to figure out how many people it affects. Their study, published in the Journal of Dental Research, suggests that 5.5 percent of people grind their teeth or clench their jaws in their sleep.
"I think it's more commonplace than people realize," says Alice Boghosian, an American Dental Association spokesperson and a clinical instructor at the University of Illinois at Chicago. "It's normal to have some wear on your teeth, but if I see the wear of a 50-year-old on a 20-year-old, I'm like, hm, what are you doing?" Usually, they're clenching and grinding. At her private practice, Boghosian (who is also a bruxer), sees patients every week with worn teeth, chipped teeth, cracked teeth, and teeth "split like a piece of firewood."
Paris Bethel was in her teens when her dentist told her that her teeth were worn down. She has ground her teeth so consistently for so long—more than eight years and "still going strong"—that her gums are receding from the pressure and some of her teeth have smoothed out from the friction. "I've been told that as I get older the symptoms will increase and that I should not be surprised if I start experiencing headaches or jaw aches," she says, both of which are common symptoms of bruxing, in addition to the dental distress.
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People clench and grind for many reasons, but certain factors increase your risk. Smoking doubles your risk of sleep bruxism, and so does boozing, according to a review published last year in the Journal of the American Dental Association. Drinking more than eight cups of coffee per day may give you lots of energy, but it also ups your risk by 50 percent.
But several studies have linked both types of bruxism to stress and anxiety. German researchers had 69 people answer questions about their stress levels and wear a monitoring device in their mouths for five consecutive nights to track their gnashing. They found that people who reported high levels of work stress, daily problems, and fatigue were more likely to grind and clench in their sleep than the more mellow crowd. You might also brux during tense daytime events, like while lifting weights, chopping vegetables, or attending stressful meetings.
Daniel Taroy, 24, first realized he was bruxing about three years ago. Friends and family members noticed he was grinding in his sleep, and eventually his dentist pointed out wear and tear on his canines. "It happened around the time I graduated college and moved to New York City, which was around the time I was starting my first job," he says. "I think the stress of moving to a new city and starting a new phase of life contributed."
In some cases, treatment is as simple as popping a mouth guard in. "A night guard is the gold standard," says Ruchi Sahota, an ADA spokesperson and a practicing dentist in Fremont, California. When made correctly, they protect your teeth because the force of your jaw wears down the plastic instead of the enamel. But if you use a dodgy appliance, it can actually increase pain, alter your temporal mandibular joints, or cause an anterior or posterior open bite, Klasser says.
Taroy has tried two over-the-counter night guards: One of the boil-and-bite variety and one sans the self-molding step. "The boil-and-bite was easy enough to use, but I felt that after a while, I still ground my bottom teeth against it," he says. "So I switched to the no-boil guard, which is effective but also kept coming dislodged at night, which can get annoying." Now, he plans to have a custom guard made at his next dentist visit. "If you're going to have one of the appliances fabricated, it should be done by a professional," Klasser says.
While the night guard has obvious benefits, it's also important to think about what may be causing your bruxism and address that problem head-on, Sahota points out. Reducing your intake of nicotine, alcohol, and caffeine can reduce your risks. "And if it's stress or anxiety that's contributing to your bruxism, what can you do to alleviate that?"
In the end, Wise didn't feel that the higher dose of medication fixed her problem, but meds may be a solid strategy if you're struggling with anxiety. "If the medication is a form of therapy, if it's monitored by a doctor, then it may be one tool in their tool belt," Sahota says. Theoretically, weed could ease your anxiety and in turn help you stop bruxing, but Bethel—a regular bedtime toker—hasn't noticed any benefits.
Sahota always recommends exercise, meditation, and counseling to her stressed and anxious bruxing patients, and also suggests finding ways to properly unwind at night to ease your muscles and mind. (A review published earlier this year even found that because of their relaxing effect, botulinum toxin—Botox—injections in your masseter and temporalis muscles, the ones used to grind and clench, can ease bruxing.)
Daytime grinding and clenching is just like any other habit, like picking your nails, clicking your tongue, or tapping your foot. Visual cues—like a stickie note on your desktop reminding you to "stop clenching!" at work—can help you block the urge or remind you to relax your jaws. Yes, it'll take effort, but it's better to break the habit than to break your teeth.
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