Grinding Teeth, Apnea & Burn-out

If you grind your teeth and your dentist has given you a night guard for it, this article is for you.

The old fashioned method of treating bruxism is to cover the teeth with a night guard to protect them from the strong vertical forces caused by grinding, which causes teeth to crack, break, and, over decades, slowly wear the teeth away to stubs.

The problem with this thinking is that a night guard fails to treat the root cause of why we grind our teeth.

The newest research shows that the brain stimulates the grinding response every time you stop breathing at night. The grinding motion pushes the jaw forward, reopening your airway, allowing you to breathe again.

This evidence demonstrates that teeth grinding (bruxism) is a red flag for sleep apnea.

So while your night guard might protect your teeth at night, it’s at the very best a bandaid solution for the symptom of a deeply serious underlying condition.

A night guard will protect your teeth, but it isn’t going to protect your grinding muscles and jaw joint from damage. A night guard could also be interfering with a vital instinctual response that you use every night to prevent yourself from suffocating.

I no longer will make night guards for my patients because of this new paradigm. Typically, standard of care is treating the root cause of a condition, not just the symptoms.

Treating sleep disordered breathing (sleep apnea being on the far right of that spectrum) can protect your teeth by eliminating your need to grind, but more importantly, will allow your brain and body to properly repair themselves with uninterrupted sleep.

what you should know before you accept a mouth guard from your dentist

Teeth grinding (bruxism) is the instinctual response the body uses to reopen a collapsed airway by advancing the jaw forward.

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So, if you’re grinding your teeth, you should be concerned with two things:

1Protecting your teeth from the strong vertical forces of grinding, which can cause them to break, crack, become sensitive, cause you pain, and prematurely yellow and cause your gums to recede.

2That you should be tested for sleep apnea, a potentially life-threatening condition.

Have you ever felt like your night guard just makes your grinding worse?

A night guard can making bruxism worse because it can prevent you from being able to push out your lower jaw, thereby preventing the airway from opening and making your sleep apnea even worse, effectively choking you and causing you to need to grind harder and more often.

grinding as an indicator for sleep apnea

One of my pet peeves is seeing dentists who treat the mouth and the teeth in isolation from the rest of the body.

So, what do teeth have to do with sleep apnea?

Every time you put something into the mouth before you go to sleep, you reposition how the jaw, tongue, and soft palette all interact at the back of the airway, determining the way you are able to breathe and sleep at night.

This means that your dentist is responsible for your airway and, thus, your sleep ability. You deserve and should expect a dentist who considers sleep apnea if you grind your teeth. A dentist who treat just your teeth in isolation from the rest of the body is doing you a great disservice and maybe even harming you.

You certainly can’t die from grinding your teeth, but you can die from the reason you grind your teeth: obstructive sleep apnea (OSA).

treating sleep apnea to treat grinding

I can’t treat my patients’ grinding without treating the root cause of their grinding—and that’s treating their airway.

Prescribing a night guard to someone who is grinding their teeth at night is, at best, a bandaid solution and, at worst, could be making it even harder for you to breathe at night.

Not everyone in the dental and medical field is up to speed on this just yet, so be prepared to have to really advocate for yourself or find a dentist and doctor who is up to speed.

what you should expect from your dentist

So personally, as a practicing dentist and someone who treats bruxism, TMD, and sleep apnea and having read all the latest literature on this topic, I now have decided not to make night guards for my patients the way I used to — I now have to rule out a sleep disturbance first and proceed only after having an sleep specialist MD verify the status of a person’s sleep ability — that is, how well they are able to breathe at night after the muscles in their airway become paralyzed during deep sleep.

•If your dentist isn’t screening you for sleep apnea, find one who can through the Academy of Dental Sleep Medicine database.

•Work with your dentist to identify if you grind your teeth.

•Get a referral from your primary care physician to see a sleep specialist, who can get you a prescription for a sleep study.

•The sleep study will determine the level of sleep apnea that you have—mild, moderate, or severe. Sleeping with a CPAP machine at night will blow air down your throat so that you’re able to access deep sleep.

•If you can’t stand the idea of sleeping with a CPAP, you may be a candidate for an oral appliance from your dentist. An oral appliance is like a retainer that you wear at night that keeps your jaw pushed forward, and thus, your airway open even as your muscles become paralyzed in deep sleep. If you have severe sleep apnea, oral appliance therapy is not recommended.

•If your dentist has recommended a repositioner for you, get a second opinion. A repositioner does what it sounds like—it repositions your jaw. This could be playing with fire when it comes to whether you’re able to breathe at night.

 

Your dentist must treat the root cause of your grinding. The only way s/he can do that is by:

1. Suggesting that you get a sleep study.

2. Ruling out sleep apnea before making you a night guard

or

3. Properly addressing your sleep apnea with a CPAP and oral appliance therapy. Your teeth grinding will be cured if you treat your sleep apnea because you will have taken away your body’s impulse to grind in the first place.

If you’re grinding your teeth and not happy with your sleep quality, check out my #1 bestselling book The 8-Hour Sleep Paradox, which is all about how to achieve your best night of sleep to become your brightest, healthiest, most capable self.

Mark Burhenne DDS

sources

Sleep bruxism etiology: the evolution of a changing paradigm

Bruxism & Obstructive Sleep Apnea

the real reason you grind your teeth

Last updated on September 14, 2018

the answer to why you grind your teeth used to be stress or a bad bite, but the newest research shows that it’s due to interrupted sleep breathing.

Until recently, teeth grinding had been a mystery amongst doctors and dentists. The working theory used to be that grinding was caused by stress, but then again, this didn’t explain why we see that a fetus in utero grinds their teeth — and so, grinding remained a mystery among dentists, doctors, and researchers.

But thanks to the latest research, it’s now accepted that grinding is an instinctual response that helps us survive.

This powerful new research has flipped on its head how we both treat grinding and how we think about diagnosing sleep apnea.

For more, check out my #1 bestselling book The 8-Hour Sleep Paradox.

why you grind your teeth at night

During the night, the brain cycles through lighter and deeper stages of sleep.

As the brain approaches deep sleep, all the muscles in the body have to fully let go and relax. This easily causes trouble for the airway — the jaw is heavy and easily blocks the airway and the tongue, when fully relaxed, expands to almost twice its size to block the airway as well.

Researchers studied brain scans of people with partial blockage in their airways while they slept and what they noticed is that it was grinding (also called bruxism) that reopened the airway and got the study participants breathing again.

As soon as they were given something to keep their airway open all night long — like a CPAP machine or a dental appliance that held the jaw in place so the tongue and jaw don’t block the airway — their grinding stopped and so did the “apneic” events, or the loss of breathing during sleep.

the real consequences of grinding

If grinding is what saves us, then what’s wrong with it?

While grinding is effective at saving us at night, there are consequences to having interrupted sleep every night.

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You’re not sleeping well if you grind your teeth. Even with slight sleep apnea, you’re waking up in a damaged state. Tensing up the muscles to grind bounces the body out of deep sleep, and all the health benefits of sleep you read about come from deep sleep. This is where human growth hormone (HGH) is released, reversing the aging process, tightening skin, improving memory, burning fat, and building muscle, and potentially warding off diseases like Alzheimer’s. Untreated sleep apnea can have serious and life-shortening consequences like high blood pressure, heart disease, stroke, automobile accidents, diabetes, depression, anxiety, and weight gain. Don’t fall into the eight hour trap — just because you’re unconscious for eight hours, doesn’t mean it’s quality sleep.

Damages our teeth and jaw joint. Years of grinding and clenching can damage your teeth, cause tooth decay and tooth sensitivity, and lead to permanent jaw pain and damage to the jaw point.

A mouth guard makes things worse. A mouth guard is put in place to protect the teeth from grinding, but since it can reposition the jaw, it can actually make the obstruction of the airway worse (more on this in a bit).

bruxism: the new red flag for sleep apnea

Grinding is the new indicator for obstructive sleep apnea.

If you grind your teeth, the new standard of care is that you get a sleep study because you are likely having episodes of interrupted breathing during the night and missing out on all the health benefits of deep stage sleep.

Even if you’re otherwise healthy, sleep apnea is known to significantly increase your risk of high blood pressure, stroke, cancer, diabetes, depression, and obesity.

A Swedish study estimated that as many as half of women aged 20 to 70 suffer from some degree of sleep apnea — which can range from slight to severe. The old idea of an obese, middle-aged man who snores is no longer what we should think of when it comes to sleep apnea.

the new at risk groups for sleep apnea

•Petite women

•Children with ADHD and other learning disabilities

•People with a long neck

•People who did not breastfeed as infants

•People with anxiety and depression

•Anyone who grinds their teeth at night

the new way to treat grinding

treating sources, not symptoms

Treating the airway cures teeth grinding.

To treat grinding, you have to treat the source of what’s causing it, and that’s a small airway.

If you grind your teeth, you might have been told that you need to sleep with a mouthguard to protect your teeth from wear and tear — and that’s based on the old standard of care.

Not treating teeth grinding can lead to excessive wear and tear on teeth, leading to tooth decay, periodontal tissue damage, jaw pain, and headaches.

The new understanding is that, in order to treat teeth grinding, you have to treat the root cause that is causing you to grind your teeth — and that’s the obstruction of the airway.

Once you remove the need to grind, teeth grinding stops.

If you grind your teeth, it should be considered first due to its seriousness that you likely have a small airway and the reason you’re grinding is to open your collapsed airway while you’re sleeping.

In fact, wearing a mouth guard to protect your teeth from grinding may even make you grind more, since a mouth guard repositions the jaw in such a way that the airway could be getting blocked more than it would be without the mouth guard.

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treating grinding with a mouth guard: more harm than good?

But how do you know if you grind your teeth if you’re asleep when you’re doing it?

Most people don’t know that they grind their teeth until their dentist tells them.

how to know if you’re grinding your teeth

•Wear on your teeth

•Teeth that are worn flat

•Abfractions

•Sore muscles

TMJ pain

•A jaw that clicks

what to do if you grind your teeth

•Talk to your dentist. Your dentist can’t make the diagnosis — she or he will leave that to the sleep medicine MD, but your dentist can screen you for teeth grinding and examine the beginning of your airway as you lie flat in the chair at your next appointment. There is an oral appliance your dentist can make for you that keeps the airway open while you sleep, which can work great in conjunction with a CPAP machine or even by itself in mild cases.

•Find out if you grind your teeth. The telltale signs of a grinder are flat, worn teeth, jaw clicking, or jaw pain. Ask your dentist to be sure.

•Talk to your doctor about getting a sleep study. Ultimately, you will need a sleep study to get a diagnosis for sleep apnea from a sleep specialist.

•Reconsider the night guard. This is the old way of thinking and, even though it’s protecting your teeth, your night guard could even make your sleep apnea worse.

coffee stains and teeth grinding: early warning signs of adrenal fatigue?

Last updated on July 3, 2018

if you’re teeth grinder who loves their coffee, it could be that your coffee habit is a bandaid for larger health issues. here, i cover the coffee paradox and what to do if you’re a grinder who loves their coffee.

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BY DR. BURHENNE

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This post is my response to a great podcast episode, “Is Drinking Coffee Good For You?” by Chris Kresser, who by the way, is extremely analytical and knowledgeable about so many things regarding whole body health and has a must-listen podcast that I highly recommend subscribing to. I’m very picky about which podcasts I subscribe to, but Chris’ is one of the best.

This episode discusses how coffee is a “gray area” food — meaning that scientific research suggests that coffee is beneficial when it’s well tolerated by the individual, but it’s not always well tolerated. This really resonated with what I see in my patients on a daily basis in my practice (which I’ll get to in a bit).

The thing that really resonated the most about the episode is this:

People that need coffee are the ones that shouldn’t be drinking it because it is a bandaid for a deeper issue.

the coffee paradox

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We drink coffee because we’re tired and need a boost, but the reality is that coffee makes us more tired due to its effects on the adrenal gland.

If you drink coffee and, later in the day, your energy crashes, you might think you need more coffee, but the crash is often a sign that the coffee is messing with your adrenal function.

The important thing is to pay attention to your individual response to coffee. It depends on how much you can tolerate. If you’re doing well with coffee, you should feel good with a natural boost, not jittery and wired.

For people who tolerate coffee well, there is lots of research that shows that coffee is beneficial to health, potentially because it’s loaded with phytochemicals and antioxidants.

If you have one cup a day and you find that to be enough, you’re probably doing well with tolerating coffee.

But if you have a cup of coffee and afterwards, find yourself craving another, this could be a sign of another issue in the body.

coffee dependence and bruxism as indicators for sleep apnea

As a dentist, when I look in someone’s mouth and I see coffee staining as well as the effects of teeth grinding, my radar goes up.

Consider this:

1. Grinding of the teeth can be used as an indicator for sleep apnea. Brain scans of people with sleep apnea indicate that grinding the teeth is associated with the end of the pause in breathing, meaning that grinding is the thing we do when we sleep in order to restore the airway and breathe again after it has collapsed or has been obstructed, pausing our breathing.

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2. Coffee dependence can signal adrenal fatigue. If you depend on coffee to get the energy and focus you need to make it through the day, this could be a sign that your adrenal gland is fatigued. In people with sleep apnea, the adrenal gland is overworked from producing the adrenaline needed — the fight and will to survive — each night during episodes of paused breathing due to a collapsed airway.

The two things that stain the teeth the most are coffee and tobacco, both of which are stimulants to the muscles, so they make you grind your teeth more often and more intensely.

It’s all connected.

the teeth grinding and adrenal fatigue connection

It’s a vicious cycle:

You’re grinding your teeth at night to reopen a collapsing airway.

You wake up in the morning without having gotten the restorative benefits of deep sleep, so you need coffee to feel sharper and more awake.

The caffeine fires up the muscles, which makes you a better grinder and causes further damage to your teeth.

If you’re grinding your teeth and are a big coffee drinker, I’d recommend reconsidering coffee: Is it a pleasurable morning drink? Or is a stimulant you depend on to help you get through the day?

If the latter, talk to your dentist and ask about whether you grind or clench your teeth and, if so, request a sleep study from your primary care physician.