Bruxism: When the Day Is Held In and the Jaw Will Not Let Go at Night

Oat is the person everyone praises for being even-tempered — the one who, whatever the situation, always seems to be coping.

At work he meets every crisis calmly. He never raises his voice. He never lets anyone see him under strain. However heavy the work, he simply smiles and deals with it. Then one morning his partner said quietly, “you were grinding your teeth so loudly last night. That squeaking, all night.”

It occurred to Oat that lately he had often been waking with a tight jaw, and that some mornings brought a throbbing ache at his temples. At his last dental appointment the dentist had remarked that his molars were showing unusual wear, and thought he was probably grinding in his sleep — possibly from stress.

Even though he feels he is not stressed at all.

What bruxism actually is

Bruxism is repetitive activity of the jaw muscles during sleep — clenching, grinding, and sustained bracing — usually without the person knowing. Besides the sleep form, some people clench or brace the jaw while awake during the day, which tends to occur during concentration or under stress.

Current understanding holds that grinding during sleep is associated with small arousals of the brain during sleep (micro-arousals) and with central nervous system activity, rather than being explained by the teeth or the bite alone, as was once believed. Put simply, it is a matter of how the brain and nervous system are working rather than merely a problem in the mouth. And it is more common than many people think.

When the hand is clenched all day, the jaw will not release at night

This is where stress and disposition come into it.

Picture someone who has carried a heavy bag all day. When they put it down, the hand stays curled for a while as though still gripping something, because the muscles have grown so used to bracing that they have forgotten how to release. Many people's jaws at night are similar. The emotion held in through the day, the smiling acceptance of everything, the effort of appearing to cope — that tension does not go anywhere. It simply has nowhere to go. And for some people it shows up in the jaw during sleep, when conscious self-control is no longer there.

From our experience with people who have this condition, we often notice certain patterns in common. A good number are people who accumulate stress readily, who find it hard to set things down, who carry worry inside — and who frequently do not look stressed at all from the outside, because they are skilled at keeping those feelings hidden. This is a clinical observation consistent with what we see in the therapy room. Beyond that, on the broader picture of stress and anxiety, a number of studies have found an association with bruxism, particularly with the daytime, waking form.

But stress is not the whole explanation

What is worth guarding against is describing bruxism as purely a matter of stress. That is incomplete, because this is a condition with several contributing factors.

Besides stress and arousal during sleep, research has found other relevant factors: in some people caffeine, alcohol, smoking, certain medications, and a genetic tendency may all play a part. So someone who grinds their teeth may not be under any particular strain, but may have another factor as the principal player. Understanding this helps us avoid concluding that we, or someone close to us, are "weak" or "not managing life" merely because of grinding — and helps us look for care that meets what is actually there.

Protect the teeth first, then tend the source

The most urgent matter in bruxism is protecting the teeth from further damage, because the force of grinding during sleep is enough to wear teeth down, crack them, or cause jaw-joint problems and headaches. Seeing a dentist is therefore an important first step. A device such as an occlusal splint — what many people call a night guard — protects the tooth surfaces from abrasion.

But there is something to be clear about. A splint principally protects the teeth. It does not mean the grinding behavior goes away. It is rather like wearing a helmet, which reduces damage in an accident without addressing why the fall happened. Comprehensive care therefore usually has to look at the source as well: adjusting triggers such as caffeine or alcohol, attending to sleep, and managing stress.

Where hypnotherapy comes in

Since accumulated tension that is hard to set down is one of the factors found commonly, working with that source is where hypnotherapy has a part to play.

Rather than looking only at the symptom in the jaw, this approach attends to the response patterns underneath — the blueprint of holding every feeling inside, being someone who finds it hard to let go, or a chronically over-aroused nervous system — by bringing the body into deep relaxation and practicing visualization, in order to teach the system inside how to set things down and release. Not only in the therapy room, but carried into daily life.

At NBRH we work from the principle of Neuro-Behavioral Repatterning & Hypnotherapy: changing the response patterns of the nervous system and of behavior in a structured way. Caring for bruxism sustainably usually does not end at the jaw. It includes teaching both body and mind a letting-go they may have forgotten long ago. That is what lasting change means here.

To understand the channels through which anxiety and tension send their signals into the body, we have written “Anxiety: Why the Brain Reads Everything as a Threat”. And because the grinding usually happens at night, “Why Trying Harder to Sleep Keeps You Awake” covers the sleep side of the same tension.