Understanding The Connection Between Sleep Apnea, Teeth Grinding, And Jaw Disorders

Exploring how sleep-related breathing issues and bruxism impact oral health and what treatment options are available to improve quality of life

Dream Land Health & Sleep Solutions, Karan Nagar

Diagram showing the possible mechanism linking SAHS and SB

Sleep bruxism (teeth grinding) is defined as a sleep-related movement disorder characterised by rhythmic masticatory muscle activity (RMMA) associated with tooth grinding (TG) and occasional tooth clenching. An international group of experts recently reviewed the definition of bruxism, and this updated definition has been adopted for the International Classification of Sleep Disorders.

The medical term for teeth grinding is bruxism (BRUK-siz-um), a condition in which you squeeze or grind your teeth together, also called clenching or grinding. Bruxism is common and can happen during the day or night. If you have awake bruxism, you clench or grind your teeth when you’re awake without being aware that you’re doing it. If you have sleep bruxism, you clench or grind your teeth during sleep.

People who clench or grind their teeth during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing called sleep apnea (SAHS). Some people may not know they have sleep bruxism until they develop tooth or jaw problems because of it.

In some people, bruxism can be a problem and happen often enough to lead to jaw pain, headaches, damaged teeth, and other issues. The grinding sound can disrupt a bed partner’s sleep.

What exactly causes bruxism isn’t completely understood. It may be due to a mix of physical, mental health, and genetic factors.

Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration, or tension. Bruxism may also be a coping strategy or a habit when you’re thinking deeply or concentrating.

Sleep bruxism may be a sleep-related chewing activity linked with brief disturbances during sleep.

These factors can raise your risk of bruxism:

• Stress. Having extra anxiety or stress can lead to teeth grinding and clenching. So can anger and frustration.
• Age. Bruxism is common in young children, but it usually goes away by adulthood.
• Awake-time mouth habits. Mouth habits, such as lip, tongue, or cheek biting, and chewing gum for long periods of time, can increase the risk of awake bruxism.
• Medicines and other substances. Smoking tobacco or drinking caffeinated beverages, or alcohol can raise your risk of bruxism. So can using recreational drugs or taking medicines that aren’t approved by your healthcare professional. It’s not common, but bruxism can be a side effect of mental health medicines such as some antidepressants and medicines to treat seizures and attention-deficit/hyperactivity disorder (ADHD).

Bruxism can be linked to some mental health and medical conditions. These may include Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea, and ADHD.

Here’s how these conditions are connected:

**Sleep Apnea as a Risk Factor for Bruxism:** Some studies suggest that episodes of interrupted breathing in obstructive sleep apnea may trigger bruxism as the body attempts to open the airway. This can be a subconscious response to restore oxygen flow.

**Bruxism and Sleep Arousals:** Bruxism episodes are frequently associated with microarousals (brief awakenings) during sleep, which are common in sleep apnea.

**Shared Risk Factors:** Both conditions are often associated with factors like stress, anxiety, alcohol consumption, smoking, and certain medications.

For most people, bruxism doesn’t cause serious complications. But severe bruxism may lead to:

• Damage to your teeth or jaws and to fillings, crowns, or other dental repairs.
• Tension-type headaches.
• Severe facial or jaw pain.

Conditions that occur in the temporomandibular joints (TMJs)—these are jaw joints just in front of your ears—can cause pain and may sound like clicking when you open and close your mouth.

If you suspect you might have either bruxism or sleep apnea, seeking professional evaluation is crucial. A dentist can identify signs of tooth wear and jaw tenderness related to bruxism, while a sleep specialist can diagnose sleep apnea through a sleep study (polysomnography).

Treatment often involves a multi-faceted approach addressing both conditions:

• Oral appliances or custom-fitted mouthguards, or mandibular advancement devices.
• Continuous Positive Airway Pressure (CPAP): a machine that delivers pressurised air through a mask to keep the airway open, treating sleep apnea and potentially reducing bruxism triggered by breathing interruptions.
• Lifestyle modifications like avoiding alcohol, caffeine, and tobacco before bedtime, practising relaxation techniques, and maintaining a healthy sleep schedule can help.

Managing stress or anxiety—underlying factors—may involve therapies like counselling or biofeedback.

It is important to work with a healthcare team that includes a dentist and a sleep specialist to receive an appropriate diagnosis and develop a personalised treatment plan. Addressing both bruxism and sleep apnea can significantly improve overall health, sleep quality, and dental well-being.

Dr Owais Digoo 

sh*********@***il.com