Raising awareness of bruxism

Life can be stressful for all of us, whether it is our bank balance, work or home life. Stress and anxiety can affect us all differently, some worse than others, and it can manifest in a number of symptoms. According to health studies the five main side effects of stress are: depression, weight gain, weak immune system, dyspraxia and insomnia.

Now these five side effects are understandable but where is bruxism in that list? Tooth grinding and clenching is an extremely common complaint and is easily treated but clearly is not widely recognised as a symptom of stress.

Some people suffer from bruxism more than others; reasons for this can include a stressful lifestyle, caffeine, medication taken for depression/anxiety or to aid sleeping, smoking and alcohol.

According to the Bruxism Association (www.bruxism.org.uk) 1 in 10 people suffer from bruxism; ask yourself are 1 in 10 of your patients being treated for bruxism? Look at your laboratory bill, how much of your bill is made up of occlusal splints and mandibular advancement devices (MADs)?

A few weeks ago I was at my sister's house and she was telling me that they have moved to a new dental practice and how impressed they were with the dentist; she proceeded to tell me how thorough he was, asking a series of questions ranging from oral health to general health. ‘You'll never guess,’ she said. ‘But he has found the source of all the discomfort Toby is having - his headaches and jaw ache especially in the morning - the dentist says they are related to clenching and grinding his teeth.’

My sister and nephew had no idea the symptoms he had been suffering were due to bruxism. Once it had been explained to them and the treatment involved they were relieved. Toby now wears a night guard and has been given a list of exercises to do at home and after only three weeks there has been significant improvement.

My sister had originally taken Toby to their GP to seek a solution to his discomfort. After several visits to their GP over a number of weeks with these complaints, why did it take a routine dental visit to discover the source of these symptoms? Why didn't the GP recognise these symptoms as bruxism?

We cannot blame GPs for missing the diagnosis and not directing patients to their GDPs; this is due to lack of awareness for both medical professionals and the general public; but as GDPs and DCPs are we partly to blame for not raising awareness among our fellow healthcare professionals and not asking the right questions of our patients?

In all honesty I think we probably are slightly to blame. By raising awareness we can prevent patients going undiagnosed for long periods of time and unnecessary doctor's appointments taking up their valuable clinic times.

With any health issue, before a doctor's appointment is even considered, the first thing we often reach for is the mouse and keyboard and why not; surely there is no harm in doing a bit of research.

The internet is so dangerous when it comes to ‘self diagnosis’ but we all do it! I did an experiment and typed into a search engine ‘head and neck pain’. My jaw dropped, I couldn't believe what came up, statements such as ‘Neck pain could be a link to arthritis’ and as I scrolled down it went on to state… ‘If as simple as muscular strain then it will clear itself within a few days.’

Can you imagine someone's reaction after reading that? The events that are likely to follow are a panicked call to the GP; the patient being frustrated therefore causing more anxiety; and symptoms not improving and potentially worsening.

My nephew's experience was similar. After a few weeks of symptoms and suffering in silence he informed his parents and that same day a GP appointment was booked. They left the GP surgery a little baffled and frustrated; the GP said the headaches could possibly be down to sitting in front of the computer studying for long periods of time often late at night. He was advised to take breaks whilst studying and get some early nights, to monitor his symptoms and return if they worsened.

Awareness is the answer. Not just aimed at GPs but the general public and possibly a gentle reminder to GDPs - are they asking the right questions of every patient?

After speaking with a few family members and friends it seems suffering from the symptoms of bruxism is common but not something they would ever think of asking their dentist about. Of course not all head and neck pain will result in bruxism but surely it's a good place to start.

Methods of increasing awareness could include providing information in your patient waiting area; sending information to schools; revising or rewording the questions to our patients; or placing an article in the local press.

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Pounds, R. Raising awareness of bruxism. Vital 8, 4 (2011). https://doi.org/10.1038/vital1350

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