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Grinding Of Teeth During Sleep Associated With Other Disorders

NORTHBROOK, IL -- January 23, 2001 -- The grinding or clenching of teeth during sleep on a weekly basis affects more than eight percent of the population and is associated with other disorders, such as daytime sleepiness and anxiety, according to a new study.

The study, based on 13,057 participants in Italy, Germany, and the United Kingdom, was reported in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.

The condition is known as sleep bruxism, an oral habit characterized by rhythmic activity of the jawbone muscles that cause a forced contact between dental surfaces during sleep. It has been linked to headaches, joint discomfort and muscle aches, premature loss of teeth, and sleep disruption for both the person with bruxism as well as his or her bed partner.

The study, carried out in the three European countries, aimed to document the prevalence of sleep bruxism in the general population, the risk factors associated with the disorder, and its links to other health-related and sleep-related issues. Participants were interviewed by phone. The duration of the interviews averaged 40 minutes and ranged from 10 to 333 minutes. The information gathered was entered into a Sleep-EVAL system, a software system designed to conduct epidemiologic studies on sleep, sleep habits, and mental disorders in the general population.

Validation of the data was conducted at Stanford University's Sleep Disorder Center in Palo Alto, California and the Regensburg University Sleep Disorders Center in Germany.

The International Classification of Sleep Disorders (ICSD) suggests the following as minimal criteria for sleep bruxism: the presence of teeth grinding during sleep and, at least one of the following associated features - abnormal tooth wear, muscular discomfort, or sound associated with the tooth grinding. The participants in the study were divided into one of three groups: those who met the ICSD criteria, those with tooth-grinding alone, and those without tooth-grinding.

Tooth grinding which occurred at least weekly during sleep was reported by 8.2 percent of the participants. More than 54 percent of those with tooth grinding reported some related problem, including 23 percent who said they needed dental work because of the grinding and eight percent who claimed discomfort of their jaw muscles upon awakening. More than 23 percent said the grinding was loud enough for bed partners to hear it. The total, then, for all those in the study population who met the ICSD criteria was 4.4 percent, suggesting that bruxism is the third most common form of sleep disorder following talking in one's sleep and snoring.

Snoring, breathing pauses during sleep, and obstructive sleep apnea were significantly more frequent in the sleep bruxism group and the tooth-grinding alone group than in the rest of the participants. Mental disorders, mainly anxiety disorders and hallucinations, were also significantly related to tooth grinding during sleep. About 69 percent of those with sleep bruxism related their condition to either aggravation, stress, or anxiety. Daily use of alcohol, tobacco, or caffeine were also associated with sleep bruxism.

Researchers also noted that bruxism was unrelated to gender and decreased significantly with age. The highest prevalence was observed in the 19- to 44-year-old group.

Speaking on behalf of his colleagues, Maurice M. Ohayon, M.D, Stanford University School of Medicine, said "the results of this study raise an important concern about the risk of sleep apnea for sleep bruxers. A plausible explanation for this association," he said, "could rely on the shared anatomic problems proposed by some research such as mandibular (jawbone) deficiency, temporomandibular abnormalities, and craniofacial abnormalities."

Dr. Ohayon said that sleep bruxism should be considered in patients with sleep-disordered breathing disorders. He called on general practitioners to inquire about sleep bruxism and sleep apnea symptoms when abnormal tooth wear damage is identified. He also urged dentists to ask about symptoms of sleep-disordered breathing when dental signs of bruxism are present.

"Finally," he said, "further research is necessary on the pathophysiologic mechanisms of this largely unknown sleep disorder."

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