With this article, Dr. Damla Yildirim, PhD in clinical psychology, raises awareness of the connection between bruxism – meaning teeth grinding or clenching – and psychological problems.
The therapists listed on It’s Complicated are trained in many different modalities and have experience with all sorts of conditions. One of the lesser known specialties is bruxism, or what is commonly referred to as teeth grinding or clenching, which clinical psychologist Dr. Damla Yildirim has written an informative article about. She has permission from her client, who came to her as a “bruxer”, to share her story.
34 years old, female, she has been aware of her bruxism since she was 20 years old. Her first attempt to manage her bruxism was to visit her dentist and wear a night splint. The results were not as she had hoped. She then sought out Oral and Maxillofacial Surgery and made her first appointment for Masseter-Botox. She said that “it was very helpful.” She has continued treatment regularly for several years now and no longer has any complaints (i.e., facial pain, sensitive gums) due to her bruxism. However, she continued to report her mental state with the following signs and symptoms: sleep disturbances, difficulty waking up, rapid weight change (with a history of eating disorders).
After the initial consultation, and knowing her psychological history and health status, I created an individualized treatment plan to help her deal with life’s stressors in a healthier way and achieve positive long-term results for her mental health. In addition, I took a collaborative approach and sought information from other professionals as needed. I made sure that the mind and body were in constant two-way communication and neither were considered in isolation from the other.
In each of the subsequent therapy sessions, we made progress in strengthening her emotional self-awareness and addressing her personal needs. In this way, I was able to not only help her address the issues that had led her into therapy, but also focus on helping her maintain the growth and progress she had made.
The psychological history of Bruxism
Bruxism is common and has a complex etiology and psychological history. In chronic bruxism, the consequences are many: headaches, sleep disturbances, facial pain, jaw problems (e.g., sore jaws, jaw clicking), and more. Importantly, bruxism is more pronounced during times of increased stress and anxiety. Therefore, it is important to understand and recognize the relationship between bruxism and psychological problems.
Bruxism during sleep is a particularly common phenomenon. The type of bruxism, whether teeth grinding or teeth clenching, receives less attention in the psychological field. In clenching, the lower jaw is kept closed by pressing it firmly against the upper jaw. Grinding, on the other hand, involves the lower teeth rubbing against the upper teeth by moving the lower jaw back and forth while the jaws are in a closed position. The second type of grinding can affect others, such as when you sleep with the bruxer, which can cause conflict in the relationship.
There are several factors that may favor the occurrence of bruxism during sleep, such as 1) personality type, 2) a genetic predisposition, 3) the use of certain medications, and 4) the presence of stressful situations. For example, this study is about neuroticism and bruxism. It provides evidence of the relationship between neuroticism and bruxism and other stress-related oral health symptoms. In addition, a recent systematic review and meta-analysis found that stressed individuals are more likely to experience bruxism compared to non-stressed individuals. The conclusion seems to be that “bruxism” is correlated with stress, depression and anxiety.
In the case of bruxism, psychological problems are mainly defined as nonspecific symptoms of stress, anxiety, and depression, which are more common in women, partly explaining why bruxism is less common in men. These gender differences also need to be taken more into account in the treatment of bruxism in order to achieve a better understanding of the associated psychological problems.
In conclusion, there is an urgent need to raise public awareness of the relationship between bruxism and psychological factors. In fact, a bruxer’s first visit to a clinical psychologist is as important as his or her visits to the doctor. It seems important to examine bruxers’ feelings of loneliness, job dissatisfaction, and work- or family conflicts, as these are associated with the greatest risk for psychological problems that can exacerbate bruxism. It is also important to consider protective factors, such as being able to balance work and family, and having social support during difficult times.
When to see a clinical psychologist
Mild bruxism may not require treatment. However, in some people, bruxism can be so frequent and severe that it causes jaw discomfort, headaches, sensitive gums, tooth damage, and other stress-related and psychological problems. Because you may be suffering from sleep bruxism and not be aware of it until complications arise, it is important to raise public awareness of the signs and symptoms of bruxism, with an emphasis on its association with psychological problems. We, the clinical psychologists, want to reach out to bruxers and help them improve their mental health and well-being. Please contact me if you are one of the bruxers out there.
Chemelo, V. dos S., Né, Y. G. de S., Frazão, D. R., Souza-Rodrigues, R. D. de, Fagundes, N. C. F., Magno, M. B., Silva, C. M. T. da, Maia, L. C., & Lima, R. R. (2020). Is There Association Between Stress and Bruxism? A Systematic Review and Meta-Analysis. Frontiers in Neurology, 11, 590779. https://doi.org/10.3389/fneur.2020.590779
Gungormus, Z., & Erciyas, K. (2009). Evaluation of the Relationship between Anxiety and Depression and Bruxism. Journal of International Medical Research, 37(2), 547–550. https://doi.org/10.1177/147323000903700231
Lobbezoo, F., Ahlberg, J., Raphael, K. G., Wetselaar, P., Glaros, A. G., Kato, T., Santiago, V., Winocur, E., De Laat, A., De Leeuw, R., Koyano, K., Lavigne, G. J., Svensson, P., & Manfredini, D. (2018b). International consensus on the assessment of bruxism: Report of a work in progress. Journal of Oral Rehabilitation, 45(11), 837–844. https://doi.org/10.1111/joor.12663
Sutin, A. R., Terracciano, A., Ferrucci, L., & Costa, P. T. (2010). Teeth grinding: Is Emotional Stability related to bruxism? Journal of Research in Personality, 44(3), 402–405. https://doi.org/10.1016/j.jrp.2010.03.006
Viertiö, S., Kiviruusu, O., Piirtola, M., Kaprio, J., Korhonen, T., Marttunen, M., & Suvisaari, J. (2021). Factors contributing to psychological distress in the working population, with a special reference to gender difference. BMC Public Health, 21(1), 611. https://doi.org/10.1186/s12889-021-10560-y
Yildirim, D., Vives, J., & Ballespí, S. (2022). Anxiety and Depression: The Moderating Effects of Attention to Emotion and Emotional Clarity. Psychological Reports. https://doi.org/10.1177/00332941211070764