Most people who grind their teeth do not know they do. It largely happens during sleep, and the damage accumulates over years at a rate too slow to notice in a mirror.
Enamel does not grow back. Unlike early decay, which can sometimes be halted and remineralised, wear has no reversible stage at all — which is why spotting it early is worth more here than almost anywhere else.
The signs
On the teeth:
- Flat, polished facets on the biting edges, often matching exactly when you slide your jaw sideways
- Front teeth becoming shorter, or developing see-through edges
- Small chips along the biting edges
- Cracks appearing in enamel
- Fillings and crown edges that keep fracturing
- Teeth becoming sensitive as enamel thins
Elsewhere:
- Jaw muscles aching, worst on waking
- Headaches around the temples in the morning
- Clicking, or restricted opening
- A ridge of indentations along the side of the tongue, or a white line along the inside of the cheeks at biting level
- A partner hearing it
Why it happens
Sleep bruxism is not fully understood, and it is not simply a bad habit. It is associated with micro-arousals during sleep, and with:
- Stress and anxiety
- Disturbed sleep, and obstructive sleep apnoea in particular
- Alcohol, caffeine, smoking and some recreational drugs
- Certain medications, including some antidepressants
Daytime clenching is a different pattern, more clearly linked to concentration and stress, and more amenable to simple awareness.
What can be done
A splint or night guard. A hard acrylic guard made to fit takes the wear instead of your teeth. It is the single most useful intervention, and it is important to understand what it is doing: it is armour, not a cure. The grinding continues; the teeth stop paying for it.
Boil-and-bite guards from a chemist are better than nothing for short-term protection, but they fit less precisely, are bulkier, and wear through quickly. You often hear that soft guards make people clench harder; the studies that have measured it do not show that.
Addressing acid. If you also drink a lot of fizzy or citrus, or have reflux, the two combine badly: acid softens the surface, grinding then removes it. Dealing with the acid often slows the wear more than anything else.
Reducing the triggers, where identifiable — caffeine late in the day, alcohol before bed, unmanaged stress.
Rebuilding, if a lot has already been lost. This is complex, expensive work and the strong argument for catching it early, when a guard is enough.
What to ask about
Ask to be shown the wear. Most dentists will happily point out the facets on your own teeth and photograph them, and photographs taken now are what makes it possible to tell in five years whether it is progressing or stable.
You cannot grow enamel back. Protecting what is there is the entire strategy.
