The Daily Grind: It's Such a Pain

By Lisa Rein
Washington Post Staff Writer
Tuesday, September 23, 2008

This was supposed to be my exciting new life in Washington.

I had been hired by one of the nation's great newspapers. I was setting up a cute apartment in Dupont Circle. And yet my body was sending me a signal that all was not well: I was waking every morning with a throbbing pain in my jaw.

A dentist took one look into my sore mouth and pronounced me a victim of an affliction common among Type A people who move to Washington for stressful jobs.

Bruxism. I was grinding my teeth at night.

It was so bad that a diagnostic test, which involved sliding my teeth from side to side on a thin sheet resembling carbon paper, turned up several molars that were practically flattened and one that was starting to crack. At 35, I was losing my teeth.

It turns out that we are a nation of bruxers . About 10 percent of adults grind regularly, although dentists say that half of the population, including children, gnash at some point in their lives. But as many as half of the serious grinders don't seek treatment, either because they don't see a dentist or because the habit doesn't cause them pain. Eventually they'll wear right through their teeth, though, and that will be really painful -- as well as costly.

The long-term damage to teeth, gums and jaws can be severe, and don't forget fatigue from disturbed sleep. Grinding is side-to-side destruction, while less common clenching involves a bearing down that can bring on painful headaches.

Cave men probably wore out their teeth, too, dentists say, what with gnawing on bones and eating hard-to-chew foods that threw off their bite. Today's malady is triggered by the stress of such events as divorce or a new job, or by a bite that is misaligned just enough to prevent the teeth from meeting evenly when they close, triggering the instinct to gnash. That can cause jaw pain, called temporomandibular disorder, or TMD, because sliding your teeth around can stress the jaw joint and the muscles around it; conversely, the discomfort of TMD can cause more grinding. Consuming caffeine and alcohol can also aggravate the tendency.

Your teeth may seem destined to come together. But the average set of upper and lower teeth have less contact while chewing three meals a day than you might think, touching for a total of about eight minutes. In contrast, an aggressive grinder can go at it for as long as 80 minutes in a single night.

"You're aging your teeth by 10 years," said Joseph Kravitz, a Washington dentist who specializes in reconstructive work.

Many grinders have no idea they do it until a dentist tells them, they wake themselves up or their partners are awakened by loud crunching noises. And the underlying causes and remedies of bruxism still are poorly understood, partly because people don't grind consistently, making it more difficult to diagnose.

"The problem is that it's extremely variable," said Michael Smith, an associate professor of psychiatry at the Johns Hopkins School of Medicine who is leading a study of sleep disorders and jaw pain, including bruxism. "It waxes and wanes. We don't know what cause comes first."

Bruxism is only now getting attention from the academic world, as the field of sleep medicine takes off. A relatively small number of dentists go into research, hampering efforts to understand the disorder's causes and treatment.

Was there hope for me?

After my diagnosis, my dentist immediately made a mold of my teeth to measure me for a night guard, a plastic device that fits over the top or bottom teeth. The guard acts as a buffer, blocking the upper and lower enamels from contact. It does not stop the grinding. My custom-made guard cost $400, of which about $260 was covered by insurance. Not every policy is that generous.

(And not every tooth-grinder benefits from a guard. Really vigorous gnashers eventually wear right through them, and dentists say some of those bruxers need to deal with their stress by learning relaxation techniques and in therapy. "We're not asking about their mother and father or anything," said Edward Grace, a dentist and psychologist at the University of Maryland Dental School. "We recommend reducing stress in any way they thought possible.")

In my case, after a few adjustments my clear night guard was going to bed with me every night. It clicked snugly into place over my upper teeth, and when I closed my jaw my tongue felt only a smooth plastic surface. It looked like a pair of dentures, and its daytime home was a blue plastic case on the night table. My guard became a more valued traveling partner than my toothbrush: I would choose plaque over pain any day.

My jaw pain stabilized. I felt cured. I was still stressed out, of course, just not in pain.

My husband says my guard makes my morning breath stink. Small price to pay, I tell him as I run to the bathroom to rinse my mouth.

I've paid a different kind of price, though, in the seven years since my condition was diagnosed. Within four months I lost my guard, probably swept into the pile of dust under the bed by the cat or vacuumed up by the cleaning crew. I was fitted for another one but discovered that I would have to pay for it on my own, since my insurance policy covered just one "occlusal device" every three years. (Insurance companies must know how fast people lose these things.) A year later, that guard had been lost, too.

Guard No. 3 was a state-of-the-art model called an NTI-tss, which looked a lot simpler than its virtually unpronounceable technical name: nociceptive trigeminal inhibitory device. Shaped sort of like a mouth puckered up for a kiss, it sat snugly on my two front teeth. I loved its compact fit. But I left that one in a Holiday Inn in Norfolk, where I went to cover a speech by President Bush. I made a desperate call to the hotel, but it was gone. Probably it did not end up in the lost and found.

After No. 3 was gone, I opted for the $49, over-the-counter version to save money. I dutifully boiled my new guard in a pot on the stove to soften it before molding it to my teeth. Then I cut it to size with a scissors.

I put it in my mouth, quickly gagged and tossed it in the garbage can.

When I started commuting to our bureau in Annapolis two years ago, my new dentist fitted me with guard No. 5, this one to cover just my bottom teeth.

"Don't worry," he told me. "I think you'll be able to keep track of this one. We're going to make it brown, so you'll see it."

So far, so good.

© 2008 The Washington Post Company