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Clenching | An Unexpected Culprit

By Carl Wharam, PT, DPT

2020 was a grind–in some cases, literally!  Between the pandemic, trying to engage children in eLearning instead of Youtube or TikTok, and not to mention having life drastically altered, we have a lot of stress right now.  Stress affects the body in many ways, including preventing sleep, giving us grey hair, making us moody, and sometimes we even clench or grind our teeth. Grinding your teeth is called bruxism, which can be voluntary or involuntary and can occur when you are sleeping or awake.  

Stress has been shown to be correlated with bruxism, and we have seen an influx of patients coming in with problems related to clenching or grinding their teeth1,2.  The big difference between clenching and grinding is that clenching is compressing the teeth together, whereas grinding is essentially clenching with movement.  Normally, humans use less than 100 pounds per square inch (PSI) of force while chewing.  For example, eating a pork chop requires about 20-25 PSI3.  But when you grind during the day, you can create up to 160 PSI and grinding at night can reach about 500 PSI4!  To put that in perspective, a lion usually exerts about 600 PSI per bite5.

Our teeth and jaws were not meant to handle a lion’s bite. The extra compression force on the temporomandibular joint (TMJ or jaw) and teeth can lead to a litany of problems including1,6:

  • Cracked teeth
  • Poor sleep
  • Neck pain
  • Jaw/teeth pain or soreness
  • Ringing in the ears (tinnitus)
  • Headaches

With people coming to the clinic for clenching, headaches and jaw pain during the stay-at-home period, I’ve seen people who fractured their nightguards, cracked their teeth, have headaches that rival migraines and even bitten through a mouthguard “like it’s a chew toy”, as one patient told me.  The jaw is a resilient joint, but it’s not impervious to injury and when things are breaking, something must change.

The question is how do you prevent this from happening? One of the most common things I teach patients is where to keep their tongue.  Where is your tongue as you are reading this?  Is it hanging out on the floor of your mouth, floating in the middle or up near the roof?  We aim to have the tongue up near the roof of your mouth to give good support to the mouth and prevent clenching. 

Try saying “NNNNN”.  This helps you understand where the tip of your tongue should be.  Now say “siiiinnnnngggg” and notice where the back of your tongue is.  It should be near your back molars.  If you combine those tongue positions, viola, we have good oral posture.  Just like you can have good sitting or standing posture, you can work towards good oral posture as well.  It’s an invisible problem that few people understand.  

When your tongue is flopped on the floor of the mouth, it’s easier to clench, but by placing your tongue in good oral posture, it makes it harder to smash your teeth together.  Try it for yourself! See? It’s a lot harder to clench.  Even when you are stressed, this will save your teeth and jaws some unnecessary wear and tear.

Stress isn’t going anywhere, and if you are suffering from jaw pain, facial pain or headaches, you may benefit from craniofacial therapy, which is physical therapist care specifically designed to address pain, dysfunction and injuries of the head, face and jaw.  The staff members at PhysioPartners Renaissance CranioFacial Group have developed specialty skills in this area and have saved many a tooth from cracking under the pressure.

Your physical therapist will work with you to improve your tongue and sitting posture, strengthen and stretching your tongue, TMJ and neck, as well as help restore balance to your head and upper neck.  We will also analyze your bite to make sure it’s not causing you to clench more or load more on one side.  

A cracked tooth is no fun and getting it fixed can be costly. Schedule a consultation with a craniofacial physical therapist today, and your future self will thank you. The cost savings in dental work is a bonus!


Bibliography

1.Wieckiewicz M, Paradowska-Stolarz A, Wieckiewicz W. Psychosocial aspects of bruxism: the most paramount factor influencing teeth grinding. Biomed Res Int. 2014;2014:469187.  

2.Ahlberg J, Rantala M, Savolainen A, et al. Reported bruxism and stress experience: Reported bruxism and stress experience. Community Dent Oral Epidemiol. 2002;30(6):405-408.  

3.The power of the human jaw. Sci Am. 1911;105(23):493-493. 

 4.How to stop grinding your teeth (Bruxism). Azfd.com. Accessed December 22, 2020. https://www.azfd.com/blog/stop-grinding-your-teeth-bruxism-guide/  

5.jithin. Top 10 most powerful animal bites. Themysteriousworld.com. Published March 21, 2017. Accessed December 22, 2020. https://themysteriousworld.com/most-powerful-animal-bites/  

6.Ciancaglini R, Gherlone EF, Radaelli G. The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population. J Oral Rehabil. 2001;28(9):842-848.

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