Wake Up with Head/Neck Pain in the Morning? Be Careful: It Could Be Bruxism

If you wake up in the morning with pain in your head, neck, back, or jaw, or if your teeth have started to wear down and become sensitive, these could be signs of a condition that is quite common in society: bruxism, or teeth grinding and clenching.

On this topic, Associate Professor Dr. Rana Turunç from the Faculty of Dentistry at Altınbaş University provided a wealth of important information, covering everything from the causes that trigger bruxism to its symptoms and treatment methods. 

What is bruxism, and what causes it? 

“Bruxism is the clenching or grinding of teeth during sleep or throughout the day, usually without the person being aware of it,” says Assoc. Prof. Dr. Rana Turunç, emphasizing that this condition can have multiple causes:

"Stress and anxiety are among the most common causes. However, sleep disorders, especially sleep apnea, gastroesophageal reflux disease (GERD), structural abnormalities in the jaw and teeth, and genetic predisposition can also contribute to bruxism. In addition to these factors, alcohol, tobacco, and caffeine consumption can increase the severity of bruxism. Stimulants or certain medications taken before bedtime can trigger involuntary contractions in the jaw muscles."

Who does it affect? Are children affected? 

Bruxism can occur in any age group. According to research, the incidence rate in children ranges from 10% to 50%, while in adults it ranges from 5% to 90%. However, in children, this condition is usually temporary and may disappear on its own with growth. Therefore, treatment is often unnecessary in children, but monitoring is important. 

How are the symptoms recognized? 

Patients usually experience jaw pain, headaches, and tension in the neck and facial muscles when they wake up in the morning. In long-term bruxism, facial aesthetics may be impaired due to enlargement of the chewing muscles, resulting in a square face appearance or asymmetries. Tooth wear, cracks, sensitivity, and fractures in fillings and veneers are also common. In some patients, pain radiating to the ear, ringing in the ears, difficulty opening the mouth while eating, and decreased sleep quality are also noticeable.

How is it diagnosed? 

"The diagnosis is usually made after evaluating the patient's complaints and medical history, followed by a clinical examination. Additionally, if the patient has a grinding behavior, it is important that their partner has been bothered by the sound for a long time. However, the most reliable method for a definitive diagnosis of bruxism is polysomnography (sleep test) with sound and video recording, evaluated together with electromyography (EMG) measurements. These tests show how much and how intensely the chewing muscles work during sleep and how often teeth clenching or grinding movements occur. However, since they are performed by specialist doctors in specialized centers, they are costly and are often unnecessary if there is no suspicion of sleep apnea. 

How is it treated? 

Assoc. Prof. Turunç emphasizes that treatment is not always necessary, but may be required in severe cases where it is thought to cause tooth wear, jaw joint pain, or pain in the chewing muscles. In such cases, treatment must be tailored to the individual:

"If bruxism is stress-related, psychological support, relaxation exercises, and lifestyle changes are recommended. For sleep hygiene, stimulants such as coffee, cigarettes, and alcohol should be avoided at night; physical activity, eating, and mental stimulation should be limited a few hours before bedtime, and the sleeping environment should be quiet and dark. If sleep apnea is present, an evaluation at a sleep center and collaboration with an ear, nose, and throat specialist may be necessary. If there are problems with the bite or jaw relationship, orthodontic treatment may be necessary. If reflux is present, diet and medication treatments for this condition may also be effective in reducing bruxism. If medications that trigger teeth grinding are being used, it is recommended to consult with the physician and change these medications if possible. If bruxism causes pain in the jaw muscles or joints, limited mouth opening, or aesthetic concerns due to overgrowth of the chewing muscles, physical therapy, muscle relaxants, or psychiatric/neurological medications, and Botox (botulinum toxin) injections may also be beneficial. Tooth wear caused by bruxism should be restored with fillings or crowns and then protected with splint therapy. 

What is splint (night guard) treatment? 

A splint, also known as a “night guard,” is a transparent appliance customized to the jaw structure. Its purpose is to prevent teeth from rubbing against each other, thereby stopping further wear, relaxing the jaw muscles, and reducing excessive load on the jaw joint. A splint provides significant physical and functional protection, especially when worn at night while sleeping.

However, every mouth structure is different. Therefore, instead of standard splints purchased online, custom splints prepared in a laboratory according to your dental impressions taken by your dentist should be preferred. Otherwise, harm may be caused instead of benefit."