Is Everyone Else Grinding Their Teeth Too?

I was undone by a giant bag of Cool Ranch Doritos. I was twenty-three and—as I was prone to doing in those years—hadn’t eaten anything all day. When I arrived at the downtown hotel room where a friend was hosting a birthday party, the tangy chips beckoned. I crunched on them by the fistful. But by the time I’d emptied the bag, something felt terribly wrong. It wasn’t just my cheeks puckering from the acerbity. My jaw stiffened. My ears rang. What felt like an electric current seemed to be zapping through my face and down my neck.

I spent the rest of the night locked in the bathroom, ashamed that I’d eaten so many chips that I couldn’t move my mouth or speak. Days later, when I reported the incident to my family doctor, she didn’t examine my jaw or run a single test. “You have TMJ,” she said. I asked her what that was; she told me to google it and promptly left the exam room.

After scrolling through WebMD, I learned about temporomandibular disorders, or TMD. (TMJ is the acronym for the joint itself, while TMD refers to the disorders.) The term lumps together a set of conditions that cause pain or loss of function in the jaw joints and muscles. In a later appointment, I told my dentist that I still felt a lingering ache in my face. He proclaimed that I must be grinding my teeth at night; I had no reason to question his diagnosis.

The clinic ordered a night guard, a custom-fit plastic shell that cost around $400 and would do nothing to stop the grinding but would protect my tooth enamel while I slept. The first night I tried it out, I spent an hour staring at the ceiling, feeling the rigid plastic poking my gums. After the second hour, I popped the slimy device back in its case and shoved it in a drawer, never to be seen again.

The phrase “gnashing of teeth” appears seven times in the New Testament, typically describing the fate of those who have fallen out of God’s favour. In the Parable of the Weeds, Jesus describes separating the wheat from the weeds and throwing the latter into an inferno, “where there will be weeping and gnashing of teeth.” For many people, teeth grinding can come with an array of hellish consequences: fractured teeth, eroded enamel, earaches, headaches, difficulty chewing food, or a jaw that gets locked in the open or closed position (like in the Dorito incident).

Some research suggests that about 30 percent of adults have TMD. A study this past June from Journal of Clinical Medicine projected that number would rise to 44 percent by 2050—though it’s not completely clear why. Sidney Lisser, a chiropractor and lead jaw clinician at the Jaw and Facial Pain Centre in Toronto, believes that more people are experiencing pain from grinding, but research is divided on whether bruxism and pain are correlated. He’s adamant that TMD should not be conflated with grinding: not all grinding leads to TMD; not all TMD is caused by grinding; and not all grinding is painful or needs treatment.

Anecdotally, Lisser has noticed a significant increase in referrals to his clinic since 2016. But he’s also aware that “TMJ” and “bruxism,” the medical term for teeth grinding or clenching, are becoming buzzier catchphrases for both providers and patients. Then there was the stress of the pandemic: in an interview with the Australian Broadcasting Corporation, one dentist called 2021 “the year of the cracked tooth.” Social media is littered with tension-release techniques, facial yoga, and various products claiming to solve the problem, including “TMJ pillows,” a vibrating massage pen, and a plastic “jaw stretcher” that retails for over $100.

The proliferation of these treatments points to a number of issues, one of which, I suspect, is patient frustration. It’s not uncommon for dentists to jump to a night guard as the primary solution for jaw pain. But what if that doesn’t work? What if the patient can’t comply with that form of treatment for any reason? What if they grind their teeth when they’re awake? And isn’t it worth finding out why the patient is doing it in the first place?

None of my clinicians seemed interested in engaging with these questions. Left to my own devices, I found myself googling “tmj relief??” and encountering the dubious suggestion that regularly “mewing”—actively pushing the tongue to the roof of your mouth with your lips closed—could somewhat relieve the pain while also enhancing the jawline. (I’ll take the pillow, thanks.) One thing I’ve come to suspect is that clinicians and patients might be spending too much time thinking about a cure instead of thinking about where the pain is coming from.

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So far, clinicians have suggested three possible causes for grinding. Stress is perhaps the most obvious of these for awake bruxism. There’s a lot to be gnashing our teeth about lately. Lisser presumes that constant access to our devices is adding to that anxiety. It so happens that the morning we’ve scheduled our interview for is the first time in many days that my toddler hasn’t been sick, and I am behind on almost every work- and home-related task. I later learn that many of those seeking treatment for TMD are women.

Then there are the less straightforward causes. A 2024 report found that more than 16 percent of Canadians received antidepressants from community pharmacies the previous year. One class of those antidepressants is selective serotonin reuptake inhibitors (SSRIs), which work by keeping serotonin available in the brain—instead of the serotonin being reabsorbed by nerve cells, as it normally would, the medicine blocks this reabsorption and keeps the neurotransmitter active for longer, resulting in a better mood. These medications can be crucial for the people who take them to show up at work, complete day-to-day tasks, and take care of themselves and their families. But recent studies suggest that these antidepressants may also increase jaw clenching or grinding. This could be because serotonin affects the way we regulate our movements. Dentists warn that this isn’t a reason to stop taking an SSRI but that it’s at least worth a conversation with the clinician who prescribed it.

Finally, there are sleep disorders. Researchers have found that many patients who have sleep apnea also grind their teeth at night. People with sleep apnea wake up often—briefly and usually without realizing it—as their breath stops and starts overnight. One hypothesis suggests that the mouth muscles could be trying to reopen the airway narrowed by sleep apnea and this may lead to bruxism. It’s a compelling theory, especially when you consider that more and more people are being diagnosed with the sleep disorder in the United States and Canada. But many clinicians are skeptical of this explanation, and studies are still inconclusive. In fact, a 2019 review of seven scientific articles said that there is still no conclusive evidence to support a relationship between the two conditions. For now, the connection remains what one study called a “medical puzzle.”

Of course, these aren’t the only reasons someone might grind their teeth or end up being treated for TMD. In fact, there is a two-day course at the University of Toronto dedicated to the diagnosis and management of the disorder. Lisser is one of the instructors, and he believes that part of that diagnosing process involves eliminating other causes. For example, when a patient comes in to see him complaining of jaw pain, he first checks for red flags, such as a recent injury or oral lesions. Once more serious conditions are ruled out, Lisser looks at the patient’s history and does a physical examination to see if there’s any injury to the muscles, joints, or other structures of the jaw. Rehabilitation can involve looking at their usual jaw movements. The patient could be observed while eating a bagel, for instance, while a clinician assesses their chewing patterns (my jaw hurts just thinking about this).

The U of T course is also taught by Bruce Freeman, an orthodontist and co-director of the Facial Pain Clinic at Mount Sinai Hospital, and Iacopo Cioffi, an orthodontist, pain researcher, and associate professor at U of T’s Faculty of Dentistry. When I spoke with Freeman and Cioffi, they told me something about night guards I had suspected for a while. “There have been trials that show that night guards are not more effective than physio; they’re not more effective than placebo,” Cioffi says. He emphasizes that they can be part of a toolkit for managing pain, but they are not a standalone solution for TMD. He compares the condition to a cavity. Dentists tend to find a cavity, fix it with a filling, and consider the pain gone. He believes the field needs to see TMD differently—not as something that can be fixed with a night guard: “We need to deal with it the way we deal with other chronic pain.”

That can look like a combination of approaches: manual therapy (including physiotherapy), massage, relaxation techniques, pain medications, and even psychotherapy. Cognitive behavioural therapy, for example, has been found to help people defocus their pain. Freeman tells me some of his patients say they feel better after just talking to him about their experience. That isn’t to say that their symptoms weren’t real or severe but that, perhaps, they just needed to feel heard.

When I set out to write this piece, I thought it would be quick and easy. Night guards are bad! We’re all stressed out! The reality turned out to be a bit more complicated than that. What I was really looking for, it seems, was a chance to talk it out. The more I discussed the piece, the more I encountered friends, colleagues, sources, and experts who dealt with similar frustrations. It’s liberating to talk about your pain without immediately being cut off by a provider.

Like everyone else I know, I try to manage my stress. I have always been an anxious person, but the Doritos debacle was probably the first physical manifestation of that tendency. When I spoke to Lisser, he noted that he encourages his patients to make lifestyle modifications. None of it is especially surprising: less screen time, better sleep hygiene, good nutrition. I’ve seen some of this in action. At twenty-three, I was hard on my body. I smoked ten to fifteen cigarettes a day, skipped meals, and rushed between multiple jobs. I didn’t believe in psychotherapy or a good night’s sleep. As I approach my late thirties, I’ve softened. I’ll probably never be as skinny or competitive as I once was, but at least I can unclench my jaw.

I’ve also come to rely on what some professionals would likely consider Band-Aid solutions: an occasional facial stretch found on a physiotherapist’s YouTube, slicing apples instead of biting straight into the whole fruit, showing as much restraint as I can around crunchy snacks, and remembering correct jaw posture (according to Google, anyway) while I type away at my desk job: teeth apart and tongue lightly resting against the roof of the mouth, with the tip just behind the incisors.

A few months ago, I took a new step by booking a specialty jaw massage at a small but luxurious spa in downtown Toronto. The therapist started with the usual tension suspects: shoulders, base of the neck, even the scalp. She slid an oily gua sha tool around my cheeks and pinched the skin with a tiny suction cup. Then it was time to work on the inside of my mouth. With latex-gloved hands, she pushed on pressure points on my gums. She stretched my lips in every direction to reach sore spots I didn’t know I had. I wasn’t sure whether to feel deep embarrassment or sublime relaxation.

At the end of the appointment, she told me she could tell I had a desk job. I wondered how she could clock my sedentary lifestyle from just one interaction, but as I walked home from the subway station, I noticed something else—something I knew would be temporary. For the first time in as long as I could remember, I couldn’t feel the tension in my face. At least for now, my jaw was weightless.