How Does Post-Traumatic Stress Disorder Affect Teeth Grinding and Jaw Pain?

What you need to know

• People with post-traumatic stress disorder (PTSD) are more likely to clench their teeth while awake compared to those without PTSD
• PTSD was associated with higher levels of jaw and facial pain
• Daytime teeth clenching and jaw pain may be common but underrecognized issues in PTSD patients

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. People with PTSD may have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares, feel sadness, fear or anger, and feel detached or estranged from other people.

PTSD can occur in people who have experienced or witnessed a shocking, scary, or dangerous event. It’s natural to feel afraid during and after a traumatic situation. This fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD.

How common is PTSD?

The prevalence of PTSD varies depending on the population studied and the types of traumatic events experienced. According to data from the World Mental Health surveys cited in this study, the risk of developing PTSD after exposure to trauma is around 4% when considering all types of traumatic events. However, rates tend to be higher in urban environments compared to war zones.

For example, the risk of PTSD is estimated to be about:

• 19% after experiencing rape
• 11% after kidnapping
• 11.7% after physical abuse by a romantic partner
• 5% after physical abuse in childhood
• 3.6% after combat experience in war

Once PTSD develops, symptoms typically last for about 6 years on average across all trauma types. However, PTSD related to war combat tends to last longer - about 13 years on average.

What is bruxism?

Bruxism refers to repetitive jaw muscle activity that involves clenching or grinding of the teeth and/or bracing or thrusting of the jaw. There are two main types:

1. Awake bruxism - Clenching or grinding that occurs during waking hours
2. Sleep bruxism - Clenching or grinding that occurs during sleep

Some common signs and symptoms of bruxism include:

• Flattened, fractured, chipped or loose teeth
• Worn tooth enamel
• Increased tooth pain or sensitivity
• Tired or tight jaw muscles
• Jaw, neck or face pain
• Dull headache starting in the temples
• Sleep disruption

Bruxism can be mild and may not require treatment. However, in some people, bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems.

How does PTSD relate to bruxism and jaw pain?

This study examined the relationship between PTSD, bruxism (teeth grinding/clenching), and orofacial (mouth and face) pain. The researchers compared 38 patients diagnosed with PTSD to 38 control participants without PTSD.

Key findings include:

1. Awake bruxism was significantly more common in PTSD patients

   • 64.86% of PTSD patients reported awake bruxism compared to 32.43% of controls
   • People with PTSD were over 3 times more likely to report awake bruxism

2. Sleep bruxism was also more common in PTSD patients, but the difference was not statistically significant after accounting for other factors

   • 60.53% of PTSD patients reported sleep bruxism vs 27.03% of controls

3. PTSD patients reported higher levels of orofacial pain

   • On a 0-10 scale, average pain scores were:
     • Current pain: 2.42 for PTSD vs 0.26 for controls
     • Worst pain in past 6 months: 4.53 for PTSD vs 0.87 for controls
     • Average pain in past 6 months: 4.08 for PTSD vs 0.71 for controls

4. PTSD was associated with about 2-3 times higher rates of orofacial pain after accounting for other factors

These findings suggest that people with PTSD may be at higher risk for developing problems with daytime teeth clenching and chronic orofacial pain. The authors note that these issues may be underrecognized in PTSD patients.

Why might PTSD increase risk of bruxism and jaw pain?

While this study cannot determine the exact reasons for the link between PTSD and bruxism/jaw pain, the authors suggest a few potential explanations:

1. Stress and anxiety: PTSD is associated with chronic stress and anxiety, which are known risk factors for bruxism, especially awake bruxism. People may clench their jaw muscles as a physical response to psychological tension.

2. Hyperarousal: PTSD often involves a state of hyperarousal, where people feel constantly on edge and alert for danger. This heightened state of arousal may increase muscle tension throughout the body, including in the jaw.

3. Sleep disturbances: PTSD commonly disrupts sleep patterns. Poor sleep quality and frequent nighttime awakenings could potentially increase nighttime teeth grinding, though this study did not find a significant association with sleep bruxism specifically.

4. Pain processing changes: PTSD may alter how the brain processes pain signals. Some research suggests PTSD can lead to increased pain sensitivity in some cases.

5. Medication effects: Some psychiatric medications used to treat PTSD may potentially increase risk of bruxism as a side effect, though medication use was not analyzed in this study.

What are the implications of these findings?

The results of this study highlight the importance of assessing for oral health issues in patients with PTSD. The authors suggest that healthcare providers working with PTSD patients should consider screening for bruxism and orofacial pain. Early identification could help prevent long-term complications like tooth damage or chronic pain conditions.

For patients with PTSD who are experiencing jaw clenching or pain, seeking evaluation from a dentist or oral health specialist may be beneficial. There are various treatment options that can help manage bruxism and reduce pain, such as mouth guards, stress reduction techniques, and physical therapy for the jaw muscles.

The findings also point to the wide-ranging effects that PTSD can have on physical health. This underscores the importance of comprehensive care for trauma survivors that addresses both mental and physical symptoms.

Conclusions

• PTSD appears to increase risk of daytime teeth clenching (awake bruxism) and orofacial pain
• People with PTSD may benefit from screening for oral health issues
• More research is needed to understand the connections between trauma, stress, and oral health
• Comprehensive care for PTSD patients should consider potential impacts on dental and jaw health

While this study provides valuable insights, it’s important to note that it was relatively small and relied on self-reported symptoms. Larger studies using objective measures of bruxism and pain would be helpful to confirm and expand on these findings. Additionally, research exploring specific PTSD treatments and their effects on oral health could provide guidance for integrating dental care into PTSD treatment plans.