There's no pain at the time, no sound the person can hear, and no moment where anything obviously goes wrong. Often the first they learn of it is when a partner mentions the noise, or when we point out wear on a back tooth during a routine examination — wear that has taken years to develop and cannot be undone.

Teeth grinding, known clinically as bruxism, is one of the more common things we see and one of the most frequently missed. It's worth understanding what it is, what it does, and what can realistically be done about it.

01Two conditions, one name

Sleep grinding and awake clenching behave differently

Sleep bruxism happens during sleep and is entirely involuntary. The forces involved can be considerably greater than anything generated while chewing, because the reflexes that normally protect the jaw are dampened while you're asleep. You cannot decide to stop, which is why advice to "try not to grind" is of limited use.

Awake bruxism is different in character — more often clenching than grinding, and typically tied to concentration or tension. The jaw sets while driving, working at a screen, or lifting something heavy. A systematic review published in Clinical Oral Investigations in 2023 pooled seventeen studies and found awake bruxism in around 15% of adults, though the authors noted substantial variation in how different studies measured it.

Plenty of people have both, and they tend to need different approaches.

02What causes it

Increasingly understood as a nervous system behaviour

The NHS identifies stress and anxiety as the most common cause of teeth grinding. That matches what we see: episodes often cluster around difficult periods, and patients frequently connect the onset to something specific when they think back.

Other recognised contributors include sleep disorders, certain medications, smoking, and heavy alcohol or caffeine consumption. Sleep-disordered breathing deserves particular mention — if you also snore heavily, wake unrefreshed, or have been told you stop breathing at night, that's a conversation worth having with your GP as well as with us.

What has changed in recent years is how bruxism is thought about. It was once treated as a straightforward dental problem caused by teeth that didn't meet properly. The current view is that it's better understood as a centrally driven behaviour — something the nervous system does — which is why treatment aimed only at the teeth manages consequences rather than causes.

03The signs

What you might notice yourself

• Jaw ache or tightness on waking, particularly around the angle of the jaw or in front of the ears, often easing within an hour or two of getting up.
• Headaches first thing, usually across the temples, where one of the main closing muscles sits.
• Teeth that feel sensitive to cold or to biting, especially if it comes and goes.
• Front teeth looking shorter than they used to, or edges gone flat and even.
• Being told you make a noise at night. Partners usually report it long before the person doing it notices anything.
• A jaw that clicks, catches or aches when you open wide. The NHS notes that grinding can contribute to temporomandibular disorder, or TMD.
• Ear pain with no ear problem. The jaw joint sits directly in front of the ear canal and readily refers pain into it.

Any one of these alone means little. Two or three together are worth mentioning at your next appointment.

What we see that you can't

Much of the evidence of grinding is visible to us well before it becomes obvious to you, which is one of the practical arguments for regular examinations even when nothing hurts.

We look for flattened biting surfaces, and particularly for wear facets on opposing teeth that match one another when the jaw moves sideways. We look for enamel worn through to the dentine underneath, which appears as a yellower, softer-looking area and tends to accelerate once exposed. We check for small vertical cracks in enamel, for teeth that have become mobile, and for chipping along the edges of front teeth.

We also look elsewhere: a ridge of thickened tissue along the inside of the cheek at the level where the teeth meet, scalloped indentations along the edge of the tongue, and enlargement of the muscles at the angle of the jaw in people who clench heavily. Where existing dental work is present, repeated failures tell their own story — fillings that keep fracturing, crowns that debond more than once.

04Why it matters

What wear costs you later

Once enamel has worn away it is gone, and what replaces it is dental work — which itself has a finite lifespan and will need replacing in turn. Someone who wears their teeth down significantly in their thirties is committing to a much longer maintenance path than someone who doesn't.

Beyond wear, sustained grinding can contribute to jaw joint and muscle problems, to teeth loosening where the supporting tissues are already compromised, and to persistent headache people often attribute to something else. It also tends to shorten the life of crowns, veneers and implants — which is why it's something we'd want to identify before significant restorative work rather than afterwards.

05What can be done

A splint or night guard

The NHS notes that a dentist may recommend a mouth guard or mouth splint worn at night. It's important to be clear what this does: a splint is a physical barrier that takes the wear instead of your teeth, and it can reduce muscle discomfort for many people. It does not stop the grinding itself. Anyone telling you a splint cures bruxism is overstating it. What it does is protect the thing you can't replace while other causes are addressed — a genuinely worthwhile job.

Fit matters considerably. A splint made from impressions or a scan of your own teeth is a different proposition from a boil-and-bite guard bought online, both in comfort and in how the bite is distributed across it.

Addressing what's driving it

Because stress is the most commonly identified cause, the NHS recommends relaxation techniques including breathing exercises and regular physical activity, along with improved sleep habits — consistent bedtimes and a dark, quiet room. Reducing alcohol and caffeine, particularly in the evening, is also advised. For jaw pain or swelling the NHS suggests painkillers such as paracetamol or ibuprofen, and applying an ice pack for twenty to thirty minutes. Where stress or anxiety is the underlying driver, your GP can help with that side of it, and that route is often more productive than anything we can do with the teeth alone.

Awareness training, for daytime clenching

Because awake clenching is at least partly voluntary, it responds to noticing. Patients who set a recurring reminder to check whether their teeth are touching often find they are — and the habit can be interrupted. At rest, your teeth should be very slightly apart with your lips together.

Restoring what has already worn

Where wear has gone far enough to cause sensitivity, function problems or appearance concerns, teeth can be rebuilt. This is careful work, best done once the grinding itself is being managed — otherwise the new work simply enters the same cycle.

06When to raise it

Sooner is materially better

Book an appointment if you're waking with jaw ache or headaches, if your teeth have become sensitive without an obvious cause, if you've noticed your front teeth looking shorter or more even along the edges, if your jaw clicks or catches, or if someone has told you that you grind at night. The NHS advises seeing a dentist if you have tooth damage, sensitivity or jaw and ear pain, and seeing a GP for help with the stress or lifestyle factors behind it.

The reason to come in sooner is straightforward: nothing we can do puts enamel back. Everything we can do is about protecting what's still there. The earlier that starts, the more there is to protect.

[Practice name] assesses tooth wear and jaw discomfort as part of a routine examination and provides custom-made splints at [location]. If any of this sounds familiar, mention it at your next visit or call [number].