Every night, while many people reach for their memory foam pillow or a good book to help them sleep, I reach for a small, green case on my bedside table. Inside is a custom-made, acrylic mouth guard, which fits over my teeth perfectly. I wear it to bed without fail.

This nightly ritual is not sexy, but necessary to protect my teeth. Like many other Americans, I grind my teeth at night, a condition called nocturnal bruxism. With the bite guard, I go to sleep looking like a prizefighter ready to spar, but wake up feeling relatively normal, and my teeth are— for the most part—unscathed. Without it, I wake up with a splitting headache and new damage to my teeth.

In severe cases like mine, the damage can be intense. But most people who grind their teeth have no idea they are even doing so, says Shawn Adibi, DDS, MEd an associate professor in the Department of General Practice and Public Health at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry. He says many people find out they are grinding from their spouse or partner who hears it at night or from their dentist. “When we tell them they are grinding their teeth at night, they are adamant that they don’t,” he says. “But we see the wear and tear, the shiny spots on the teeth that are indicative of grinding.”

With continued grinding, damage quickly becomes evident. The constant friction from the top and bottom teeth sliding against each other wears down tooth enamel—weakening the teeth and making them more vulnerable to cavities and breakage. The relentless grinding also has potential to stress the joints surrounding the jaw, causing severe and sometimes chronic headache, and in serious cases, lasting jaw damage.

The daily (or nightly) grind

Teeth grinding is an increasingly common condition, probably because we pay more attention to our dental health than in times past, Adibi says. But why do we do it?

A combination of emotional and physical stress contribute to teeth grinding, Adibi says. He suggests patients who grind primarily because of stress work with mental health professionals to develop coping strategies, adding that both anti-anxiety medications and therapy help.

“Once it (the stress) is controlled, the dentist has a better chance of managing the bruxism,” he says.

For some patients, Adibi prescribes a bite guard, also called a bruxism appliance or night guard, to protect further destruction of the teeth. The goal is to stop the damage from progressing, he says.

Botox your bite

Damage control is the name of the game when treating bruxism. But little progress has been made to stop teeth grinding at its source, says neurologist William Ondo, MD, a visiting professor of neurology at UTHealth Medical School. Ondo has studied the use of botulinum toxin, sold commercially as Botox, to treat bruxism. He helped pioneer the use of Botox as a treatment for patients with movement disorders and has used it off-label on patients with bruxism for more than 20 years. “It (Botox) seemed like an intuitive and obvious way to relax the jaw closing muscles,” he says, adding that Botox has more than 200 medical uses in addition to reducing the appearance of wrinkles. It is used most frequently to control involuntary movements, reduce glandular secretions and reduce the transmission of pain.

Ondo’s study was a placebo-controlled clinical trial involving 23 participants with bruxism—13 were injected with Botox, 10 with a placebo. The injections weakened the study participants’ jaw muscles and temporarily prevented them from grinding their teeth at night.

Results presented at the American Academy of Neurology meeting in April show Botox’s potential as a treatment for teeth grinding, Ondo says. Patients in the study who received the Botox injections ground their teeth less, according to reports from study participants and feedback from their spouses or bed partners. The effects of Botox lasted three to four months and cost an average of $1,000 per treatment, depending on insurance coverage.

Ondo says the next step is to test out Botox for bruxism in a multicenter trial, with the goal of getting the Food and Drug Administration’s approval for the usage.

Using Botox to treat bruxism in some cases is helpful if the patient has chronic pain, says Adibi of the study. However, he recommends a treatment program that also addresses the underlying causes of the teeth grinding and a more long-term solution to protecting the teeth.

“Hopefully more research can be done on new treatments such as this,” he says.

Teeth grinding tips

Until a cure for bruxism is found, wearing a bite guard at night and reducing stress is the best strategy to stem the damage from teeth grinding, Adibi says. He also offers the following tips:

  • For day grinders (diurnal bruxism): keep your teeth apart at least 2 millimeters at all times. This will be hard, at first, because you may be totally unaware of when you are grinding or clenching your teeth, Adibi says. “The only time your teeth should touch is when you swallow food or your own saliva.”
  • Use over-the-counter pain relievers to treat pain and headaches caused by teeth grinding. Stronger medications such as muscle relaxants do little to help teeth grinding. Anti-anxiety medications may indirectly help reduce bruxism, since they help alleviate the stress and anxiety that may have been the cause of teeth grinding. “We have seen correlation between emotional stress and bruxism, but not a cause and effect relationship, yet,” Adibi says. “Will medication help emotional stress? You bet.”
  • Be sure to get a custom-made, acrylic bite guard from your dentist. Over-the-counter bite guards are typically made of softer materials, “may do more harm than good because they are often not fitted well,” Adibi says.

This article, which has been updated, originally appeared on HealthLEADER, an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth). Visit HealthLEADER for more articles on a broad array of health and wellness topics.