Grinding, clenching and jaw pain

Waking with a tight jaw or a dull headache at the temples. Teeth that are flattened, chipped at the edges, or increasingly sensitive. A partner who has heard it. Scalloped indentations along the edge of the tongue, or a ridge of thickened tissue along the inside of the cheek where it meets the biting plane.

Night grinding is a sleep-related movement behaviour and is not under your conscious control. Daytime clenching usually is, and is strongly tied to concentration and stress — many people hold their back teeth together while driving or working without noticing.

The daytime version responds to awareness. Teeth should be apart at rest, with the lips closed and the tongue at the roof of the mouth. Only the night version needs an appliance.

Enamel wear, cracked cusps, fractured fillings, and in the longer run teeth that need crowning rather than filling. It also loads the jaw joint and the muscles around it, which is where the headaches and the aching on chewing come from.

A custom-made guard takes the wear instead of the teeth. It does not stop the grinding. It is worth knowing the distinction, because it explains why a guard needs replacing periodically — it is doing its job by wearing out.

Over-the-counter boil-and-bite guards fit less accurately, and a poorly fitting appliance can alter the way the teeth meet. Worth discussing before buying one.

Clicking, locking, pain in front of the ear, or difficulty opening wide point at the jaw joint itself. That is a different assessment, and often a different management plan — heat, soft diet, jaw exercises and load reduction before anything irreversible. Say if any of those apply to you.