Pathological Parafunction (Teeth Clenching)
You may be familiar with the term “clenching teeth”, however, a more severe form of parafunctional behavior is “pathological parafunction.”
Bruxism and clenching are common parafunctional activities. At the pathological level, it can manifest during sleep or wakefulness, each with various contributing factors. Your sensory system in the orofacial area is unique and complex. Bruxism and clenching have a prevalence of 50-90% in the general population with no significant differences between genders. Given the high percentage of people impacted, these behaviors merit a closer look. Our San Diego, Los Angles pain clinics specialize in treating the pain that inevitably accompanies pathological parafunction.
“It is a very common condition in the general population (80-90%), in which at some point in life people will tighten or grind their teeth to some degree,” according to the National Institute of Health’s August 2022 Probable awake bruxism – prevalence and associated factors: a cross-sectional study.
There are evidence-based conclusions about the significant association between pathological disorders and orofacial musculoskeletal pain. Behaviors, thoughts, or conditions that are abnormal can impact painful pathological parafunction. The pain could be associated with the hard and soft tissues of the head, face, oral cavity, or with a dysfunction of the nervous system. Our goal is to properly recognize what type of pain is affecting our patients, to initiate the most appropriate therapy to eliminate or reduce their pain and improve their quality of life.
What Distinguishes “Pathological Parafunction” from “Clenching Teeth?”
Definitions that explain pathological parafunction vs. clenching teeth:
Clenching teeth is a common parafunctional activity that can occur during sleep or wakefulness. It is broadly defined as the forceful pressing of teeth together without grinding.
Pathological parafunction, or oral parafunction, is a repetitive behavior that involves the mouth and can include bruxism, clenching, lip biting, and thumb sucking. This oral parafunction is a broader term encompassing any nonfunctional, repetitive behavior affecting oral structures. It is a severe form of parafunctional behavior. These habits are not associated with speech, deglutition, or mastication.
Bruxism is defined as a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible.
Oral pathological parafuction is any non-functional, repetitive behavior involving the oral muscles or structures. Oral parafunction is a term for abnormal or unusual habits or activities that involve the oral cavity.
The distinctions are important because while most parafunctional behaviors are relatively harmless, pathological parafunction can cause significant pain and damage to oral structures.
What is the Difference Between Bruxism and Parafunction?
Summary of key characteristics that differentiate pathological parafunction:
- Extreme clinical manifestations: This may include chipped, cracked, or fractured teeth, masseter hypertrophy, and broken oral appliances.
- Rapid wear and tear on oral appliances: Patients with pathological parafunction may wear through oral appliances much faster than those with typical parafunction.
- Muscular dysfunction: Parafunctions can cause increased tension and hypertrophy of the masticatory muscles.
What Causes “Pathological” Teeth Grinding?
Psychological factors: Stress, anxiety, and depression can cause people to grind their teeth involuntarily, especially during sleep, often leading to a need for an oral airway device. Stress is a big factor, but it can also be linked to genetics, certain medications, or even caffeine.
Nervous system pathologies: Bruxism (a condition where a person grinds, clenches, or gnashes their teeth) can be caused by head trauma, central nervous system damage, or other nervous system disorders.
A sustained stressful state can trigger parafunctional episodes that contribute to myofascial pain.
“Several factors may contribute to parafunction including stress/anxiety, genetic predisposition, and medications/stimulants. Particularly, certain antidepressants such as selective serotonin, reuptake inhibitors (SSRI’s) and ADHD medications like methylphenidate can play a role in increased levels of parafunction. Excessive caffeine intake can also contribute to these symptoms.” – Pathological Parafuction: Diagnosis, Clinical Presentation and Treatment Options
Consequences of Pathological Parafunction
Consequences of pathological parafunction typically include can jaw pain, headaches, and fractured teeth. Due to strong, sustained masticatory muscle contractions during these behaviors, patients often present with severe pain in the orofacial region. Pain is often described as dull, achy, sore, and tense or tight. While pain may be referred, it is typically located in the masseters, temporalis, TMJ capsules, and/or frontal region.
Another risk is maxillary or mandibular tori. These are bony growths on the jawbones that can be exacerbated by bruxism. The presence of maxillary or mandibular tori can be influenced by bruxism and significant bruxism can increase incidence of tori. An altered occlusion can disrupt oral function and cause psychosocial issues due to compromised dentofacial aesthetics. Occlusal changes, especially sudden ones, can be secondary to TMJ or muscle disorders.
This is when unknowingly grinding your teeth can become dangerous.
If treatment is delayed, you may experience detrimental effects on your temporomandibular joint (TMJ). Parafunctions can also permanently alter a person’s appearance. For example, thumb sucking or tongue thrusting can pull the front teeth forward, making it difficult to bite together.
Most people grind their teeth; only a few sustain significant damage from it. By seeking proper diagnosis and TMJ treatment from a facial pain professional, you can effectively prevent or diminish serious issues with the jaw and facial structure.
Treatment for Pathological Parafunction
Unlike typical parafunction, pathological parafunction requires treatment to ease pain symptoms and prevent further damage. Due to the associated pain and dental damage, your treatment plan may be supported by detailed case reports illustrating the effectiveness of the selected interventions.
Effective management often requires a multimodal, multimodal, collaborative treatment approach for facial pain care. Your facial pain specialist will explain your best options and can manage your overall pathological parafuction treatment.
Treatment options for pathological parafunction may include:
- Oral appliances: Using multiple oral appliances (occlusal splints) with varying vertical dimensions can disrupt the pattern of muscle contraction and extend the lifespan of the devices. Custom mouth guards can be made to fit over the teeth precisely. They offer a reliable barrier against the detrimental effects of bruxism. Regular use of mouth guards can significantly mitigate damage, ensuring better oral health and comfort.
- Dual flat plane orthotic: This type of appliance means patients wear both upper and lower orthotics simultaneously to prevent any tooth contact on the appliances which extends the lifetime of the appliance.
- Botox injections: Injections of Onabotulinum toxin A can reduce the strength of the masticatory muscles and alleviate pain.
- Pharmacotherapy: Medication management may include clonidine, clonazepam, and buspirone may be used to reduce muscle activity and manage pain.
- Stress reduction techniques: Practicing mindfulness and relaxation techniques can significantly lower stress levels, potentially reducing pain symptoms and the incidence of bruxism. Techniques such as deep breathing, meditation, and biofeedback may assist in reducing muscle activity and tension, leading to fewer pathological parafunction episodes.
Here’s a real-life example of pathological parafunction:
Imagine someone who grinds their teeth so hard, their jaw hurts constantly, and they even had dental fractures. That’s a classic case of pathological parafunction.
A woman treated at our clinic initially had pain upon palpation of bilateral masseter, temporalis, suboccipital muscles, and sternocleidomastoids. After Botox treatments took effect, she reported a 50-70% decrease in ringing in her ears and significant reduction in jaw discomfort. Upon completion of parallel dental treatment to restore fractured crowns, she wore custom maxillary and mandibular orthotics and reported no further dental fractures secondary to bruxism.
Of critical importance is early diagnosis and intervention to prevent long-term consequences.
CONCLUSION: Prevent Damage to Oral Structures and Reduce Facial Pain
Common parafunction problems are easy to distinguish from more severe cases. Many severe cases of parafunction with dire consequences to oral structures can be avoided or diminished. Providers at Facial Pain Specialists offer careful monitoring and preventive treatment. Schedule your evaluation so you can prevent possible damage to your oral structures and the formation of painful conditions.