Bruxism is the clenching or grinding of teeth, most often at night, sometimes during the day without even realizing it. It is one of the most frequent clinical situations in practice, and one of the most silent.
Here’s how Dr. Zerguine approaches it at Dental Swiss Clinics in Montreux: without dramatizing, without offering unnecessary treatment, but without letting wear progress without the patient knowing.
The first sign: wear facets
The first sign I look for during an examination is wear facets. These are flat, smooth, shiny surfaces on the teeth, where the enamel has been gradually ground down by repeated contact between the upper and lower teeth.
These facets appear long before any pain. They tell a story the patient doesn’t yet feel: their teeth are working at night, under forces far exceeding those of normal chewing.
What patients already know
Interestingly, when I tell a patient they clench or grind their teeth, the most frequent reaction is not surprise. Most already know. A spouse who hears grinding at night, jaw tension upon waking, an identified period of stress.
What’s missing isn’t information. It’s awareness of what bruxism does to teeth over time. The wear is slow, painless, and invisible day-to-day. Until the day the teeth have shortened, the vertical dimension has collapsed, and the anterior teeth start to wear down in turn.
The silent stage: no pain, no symptoms
This is the most important point to understand. At the wear facet stage, there are generally no clinical manifestations: no tooth sensitivity, no joint pain, no restoration fractures in the mouth.
The patient feels nothing. And that’s precisely why this stage is deceptive: the absence of symptoms does not mean the absence of progression.
At this stage, my approach is simple: inform the patient, document the wear, and monitor its progression during regular check-ups. No treatment is imposed. The patient simply needs to be aware of what is happening.
When a night guard is indicated
A bruxism night guard becomes relevant when joint pain appears: jaw tension or pain, temporomandibular joint pain, or stiffness upon waking.
At this point, the patient becomes proactive because they feel something. The night guard protects the teeth during the night and relieves the joints by distributing forces.
It is a custom-made device, fabricated in the clinic from a digital impression. The bruxism night guard is offered at CHF 340 at Dental Swiss Clinics.
When we talk about reconstruction
There is a stage where protection is no longer enough: when wear has caused the posterior teeth to lose height and the vertical dimension has collapsed.
In my practice, reconstruction is considered in one specific case: when the patient wishes to rehabilitate their anterior teeth. Worn, shortened front teeth that cannot be durably restored as long as the back teeth no longer support the height of the jaw.
In this situation, the clinical rule is constant: we first reconstruct the posterior segment to restore the vertical dimension, then we restore the anterior aesthetics on stable foundations. Rehabilitating the front teeth without stabilizing the back teeth leads to predictable failures: fractures, debonding, accelerated wear.
This process is detailed in the article on complete aesthetic dental rehabilitation.
A philosophy: inform, not alarm
Bruxism affects a large part of the population, to varying degrees. Not all bruxers need a night guard. Very few need reconstruction.
What every patient deserves, however, is to know where they stand: the presence or absence of wear facets, their evolution over time, and when intervention would become relevant.
This is the role of regular check-ups. Not to propose treatment at all costs, but so that the decision, if it must come one day, is made at the right time and with full knowledge of the facts.
Frequently Asked Questions
How do I know if I grind my teeth at night?
The most frequent signs: a spouse who hears grinding, jaw tension upon waking, and especially wear facets visible during a dental examination. A check-up can objectively confirm the diagnosis.
Is bruxism painful?
Not initially. Wear usually progresses without pain, sensitivity, or joint symptoms. This is what makes it deceptive: the absence of pain does not mean the absence of progression.
Is a night guard always necessary for bruxism?
No. A night guard is primarily indicated when joint pain appears or when wear progresses significantly. In the initial stage, information and monitoring are often sufficient.
What happens if bruxism wears down teeth for years?
The posterior teeth shorten, and the vertical dimension can collapse. At this stage, restoring the anterior teeth first requires reconstruction of the posterior segment. This is a more complex treatment than simple protection.
Does stress cause bruxism?
Stress is a recognized contributing factor, particularly for daytime clenching and nighttime grinding. Periods of professional or personal tension often coincide with an intensification of bruxism.
To assess your situation, contact Dental Swiss Clinics in Montreux, Monday to Friday from 8 AM to 8 PM.