5) Occlusal Adjustments
I’m biased against this one in all but the rarest cases, so I’ll admit that at the outset. Unless you’re a dentist, you probably read the phrase “occlusal adjustments”, and think to yourself something akin to “what the heck?” The term “occlusal adjustment” in dentistry refers to the process of altering the way your teeth come together. As you might imagine, if you alter the way your teeth come together, you alter the sensory neurological signals the brain gets back during clenching. In this sense, occlusal adjustment has an ability to act as a pattern interrupt to the clenching and grinding cycle (in either a good way, or a bad way) which is similar to the insertion of a mouth guard into your mouth. However, unlike the insertion of a mouth guard into your mouth (which can quickly be reversed by removing the mouth guard from your mouth), the most common forms of occlusal adjustment are permanent. Altering the shape of people’s teeth by grinding away part of their teeth with a carbide or diamond grinder is not reversible.
Ten years ago, the number of dentists performing occlusal adjustments was significantly greater than the number of dentists who perform such procedures today. One might suppose that part of the reason for the reduction in the use of occlusal adjustment as a technique for attempting to reduce or eliminate bruxism, is that while grinding away part of someone’s teeth provides a great source of income for dentists, it weakens teeth, and makes them more susceptible to damage from clenching, more sensitive to heat and cold, etc.. Add to that the fact that some patients actually get worse instead of better, and you can see why some dentists consider performing occlusal adjustment to bring a risky increase in their likelihood of being sued by a patient. To quote one dentist I talked to at the 2008 Yankee Dental Congress in Boston, “not many people do that anymore… too much liability”.
But potential liability or not, and sketchy outcomes or not, some dentists still recommend and perform occlusal adjustment as a first treatment to try to reduce bruxism in their patients. And, as you might guess, occlusal adjustment often costs thousands of dollars, whether or not it works, or causes any other damage. Unless you are someone who has something seriously wrong with your bite, and you have consensus of several independent opinions from several independent dentists (preferably not dentists who know each other), you might want to try many other things before trying occlusal adjustment in an attempt to reduce or eliminate your bruxism.
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