Thyroid Disease and Teeth Grinding: The Hidden Cause of Bruxism

Do you feel pain in your jaw muscles when you wake up in the morning? Could you be clenching or grinding your teeth throughout the night? If you have thyroid disease, the cause of these complaints may not be just stress—there may be much more specific medical reasons behind them. Unfortunately, many doctors overlook this connection, and patients are often dismissed for years with the advice to “just wear a night guard.”

What Is Bruxism and Why Is It So Important?

Bruxism is the involuntary clenching, grinding, or overuse of the jaw muscles during sleep or while awake. This condition not only damages the teeth but can also lead to:

• Permanent damage to the temporomandibular joint (TMJ)
• Chronic head and neck pain
• Significant deterioration in sleep quality
• Social withdrawal due to embarrassment from jaw noises
• Loss of chewing function

So why is this condition different in thyroid patients?

The Hidden Face of Hypothyroidism: The Real Cause Behind Jaw Pain

In patients with thyroid hormone deficiency, bruxism and jaw problems are much more complex.

Why Are Thyroid Patients Different?

Changes in Muscle and Connective Tissue:
Hypothyroidism causes stiffness in muscles and connective tissues. The jaw muscles are also affected and remain constantly tense.

Disruption of Sleep Structure:
There is a reduction in deep sleep stages, which triggers bruxism.

Increased Pain Sensitivity:
The same stimulus causes much more pain in thyroid patients.

Macroglossia (Enlarged Tongue):
As the tongue grows, chewing biomechanics are disrupted, increasing protective muscle activity.

How Does It Affect Your Life?

• Inability to eat breakfast due to jaw stiffness in the morning
• Jaw fatigue while speaking
• Increased jaw pain in cold weather
• Inability to chew hard foods

The Lesser-Known Effect of Hyperthyroidism

Hyperthyroidism also triggers bruxism, but through different mechanisms:

• Excessive irritability and anxiety: increases daytime clenching
• Muscle hyperactivity: jaw muscles become overactive just like the rest of the body
• Sleep disturbances: nighttime awakenings increase bruxism episodes

Parathyroid and Calcium: A Major Cause That Is Often Overlooked

The Dramatic Impact of Hypocalcemia

Insufficient parathyroid gland function or low calcium levels cause neuromuscular hyperexcitability.

Symptoms:

• Perioral paresthesia: tingling around the lips
• Carpopedal spasm: contractions in the hands and feet
• Involuntary jaw spasms resembling teeth grinding
• Positive Chvostek and Trousseau signs

Impact on Daily Life:

• Sudden jaw locking while eating
• Waking up at night due to sudden muscle cramps
• Jaw trembling while speaking
• Jaw stiffness worsened by cold weather

Critical Point:
Giving only a night guard is completely ineffective in these patients!
Calcium and active vitamin D (calcitriol) treatment must be started first.

How Do We Distinguish Bruxism in Thyroid Patients?

In thyroid-related bruxism, the following findings stand out:

• Accompanied by general fatigue
• Cold intolerance
• Hair and skin changes
• Enlarged tongue (macroglossia)
• Perioral tingling (if hypocalcemia is present)
• Symptoms worsening in cold weather

Revolutionary Treatment Approaches

1. Treat the Underlying Cause First!

Hypocalcemia/Hypoparathyroidism Treatment:

• Calcium + calcitriol (active vitamin D)
• Magnesium replacement
• IV calcium in emergencies
• Regular monitoring (monthly calcium checks)

Thyroid Disease Treatment:

• Hormone replacement must be optimized
• Target TSH: 0.5–2.5 mIU/L
• Free T4 should be in the upper half of the normal range
• Improvement begins within 2–3 months

2. Concurrent Protective Therapies

Stabilization Splint (Night Guard):

• Should be made of hard acrylic
• Soft guards can increase muscle activity
• Follow-up every 3–6 months
• Night use only is sufficient

Physiotherapy and Exercises – Daily Routine:

• Morning: 5 minutes of jaw massage
• Noon: Neck stretching exercises
• Evening: Warm compress application
• Night: Relaxation techniques

3. Advanced Treatment Options

Botulinum Toxin A (Botox):

• Indication: Severe cases resistant to conservative treatment
• Application: Masseter and temporalis muscles
• Dose: 50–100 units total (depending on muscle size)
• Duration of effect: 3–6 months
• Results: 80–90% pain reduction, 60–70% decrease in muscle activity

Who Should Consider Botox?

• Patients whose symptoms persist despite splint therapy
• Those with significant masseter hypertrophy
• Patients experiencing severe pain affecting daily life
• Patients whose thyroid hormone levels are under control

Nutritional Support: An Evidence-Based Approach

Vitamin D and Calcium Replacement

Who Should Receive It?

• Those with 25-OH vitamin D < 30 ng/ml
• Patients with low serum calcium
• Individuals with chronic pain complaints
• Patients presenting with muscle cramps

Correct Dosage:

• Vitamin D: 1000–4000 IU/day
• Calcium: 1000–1200 mg/day (with meals)
• Magnesium: 200–400 mg/day

Magnesium: The Forgotten Mineral

Magnesium plays a critical role in muscle relaxation:

• Regulates the muscle contraction-relaxation cycle
• Optimizes neural transmission
• Improves sleep quality
• Reduces stress hormones

Warning Signs: When Is Emergency Intervention Needed?

Hypocalcemia Crisis:

• Laryngospasm (inability to breathe)
• Tetany (widespread muscle contractions)
• Cardiac arrhythmias
• Altered consciousness

Thyroid Crisis:

• Palpitations
• High fever
• Confusion
• Excessive sweating

Treatment Algorithm: Step-by-Step Guide

1. Evaluation Phase (First 2 Weeks)

Laboratory Tests:

• TSH, free T4
• Total and ionized calcium
• Phosphorus, magnesium
• 25-OH vitamin D
• PTH

2. Emergency Correction (2–4 Weeks)

• Treatment of hypocalcemia (if present)
• Optimization of thyroid hormones
• Acute pain management

3. Protective Therapies (1–3 Months)

• Preparation and adjustment of splint
• Start of physiotherapy
• Lifestyle modifications
• Nutritional supplementation

4. Advanced Therapies (3–6 Months)

• Botox evaluation
• Surgical consultation (if needed)
• Psychiatric support (for chronic pain)

Success Story: Real Patient Experience

Ms. Elif (42):
“For 10 years, I woke up every morning with jaw pain. Three different doctors only gave me a night guard, but nothing changed. When my thyroid hormone came back low, we started treatment. After 2 months, my morning pain decreased by 80%. I wish we had known earlier!”

Conclusion

In thyroid patients, bruxism is not just “stress-related teeth grinding.”
Thyroid diseases cause specific changes in the jaw joint system and require specialized treatment approaches.

If you have thyroid disease and are experiencing jaw problems, please do not rely solely on a night guard. Work with a team that understands how your condition affects jaw health and applies a multidisciplinary approach.

Remember: Correct diagnosis + correct treatment = a pain-free life.

Dr Tansu Uzel Clinic accurately establishes the link between thyroid disease and teeth grinding, and applies the correct treatment with the correct diagnosis. You can now get in touch and follow our Instagram account to see those undergoing treatment.