DUBNER: I’m sure that is the only time in the history of humankind that those two words have ever been spoken together.
* * *
DUCKWORTH: I’m Angela Duckworth.
DUBNER: I’m Stephen Dubner.
DUCKWORTH + DUBNER: And you’re listening to No Stupid Questions.
Today on the show: Why do people grind their teeth?
DUBNER: I’m not saying your dentist is a crook, but your dentist might be a crook.
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DUBNER: Angela, we have discussed in the past on this show the fact that you are not the world’s best sleeper.
DUCKWORTH: That’s true. And continues to be true.
DUBNER: You’ve also mentioned to me that you grind your teeth. I have learned this is called “bruxism,” and technically there’s both “awake bruxism” and “sleep bruxism.”
DUBNER: Are you an awake bruxist or an asleep bruxist — or both, perhaps?
DUCKWORTH: I don’t know how someone knows that they’re a bruxer in their sleep. I mean, there are definitely times where I notice that my teeth are clenched. And I then think, “Oh gosh, is that what I’m doing?” Teeth clenching, by the way, and teeth grinding are not the same thing. They’re both called bruxism, I guess, technically, but I think I have the grinding part.
DUBNER: So, whether you grind, or clench, or whatnot, we are all bruxists, if we are in either of those categories.
DUCKWORTH: That’s correct, if you do either of those things.
DUBNER: Can I ask, when you grind your teeth, whether it’s awake or — if you have any cognizance of it — while you’re asleep, what is the sensation? Does it feel as if you are scratching an itch, that you’re relieving some kind of desire or pressure, or is it totally unconscious? I’m curious to know what it feels like.
DUCKWORTH: I don’t know what it feels like to grind my teeth, in part because I didn’t know I was doing it until my dentist said to me, “You know, you’re, like, grinding your teeth into dust.”
DUBNER: What about your husband? He’s right there.
DUCKWORTH: You can apparently hear when somebody’s teeth are grinding against each other, if you’re listening closely and it’s a very quiet room, which, you could say that’s the setting of the bedroom, but also, you know, when I’m sleeping, Jason’s usually sleeping.
DUBNER: As far as you know. He might be —.
DUCKWORTH: He might be rubbing my jaw! Maybe he’s the problem?
DUBNER: Now, here’s the other thing. You also mentioned to me recently that your sister asked you why people grind their teeth. So, this is sort of peak bruxism in our universe. And I’m therefore coming to you today with a long list of questions. So, I want to know: why do people grind their teeth? Why do you grind your teeth? I also want to know how widespread a problem this is and what can be done about it. So, let’s start with you. Why don’t you tell us your teeth-grinding story.
DUCKWORTH: My teeth grinding story. I feel like this is like, you know, “Teeth Grinding Anonymous.”
DUBNER: This is your life on “Dental Podcast.”
DUCKWORTH: Yeah. We’re going to get vulnerable here. Well, I am not aware of, of having ground my teeth in childhood, but apparently research suggests that teeth grinding is pretty common in childhood, possibly more common in childhood than in adulthood. Although, in general, almost nothing is known scientifically about teeth grinding. I’ll just say that from the beginning. I say that because I looked it up. I was trying to cure my own problem, and I live next to a dentist, and one of my graduate students got married to a dentist. So, I’ve been asking lots of experts about bruxism.
DUBNER: So, you’re just lousy with dentists, but you also looked it up in some index beyond just the dentists you know, I assume.
DUCKWORTH: Correct. I am lousy with dentists, but the scientific research is lousy. That’s the thing that these dentists will tell you, that it’s shockingly, poorly researched. And I will tell you my story, Stephen, I will get vulnerable with you, but I want to start with just some epidemiological estimates of how prevalent this habit of teeth grinding is. So, as you said, there’s awake teeth grinding and there’s sleep teeth grinding. What really shocked me was that when you ask people about their teeth-grinding habits, it’s about one in three, maybe one in five adults in the United States, who think they grind their teeth while they’re awake. What about when you’re asleep? What would your guess be? Would it be higher than that or lower than that?
DUBNER: It’s hard for me to say, because I’m so distrustful that the data you’re about to tell me is reliable data. Only because, look how little we know about sleep. I mean, we’re learning more. The science of sleep, it really has grown quite nicely over the past few decades. But since bruxism is the act of grinding your teeth while sleeping, I have a feeling that we don’t actually know that much. If I had to guess whether there’s more while awake or while asleep, I would think it would be more while awake. But that’s because I’m thinking that the primary cause, or causes, of bruxism are some kind of anxiety, or aggression, or unhappiness, or something, and I would like to think that we don’t manifest that as much in sleep as we do while awake.
DUCKWORTH: Okay, so you are right. I actually was going down the same path as you when I was thinking about this. I was like, “Well, it’s probably a stress thing, right?” And I was thinking about that as something you would do, you know, subconsciously while you’re asleep, while you’re having anxiety dreams or whatever. But it turns out, if these estimates can be believed, if it’s one in three — maybe one in five — somewhere in that range, for awake bruxism, for sleep bruxism, it’s about half of that. This idea that it’s an anxiety habit, it has some merit. There’s correlational studies relating bruxism to anxiety. But, in general, it can be a habit that you start subconsciously. That doesn’t necessarily have to be a stress response.
DUBNER: So, this is interesting to me, because I thought that we were addressing a problem that was more easily quantifiable. I’m just looking up here from the Mayo Clinic. Check this out. “Doctors don’t completely understand what causes bruxism.” After I read the rest of this, you may want to remove that word “completely” from your mind. Okay? It says, “Doctors don’t completely understand what causes bruxism, but it may be due to a combination of physical, psychological, and genetic factors. Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration, or tension, or it may be a coping strategy or a habit during deep concentration, or —.” I mean, on, and on, and on, and on, and on.
DUCKWORTH: I know, right? It’s like, what’s not bruxism?
DUBNER: Here’s what the Mayo Clinic says does increase your risk of bruxism. Not “may,” but “does.” So, that sounds fairly certain, but when you read the categories, I start to think it’s pretty much a human. So, here’s some of the factors. “Stress, age, personality type, medications and other substances, family members with bruxism, other disorders,” and on, and on, and on, and on.
DUCKWORTH: So, the way I would say it is this: that the causes of bruxism are various and basically so under-understood that it’s not that helpful to even begin listing them.
DUBNER: Okay. So, let’s stick on you for a little bit. First of all, I don’t want you to feel bad about yourself.
DUCKWORTH: Well, look, there’s so many of us. I don’t feel so bad.
DUBNER: Exactly. And I also wanted to say, you’re in very good company, because apparently George Clooney is a grinder. Brooke Shields is a grinder.
DUCKWORTH: I want Barack Obama to be a teeth grinder. That would make me feel better.
DUBNER: You know what? Let’s just say he is. Because, first of all, that’s going to be really hard for Rebecca to fact check that he is not.
DUCKWORTH: Yes, indeed.
DUBNER: And, second of all, I would like to think that if somewhere between a fifth and a third of all people are grinders — and if grinding or bruxism is associated with worrying, or anxiety, or stress, I would like to think that he has, in his life, experienced some serious stress. He was president in the United States. That’s kind of a big job. He may not be a grinder, but I bet he has ground.
DUCKWORTH: I agree. And, by the way, you said you were not a teeth grinder, correct?
DUBNER: Well, you know, I said that, but now you told me that you are a teeth grinder, and you have no evidence, no recollection, no good reason to think you are, other —.
DUCKWORTH: Well, I have evidence from my dentist.
DUBNER: Well, wait a minute. I’m not saying your dentist is a crook, but your dentist might be a crook.
DUCKWORTH: My dentist now agrees with my dentist before. But they could both be crooks, you’re saying!
DUBNER: I’m not really thinking they’re crooks, but, theoretically, it’s a nice little scam, because if I tell you, “Angela, oh, I see evidence here. You’re a bruxist. You’re grinding your teeth, and we are going to have to do something about that.” And so, maybe this is a nice low-scale way of selling you something you don’t necessarily need. I don’t know what they sell you. So, what do they do? What is the treatment that they’ve proposed for your grinding?
DUCKWORTH: So, when your dentist says, “Unfortunately, I have to bear the bad news that you are grinding your teeth,” the next sentence is usually, “What I recommend is a mouth guard.” This has, again, a technical term. I think they’re called mouth splints. Anyway, the idea is you put this piece of plastic into your mouth, and it just prevents your teeth from coming together and grinding each other. I mean, it’s the most primitive of devices.
DUBNER: Yeah. That doesn’t sound like they’re going to get rich selling mouth guards.
DUCKWORTH: Well, they can be expensive, because —.
DUBNER: They have to be custom fit?
DUCKWORTH: Yes. So, you have to, like, get a mold.
DUBNER: What did you pay for this mouth guard, then?
DUCKWORTH: Well, Stephen, I did not actually take either dentist up on the mouth guard option, you’ll be surprised to know.
DUBNER: You know, here you are, “Miss Behavior Change,” telling everyone that most of life’s problems can be solved by adhering to the advice given by smart, well-meaning experts. And here you are saying, “Eh, bruxists, mouth guards, dentists!”
DUCKWORTH: Bruxism, schmuxism.
DUBNER: I’m sure that is the only time in the history of humankind that those two words have ever been spoken together.
DUCKWORTH: I think so, and maybe the last time. I don’t want to discount the professional advice of my dentist, but I asked both dentists, like, “So, how does this work?” They were like, “Oh, we make a mold. We mold it to your teeth, and then we give you this mouth guard that you stick into your mouth like a horse bit. And, you know, you might drool, and it’s unattractive. But the good thing is, 30 years from now, you’ll still have your molars.”
DUBNER: Why did you not take the advice?
DUCKWORTH: Well, first of all, I guess, I wasn’t aware — and neither is my dentist — about whether I’m a nighttime teeth grinder or a daytime teeth grinder. I mean, I could maybe stomach the idea of putting in a mouth guard at night, but walking around all day with a bit in my mouth, I just didn’t want to do that.
DUBNER: Can I say, if you start doing that, I will bring sugar cubes the next time I visit.
DUCKWORTH: Yeah — a carrot. But there is good solid research that if you stick a piece of plastic in your mouth, you will not grind your teeth to dust. What they don’t do is prevent you from grinding. They just prevent the consequences of grinding. So, you could be just grinding your mouth guard.
DUBNER: I do see here from Johns Hopkins, some prescribed treatments or solutions: a mouth guard, as you had noted, behavior changes — this says, “You may be taught how to rest your tongue, teeth, and lips properly. You may also learn how to rest the tongue upward to relieve discomfort on the jaw while keeping the teeth apart and lips closed.” Tongue up. Tongue up. Teeth apart.
DUCKWORTH: That’s called your oral posture, by the way.
DUBNER: And do you have good oral posture? Do you know?
DUCKWORTH: Well, I looked into that too. You know, we all have a sense of our back and our posture — whether we’re hunched over or sitting up straight, et cetera. The same goes for your tongue and your teeth, and there are different positions on what good oral posture is, but a common thought is that you are supposed to have your mouth closed, not open. And then, it seems like the tongue rests against the upper palette. So, behind the front teeth. I hope you’re doing all this while I’m coaching you through it. But I want to say this about your tongue. The most important thing is that it’s completely at rest — that it’s relaxed. So, that’s good oral posture. But I just want to say that bruxism — teeth grinding, clenching, et cetera — and oral posture may be linked, but then again, not really sure.
DUBNER: Here’s another proposed treatment from Johns Hopkins. Biofeedback. Biofeedback involves an electronic instrument which measures the amount of muscle activity of the mouth and jaw. It then signals you when there is too much muscle activity so you can take steps to change that behavior.
DUCKWORTH: I just want to give you a visual image, because I read that too, and I’m like, “Biofeedback? Like, what?!” So, some of these involve the mouth guard, but it’s got a sensor.
DUBNER: So, it can shock you when you start to grind. Love it.
DUCKWORTH: You know, there was less data on biofeedback, because that’s not as commonly practiced as just putting a mouth guard in.
DUBNER: I wonder why.
DUCKWORTH: You wonder. So, yes, if you can get yourself to wear, not only a mouth guard, but a mouth guard that’ll shock you, then maybe that’ll be your cure.
DUBNER: Now, the mouth guard that your dentist wanted you to wear, was it an electric-fence mouth guard, or just a regular, plastic mouth guard?
DUCKWORTH: I don’t think it was an electrified mouth guard. At least that didn’t come up. I didn’t even want to see it, so, I can’t be sure.
DUBNER: You know, I’m curious, Angie, to hear from our listeners about this. I would particularly like to hear a success story. So, if you — or someone you know — was a bruxer or a bruxist and was able to overcome it, at least in part, tell us how it happened. I also want to know if you were an awake or an asleep bruxist. Just use the voice memo app on your phone. Record in a nice, quiet place. Get right up close to the phone to talk, and send your voice memo to email@example.com, and maybe we will play your voice memo in a future episode.
Still to come on No Stupid Questions: Stephen shares an uncomfortable oral surgery story.
DUBNER: I looked down to see, “Is that what I’m thinking I’m feeling?” And it was definitely that.
* * *
Now, back to Stephen and Angela’s conversation about how to stop grinding your teeth.
DUBNER: Now, did this make things uncomfortable between you and your dentist when you went back the next time? It had to be at least implicit that you ignored her advice?
DUCKWORTH: Well, I think that this is very common to not want a mouth guard. So, there was no surprise on either dentists’ part when I said, “You know, let’s talk about that next time.” And then, said it again, and again. Actually, not that long ago, I had something else to say to my dentist when mouth guards and teeth grinding came up, and the word I said was “Botox.”
DUBNER: I did come across the use of Botox, but I came across it in a critical description of the treatment of bruxism.
DUCKWORTH: I want to tell you — before you tell me — yeah, I’ve done it. I’ve gotten Botox.
DUBNER: You did? Now, wait a minute, wait a minute, wait a minute. You’re getting Botox for your bruxism? Or you wanted to get Botox and you thought bruxism was a good cover story?
DUCKWORTH: Okay. I did not get Botox in the places that you get Botox to look younger, I guess. When you get Botox for teeth grinding, the Botox is injected, actually, in these jaw muscles. And it is used to, like, paralyze the muscles.
DUBNER: Well, here I’m reading from a piece in The New York Times, which seems fairly obsessed with tooth problems, I have to say.
DUCKWORTH: The New York Times in general, or this piece?
DUBNER: Yeah, The New York Times in general. Like, I’ve seen The New York Times, especially during COVID, writing a lot about tooth issues. And one line of inquiry has been that a lot of people do seem to be grinding their teeth or not taking care of their teeth for all the reasons you would think during a pandemic. They’ve written a number of tooth stories. This one is from 2021. It’s called “Grind Your Teeth? Your Night Guard” — which I guess is the “mouth guard” — “May Not Be the Right Fix.” And here’s a quote I will read you. This is from a Karen Raphael, who is a psychologist and a professor at New York University College of Dentistry. She’s referring to the widespread use of bite guards, tranquilizers, and even Botox injections to prevent bruxism. She says, “There’s tremendous overtreatment for a nonproblem. There is no evidence that tooth-wear patterns reflect current grinding.” She says that, “Tooth wear is more often associated with an acidic diet, which both erodes enamel and triggers bruxism to increase the pH in the mouth” — I guess, by stimulating saliva or something. Treating bruxism in this instance would be treating the effect rather than the cause. So, I don’t know if that’s correct, Angela. I’m not a dentist, but it does give me a little bit of pause when I hear that your dentist diagnosed you as a bruxist by having seen patterns of wear, whereas this dental professor seems to say that they may have the arrow traveling in the wrong direction.
DUCKWORTH: I will say that not only my dentist, but most of the research that I read did suggest that it’s a thing. It’s not like, “Oh, teeth grinding, we’re making up a problem that doesn’t exist.” I will say that the idea that I could have a teeth-grinding problem was substantiated when portions of my teeth started falling out of my mouth.
DUBNER: Well, there you go. Okay.
DUCKWORTH: There was this very stressful period in my life. I mean, I was on tenure track. I think it must have been, like, a decade ago. And I would just be eating not even anything crunchy, and I was just like, “Woop. Wait, what’s that? Oh, there’s a little bone in this. No, it’s my bone!” So, as my teeth started just shearing off, like melting icebergs, that just gave a lot of credibility to these stories my dentists were telling me about my teeth grinding.
DUBNER: Well, okay. I can see how you could get from A to B, even to C in that story, but I could also imagine there are a lot of other potential reasons why your teeth are crumbling and falling apart.
DUCKWORTH: I mean, if you take that pH thing, you could say, like, “Oh, maybe you’re drinking too much Diet Coke.”
DUBNER: Yeah. You could also say you’re having a lot of tooth decay from all different kinds of reasons — going back to the diet, and nutrition, and sleep, and all the other things that make up our dental health. But I don’t mean to be an “anti-dentite.”
DUCKWORTH: You do seem a little anti-dentist. I’m just saying. You’re going to get a lot of hate mail from dentists after this.
DUBNER: I have great respect for — and admiration for — dentists I have had. Although I did have one oral surgeon — it’s a kind of scarring memory. I needed a root canal, and I was in graduate school, and I had, like, less than $0. So, the only way I could get it done was through my graduate student medical coverage, which was at Columbia, where they have a dental school.
DUCKWORTH: And you had, like, a student, right?
DUBNER: I did. I still distinctly remember the pain and the sensation, but I also remember that it took, like, eight visits to get a root canal, because, you know, they were beginner.
DUCKWORTH: You had an eight-visit root canal? That’s terrible.
DUBNER: Maybe it wasn’t eight, but it was a lot. Then I have another sort of scarring memory that gets to a slightly separate question, which is: have our teeth evolved to keep up with modern life? And I’ve heard some people say maybe not. Like, wisdom teeth. We get our wisdom teeth pulled, so they seemed to be fairly extraneous. And so, my scarring incident did happen with a wisdom tooth extraction. I went to this oral surgeon. Lovely guy. I’d never met him before. I think I was having, like, at least two of them pulled. You know, he anesthetizes me to some degree, but I’m fully conscious. And then, he gets out what looked like vice grips or something that a car mechanic would use. And, you know, you have to really pull. You’ve got to lean into it. And as he’s doing it, he’s wearing, uh, like, scrubs, medical scrubs. I’m concentrating on my tooth thinking, like, how much is this going to hurt? But then, what I feel is his penis on my arm, because he’s pressing into me so hard with his vice grips.
DUCKWORTH: Are you sure? How do you know it was that?
DUBNER: Oh, I’m so sure.
DUCKWORTH: Because it could have been his elbow.
DUBNER: It was not his elbow, because I looked down to see what part — “Is that what I’m thinking I’m feeling?” And it was definitely that. You know, like, he’s doing his best. He’s working hard. And all I can think about is: when he gets over to the other side, am I going to get the penis again on the other arm?
DUCKWORTH: Well, you would expect so.
DUBNER: And as it turns out, no. He had, like, a different angle from the other side. It was a one time deal. But yeah, it was memorable.
DUCKWORTH: Wow. Have you had therapy for this?
DUBNER: I feel like I just did.
DUCKWORTH: I don’t know. I’m not doing a very good job of it. I’m just laughing at you.
DUBNER: But let me ask you this. We’ve tried to assess how commonplace bruxism and/or teeth grinding, jaw clenching, and so on are, and it seems to be a pretty substantial portion of the population do it.
It does sound, however, as though the problem is not as well defined as one might like. And it also sounds, from what you’ve been telling me, that the proposed treatments are not as well understood as we might like them to be. Would you agree with that?
DUCKWORTH: I would agree with that. And I think treatment is exactly what most people care about. Really, I just want to know how to make my teeth not fall out. So, I did go to my dermatologist. I did get Botox injections. I think that may have helped me. I know there’s not a lot of data. My dentist was like, “Cool, tell me what happens.” I don’t want to go to my dermatologist every six months to get Botox injections. It’s expensive. It’s not easy to make appointments. I probably have some aversion to the word “Botox,” but I think the evidence that I have amassed in my amateur sleuthing on bruxism points to this old technique from behavioral science called behavioral activation therapy, and sometimes it’s called functional analysis. But I want to tell you that story, because that story involves Wendy Wood, who I think of as kind of, like, the reigning world expert on habits and habit formation. So, I decide, yes, I have a teeth-grinding problem. I don’t want to have a mouth guard. I try Botox, but I’m thinking that’s maybe not my long-term solution. So, I asked Wendy Wood for advice about this, and she pointed to this paper that was written in 1981 by a dentist named Michael Rosenbaum and also someone named Teodoro Ayllon. I want to say that I live next to a dentist named Michael Rosenbaum, but not the same Rosenbaum.
DUBNER: You’re saying there are two Michael Rosenbaum dentists in America?
DUCKWORTH: I know. Right? Uncanny.
DUBNER: What a world.
DUCKWORTH: Although, I have to say, doesn’t “Michael Rosenbaum” sound like a dentist? I mean, what else would you do?
DUBNER: What kind of comment was that? “What else would you do?”
DUCKWORTH: I know. I’m going to get into trouble for that.
DUBNER: You could be an astronaut. You could be a modern dancer.
DUCKWORTH: You could be anything!
DUBNER: You could be an etymologist. You could be an entomologist. I know that wasn’t antisemitic, but, yeah, “What else could you be?!”
DUCKWORTH: I was going to say, can I just suck back that comment?
DUBNER: Also, he could be an accountant, to be fair, if not a dentist. Okay. Carry on.
DUCKWORTH: Alright. So, this article is called “Treating Bruxism With the Habit Reversal Technique,” and it came out of a journal called Behavioral Research and Therapy. So, the idea is that, if you understand teeth grinding as a habit that you might, like so many of your habits, only have partial awareness of. You know, do you bite your nails? Do you pick your nail cuticles?
DUBNER: Oh, you’re asking me?
DUCKWORTH: Yeah, it’s a question for you. You don’t have any tic-like habits?
DUBNER: I do have one that I was not aware of, until I was made aware of it by a financial penalty. We rented a house a few summers ago. It was actually the first summer of COVID. So, we wanted to get out of the city for a couple months. And I was working in that house in the basement where I was doing this — radio, interviewing people, recording. And they had a son, this family, who was of the age where one plays a lot of video games, and he had a special gaming chair, and it was really comfortable for sitting in for hours, and hours, and hours, and hours a day. And only when we moved out and I got a letter from them that said that there were some damages from our stay did I realize that, apparently, I poke my pen into the seat of the chair, repeatedly — as if voodoo doll torturing kind of like hundreds — they sent me a photograph.
DUCKWORTH: You had poked hundreds of little holes into this boy’s gaming chair? Wow.
DUBNER: So, I guess that when I am interviewing people and so on, my mind is kind of engaged in that. But my hand with my pen in it was torturing the chair.
DUCKWORTH: I mean, it’s not gonna make your teeth fall out, but, you know —.
DUBNER: We’ll see. One thing leads to another —.
DUCKWORTH: These are habits, right? So, what a habit is, is when you have a cue and then you have a behavior that runs off — like, on automatic — when triggered by the cue. Now, it can be an external cue. Like, you see something — like, an ashtray, and you’re a smoker, and then that makes you crave a cigarette, but it also can be internal. Regardless, these habits are basically your brain on autopilot. And so, one of the problems with breaking any habit, including bruxism, is: how do you change your behavior when the behavior itself is unconscious? And that’s including awake bruxism.
DUBNER: So, what do you do?
DUCKWORTH: So, here is the article that Wendy and I were talking about. It’s actually four case studies of four patients. And they have different kinds of bruxism problems. And what the habit-reversal technique is, is understanding the sequence of cue, behavior, and reward, because that’s what creates a habit. You have a cue, it triggers a behavior. And if you are rewarded for that in some way over time, after many, many, many, many, many, many repetitions, all you need is the cue. You don’t even need the reward. It just — you do it.
DUBNER: So, first you have to identify the cue. Is that the idea?
DUCKWORTH: Yeah. So, what this dentist trained these four patients to do is to become self-aware of the earliest possible clue that they were about to do the behavior that they were about to do. And sometimes it’s just like, “Oh, you’re starting to clench your teeth.” Start to notice that. And there were a couple patients who were teeth clenchers. They were trained to open their mouth. So, what you’re doing is you’re taking that cue, and you’re replacing the original behavior — clench — with an opposite and “impossible to do while you’re doing the other thing” behavior.
DUBNER: And were all four of them able to ultimately identify the cue that led to their grinding?
DUCKWORTH: Yeah. So, here’s a quote: “Diane and Chuck were taught to detect any urges to clench their teeth and the first instance of their teeth coming into contact, accompanied by a slight increase in muscular tension.” So, that’s the kind of training you do. And usually what behavioral therapists do is have you keep a diary, and so you begin to also see if there are situations, for example, or people that you’re around that you tend to do this around. So, they become self-aware, and they’re given these competing habits. It’s like an anti-habit. It’s like, “Well, your habit is to clench your teeth, but now I want you to have the habit of opening your mouth as soon as you detect that you’re about to clench.” So, the anti-habit for teeth grinders, is when you’re about to do it, when you notice that you’re about to do it, then you just stop and you lightly clench your teeth.
DUBNER: Okay. So, you know that I’m going to say to you, “Well, Angela, that’s a nice story, but these were four people, and this doesn’t feel quite like the kind of science that we like to talk about when we talk about, quote, ‘science.’” On the other hand, I will say what this story does have in common with a lot of the really fruitful stuff that you’ve taught me over the years is that one of the best things that any of us can do, really in any circumstance to address a problem, is to pay attention — to, like, learn how to notice. Do you think that it really is viable for most people who may be suffering from this, who are listening today, to find a way to notice the cue, to interrupt the cue, and to break that habit?
DUCKWORTH: Well, let me first say about these four people, and I know four is a small number, upon follow up — like, six months and even a year later — they were more or less cured. It’s just striking data. It’s like, baseline, okay, they’re doing it. And then, it’s like, okay, you get the habit-reversal period of a few weeks. And then, it goes down. And then, you look over follow-up periods, and it’s like, “Oh my gosh, they are really cured.” So, n of four, but I just want to say that on behalf of Rosenbaum and his colleague, in terms of this idea of monitoring yourself, there is actually a ton of data from a lot of different domains — mostly from eating, it turns out, not from teeth grinding. If you have, for example, dieters who don’t realize that they’re eating more than they said they ate when they thought about it, but then, when they keep a diary, they’re like, “Oh, I guess I did have seconds.” So, the research literature on self-monitoring, I think, is quite solid. And it suggests, A) people can bring their attention to things that they weren’t paying attention to before, B) that in of itself, without anything else, tends to actually bring about behavior change. And the reason is, in part, that when you notice that you’ve done something that you don’t want to do, you are not, like, electric-shocking yourself — like the mouth guards with that contraption in it — but you’re immediately punishing that behavior. You’re like, “Oh God, I can’t believe I ate that. Oh God, I can’t believe I clenched my teeth.” And that punishment is, in some cases, enough to just start shaping your behavior in a different direction.
DUBNER: So, did you try this habit-reversal technique yourself?
DUCKWORTH: Oh, Stephen, I wish I could say that I did, but when I read that whole article, I was like, “Oh gosh, I am definitely not doing that.”
DUBNER: Why? What turned you off?
DUCKWORTH: I think that the idea of keeping a diary and then spending a fair amount of my conscious, waking activity paying attention to whether I’m —.
DUBNER: You’re too lazy to stop grinding your teeth, is what you’re telling me.
DUCKWORTH: I think my solution is genius, and here’s what it is. So, after discussing all of these options with my dentist, I said, “How about if I get Invisalign?”
DUBNER: That’s what your Invisalign is all about?
DUCKWORTH: Two for one, right? Now, I cannot make any medical or dental recommendation. This is not based on science. But I was like, “Look, what’s a mouth guard? A mouth guard is a piece of plastic you put in your mouth.”
DUBNER: So, I might as well get some Invisalign — straighten the teeth while refraining from grinding. That’s the idea?
DUCKWORTH: Yeah. No drooling.
DUBNER: Amazing. So, I’m glad that worked for you. I will say this: it strikes me that it’s very hard to grind your teeth while speaking. So, another solution would be we should just do No Stupid Questions 24/7. You will never grind again.
DUCKWORTH: Genius. I’ll take that under consideration.
No Stupid Questions is produced by me, Rebecca Lee Douglas. And now here is a fact-check of today’s conversation.
In the first half of the show, Angela notes that mouth guards have to be personalized for patients’ teeth and can be very expensive. While this is true for the type of medical-grade products that you might get from a dentist, we should note that these sorts of oral appliances can be purchased over the counter as well. The New York Times product review website “Wirecutter,” recently investigated 11 low-cost options. We’ll link to their recommendations in the show notes. However, experts warn that many drug-store mouthguards are made with softer plastic that can actually cause people to clench their teeth more than they otherwise would. And in addition, experts note untreated sleep apnea can worsen with mouth guard use.
Later, Stephen and Angela joke about, quote, “electric-fence mouth guards” — a visual which I’m sure will haunt many listeners. According to “The Journal of Oral Rehabilitation,” the primary forms of biofeedback for bruxism are quite a bit less dramatic. Treatment usually involves a mouth splint or a portable EMG device that alerts the wearer through vibration, a small sound, or a perceptible but not painful electrical pulse.
Also, Angela says that she received Botox for her bruxism. And she notes that injections of this sort are not made for cosmetic purposes, but to relax the jaw muscles. However, while this procedure — referred to as “masseter Botox” — is often used to address issues with teeth grinding, jaw pain, and headaches, many people get it for purely aesthetic reasons and achieve a slimmer-looking jaw.
Finally, Angela notes that a dentist named Michael Rosenbaum co-authored the 1981 article “Treating Bruxism with the Habit Reversal Technique.” In this case, the Michael Rosenbaum she’s referencing is not actually a dentist, but rather a clinical psychologist. Michael Rosenbaums can certainly be anything that they set out to be. We believe in you Michael Rosenbaums!
That’s it for the fact-check.
Before we wrap today’s show, let’s hear your thoughts on our recent episode on social comparison and coveting. Here’s what listener Josh Bertalotto had to say:
Joshua BERTALOTTO: Hi. My name is Joshua Bertalotto, and I’m a second year law student at the Colorado School of Law. I’m a proud first-generation, low-income Mexican and Native American law student. But in 2014, I had my first experience with coveting when I attended a top-ten, prestigious institution coming from my small town in the middle of nowhere, Louisiana. It was the first time in my life I was rubbing shoulders with people whose parents owned NBA teams or were CEOs of companies, and were paying their tuition, and paying for their credit card bills, and everything like that. I coveted the idea of having all of those physical possessions. It wasn’t until many, many conversations with friends many years later that I had the realization that they also coveted things about my life, whether it was the unique background I had, whether it was this confidence that I had. And I realized in that moment that while I coveted their physical possessions, they also coveted things about me that they did not see as easily attainable. And that was a really good realization to have. Unfortunately, it came about four years too late. But now that I’m in law school, it does help a lot.
Thanks so much to Joshua Bertalotto and to everyone who sent us their thoughts. And remember, we’d still love to hear about your experiences with bruxism. Send a voice memo or an email to NSQ@Freakonomics.com. Let us know your name and if you’d like to remain anonymous. You might end up on an upcoming show!
Coming up next on No Stupid Questions: Why do we still have umpires?
DUCKWORTH: Why do we have these fallible human beings in charge of such consequential decisions when we live in the era of artificial intelligence?
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No Stupid Questions is part of the Freakonomics Radio Network, which also includes Freakonomics Radio, People I (Mostly) Admire, and Freakonomics, M.D. All our shows are produced by Stitcher and Renbud Radio. This episode was mixed by Eleanor Osborne. Our staff also includes Neal Carruth, Gabriel Roth, Greg Rippin, Julie Kanfer, Morgan Levey, Zack Lapinski, Ryan Kelley, Katherine Moncure, Jasmin Klinger, Jeremy Johnston, Daria Klenert, Emma Tyrrell, Lyric Bowditch, Alina Kulman, and Elsa Hernandez. Thanks also to orthodontist Bryon Viechnicki for being Angela’s official dental consultant for today’s show. Our theme song is “And She Was” by Talking Heads — special thanks to David Byrne and Warner Chappell Music. If you’d like to listen to the show ad-free, subscribe to Stitcher Premium. You can follow us on Twitter @NSQ_Show and on Facebook @NSQShow. If you have a question for a future episode, please email it to firstname.lastname@example.org. To learn more, or to read episode transcripts, visit Freakonomics.com/NSQ. Thanks for listening!
DUBNER: Awake or asleep. Grinding or clenching.
DUCKWORTH: Bruxists, all of us!
- “Managements of Sleep Bruxism in Adult: A Systematic Review,” by Hajime Minakuchi, Masanori Fujisawa, Yuka Abe, Takashi Iida, Kyosuke Oki, Kazuo Okura, Norimasa Tanabe, and Akira Nishiyama (The Japanese Dental Science Review, 2022).
- “Desperate Americans Are Getting Botox for Their Teeth,” by Ali Francis (The Atlantic, 2022).
- “Anxiety, Depression, and Anger in Bruxism: A Cross-Sectional Study Among Adult Attendees of a Preventive Center,” by Alessandra Carvalho Goulart, Astrid Marie Arap, Henry Bittar Bufarah, Danielle Bismarchi, Marcos Rienzo, Danielli Haddad Syllos, and Yuan-Pang Wang (Psychiatry Research, 2021).
- “We Tried to Find the Best Mouth Guard for Teeth Grinding. We Bit Off More Than We Could Chew,” by Nancy Redd (The New York Times, 2021).
- “Grind Your Teeth? Your Night Guard May Not Be the Right Fix,” by Kate Murphy (The New York Times, 2021).
- “Using Habit Reversal Training to Reduce Physical and Verbal Tics,” by Owen Kelly (Verywell Mind, 2020).
- “Bruxism: An Umbrella Review of Systematic Reviews,” by Gilberto Melo, Joyce Duarte, Patrícia Pauletto, André Luís Porporatti, Juliana Stuginski-Barbosa, Ephraim Winocur, Carlos Flores-Mir, and Graziela De Luca Canto (Journal of Oral Rehabilitation, 2019).
- “Efficacy of Biofeedback Therapy on Sleep Bruxism: A Systematic Review and Meta-Analysis,” by L. Jokubauskas and A. Baltrušaitytė (Journal of Oral Rehabilitation, 2018).
- “The Celebrity Life Can Be a Grind,” by Nikki Swartz (SleepRight, 2018).
- “Treating Bruxism With the Habit-Reversal Technique,” by Michael S. Rosenbaum and Teodoro Ayllon (Behaviour Research and Therapy, 1981).
- “Bruxism,” by Johns Hopkins Medicine.
- “Bruxism (Teeth Grinding),” by Mayo Clinic.