Common Night-time Oral Care Complaints

A lot can happen in your mouth in 8 hours, especially during the hours of sleep where bacteria are actively gathering and multiplying on the teeth. This also includes many aches and discomforts such as dry mouth or grinding. However, don’t let the thought of this disrupt you from getting a good night’s sleep. There are many ways to promote a healthier, more comfortable mouth while you sleep. Here are the most common night-time oral care complaints and our recommended tips and products to help deal with them.

Approximately 20% of the global population suffers from dry mouth, professionally known as xerostomia. This condition can be extremely irritating and have a major impact on the health of your teeth and gums, with dry mouth and bad breath often coming hand in hand.

What are the causes?
During the day, the mouth produces saliva as a protective barrier with antimicrobial components which help to fight against damaging acids and bacteria. When we sleep, the saliva glands do not work the same way as they would when we are awake. This usually causes an increasingly dry mouth during the night, creating a perfect breeding ground for bacteria and viruses to grow. This dry mouth may also consequently lead to ‘morning breath’ and can worsen with individuals who sleep with their mouths open. This is particularly common in individuals with nasal obstruction, forcing them to breathe through the mouth more often, leading to an increase in dry mouth, especially during the night.

Other causes of dry mouth can include but are not limited to:
•Dehydration: This can occur from not drinking enough water, sweating a lot or being sick.
•Taking medication: Dry mouth is a common side effect of some medication. Among the more likely types are drugs used to treat depression, anxiety, and high blood pressure, as well as some antihistamines and pain medication.
•Breathing through the mouth: As mentioned above, breathing through the mouth during the night can occur due to a blocked nose or by sleeping with your mouth open.
•Lifestyle: Excessive drinking or smoking habits can also lead to dehydration and hence dry mouth.

What are the treatments?
A dry mouth is rarely a sign of something serious, however, it can be very uncomfortable to experience. There are multiple things that can be done to try help ease the symptoms of dry mouth before contacting your GP or a specialist. These include:
-Sucking on ice cubes or chew sugar-free gum to promote saliva production before bed
-Regularly drinking water throughout the day and at night
-Use lip balm if your lips are also dry
-Brush your teeth effectively, twice daily (You are more likely to get bad breath and tooth decay if you have dry mouth and do not perform an effective oral care routine).

What to avoid?
There are also some things that should be avoided in order to decrease the symptoms of dry mouth. These include:
-Consumption of too much alcohol, caffeine or fizzy drinks should be reduced
-Acidic foods with excess spices, salts and sugar should also be reduced or avoided
-Sleeping with dentures: This should never be done as it can cause dry mouth, bad breath as well as sore and inflamed gums.
-Smoking can also lead to oral conditions starting with dry mouth and developing into oral cancer, tooth loss and gum problems.
Often, the discomfort of dry mouth can more effectively be treated using OTC products such as BioXtra or Xylimelt discs. These products can come in the form of gels, sprays or tablets and are used to keep the mouth moist. More information about dry mouth treatments can be found by contacting a pharmacist.

Teeth clenching and grinding, also known as bruxism, is an involuntary reaction, typically to stress or anxiety. This can usually occur during the night and often goes unnoticed, causing a key challenge as it is harder for people to be aware that it is happening. While asleep, we do not quite grasp the strength of our bite; due to the force applied to the teeth during these episodes of sleep bruxism, this condition and strong impact on our teeth can inflict serious problems for the teeth and jaw which may require treatment to reduce its impact.

What are the symptoms?
The main symptom of this condition is the involuntary clenching and grinding of the teeth during sleep. These movements usually resemble chewing but at a much greater force, occurring in multiple episodes throughout the night at an inconsistent rate. It is normal for people who grind their teeth to not be aware of it unless they are told about it by a partner or family member. However, there are often other symptoms that can be an indication of sleep bruxism.
Typically, frequent jaw pain and neck pain when you wake up may be signs of teeth grinding. These occur due to the tightening of these muscles during the bruxism episodes. Morning headaches such as tension headaches are also another potential symptom. A more physically noticeable symptom of bruxism may be unexplained damage or chipping of the teeth, indicating a sign of night-time clenching, and grinding.

What are the long-term effects?
As covered, short-term bruxism can cause aches around the jaw and head. Long-term consequences include significant harm due to an increase in pain and erosion of the teeth, also damaging any dental crowns, fillings, and implants in the process. From this, problems arise with the joint that connects the lower jaw to the skull, known as Temporomandibular joint (TMJ). These problems can provoke difficulty with chewing, jaw pain, clicking and locking of the jaw and other complications.
However, it is important to note that serious side effects do not necessarily affect everyone with sleep bruxism and that the extent of the symptoms and consequences depend on a few factors. These include the severity of the grinding, the alignment of the teeth and other existing conditions.

What causes this?
Multiple factors can influence the risk of teeth grinding, so it is usually not possible to identify a single cause. Regardless, certain risk factors are associated with a greater probability of sleep bruxism, with the most significant one being stress or anxiety. While facing negative situations, it is a common reaction to clench the teeth. This habit can be carried over during sleeping. Other factors which have previously been associated with this condition include smoking, alcohol consumption, depression and snoring, though further research is required to better understand the connections between the two.

What are the treatments?
Although, some people have no symptoms, other people require treatment to help cope with their symptoms. Unfortunately, there is no one treatment that can completely eliminate or cure teeth grinding, and it is typically advised to see a dental professional who can fully explain all available treatments. However, there are several alternative approaches without the need of a dentist which can be taken to decrease the number of bruxism episodes, ease pain and to limit damage to the teeth and jaw. Some of these treatments are explored below:

1- Reducing stress: As high stress levels contribute to bruxism; it is logical to try to take steps to both reduce and manage stress. It is often said to do so by avoiding stressful situations, but this may be quite unrealistic and difficult on a daily basis. Through cognitive behavioural therapy (CBT), addressing and coping with stress can be learnt by practicing relaxation techniques to help improve sleep.
2- Mouthguards: The most popular treatment for teeth grinding is to wear a nightguard. These do not prevent bruxism but are used to reduce the damage to the teeth caused by the bruxism episodes. These guards are usually made specifically to fit and cover the teeth so that there is a barrier against the impact of grinding. However, they can be quite expensive to have moulded by a profession. An alternative is an over-the-counter nightguard which covers a wider section of the teeth, a good selection of these can be found here.
To find relief from the symptoms of bruxism, it is usually recommended to avoid excessive chewing to prevent painful movement of the jaw. A hot or cold compress can also be applied to the jaw for temporary pain relief.

Snoring is the noisy sound made during sleep which can occur as air flow passes the relaxed tissues in the throat, causing the tissues to vibrate as you inhale and exhale. Snoring tends to get worse with age and is often very disturbing and a nuisance to a partner. Occasional snoring is generally quite common but for some people, it can be a chronic problem and may sometimes indicate a more serious health condition. Generally, certain lifestyle changes such as weight loss and alcohol avoidance can help to stop snoring. Additionally, medical devices or in some extreme cases surgery is available to help reduce it.

What are the symptoms?
Snoring can be associated with the sleeping disorder Obstructive Sleep Apnea, also known as OSA. This does not mean that all snorers have OSA but if accompanied with a few of the following symptoms, it could be an indication to seek further evaluation:
-Sore throat in the mornings
-Morning headaches & restlessness
-Gasping or choking at night with chest pain
-High blood pressure

It is important to note that in children, a poor attention span or behavioural issues may also be indications of OSA. OSA is usually characterised by loud snoring followed by periods of silence when breathing is very minimal, which can eventually result in you waking up with a loud snort or gasp. This pattern of breathing can be experienced multiple times during every night sleep.

What are the causes?
There are a number of factors that can cause snoring, this includes the anatomy of your mouth, sinuses, allergies, weight, and alcohol consumption. When asleep, the muscles in the roof of the mouth, tongue and throat relax. Through some factors, these may relax enough to partially block your airway. This narrowing of the airway causes the airflow to become more forceful as it passes through, causing an increase in tissue vibration and hence an increase in snoring. The most common factors and causes of snoring are explored further below:

•Anatomy of the mouth: Having lower or thicker tissue in the mouth can narrow the airway. This is common in people who are overweight as they may have extra tissues in the back of the throat causing obstruction of the airflow and heavier breathing.
•Alcohol Consumption: Drinking too much alcohol before bed can lead to the over relaxation of the throat muscles, decreasing the bodies natural defence against airway obstruction.
•Nasal Problems: Nasal problems such as chronic nasal congestion or an uneven partition between the nostrils may contribute to variations in airflow, also causing snoring.

What are the consequences?
Habitual snoring may be more than just a nuisance. Aside from it being a disruption to a partner, if associated with OSA, you may be at risk for other complications. These include difficulty concentrating, constant sleepiness, greater risk of high blood pressure and increased behaviour problems such as aggression.

What are the treatments?
In some cases, it is important to see a professional to assess if snoring is caused by any underlying conditions. However, in most cases, snoring can be reduced or treated by following some home remedies.
1- Weight Loss: This can help decrease the amount of tissue in the throat to reduce obstruction of the air passage.
2- Sleeping on your side: By sleeping on the back, the tongue can move to the back of throat due to gravity, partially blocking the airflow. Due to this, sleeping on your side can sometimes help allow air to flow more easier and to reduce snoring. Raising your pillow slightly can also elevate the head to keep your airways open.
3- Treat allergies: Allergies can reduce airflow through the nose, forcing breathing through the mouth. This not only increases the likelihood of snoring but also increases the risk of dry mouth. Allergies can usually be treated with over-the-counter medications.
4- Use a dental mouthpiece: These oral appliances can be used to keep the air passage open, making it easier to breathe during the night. Usually, a professional can create this for you but there are cheaper alternatives that can be bought online.