John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Nocturnal Bruxism

RRP Treatment of Nocturnal Bruxism by Dr. Tkach

What is Nocturnal Bruxism?

Bruxism is the act of clenching and grinding your teeth. Nocturnal bruxism is the act of clenching and grinding your teeth at night while sleeping. People with nocturnal bruxism are not aware of it. Usually, their dentist tells them. This news comes as a surprise. Many people find it hard to believe. However, the condition looks characteristic to dentists. When they make the diagnosis, they are sure of it.

A clue may come from family members who have heard the squeaking and grinding sounds while the patient is sleeping. Eventually untreated bruxism wears down the strong hard white enamel covering the teeth. There are restorative resurfacing procedures, porcelain laminate veneers (PLV's), but if the underlying cause is not treated, the resurfaced surfaces will wear down again soon. There may come a time when the damaged surface can no longer be repaired.

Bruxism is a major cause of temporomandibular joint disorder, a painful problem that interferes with chewing. It can lead to headaches and sleep disorders.

How Common is Nocturnal Bruxism?

Estimates vary from 5-8% of the population. It varies from country to country.

Causes of Nocturnal Bruxism

Because dentists feel they have not been able to completely define the pathologic basis of the bruxism process, they feel the definitive treatment of bruxism has not been found. Some studies conclude that nocturnal bruxism is highly correlated with stress. Other studies say it is not related to stress factors. There are more articles implicating stress than those exonerating stress. BruxChecker is a mechanical device for evaluating grinding patterns in sleep bruxism.

Standard Treatments of Nocturnal Bruxism

Taking into account, the benefits and risks, the treatment of choice seems to be the occlusal splint. Here is the range of available treatments used by dentists.

  1. Mechanical devices
    1. Mandibular advancement device- this cranks the lower jaw forward at night so that the teeth do not mesh as well. I do not like this treatment and I strongly urge you to avoid it. I used such a device for 3 years for sleep apnea. It adversely affected my jaw joints, changed my speech, and made it hard to close my mouth to chew my food properly.
    2. Occlusal splint- this is a sort of bite guard that you snap in over the lower teeth at night. Even this best treatment is controversial. Some experts feel it should be monitored by the dentist if used for over 4 months.
    3. Palatal splint- this is like having braces applied.
  2. Drugs

    These include amitriptyline, bromocriptine, clonazepam, clonidine, L-DOPA, propranolol, tryptophan, and tiagabine. If the benefit is questionable, do you want to be taking drugs that go through your whole body and may give you adverse effects?

    So, why not just take pills for nocturnal bruxism? In my humble opinion, while they might help, they only mask the underlying emotional distress and suffering. They do not get rid of it. The solution is to rescue and heal a distressed (dissociated) Child ego state from early childhood trauma. In this sense, in RRP, we repair damaged souls.

Rapid Reintegration Procedure

How does RRP fit in with the treatment of nocturnal bruxism?

Nocturnal bruxism is a symptom. According to RRP theory, symptoms are expressed when some event in the present occurs that is reminiscent of a traumatic event from the past. RRP works by identifying those traumatic events and guiding you to resolving them. At the point of that traumatic event, a part of you lost its smile. We want you to get your smile back.

The Case of Mr. N.

In 2004, I was sitting next to a man at a medical conference. During the break, he asked me if I knew of a treatment for nocturnal bruxism. He told me he had a problem since early childhood. His dentist had resurfaced his teeth many times and was at the point where he was about to give up.

I suggested he come to my office at 4:30 PM for RRP. I treated him with RRP for a 16 minutes session with two well-experienced psychotherapists present. The origin of his problem was that at age 8, his parents, who both worked, burdened him with the care of his two younger brothers. He had to get them up in morning, dress them, feed them, and get them to school. That 8 year old took it very seriously. The burden was so great, he lost his smile. An 8-year-old kid should have a smile.

I have found that when parents shift parental responsibility from the parent to the eldest child, that child pays too high a price. It is too much of a responsibility for a little kid. Some parents throw other chores onto the eldest child like laundry and housekeeping. A child should be allowed to be a child. Parents have responsibilities.

During this session in RRP state, Mr. N. clenched his teeth severely and said that he could not let go of this burden. I helped him to see that the past was over and that it is okay to let go of it now. That was then, this is now. I saw him again at a medical conference in 2009. He said his bruxism went away the night of that visit and had not bothered him since.

What is RRP?

RRP is a profound new form of psychotherapy that is gentle, non-threatening, and effective. RRP offers you great hope for relief from symptoms (symptom list).

RRP is symptom oriented. It runs on feelings. Buried within the symptom is the path to cure of that symptom. What I do is to guide you gently to uncover and resolve troublesome conflicts that arose at those past critical events. It was at that point that a part of you lost your smile. You will know RRP worked when you get your smile back.

Your experience with RRP is likely to be wonderful, profound and very beneficial.

  1. History of RRP

    Canadian medical doctor Edgar Barnett invented RRP in 2003. Dr. Barnett was born and raised in England. He went to Medical School in England. Initially a family doctor, he observed that many problems were not helped by medicines alone because they were also psychological. He has been doing psychotherapy for over 40 years. He has written two books on psychotherapy: 1. ANALYTICAL HYPNOTHERAPY 2. UNLOCK YOUR MIND. His RRP evolved after 40 years of his experiences treating patients with psychological problems. Dr. Barnett started training me in RRP in April 2004. We have written a book about RRP.

  2. What is RRP?

    At first we thought it was a type of hypnosis or "waking hypnosis," and it may very well be. Dr. Barnett thinks it is a special form of hypnosis. For me, the problem with that is that hypnosis traditionally requires a procedure called induction, induction of a hypnotic trance. To you, it will seem like daydreaming.

    The reason traditional psychotherapies sometimes fail is that they require people to reveal their innermost, private, personal, embarrassing, threatening, or frightening secrets and the details of those secrets. There is none of that with RRP. It is okay to tell me personal things, but I won't require it of you.

    The procedure is between you and yourself. I, as therapist, guide you, and I am there with you so you do not need to go through it alone. Where you are about to go in the RRP state, I have been many times. I know the way in. I know the way out. I will be there with you every step of the way.

  3. The Goal of the RRP Therapy Session

    The goal of your Rapid Reintegration Procedure (RRP) session with me is to free you up from some sort of unwanted symptom that pesters you. A symptom can be any one of a large number of problems such as overeating, phobias (fears of specific things), smoking, anxiety, stage fright, test anxiety, nightmares, panic, anorexia, and so on. (symptom list)

    The first step is for you to decide what symptom you want help with. What unwanted behavior or problem do you want to get rid of or get help for? There is a feeling that goes with that symptom. Try to identify what the feeling is that you experience when you have the urge to do the unwanted behavior or experience the symptom.

  4. What Will You Experience In RRP?

    You sit in a chair with your eyes close, and I guide you through recalling feelings and finding old memories. It is very simple, it occurs very easily. It is like daydreaming. If you can daydream, you can do RRP.

    You do not need to suffer in RRP. You do not need to relive traumatic events. You can recall them without reliving them. During RRP you will still be in control at all times. If something about RRP puzzles you, just ask me. If you want to stop, you will be able to do so easily. Your being in control makes RRP easy and non-threatening.

  5. Getting Results

    RRP is results oriented. You and I want to get results for you. We want to free you up from uncomfortable symptoms and feeling. When you have gotten results from RRP it will be obvious to you. There will be immediate relief.

    We will just keep working until you get results. That may take 26 minutes or it may take four sessions of two hours each. But it does not go for years.

    If RRP does not get results for you within 4-6 sessions, then you need a different form of treatment. In that case, you should work with a psychiatrist, clinical psychologist, or counselor.

    Your RRP work with me complements your work with your primary doctor or therapist. I am not taking over your case from your doctor. I am helping out. With your permission, I shall send a report to your doctor.

    For example, if you come to me for overeating, I can help you profoundly with RRP. But I am not going to tell you what to eat or how much. That's for you and your dietician to work on.

  6. After Your RRP Session
    1. Memories will come back to you, perhaps of things you have not thought about for a long time. This will go on for months and even years.
    2. Once you have experienced RRP, you can do a lot of this RRP work yourself. When you experience the symptom, instead of bemoaning it, say to yourself, "Hot dog. This is the symptom I want to get rid of. Here's my chance, and I know how to do it now."

    It used to be that you were imprisoned by your symptom. Now, RRP can set you free.

  7. Other Things to Consider about RRP

    What will your life be like once you have achieved freedom from your symptoms? If you have been suffering from your symptoms for years, you have built up a life style, and those around you have adjusted to it.

    Ideally, RRP results are immediate and dramatic. When you have achieved results in RRP therapy, there will be no question in your mind about it. Your whole attitude about your symptoms will change and surprise you and others. You will be delighted. As I have said before, it is like being released from jail and given all the respect, rights, and privileges of a normal citizen, a first class citizen.

    If your symptoms have made you shy about going out of the house and being around other people due to the stress, that will change. You will find yourself more outgoing. You will likely create new friendships. How will that affect your current friends? How will that affect your spouse? The two of you should talk about it before you start RRP.

    I am not saying these things to discourage you from RRP. I just want you to let those close to you know that you are working on a way to free yourself from your symptoms to protect your health. And they should know that when RRP does work for you, they might notice some nice changes in you.

    I videotape the sessions for Dr. Barnett to give me supervision. These videotapes are confidential.

  8. How To Get Started With RRP

    Dr. Barnett and I are doing clinical trials of RRP in the treatment of a wide variety of symptoms, especially when standard treatments have failed. We want to take it out for a spin and see what it can do.

    Because these are trial studies, there will be no fee. If RRP sounds interesting to you do this:

    1. Determine if you want me to help you. Make a commitment to work with me. That will be very easy. I won't ask you to do anything difficult. You will find it easy to work with me.
    2. Let's work in cooperation with your doctor or therapist. Obtain a letter of referral from him or her at your expense. The letter should state clearly that the doctor is referring you to me for RRP therapy as an adjunct to the other treatments, briefly state what the symptoms are, present medicines and what drugs and treatments have been tried. Your doctor must understand I am not an internist and I am NOT trying to take over your care or your medications management. Those things are up to you and your personal doctor.
    3. Understand that I videotape the sessions for Dr. Barnett to review, and I shall review them.
    4. Discuss with your family and friends how your life is about to change. Ask them to support you in this effort. Think it over for about a week before you go on to the next step.
    5. Call my secretary to schedule yourself for RRP. (406) 587-5442.
    6. Come to my home on a Saturday morning or several Saturdays. If you are not going to come, you must call my office two days in advance and cancel. I am doing this in my spare time, and I don't have much spare time. If you fail to show up for your session, you will be dropped from the study. I'd like you to bring a spouse, relative, or friend as a chaperone.
    7. Send me a letter at 6 months, one year, two years, and three years letting me know how you are doing.
    8. Sign the attached release of liability.
    9. To prepare for RRP, do this homework assignment. Every time you experience your symptoms, instead of bemoaning it, identify the feelings associated the symptoms.

Potential Risks of RRP

Dr. Barnett has treated over a thousand patients with RRP and has found no negative consequences. RRP is new, and there is no history of adverse outcomes. The main risk of RRP is failure to get results. But, Dr. Tkach and Dr. Barnett feel that RRP is highly likely to get results. When results are slow to achieve, it may require several sessions.

Uncovering forgotten old traumas can be distressing, but finding and working through such critical events is the whole point of therapy. You will not go through it alone. Dr. Tkach will be with you every step of the way. If you become too uncomfortable, just open your eyes and stop the session. Then talk about it with Dr. Tkach before resuming RRP. You will not be required to do anything you do not want to do.

If you are feeling suicidal, tell me, and your primary doctor or therapist and get help with that.

See the separate information sheet on the recovery of false memories.

You will have to read and sign a copy of this with the release form before being seen by Dr. Tkach for RRP.

Learn more about the Rapid Reintegration Procedure or buy a copy of Dr. Barnett and Dr Tkach's book.