What are the treatment options for bruxism?

Treatment Options for Bruxism

Conservative, non-invasive approaches should be the first-line treatment for bruxism, including oral appliances, behavioral strategies, and physical therapy techniques, with more invasive interventions reserved for refractory cases. 1, 2

First-Line Treatment Options

Oral Appliances

• Occlusal splints (bite plates) are the most common dental intervention for bruxism, primarily designed to protect teeth from damage caused by grinding/clenching 1, 3
• Hard full coverage stabilization splints have shown some efficacy, while splints that don't account for occlusion may cause adverse events like tooth movement 1
• Oral appliances should be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders 1

Behavioral and Psychological Approaches

• Jaw exercises and jaw mobilization techniques to improve joint mobility and reduce pain 2
• Relaxation strategies and improvement of sleep hygiene 3
• Cognitive behavioral therapy (CBT) to address pain perception and management 2
• Patient education about the condition and avoidance of aggravating activities 1

Physical Therapy Techniques

• Trigger point therapy - manual pressure on specific muscle points to release tension 2
• Massage of masticatory muscles 1
• Postural exercises to improve head and neck alignment 2
• Heat and/or cold application to affected areas 1

Second-Line Treatment Options

Pharmacological Interventions

• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain management 1
• Muscle relaxants for acute episodes 1
• Amitriptyline has shown some benefit in an open-label study 1
• Clonidine and clonazepam have shown efficacy in reducing bruxism, though with risk of dependency for clonazepam 4

Advanced Physical Therapy

• Combined approaches such as jaw exercise with jaw mobilization 2
• Manipulation with postural exercise for better functional results 2
• Acupuncture, which has moderate evidence for effectiveness 2

Interventions to Consider Cautiously

Botulinum Toxin Injections

• Botulinum toxin (Botox) injections to the masticatory muscles may reduce the frequency of bruxism 3
• However, concerns exist regarding possible adverse effects, and it is conditionally recommended against by some experts 2
• An RCT showed no benefit of Botulinum Toxin for TMD 1

Biofeedback

• May help patients develop awareness of muscle tension but has limited evidence 2
• Conditionally recommended against by some medical authorities 2

Low-Level Laser Therapy

• Insufficient evidence to support its use 1, 2
• Conditionally recommended against by the National Institutes of Health 2

Interventions to Avoid

Irreversible Treatments

• Irreversible occlusal adjustments have no basis in evidence for managing bruxism 3
• Permanent alterations to dentition are strongly recommended against 2
• Discectomy (surgical removal of the articular disc) is strongly recommended against 2

Special Considerations

Sleep Bruxism vs. Awake Bruxism

• Treatment approaches may differ based on whether bruxism occurs during sleep or wakefulness 5
• Sleep bruxism may have a protective role during sleep, such as in airway maintenance or stimulating saliva flow 3

Bruxism with TMD

• When bruxism coexists with temporomandibular disorders (TMD), treatment should address both conditions 1
• TMD issues related to oral appliances are usually transient, with pain decreasing with continued use 1
• Mandibular exercises may improve discomfort during adaptation to oral appliances 1

Monitoring and Follow-up

• Regular dental evaluations are necessary to assess treatment efficacy and potential side effects 1
• Long-term dental side effects of oral appliances may include decreases in overbite and overjet, and changes in incisor position 1

Treatment Algorithm

1. Begin with conservative approaches: occlusal splints, behavioral strategies, and physical therapy 1, 2
2. If insufficient response, consider adding pharmacological interventions for symptomatic relief 1
3. For persistent cases, evaluate for more specialized interventions like botulinum toxin or biofeedback 2, 3
4. Avoid irreversible treatments that permanently alter dentition or joint structures 2, 3
5. Regularly reassess treatment efficacy and adjust approach as needed 2

Remember that bruxism itself does not always require treatment - management is only indicated when problems arise as a result of the condition 3, 6.