Treatment for Clenching and Grinding Without Tooth Wear
Start with an occlusal splint fitted by a qualified dental professional, combined with physical therapy techniques including massage of the masticatory muscles and heat/cold application. 1, 2
Understanding Your Situation
Your dentist's confusion is understandable because the relationship between bruxism symptoms and visible tooth damage is not always direct. Mechanical dysfunction and muscle overloading can cause significant orofacial symptoms even without visible tooth wear or active inflammation. 1 This dissociation between tissue damage and symptoms is well-documented, and it's essential to address your TMJ-related dysfunction and symptoms regardless of whether tooth wear is present. 3, 1
First-Line Conservative Treatment
Occlusal Splint Therapy
- Hard full-coverage stabilization splints are the primary dental intervention and should be your first step. 2
- These splints protect teeth from damage and may reduce muscle activity, with documented significant improvement in TMJ-related dysfunction and symptoms in longitudinal studies. 1, 2
- The splint must be properly fitted by qualified dental personnel to account for your occlusion—poorly fitted splints can cause adverse events like unwanted tooth movement. 2
- Complete pain resolution is rare, but significant functional improvement is expected. 1
- This is considered a safe, reversible, and low-cost treatment option. 1
Physical Therapy Techniques
- Massage of the masticatory muscles should be performed regularly. 2
- Apply heat and/or cold to affected jaw areas. 2
- These techniques are evidence-based for temporomandibular dysfunction and can be reasonably applied to bruxism symptoms. 3
Behavioral Strategies
- Patient education about the condition and conscious avoidance of clenching during the day is essential. 2
- Relaxation exercises can improve bruxism symptoms. 4
- Check for daytime clenching by monitoring for jaw fatigue, stiffness, or limited jaw opening throughout the day. 5
Second-Line Options If Conservative Treatment Fails
Medications for Acute Episodes
- NSAIDs for pain management during symptomatic periods. 2
- Muscle relaxants for acute episodes of severe muscle tension. 2
- Amitriptyline has shown some benefit in open-label studies, though evidence is limited. 2
Specialized Interventions (Use Cautiously)
- Specialized physiotherapy can improve muscle tension, pain, and restricted movement if basic physical therapy is insufficient. 4
- Botulinum toxin injections may reduce bruxism frequency but have concerns regarding adverse effects and showed no benefit for TMD in RCTs—this should be reserved for refractory cases only. 2
- Biofeedback has limited evidence and is conditionally recommended against by some authorities. 2
What to Avoid
Never pursue irreversible occlusal adjustments—there is no evidence basis for permanently altering your dentition to manage bruxism. 2, 6 This includes grinding down teeth or extensive dental work aimed at "correcting" your bite.
Monitoring and Follow-Up
- Regular dental evaluations are necessary to assess treatment efficacy and monitor for any developing tooth wear or other complications. 2
- If you develop TMJ pain that doesn't respond to splint therapy and physical therapy, TMJ intraarticular glucocorticoid injection may be considered, though this is not first-line management. 3
- Long-term splint use may cause minor changes in bite (decreases in overbite/overjet), which are usually well-tolerated. 2
Clinical Pearls
The absence of tooth wear doesn't mean your symptoms aren't real or significant—muscle tenderness, hypertrophy of masseter muscles, morning jaw fatigue, and limited jaw movement are all valid clinical signs of bruxism that warrant treatment. 5 Your treatment should focus on symptom relief and preventing future complications, not just protecting teeth that may already be protected by your particular clenching pattern or tooth anatomy.