Specialist Referral for Bruxism
Patients with bruxism should be referred to a dentist, specifically one with training in temporomandibular disorders (TMD) and sleep medicine, as the primary specialist for evaluation and management. 1
Primary Referral Pathway
Refer to a general dentist or dental specialist as the first-line specialist for bruxism management, since bruxism is fundamentally a dental and oral motor disorder requiring assessment of tooth wear, occlusion, and jaw function. 1, 2
When to Refer to Specific Dental Specialists:
Prosthodontist or TMD specialist: For patients requiring occlusal splints, complex dental rehabilitation, or when bruxism coexists with temporomandibular joint disorders. 2, 3, 4
Oral and maxillofacial surgeon: For patients with severe TMD complications, jaw joint pathology, or when conservative treatments have failed and surgical evaluation is needed. 1
Sleep dentist: For patients with sleep-related bruxism who require oral appliances fitted by personnel trained specifically in sleep medicine and sleep-related breathing disorders. 2, 3
Secondary Specialist Referrals
Consider these specialists based on specific clinical presentations:
Pain Management Specialist or Multidisciplinary Pain Team
Refer when patients have intractable pain unresponsive to dental interventions, as pain management alone does not constitute sufficient treatment but is an essential component. [1, @14@]
Neurologist
Consider referral when bruxism is associated with movement disorders or when dopaminergic dysfunction is suspected, as these cases may require specialized pharmacological management. 2
Psychiatrist or Psychologist
Refer when bruxism is clearly stress-related or associated with anxiety disorders, depression, or other psychological conditions, as behavioral strategies and stress management are important treatment components. 2, 5
Clinical Pitfalls to Avoid
Do not refer to ENT or general medical specialists as the primary referral unless there are specific airway concerns or other non-dental pathology, as the care pathway differs significantly depending on initial referral and dentists are the appropriate first specialists. 1
Ensure the dentist has appropriate training in TMD and/or sleep medicine before referring for oral appliance therapy, as improper fitting can cause adverse events including tooth movement and TMJ complications. 2, 3
Avoid referring directly to surgical specialists without first attempting conservative dental management, as irreversible procedures like occlusal adjustments and discectomy are strongly contraindicated and have no evidence basis. 2
Coordination of Care
The referring physician should provide the dentist with:
- Complete medical history including medications (especially anti-muscarinics, which can affect treatment). 1
- Any associated conditions like sleep apnea, movement disorders, or chronic pain syndromes. 1
- Psychological comorbidities including anxiety, depression, or stress-related disorders. 1, 5
Request from the dentist: