What are the treatment options for bruxism?

Treatment of Bruxism

First-Line Treatment: Conservative, Non-Invasive Approaches

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

Oral Appliances (Primary Protective Strategy)

• Occlusal splints are the most common and effective dental intervention for bruxism, primarily designed to protect teeth from damage caused by grinding and clenching 1
• Hard full coverage stabilization splints have demonstrated efficacy in reducing grinding noise and protecting teeth from premature wear with no reported adverse effects 1, 2
• Splints that don't account for proper occlusion may cause adverse events like tooth movement and should be avoided 1
• Oral appliances must be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders 1
• The occlusal splint is the treatment of choice based on its protective effects and absence of adverse effects 2

Important caveat: While occlusal splints protect the dentition, they do not "cure" or permanently stop bruxism activity—management is directed toward tooth/restoration protection rather than elimination of the behavior 3

Behavioral and Physical Therapy Interventions

• Patient education about the condition and avoidance of aggravating activities (such as chewing gum, biting nails, or clenching during stress) is essential 1
• Massage of masticatory muscles provides relief of associated muscle tension 1
• Heat and/or cold application to affected areas helps manage symptoms 1
• Relaxation exercises can improve bruxism symptoms 4
• Specialized physiotherapy can improve muscle tension, pain, and restricted jaw movement 4

Second-Line Treatment: Pharmacological Options

For Acute Episodes and Pain Management

• NSAIDs are recommended for pain management associated with bruxism 1
• Muscle relaxants are recommended for acute episodes to overcome muscle spasm 1
• Amitriptyline has shown some benefit in open-label studies for chronic cases 1

Specialized Pharmacological Considerations

• TRPV1 agonists (capsaicinoids) have shown efficacy in improving oral motor control in some patients 1
• Dopaminergic agents may be considered when bruxism is associated with movement disorders 1
• Short-term clonazepam therapy showed large effect size in reducing bruxism index, but risk of dependency limits long-term use 2
• Clonidine reduces sleep bruxism but has been linked to adverse effects 2

Critical warning: Treatment decisions must be individualized based on careful risk-benefit analysis, as most medications have limited evidence specifically for bruxism 1

Interventions to Use Cautiously or Avoid

Conditionally Recommended Against

• Botulinum toxin injections to masticatory muscles may reduce bruxism frequency and subjective complaints during the period of action 4, but concerns exist regarding possible adverse effects including muscle atrophy, and it is conditionally recommended against by some experts 1
• An RCT showed no benefit of Botulinum Toxin for temporomandibular disorders 1
• Biofeedback may help patients develop awareness of muscle tension but has limited evidence and is conditionally recommended against 1
• Low-Level Laser Therapy has insufficient evidence to support its use and is conditionally recommended against 1

Strongly Recommended Against

• Irreversible occlusal adjustments have no basis in evidence for managing bruxism, and permanent alterations to dentition are strongly contraindicated 1, 5
• Discectomy (surgical removal of the articular disc) is strongly recommended against 1

Special Clinical Considerations

When Bruxism Coexists with TMD

• Treatment should address both conditions simultaneously 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
• Sleep bruxism can be definitively diagnosed using electrophysiological tools (EMG) and video recording in sleep laboratories if needed 3, 4

Specialist Referral Pathway

Primary Referral

• Refer to a dentist with training in temporomandibular disorders and sleep medicine as the primary specialist for evaluation and management 1
• Provide complete medical history including medications, associated conditions (sleep apnea, movement disorders, chronic pain), and psychological comorbidities (anxiety, depression, stress) 1

Secondary Referrals

• Consider pain management specialist or multidisciplinary pain team for intractable pain unresponsive to dental interventions 1
• Consider sleep dentist for patients with sleep-related bruxism requiring specialized oral appliances 1

Common Pitfalls to Avoid

• Do not expect any treatment to permanently "cure" or "stop" bruxism—management focuses on protection and symptom reduction 3
• Avoid relying solely on occlusal splints without addressing behavioral and stress-related factors 6
• Do not perform irreversible dental procedures as they lack evidence and may cause harm 1, 5
• Recognize that stress, anxiety syndromes, and genetic disposition are dominant factors requiring a comprehensive approach beyond dental intervention alone 4, 6