What are the treatment options for bruxism?

Bruxism Treatment

Conservative, non-invasive approaches including oral appliances, behavioral strategies, and physical therapy should be first-line treatment for bruxism, with occlusal splints serving as the primary dental intervention to protect teeth from grinding damage. 1

First-Line Conservative Management

Oral Appliances

• Hard full coverage stabilization splints are the most effective dental intervention, designed primarily to protect teeth from damage caused by grinding and clenching rather than to eliminate the bruxism itself 1
• Occlusal splints successfully prevent dental damage and reduce grinding sounds, though their effects on reducing muscle activity (EMG events) are only transient 2
• Splints must be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders 1
• Critical caveat: Splints that don't properly account for occlusion may cause adverse events like unwanted tooth movement 1
• Transient TMD issues related to oral appliances usually decrease with continued use; mandibular exercises may improve discomfort during the adaptation period 1

Behavioral and Physical Interventions

• Patient education about the condition and avoidance of aggravating activities (stress reduction, limiting caffeine, improving sleep hygiene) is essential 1, 3
• Massage of masticatory muscles provides relief of associated muscle tension 1
• Heat and/or cold application to affected areas helps manage symptoms 1
• Counseling regarding sleep hygiene, sleep habit modification, and relaxation techniques should be implemented early, though evidence for efficacy is limited 2

Second-Line Pharmacological Options

Pain Management

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

Specialized Pharmacological Considerations

• TRPV1 agonists (capsaicinoids) have shown some efficacy in improving oral motor control in select patients 1
• Dopaminergic agents may be considered when bruxism is associated with movement disorders 1
• Short-term clonazepam therapy has been reported to improve sleep bruxism with large effect size, but risk of dependency limits long-term use 2, 4
• 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

Botulinum Toxin

• Botulinum toxin injections to masticatory muscles may reduce bruxism frequency, but concerns exist regarding possible adverse effects and it is conditionally recommended against by some experts 1
• An RCT showed no benefit of botulinum toxin for TMD 1
• In severe secondary bruxism (particularly in neurological disorders like cranial dystonia) interfering with speaking, chewing, or swallowing, botulinum toxin may decrease bruxism for 1-5 months and improve pain 2

Other Conditional Interventions

• 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

Interventions to Avoid

Irreversible occlusal adjustments have no basis in evidence for managing bruxism, and permanent alterations to dentition are strongly recommended against 1, 3

Discectomy (surgical removal of the articular disc) is strongly recommended against 1

Special Clinical Considerations

Coexisting Temporomandibular Disorders

• When bruxism coexists with TMD, treatment should address both conditions simultaneously 1
• The diagnostic approach should include assessment of clenching/bruxing habits, jaw joint locking or clicking, and impact on sleep, mood, and quality of life 5

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
• Intraoral examination should specifically look for excessive wear facets (indicating bruxism), muscle hypertrophy of mastication muscles, and temporomandibular joint crepitus 5

Specialist Referral Pathway

• Patients should be referred to a dentist with training in temporomandibular disorders and sleep medicine as the primary specialist for evaluation and management 1
• Consider pain management specialist or multidisciplinary pain team when patients have intractable pain unresponsive to dental interventions 1
• Provide the dentist with complete medical history including medications, associated conditions (sleep apnea, movement disorders, chronic pain), and psychological comorbidities (anxiety, depression, stress) 1

Common Pitfalls to Avoid

• Proceeding to invasive procedures before exhausting conservative options 1
• Relying on occlusal splints as the only treatment without addressing behavioral and lifestyle factors 3
• Performing irreversible dental procedures without clear indication 1
• Neglecting the biopsychosocial approach needed for successful management, including assessment of depression and chronic pain comorbidities 5
• Using NSAIDs with opioids, which carries significant risk without clear additional benefit 1