What are the treatment options for bruxism (teeth grinding)?

Treatment of Bruxism (Teeth Grinding)

Start with conservative non-invasive approaches as first-line treatment: occlusal splints fitted by qualified dental personnel, patient education, and physical therapy techniques including massage and heat/cold application to masticatory muscles. 1

First-Line Conservative Management

Oral Appliances

• Hard full coverage stabilization splints are the primary dental intervention, designed to protect teeth from grinding damage rather than cure the underlying condition 1
• Splints must be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders 1
• Splints that don't account for proper occlusion may cause adverse events like unwanted tooth movement, so proper fitting is critical 1
• Long-term use may cause decreases in overbite/overjet and changes in incisor position, requiring regular dental monitoring 1

Physical Therapy and Self-Management

• Massage of masticatory muscles provides significant symptom relief and should be incorporated into the treatment plan 1
• Heat and/or cold application to affected jaw areas reduces muscle tension and pain 1
• Patient education about avoiding aggravating activities (gum chewing, nail biting, clenching during stress) is essential 1
• Stress reduction therapy and relaxation exercises can improve bruxism symptoms, as stress and anxiety are dominant contributing factors 2, 3

Second-Line Pharmacological Options

When conservative measures are insufficient:

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

Interventions to Use Cautiously

Botulinum Toxin

• May reduce the frequency of bruxism episodes by weakening masticatory muscles 1, 2
• However, concerns exist regarding possible adverse effects, and it is conditionally recommended against by some experts 1
• An RCT showed no benefit for temporomandibular disorders, which often coexist with bruxism 1
• If used, benefits are temporary (lasting only during the period of toxin action) 2

Biofeedback

• May help patients develop awareness of muscle tension patterns 1
• Limited evidence supports its effectiveness, and it is conditionally recommended against by some medical authorities 1

Interventions to Avoid Completely

• Irreversible occlusal adjustments (permanent alterations to tooth structure) have no evidence basis and are strongly recommended against 1
• Discectomy (surgical removal of the articular disc) is strongly contraindicated 1
• These invasive procedures should never be performed for bruxism management 1

Special Populations and Considerations

Children

• Bruxism occurs in approximately 15% of children 4
• Children are usually managed with observation and reassurance alone, as most outgrow the condition 4
• Dental referral is mandatory only if significant tooth attrition, mobility, or fracture occurs 4

Adults with Coexisting TMD

• When bruxism coexists with temporomandibular disorders, treatment must address both conditions simultaneously 1
• TMD-related discomfort from oral appliances is usually transient, with pain decreasing with continued use 1
• Mandibular exercises may improve discomfort during the adaptation period to oral appliances 1

Referral Pathway

• Primary referral should be to a dentist with training in temporomandibular disorders and sleep medicine 1
• Provide complete medical history including medications, sleep apnea, movement disorders, chronic pain syndromes, and psychological comorbidities (anxiety, depression, stress) 1
• Consider pain management specialist referral only for intractable pain unresponsive to dental interventions 1
• Sleep medicine specialist may be appropriate for patients with confirmed sleep bruxism requiring specialized oral appliance fitting 1

Monitoring and Follow-Up

• Regular dental evaluations are necessary to assess treatment efficacy and monitor for side effects 1
• Watch for tooth wear progression, changes in occlusion, and development of TMD symptoms 1
• Reassess stress levels and psychological factors, as these are dominant contributors to bruxism 2, 3

Common Pitfalls to Avoid

• Don't proceed to invasive procedures before exhausting conservative options for at least 3-6 months 1
• Don't rely solely on occlusal splints without addressing underlying stress and behavioral factors 1
• Don't perform irreversible dental procedures—these lack evidence and can cause permanent harm 1
• Don't overlook the role of stress management and psychological factors in treatment planning 2, 3