What is the treatment (tx) for bruxism?

Treatment for Bruxism

Start with a hard full-coverage stabilization splint fitted by a dentist trained in temporomandibular disorders and sleep medicine, combined with patient education on stress reduction, sleep hygiene, and caffeine limitation. 1, 2

First-Line Conservative Management

Occlusal Splint Therapy

• Hard full-coverage stabilization splints are the most effective dental intervention and should be your primary treatment. 1, 2
• The splint protects teeth from grinding damage rather than eliminating bruxism itself. 1, 2
• Critical requirement: The splint must be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders. 1, 2
• Major pitfall to avoid: Splints that don't properly account for occlusion can cause unwanted tooth movement. 1
• Transient TMD discomfort during adaptation typically decreases with continued use; mandibular exercises can improve this adaptation period. 1, 2
• Long-term monitoring is necessary as splints may cause decreases in overbite/overjet and changes in incisor position. 1, 2

Behavioral and Physical Interventions

• Patient education is essential: specifically counsel on stress reduction techniques, limiting caffeine intake, and improving sleep hygiene. 1, 2
• Massage of masticatory muscles provides relief of associated muscle tension. 1, 2
• Heat and/or cold application to affected areas helps manage symptoms. 1, 2
• When combined with splint therapy, cognitive behavioral therapy provides significantly greater muscle relaxation than splint alone. 3

Second-Line Pharmacological Options

Use these when conservative measures provide insufficient relief:

• NSAIDs for pain management associated with bruxism. 1, 2
• Muscle relaxants for acute episodes of muscle spasm. 1, 2
• Amitriptyline has shown benefit in open-label studies for chronic cases. 1, 2
• TRPV1 agonists (capsaicinoids) may improve oral motor control in select patients. 1, 2
• Dopaminergic agents may be considered when bruxism is associated with movement disorders. 1, 2
• Treatment decisions must be individualized based on risk-benefit analysis, as most medications have limited evidence specifically for bruxism. 1, 2

Interventions to Use Cautiously

These have limited or conflicting evidence:

• Botulinum toxin injections to masticatory muscles are conditionally recommended against due to concerns about adverse effects and an RCT showing no benefit for TMD. 1, 2
• Biofeedback has limited evidence and is conditionally recommended against. 1, 2
• Low-level laser therapy has insufficient evidence and is conditionally recommended against. 1, 2

Interventions to Absolutely Avoid

• Irreversible occlusal adjustments are strongly recommended against as they have no evidence basis and cause permanent alterations to dentition. 1, 2
• Discectomy (surgical removal of the articular disc) is strongly recommended against. 1, 2

Specialist Referral Algorithm

Primary Referral

• Refer to a dentist with training in temporomandibular disorders and sleep medicine as the primary specialist. 2
• Provide complete medical history including medications, associated conditions (sleep apnea, movement disorders, chronic pain), and psychological comorbidities (anxiety, depression, stress). 2

Secondary Referrals

• Consider a pain management specialist or multidisciplinary pain team when patients have intractable pain unresponsive to dental interventions. 2
• Consider a sleep dentist specifically for sleep-related bruxism requiring specialized oral appliances. 2

When Bruxism Coexists with TMD

• Treatment must address both conditions simultaneously. 1, 2
• The diagnostic approach should assess clenching/bruxing habits, jaw joint locking or clicking, and impact on sleep, mood, and quality of life. 1
• Intraoral examination should look for excessive wear facets, muscle hypertrophy of mastication muscles, and temporomandibular joint crepitus. 1

Common Pitfalls to Avoid

• Never proceed to invasive procedures before exhausting conservative options. 1
• Never perform irreversible dental procedures without clear indication. 1
• Do not neglect the biopsychosocial approach including assessment of depression and chronic pain comorbidities. 1
• Never use NSAIDs with opioids as this carries significant risk without clear additional benefit. 1
• Do not rely on occlusal splints as the only treatment; combine with behavioral interventions for better outcomes. 3