What are the treatment options for a patient with bruxism?

Treatment for Teeth Grinding (Bruxism)

Start with a hard full coverage stabilization splint fitted by a dentist trained in sleep medicine—this is your first-line treatment to protect teeth from grinding damage, combined with patient education about stress reduction, limiting caffeine, and improving sleep hygiene. 1, 2

Initial Conservative Management

Your primary approach should be non-invasive interventions before considering anything more aggressive:

• Occlusal splints (night guards) are the cornerstone dental intervention, designed to protect teeth from damage rather than eliminate the grinding itself 1, 2
• Hard full coverage stabilization splints have demonstrated efficacy, but the splint must properly account for occlusion or it may cause unwanted tooth movement 1
• The splint must be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders 1, 2
• If you develop transient jaw discomfort with the appliance, this usually decreases with continued use; mandibular exercises can help during the adaptation period 1, 2

Patient education is essential and should include:

• Avoidance of aggravating activities like chewing gum or biting nails 1, 2
• Stress reduction techniques 1, 2
• Limiting caffeine intake 2
• Improving sleep hygiene 2

Physical therapy techniques provide significant benefit:

• Massage of masticatory muscles relieves associated muscle tension 1, 2
• Heat and/or cold application to affected areas helps manage symptoms 1, 2
• Supervised jaw exercises and stretching can reduce pain 3

When Conservative Treatment Isn't Enough

If you continue to have pain or muscle spasm despite the above measures:

Second-line pharmacological options:

• NSAIDs for pain management and inflammation 1, 2
• Muscle relaxants for acute episodes of muscle spasm 1, 2
• Amitriptyline has shown some benefit in open-label studies for chronic cases 1, 2

For refractory cases with specific indications:

• TRPV1 agonists (capsaicinoids) may help with oral motor control in select patients 1, 2
• Dopaminergic agents should be considered when bruxism is associated with movement disorders 1, 2, 4

Interventions to Use Cautiously or Avoid

Use with extreme caution (conditionally recommended against):

• Botulinum toxin injections to masticatory muscles may reduce grinding frequency, but an RCT showed no benefit for TMD and concerns exist about adverse effects 1, 2
• Biofeedback has limited evidence despite helping some patients develop awareness of muscle tension 1, 2
• Low-level laser therapy has insufficient evidence 1, 2

Never perform these interventions:

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

Critical Pitfalls to Avoid

• Never proceed to invasive procedures before exhausting conservative options for at least 3-6 months 2, 3
• Never combine NSAIDs with opioids—this carries significant risk without clear additional benefit 2, 3
• Never perform irreversible dental procedures without clear indication, as damage to teeth from bruxism is irreversible but the underlying cause must be treated to avoid further problems 1, 2, 5

When to Refer to Specialists

Primary referral pathway:

• Refer to a dentist with training in temporomandibular disorders and sleep medicine as your first specialist 1, 2
• Provide complete medical history including medications, associated conditions (sleep apnea, movement disorders, chronic pain), and psychological comorbidities (anxiety, depression, stress) 1, 2

Secondary specialist referrals:

• Consider a pain management specialist or multidisciplinary pain team when patients have intractable pain unresponsive to dental interventions 1, 2, 3
• Physical therapist with TMJ expertise for manual trigger point therapy, which provides substantial pain reduction 3

Special Considerations

• When bruxism coexists with temporomandibular disorders, treat both conditions simultaneously 1, 2
• Regular dental evaluations are necessary to assess treatment efficacy and monitor for potential side effects 1, 2
• Long-term use of oral appliances may cause decreases in overbite and overjet, and changes in incisor position 1, 2
• Bruxism occurs in approximately 15% of children and up to 96% of adults, with stress, anxiety, and genetic disposition being dominant factors 6, 7
• In children, management typically consists of observation and reassurance rather than aggressive intervention 6