Treatment for Jaw Clenching (Bruxism)
Begin with conservative, non-invasive approaches as first-line treatment: occlusal splints fitted by qualified dental personnel, patient education about trigger avoidance, and physical therapy techniques including massage and heat/cold application. 1
First-Line Conservative Management
Start immediately with these evidence-based interventions:
Occlusal splints (hard full coverage stabilization splints) are the most common and effective dental intervention, primarily protecting teeth from grinding/clenching damage 1. These must be fitted by qualified dental personnel with training in sleep medicine and/or temporomandibular disorders 1.
Patient education about the condition and avoidance of aggravating activities is essential—identify and counsel patients about stress triggers, anxiety, and behaviors that worsen clenching 1, 2.
Physical therapy techniques provide significant relief: massage of masticatory muscles, heat and/or cold application to affected areas, and supervised jaw exercises 1, 3. Manual trigger point therapy delivers one of the largest reductions in pain severity, approaching twice the minimally important difference 3.
Stress reduction therapy and behavioral modifications are critical since stress and anxiety are dominant factors leading to increased muscle tension 4, 2, 5.
Second-Line Pharmacological Options
When conservative measures are insufficient:
NSAIDs for pain management are recommended as first-line pharmacotherapy 1, 6.
Muscle relaxants for acute episodes provide temporary relief 1.
Amitriptyline has shown some benefit in open-label studies for chronic cases 1.
Pregabalin may be considered for patients with comorbid generalized anxiety disorder—one case report showed complete disappearance of awake bruxism at 375 mg daily, though more studies are needed 7.
Interventions to Use Cautiously
These have limited or mixed evidence:
Botulinum toxin injections to masticatory muscles may reduce bruxism frequency and produce measurable biomechanical changes in masseter muscle parameters 8, but concerns exist regarding possible adverse effects and one RCT showed no benefit for TMD 1. It is conditionally recommended against by some experts despite reducing subjective complaints during the period of action 1, 4.
Biofeedback training may help patients develop awareness of muscle tension but has limited evidence and is conditionally recommended against when used alone 1, 3.
Cognitive behavioral therapy with relaxation therapy or biofeedback provides substantial pain reduction for chronic cases 3, 6.
Critical Interventions to Avoid
Never perform irreversible occlusal adjustments or permanent alterations to dentition—these have no evidence basis for managing bruxism 1, 3.
Avoid discectomy (surgical removal of the articular disc)—this is strongly recommended against 1.
Do not combine NSAIDs with opioids—this carries significant risk without clear additional benefit 3, 6.
Special Considerations and Common Pitfalls
Distinguish between awake bruxism (20% prevalence, mainly stress-related) and sleep bruxism (8% prevalence, associated with sleep-related micro-arousals) 5. Treatment approaches may differ slightly.
When bruxism coexists with temporomandibular disorders, address both conditions simultaneously 1.
TMD issues related to oral appliances are usually transient—pain typically decreases with continued use, and mandibular exercises may improve discomfort during adaptation 1.
Regular dental evaluations are necessary to assess treatment efficacy, potential side effects, and long-term changes like decreases in overbite/overjet 1.
Avoid relying solely on occlusal splints despite their common use—they should be part of a comprehensive approach including behavioral modifications and physical therapy 3.
Children with bruxism are usually managed with observation and reassurance rather than aggressive intervention 2.
When to Refer to Specialists
Refer 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 complete medical history including medications, associated conditions (sleep apnea, movement disorders), and psychological comorbidities (anxiety, depression, stress) when referring 1.