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What is Bruxism?
Bruxism is the medical term used to describe the tendency to grind the teeth and clench the jaw with force. While anyone can experience this occasionally, for instance due to stress, without it causing any lasting harm, suffering from bruxism persistently can lead to the development of symptoms such as:
- Pain
- Discomfort
- Permanent damage to the teeth
Most cases of bruxism occur unconsciously during sleep, often triggered by stress or anxiety, but the condition can also occur while awake (daytime bruxism), for example when a person is feeling tense or deeply concentrated on a task.
In many cases, the problem can come and go over time, but it tends to worsen during particularly stressful periods.
To find out whether you might be suffering from bruxism, a simple self-check involves standing in front of a mirror with your teeth aligned and your upper teeth resting on your lower teeth. If you cannot identify any visible space between your upper and lower front teeth (incisors), it is likely that the disorder is present.
Bruxism caused by stress will typically continue until the underlying source of tension is addressed, in both children and adults. Childhood bruxism, which is usually noticed during early adolescence, tends however to resolve on its own in the majority of cases as the child grows.
Causes: Why Do People Grind Their Teeth?
It is not always possible to pinpoint the exact trigger behind bruxism, but among the most significant risk factors, we can identify the following:
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Stress and anxiety: The disorder is frequently associated with mental or psychological difficulties, so much so that it is estimated up to 70 percent of nighttime bruxism cases are linked to stress and anxiety. It is well known that excessive, constant tension can disrupt sleep, and this is one of the key mechanisms at play. In some cases, antidepressant medications themselves can contribute to the onset of this behavior.
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Sleep disorders: Certain sleep disorders, such as obstructive sleep apnea, appear to increase the likelihood of developing bruxism, through mechanisms that are still being studied and are not yet fully understood.
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Medications: Certain antidepressants and antipsychotic medications can cause bruxism as a side effect, for example paroxetine, fluoxetine, and sertraline. It is important to note that this is a possible side effect, meaning it does not necessarily occur in every patient who takes these medications.
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Lifestyle factors: Certain lifestyle-related factors can increase the likelihood of grinding your teeth at night, including:
- Excessive alcohol consumption
- Smoking
- Use of recreational drugs (ecstasy, cocaine, and others)
- Excessive caffeine consumption
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Family history: Some research suggests there may be a certain degree of genetic or familial susceptibility to the disorder, with bruxism sometimes appearing to run in families.
Bruxism in Children
Childhood bruxism occurs in approximately 20 percent of children under 12 years of age, although it often goes undiagnosed and is frequently not even noticed by parents. In general, the habit tends to disappear naturally as the child grows older.
In some cases, bruxism is actually the symptom through which a parasitic intestinal infection (pinworms) is discovered, as the nighttime itching caused by the parasites can trigger teeth grinding as a reflexive response.
Symptoms
Persistent bruxism can cause a range of symptoms, including:
- Facial pain
- Headache
- Wearing down of the teeth
Symptoms of the nighttime form of bruxism are generally most intense immediately upon waking, gradually easing over the following hours. In cases of daytime bruxism, by contrast, there is typically no discomfort upon waking, with symptoms instead worsening gradually as the day progresses.
Some symptoms, such as facial pain, often disappear once the grinding stops, but others, such as damage caused to the teeth themselves, may be permanent and require specific dental treatment.
More broadly, bruxism can cause:
- Burning sensation of the tongue
- Excessive development of the chewing muscles, giving the jaw a more square or muscular appearance
- Pain and stiffness of the jaw and surrounding muscles
- Headache
- Facial muscle pain (facial myalgia)
- Earache
- Shoulder and neck tension
- Sleep disturbances, often affecting the patient’s sleeping partner as well, who in some cases can be significantly disturbed by the grinding noise
- Wearing down of the teeth, which can result in:
- Increased sensitivity to hot, cold, and sweet foods and drinks
- Tooth fractures
- Difficulty opening the mouth fully
It is important to note that significant tooth wear only occurs in severe cases of bruxism, and mild or occasional grinding does not typically cause lasting dental damage.
Diagnosis
The diagnosis of bruxism is not based on a single test but rather on a multidisciplinary approach involving a dentist and, in certain cases, a sleep medicine specialist. According to current scientific consensus, diagnosis is classified into three levels of certainty: possible (based only on the patient’s own self-assessment), probable (based on clinical examination), and definitive (confirmed through instrumental testing).
Clinical Examination and Medical History
The first step consists of a thorough evaluation of the patient’s medical history. The doctor or dentist will ask about the presence of typical symptoms and will often gather information from a sleeping partner who may have noticed the sound of grinding at night. During examination of the oral cavity, clinical signs suggestive of bruxism include:
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Dental wear (attrition): the presence of worn facets on the chewing surfaces of the teeth, flattening of the biting edges of the front teeth, or notched lesions at the neck of the tooth near the gumline (known as abfraction).
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Hypertrophy of the chewing muscles: a visible and palpable increase in the size of the masseter muscles (the muscles of the cheek), which feel firm and toned, and are sometimes tender to the touch.
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White lines on the inside of the cheeks (linea alba): signs of chronic biting or pressure marks on the inner cheeks, or a scalloped, indented appearance along the edges of the tongue.
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Damage to dental restorations: frequent breakage of fillings, crowns, or dental prosthetics without any obvious traumatic cause.
Evaluation of Temporomandibular Disorders
Because bruxism is closely linked to disorders of the temporomandibular joint (TMJ), diagnosis often includes palpation (careful touching and pressing) of the jaw joint to detect clicking, popping sounds, or restricted mouth opening. It is essential for the clinician to determine whether the pain originates from the muscles or from the joint itself, as this distinction guides treatment.
Instrumental Diagnosis
In more complex cases, or to obtain a definitive confirmation of nighttime bruxism, the following tests may be used:
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Electromyography (EMG): this involves the use of sensors that record the electrical activity of the chewing muscles during sleep. Portable devices are now available that allow this monitoring to be performed directly at home.
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Polysomnography: this is the gold standard diagnostic test, performed in specialized sleep centers, which simultaneously monitors brain activity, heart rate, breathing, and muscle activity throughout the night. It is particularly useful when a connection with obstructive sleep apnea is suspected.
Treatment and Management of Bruxism
The main goal of treatment is not necessarily a definitive “cure” (which is often difficult to achieve when the underlying cause is psychological or genetic in nature), but rather protecting the dental structures, reducing pain, and improving sleep quality. The treatment approach is highly individualized and often combines several different strategies.
Occlusal Devices (Night Guards)
The treatment of choice remains the use of a night guard (bite splint). This is an intraoral device made of resin that acts as a protective barrier between the upper and lower teeth.
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Custom-made night guards: created by a dentist to precisely fit the individual patient’s mouth, these offer the highest level of effectiveness. In addition to protecting the teeth from wear, they are specifically designed to help correctly reposition the jaw and reduce the load placed on the chewing muscles.
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Over-the-counter, pre-formed night guards: available at pharmacies, these represent a less precise, temporary solution that can help manage immediate symptoms, but they are not a substitute for a professionally fitted device or specialist care.
Behavioral Therapy and Biofeedback
For daytime bruxism, awareness is the most powerful tool available. Biofeedback techniques make use of small devices that alert the patient, through vibrations or other signals, as soon as they begin to clench their teeth, gradually training the brain to relax the jaw muscles instead. Cognitive behavioral therapy (CBT) is also recommended for managing underlying anxiety and stress, helping to reduce the frequency of grinding episodes over time.
Pharmacological and Innovative Treatments
Medications are generally used only for short periods, or in more difficult, treatment-resistant cases:
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Muscle relaxants: prescribed at low doses to be taken before bed, helping to reduce acute muscle tension overnight.
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NSAIDs: such as ibuprofen, useful for managing episodes of acute facial or head pain associated with bruxism.
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Botulinum toxin (Botox): in recent years, injecting botulinum toxin directly into the masseter muscles has proven highly effective in severe cases. This treatment selectively weakens the muscle, reducing the force of clenching, without interfering with normal chewing function.
Lifestyle and Self-Care
Changing daily habits plays a crucial role in managing bruxism:
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Sleep hygiene: avoiding bright screens, heavy meals, and intense physical activity in the hours before bedtime.
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Stress management: practices such as yoga, meditation, or diaphragmatic breathing exercises can help reduce the nervous tension that often manifests physically in the jaw.
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Dietary adjustments: during periods of increased pain, it is advisable to favor soft foods and avoid chewing gum, which places additional strain on the already overworked chewing muscles.
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Warm, moist compresses: applying a warm, damp compress to the cheeks before bed or upon waking can help promote muscle relaxation and reduce jaw discomfort.
Prevention
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Attend regular dental check-ups, allowing early signs of tooth wear or jaw problems to be identified and addressed promptly.
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Develop awareness of the damage that stress and anxiety can cause, and find relaxation techniques that work effectively for you.
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Reduce your alcohol consumption, which can worsen the disorder.
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Quit smoking.
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Avoid the use of recreational drugs, such as ecstasy and cocaine.
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Avoid chewing on pens, pencils, and other non-food objects, a common habit that can contribute to jaw muscle overuse.
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Try to become more aware of when you are grinding your teeth during the day, and consciously work to interrupt the behavior by relaxing your jaw muscles.
When to See a Doctor or Dentist
While mild, occasional teeth grinding rarely requires treatment, you should consult a dentist or doctor if you experience:
- Frequent or severe headaches, particularly upon waking
- Persistent jaw pain, stiffness, or difficulty opening your mouth fully
- Visible wear, chipping, or cracking of your teeth
- Frequent breakage of dental fillings, crowns, or other restorations
- Clicking, popping, or grinding sounds from the jaw joint, especially if accompanied by pain
- Sleep disruption, either your own or your partner’s, related to grinding noises at night
- A child who grinds their teeth accompanied by other symptoms, such as nighttime itching around the anus (which may suggest a pinworm infestation) or signs of significant anxiety
Early evaluation by a dentist allows for timely intervention with a night guard or other treatment, helping to prevent long-term dental damage.
Frequently Asked Questions
What is bruxism?
Bruxism is a condition in which a person involuntarily grinds or clenches their teeth, often during sleep, though it can also occur while awake.
What causes bruxism?
The exact causes of bruxism are not fully understood. However, many experts believe it can result from anxiety, tension, and stress. Other contributing factors may include sleep disorders, certain medications, alcohol and drug use, and, in children, sometimes parasitic infestations such as pinworms.
What are the most characteristic symptoms of bruxism?
Bruxism can cause symptoms such as dental wear, jaw pain, headaches, and, over time, problems affecting the temporomandibular joint (TMJ).
What are the treatment options for bruxism?
Treatment can include the use of nighttime bite guards to protect the teeth, along with stress management techniques, behavioral therapy, and, in more severe cases, medications or botulinum toxin injections.
Does bruxism go away on its own?
In children, bruxism very often resolves spontaneously as they grow, particularly by the time they reach adolescence. In adults, bruxism related to a specific stressful period may improve once the source of stress is resolved, although some cases, particularly those linked to sleep disorders or genetic factors, may require ongoing management.
Can bruxism damage my teeth permanently?
Yes, in more severe or long-standing cases, bruxism can cause permanent damage, including significant tooth wear, fractures, and increased sensitivity. This is why early diagnosis and the use of a properly fitted night guard are important for protecting your dental health over the long term.
Is bruxism related to anxiety and stress?
Yes, stress and anxiety are among the most commonly identified triggers for bruxism, particularly the nighttime form. It is estimated that up to 70 percent of cases of nighttime teeth grinding are linked to psychological tension of this kind, which makes stress management an important part of treatment.
Sources and Bibliography
- NHS. Teeth Grinding (Bruxism). https://www.nhs.uk/conditions/teeth-grinding/ (licensed under the Open Government Licence)
- Melo G, et al. Bruxism: A Literature Review. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295445/
- Lobbezoo F, et al. International consensus on the assessment of bruxism: report of a work in progress. Journal of Oral Rehabilitation. 2018;45(11):837-844.
- American Dental Association (ADA). Bruxism (Teeth Grinding or Clenching). ada.org.
- American Academy of Sleep Medicine (AASM). Sleep-Related Bruxism. sleepeducation.org.
- Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. Journal of Orofacial Pain. 2009;23(2):153-166.
- Guaita M, Hogl B. Current Treatments of Bruxism. Current Treatment Options in Neurology. 2016;18(2):10.
