Last reviewed: 23 Aug 2023
Last updated: 20 Apr 2021



History and exam

Key diagnostic factors

  • grinding noises
  • oral parafunctions
  • tooth wear and soreness
  • jaw muscle or temporomandibular joint (TMJ) pain
  • jaw muscle tenderness
  • stress and anxiety
  • caffeine, nicotine, or alcohol use
  • history of sleep disorders
  • selective serotonin-reuptake inhibitor or dopamine antagonist use
  • ecstasy or cocaine use
  • muscle hypertrophy
More key diagnostic factors

Other diagnostic factors

  • headache
  • tooth hypersensitivity
  • fracture of dental restorations
  • oral mucosal changes
  • record of bruxism events and associated behavior
  • oral appliance wear
Other diagnostic factors

Risk factors

  • smoking, caffeine, alcohol consumption
  • stress sensitivity and anxiety personality traits
  • snoring, sleep apnea, and other sleep disorders
  • medication use
  • genetic disposition
  • primary motor disorders
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • polysomnographic (PSG) study
  • electromyography (EMG)
  • ecological momentary assessment (EMA)
More investigations to consider

Treatment algorithm


awake bruxism

sleep bruxism



Frank Lobbezoo, DDS, PhD

Professor, Chair, and Vice Dean

Department of Oral Health Sciences

Academic Centre for Dentistry Amsterdam (ACTA)

MOVE Research Institute Amsterdam

University of Amsterdam

VU University Amsterdam


The Netherlands


FL is a member (unpaid) of the Academic Advisory Boards of Sunstar Suisse S.A for GrindCare® and for Oral Function. FL receives research grants from Sunstar Suisse S.A, Airway management, Vivisol, SomnoMed-Goedegebuure, and Health Holland. FL is an author of several references cited in this topic.

Daniele Manfredini, DDDS, PhD

Full Professor Oral Physiology and Gnathology

School of Dentistry

University of Siena




DM is an author of several references cited in this topic.

Alessandro Bracci, DDS

Associate Professor

School of Dentistry

Department of Neuroscience

University of Padua




AB is the inventor of and owns the copyright for the software BruxApp. AB is an author of a reference cited in this topic.


Professor Daniele Manfredini, Professor Frank Lobbezoo, and Alessandro Bracci would like to gratefully acknowledge Professor Peter Svensson, a previous contributor to this topic.


PS is chairman of the clinical advisory board and has received fees for consulting for Medotech, the manufacturer of GrindCare. PS is also an author of several references cited in this topic.

Peer reviewers

Alan Glaros, PhD

Associate Dean and Professor

Kansas City University of Medicine and Biosciences

Kansas City



AG is a member of the clinical advisory board of Medotech and has received GrindCare devices for evaluation. AG is an author of a reference cited in this topic.

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