Bruxism

Last reviewed: May 2019

Last updated: January 2018

Summary

Bruxism is an umbrella term grouping together different motor phenomena of jaw muscles, such as grinding, and/or clenching of the teeth and bracing, and/or thrusting of the mandible. It can occur during sleep (sleep bruxism [SB]) or wakefulness (awake bruxism [AB]).

Etiology is mainly dependent on central factors (stress sensitivity, emotions, personality features, sleep regulation, autonomic nervous system), rather than on peripheral nervous system function or dental morphology and occlusion.

The condition covers a pathophysiologic continuum, and treatment need depends on the presence of clinically relevant consequences rather than the presence of bruxism itself.

Depending on the amount of muscle activity and the resistance of the target structures, bruxism may result in tooth wear or cracks, fracture of dental restorations, implant failure, muscle hypertrophy, pain and/or fatigue in jaw muscles, headache, toothache, disturbance of bed partner's sleep, and reduction in overall quality of life.

A diagnostic grading for clinical and research purposes has been recently proposed, recommending that any investigation specifies the diagnosis of sleep or awake bruxism as “possible”, “probable”, or “definite” based on the diagnostic approach being used.

Self-report, questionnaires, and interviews are suitable, at best, to identify a possible bruxism, while integration with clinical examination leads to a diagnosis of probable bruxism. For a definite diagnosis, measurement with audio-video polysomnography (PSG) or, alternatively, sleep-time electromyography (EMG) is needed for SB. Hour-long, wake-time EMG or, as an emerging option, ecological momentary assessment (EMA) is needed for a definite AB diagnosis.

Treatment is symptomatic and conditioned by the lack of evidence about when bruxism should actually be treated. Management options include different types of oral appliances (OA), cognitive-behavioural approaches (counseling, biofeedback, contingent electrical stimulation, relaxation techniques, hypnosis), psychotherapy, physiotherapy, and, rarely, relaxant drugs for short-term use.

Definition

Bruxism is a clinical phenomenon that can manifest in both children and adults. In 2013, an international panel of experts updated the consensus bruxism definition as: a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has 2 distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism [SB]) or during wakefulness (indicated as awake bruxism [AB]). [1]

History and exam

Key diagnostic factors

grinding noises
oral parafunctions
tooth wear
jaw muscle pain
jaw muscle tenderness
stress and anxiety
caffeine, nicotine, or alcohol use
hx of sleep disorders
selective serotonin-reuptake inhibitor or dopamine antagonist use
ecstasy or cocaine use
muscle hypertrophy

Full details

Other diagnostic factors

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

Full details

Risk factors

smoking, caffeine, alcohol consumption
stress sensitivity and anxiety personality traits
snoring, sleep apnea, and other sleep disorders
medication use
genetic disposition

Full details

Diagnostic investigations

1st investigations to order

clinical diagnosis

Full details

Investigations to consider

polysomnographic (PSG) study
electromyography (EMG)
smartphone-based ecological momentary assessment (EMA)

Full details

Treatment algorithm

ACUTE

awake bruxism

sleep bruxism

Contributors

Authors VIEW ALL 

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

Amsterdam

The Netherlands

Disclosures

FL is a member of the Academic Advisory Board of Sunstar Suisse S.A for GrindCare®. FL receives research funding from Sunstar Suisse S.A and SomnoMed. FL is an author of several references cited in this topic.

Daniele Manfredini, DDDS, PhD

Associate Professor School of Dentistry

Department of Neuroscience

University of Padova

Padova

Italy

Disclosures

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

Alessandro Bracci, DDS

Adjunct Professor

School of Dentistry

Department of Neuroscience

University of Padua

Padua

Italy

Disclosures

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

Acknowledgements

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 VIEW ALL 

Alan Glaros, PhD

Associate Dean and Professor

Kansas City University of Medicine and Biosciences

Kansas City

Disclosures

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 monograph.

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Bruxism

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

awake bruxism

sleep bruxism

Contributors

Authors VIEW ALL 

Frank Lobbezoo, DDS, PhD

Disclosures

Daniele Manfredini, DDDS, PhD

Disclosures

Alessandro Bracci, DDS

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Alan Glaros, PhD

Disclosures

Differentials

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