Bruxism - is it always bad?

Disclaimer:

Any medical/health information in this course is provided for general informational and educational purposes only and does not substitute for professional advice. Accordingly, before taking any actions based on such information, I encourage you to consult with the appropriate professionals. The use or reliance of any information contained in this course is solely at your own risk.

What is bruxism?

Bruxism is “extra” activity of the jaw muscles during sleep or during the day. Activities like clenching, grinding, or holding the jaw stiff without the teeth in contact (called bracing) all fall under the umbrella of bruxism.

Bruxism is experienced by about 22% of the population, and can be present in both kids and adults (1).

Researchers and clinicians talk about two different kinds of bruxism:

1. Bruxism while sleeping (sleep bruxism)

2. Bruxism while awake (awake bruxism)

   
   

Back in the 60s, researchers used to think that bruxism served no physiologic purpose.

Later, it used to be attributed almost entirely to psychological stress.

Now, however, we’re learning new reasons why people may have all this extra activity in the jaw muscles. The list of reasons continues to grow! Bruxism has been linked to anxiety, alcohol intake, sleep apnea, insomnia, or movement disorders like Parkinson’s Disease (2)

Bruxism increases risk of TMJ problems by 2x, but not all people with bruxism have TMJ problems (3).

Nowadays, instead of writing off all bruxism as “bad,” we are learning to take a more nuanced approach.

I like to ask the questions:

1. Is there any harm occurring to the teeth?

2. Is there any underlying cause suspected that we need to investigate further? (such as sleep apnea or Parkinson’s Disease)

3. Is bruxism potentially contributing to pain or headaches?

   
   

If the answer is “yes” to any of these, we need to dig deeper.

We still have limited research on bruxism, partially due to not having a consistent, easy way to measure it. Researchers have come up with fancy questionnaires and devices, but these are not always practical for the real world.

We still have a lot of learning to do!

What about management?

Management of bruxism is also in flux. There are all sorts of tools and methods that have been used historically to help decrease bruxism, including muscle relaxers, botox, splints, and physical therapy, with varied results.

The current best practice is to take an individual approach, perform a proper exam, and investigate any underlying causes before determining the best way forward.

One research article suggests that there’s not enough evidence to support one standard path forward for all people (4).

Because of this, we need to consider bruxism in the larger picture of what’s going on with your health and your jaw to make sure all the important factors are addressed, but not over-treated.

Need help figure out whether bruxism is important in your case? Set up a free, 15-minute phone consult here!

Cheers,

Dr. Rebecca Salstrand, PT, DPT

1. Zieliński G, Pająk A, Wójcicki M. Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis. J Clin Med. 2024 Jul 22;13(14):4259. doi: 10.3390/jcm13144259. PMID: 39064299; PMCID: PMC11278015.

2. Verhoeff MC, Lobbezoo F, Ahlberg J, Bender S, Bracci A, Colonna A, Dal Fabbro C, Durham J, Glaros AG, Häggman-Henrikson B, Kato T, Koutris M, Lavigne GJ, Nykänen L, Raphael KG, Svensson P, Wieckiewicz M, Manfredini D. Updating the Bruxism Definitions: Report of an International Consensus Meeting. J Oral Rehabil. 2025 Sep;52(9):1335-1342. doi: 10.1111/joor.13985. Epub 2025 May 1. PMID: 40312776; PMCID: PMC12408978.

3. Mortazavi N, Tabatabaei AH, Mohammadi M, Rajabi A. Is bruxism associated with temporomandibular joint disorders? A systematic review and meta-analysis. Evid Based Dent. 2023 Sep;24(3):144. doi: 10.1038/s41432-023-00911-6. Epub 2023 Jul 20. PMID: 37474733.

4. Manfredini D, Ahlberg J, Aarab G, Bender S, Bracci A, Cistulli PA, Conti PC, De Leeuw R, Durham J, Emodi-Perlman A, Ettlin D, Gallo LM, Häggman-Henrikson B, Hublin C, Kato T, Klasser G, Koutris M, Lavigne GJ, Paesani D, Peroz I, Svensson P, Wetselaar P, Lobbezoo F. Standardised Tool for the Assessment of Bruxism. J Oral Rehabil. 2024 Jan;51(1):29-58. doi: 10.1111/joor.13411. Epub 2023 Feb 10. PMID: 36597658.