Bruxism Treatment Guidelines

First-Line Treatment Options

Conservative, non-invasive approaches, including oral appliances, behavioral strategies, and physical therapy techniques, should be the first-line treatment for bruxism, with more invasive interventions reserved for refractory cases, as recommended by the British Medical Journal 1, 2
Occlusal splints are the most common dental intervention for bruxism, primarily designed to protect teeth from damage caused by grinding/clenching, according to the British Medical Journal 1
Hard full coverage stabilization splints have shown some efficacy, while splints that don't account for occlusion may cause adverse events like tooth movement, as reported in the British Journal of Anaesthesia 3
Oral appliances should be fitted by qualified dental personnel with training in sleep medicine and/or sleep-related breathing disorders, as stated in the Journal of Clinical Sleep Medicine 4
Patient education about the condition and avoidance of aggravating activities is recommended by the British Medical Journal 1
Massage of masticatory muscles is a recommended physical therapy technique, according to the British Medical Journal 1
Heat and/or cold application to affected areas is a recommended physical therapy technique, as reported in the British Medical Journal 1

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for pain management by the British Medical Journal 1
Muscle relaxants are recommended for acute episodes by the British Medical Journal 1
Amitriptyline has shown some benefit in an open-label study, as reported in the British Journal of Anaesthesia 3

Botulinum toxin injections to the masticatory muscles may reduce the frequency of bruxism, but concerns exist regarding possible adverse effects, and it is conditionally recommended against by some experts, as stated in Praxis Medical Insights 2
An RCT showed no benefit of Botulinum Toxin for TMD, as reported in the British Journal of Anaesthesia 3
Biofeedback may help patients develop awareness of muscle tension but has limited evidence, and is conditionally recommended against by some medical authorities, according to Praxis Medical Insights 2
Low-Level Laser Therapy has insufficient evidence to support its use, and is conditionally recommended against by the National Institutes of Health, as stated in Praxis Medical Insights 2

Irreversible occlusal adjustments have no basis in evidence for managing bruxism, and permanent alterations to dentition are strongly recommended against by Praxis Medical Insights 2
Discectomy (surgical removal of the articular disc) is strongly recommended against by Praxis Medical Insights 2

When bruxism coexists with temporomandibular disorders (TMD), treatment should address both conditions, as reported in the British Journal of Anaesthesia 3
TMD issues related to oral appliances are usually transient, with pain decreasing with continued use, according to Pulmonology 5, 6
Mandibular exercises may improve discomfort during adaptation to oral appliances, as reported in Pulmonology 5, 6
Regular dental evaluations are necessary to assess treatment efficacy and potential side effects, as stated in Pediatrics 7
Long-term dental side effects of oral appliances may include decreases in overbite and overjet, and changes in incisor position, according to Pulmonology 6

TRPV1 agonists, such as capsaicinoids, have shown some efficacy in improving swallow function and may help with oral motor control in some patients with bruxism, according to Clinical Nutrition 8
Dopaminergic agents may be considered in cases where bruxism is associated with movement disorders, as they can help normalize oral motor function, with evidence from Clinical Nutrition 8
Treatment decisions need to be individualized based on careful risk-benefit analysis, as most medications have limited evidence specifically for bruxism, as noted in Clinical Nutrition 8

The American Urological Association recommends avoiding the use of anti-muscarinic medications in patients with narrow-angle glaucoma unless approved by an ophthalmologist 9
The American Urological Association advises using caution with medications that may impair cognitive function, especially in elderly patients or those with existing cognitive issues 9

The British Journal of Anaesthesia recommends that patients with bruxism should be referred to a dentist, specifically one with training in temporomandibular disorders (TMD) and sleep medicine, as the primary specialist for evaluation and management 10, 11
The American College of Dentistry suggests referring to a general dentist or dental specialist as the first-line specialist for bruxism management, since bruxism is fundamentally a dental and oral motor disorder requiring assessment of tooth wear, occlusion, and jaw function 10, 11

The American Academy of Pain Medicine recommends considering a pain management specialist or multidisciplinary pain team when patients have intractable pain unresponsive to dental interventions, as pain management alone does not constitute sufficient treatment but is an essential component [12, @14@]
The American Academy of Sleep Medicine suggests considering a sleep dentist for patients with sleep-related bruxism who require oral appliances fitted by personnel trained specifically in sleep medicine and sleep-related breathing disorders 11, 13

The American Medical Association recommends that the referring physician should provide the dentist with a complete medical history including medications, any associated conditions like sleep apnea, movement disorders, or chronic pain syndromes, and psychological comorbidities including anxiety, depression, or stress-related disorders 10, 11, 14
The American Dental Association suggests requesting from the dentist a dental diagnosis and treatment plan to coordinate ongoing care, assessment of modifiable risk factors and treatment response, and regular follow-up reports 14