What Is Bruxism?
Jaw clenching and teeth grinding, collectively known as bruxism or parafunction, involve excessive activity of the jaw muscles. This may occur during the day (awake bruxism) or during sleep (sleep bruxism). Over time, excessive muscle activity can lead to myofascial pain, characterised by aching or fatigue in the jaw muscles, facial pain, headaches, tenderness around the temples or cheeks, jaw stiffness, and sometimes instability or discomfort within the temporomandibular joints (TMJs).
Why Does Clenching and Grinding Occur?
Bruxism is usually multifactorial and often develops as a result of several contributing factors acting together. Often no single cause is identified, but factors which may contribute include:
- Stress, anxiety, or emotional tension
- Habitual jaw muscle overactivity
- Poor sleep quality or sleep disorders
- Excessive caffeine consumption
- Nicotine use
- Alcohol consumption
- Jaw pain resulting in protective muscle tightening
- Certain prescription medications
- Recreational drug use (e.g. MDMA/ecstasy, cocaine, amphetamines, methamphetamine)
Addressing Triggers
Stress and Psychological Factors
Stress commonly increases jaw muscle activity. Helpful strategies may include Mindfulness or meditation, breathing exercises, regular exercise, and psychological therapies where appropriate.
Avoid Prolonged Jaw Loading
Try to avoid activities that increase strain on the jaw muscles, including:
- Gum chewing, nail biting, pen chewing
- Tough, chewy, or hard foods
- Resting the chin on the hand
- Holding a telephone between the shoulder and jaw
- Repeated wide opening of the mouth – support your chin with your fist when yawning
Sleep Health
Poor sleep may worsen sleep bruxism. Consider:
- Maintaining regular sleep and wake times
- Limiting screen use before bed
- Reducing caffeine, nicotine, and energy drink consumption
- Limiting alcohol consumption before sleep
Medications
Certain medications may contribute to clenching and grinding in some individuals. These include:
- Some antidepressants, particularly SSRIs and SNRIs such as fluoxetine, sertraline, paroxetine and venlafaxine
- Stimulant medications used to treat ADHD, including methylphenidate (Ritalin), lisdexamfetamine (Elvanse/Vyvanse), and dexamfetamine
Patients should not stop prescribed medication without discussing this with their doctor, but medication review may be appropriate.
💡 See the Knowledge Centre article Is My Medication Causing Jaw Clenching (Bruxism)? for further information.
Conservative Management
💆 Jaw Awareness and Relaxation
Many people clench unconsciously throughout the day. A healthy resting jaw position is: lips together; teeth slightly apart; jaw, face, neck, and shoulders relaxed. Regularly checking and correcting jaw position is one of the most effective treatments for awake bruxism. Reminders or alarms set for this may act as a helpful prompt.
🌡️ Heat or Cold
Apply these for approximately 10-15 minutes at a time, ensuring the skin is protected.
Warm compresses may:
- Relax muscle spasm
- Improve comfort and flexibility
- Be particularly useful before stretching exercises or before bed
Cold compresses may:
- Help reduce acute pain
- Be useful following periods of excessive clenching or muscle flare-ups
💊 Analgesia
Simple pain relief can help during symptom flare-ups. Paracetamol and anti-inflammatory medications such as ibuprofen may reduce discomfort, particularly when combined with activity modification and heat therapy. Topical anti-inflammatory gels applied over the jaw muscles may also provide temporary relief in some patients. Painkillers can help control symptoms, but they do not address the underlying causes of clenching and grinding.
🛡️ Splints and Bite Guards
A night-time splint or bite guard may be recommended. Splints help protect the teeth from wear. They may also reduce loading of the jaw joints and improve awareness of clenching behaviour. Splints do not cure bruxism itself but are often an important component of management.
💪 Physiotherapy
Physiotherapy may help reduce muscle tension, improve jaw mobility, and address contributing neck and shoulder problems. Treatment commonly includes stretching exercises, manual therapy, trigger point treatment, posture correction, and relaxation techniques. Physiotherapy is most effective when combined with jaw awareness training, avoidance of excessive jaw loading, and management of contributing factors such as stress and poor sleep.
💉 Botulinum Toxin (Botox)
In selected patients, botulinum toxin injections may be used to reduce excessive activity of overactive jaw muscles, most commonly the masseter and temporalis muscles. The aim is to reduce clenching and grinding force, decrease muscle pain and fatigue, and reduce tension-related headaches. The effect develops gradually over 2 weeks and typically lasts 3-6 months. Treatment is generally considered when conservative measures alone have not provided sufficient relief.
Expected Progress
Successful management usually requires a combination of:
- Identifying contributory factors
- Reducing triggers
- Improving jaw awareness
- Treating symptoms
Improvement is often gradual and occurs over months with sustained effort. Temporary fluctuations in symptom severity are common and do not necessarily indicate treatment failure.
