What is bruxism, and why does it happen?
Bruxism is a condition in which a person grinds or clenches the teeth involuntarily. It can happen during the day or during sleep. According to a systematic review, about 13% of adults report frequent grinding during sleep, and 22% to 31% report clenching or grinding while awake (Manfredini et al., 2013). It appears to be more frequent in people with high levels of stress and anxiety.
The causes are varied and often combined. Psychological factors such as stress, anxiety, depression or frustration are considered the most important. Physical factors include bite problems, sleep disorders such as sleep apnea, and side effects of some medications. In some people, grinding is also linked to alcohol, caffeine or tobacco use, or to certain drugs.
Grinding is a "parafunctional" activity: muscle activity unrelated to normal functions such as eating or speaking. During grinding, strong and prolonged forces can act on the teeth, which explains the damage it can cause. Treatment at the clinic starts with a diagnosis, then a personal plan that takes into account the severity, the damage already done and the likely causes.
Grinding teeth in sleep vs clenching teeth during the day
Night grinding is more common than many people think: about 13% of adults report frequent grinding in their sleep, and in children the figures vary widely between studies, from about 6% to about 50% (Machado et al., 2014). People with sleep disorders such as sleep apnea, snoring or insomnia, a family history of bruxism, or high stress before sleep are more likely to grind.
Sleep bruxism
It is hard to diagnose because the person is usually unaware of it; often a partner or family member notices the noise first. Other signs include waking up with headaches or jaw pain, tired facial muscles in the morning, sensitive teeth and visible wear. A custom night guard is the usual way to protect the teeth.
Awake bruxism
Daytime bruxism is usually clenching rather than active grinding, often during concentration, screen work or driving. People are more often aware of it but find it hard to control. Relaxation techniques, biofeedback and cognitive behavioral therapy can help.
Teeth grinding in children
Grinding during sleep is also reported in children, with figures that vary widely between studies. Mention it to your child's dentist at a check-up, so they can look for signs of wear and decide whether follow-up is needed (see teeth grinding in children). Snoring or pauses in breathing during sleep also call for a visit to the pediatrician.
What damage can teeth grinding cause?
The most visible damage is loss of enamel, the hard outer layer of the tooth, which leads to sensitivity to hot, cold, sweet and acidic foods. This wear is irreversible: the body cannot make new enamel. At advanced stages, wear can expose the dentin and even reach the pulp, causing inflammation and severe pain.
Beyond the teeth, chronic pressure on the jaw joints (TMJ) can lead to jaw joint disorders, with facial pain, ear pain, ringing in the ears and difficulty opening or closing the mouth. Tired chewing muscles and chronic headaches are also common.
Grinding can also contribute to receding gums, cracked teeth and broken restorations. In severe cases, worn teeth shorten the lower face and change the bite.
Early intervention is the key to preventing irreversible damage. Regular check-ups detect early wear, and a night guard protects the teeth; when needed, restorations such as crowns or veneers rebuild worn teeth. Selective grinding of the biting surfaces is irreversible, and there is not enough evidence that it treats bruxism (Koh & Robinson, 2003).
How is teeth grinding linked to headaches and migraines?
Grinding puts strong pressure on the muscles of the jaw, face and neck. The temporalis muscle, one of the main chewing muscles, attaches at the temples: when it stays contracted for long periods, the pain can spread to the temples and head. The trigeminal nerve, which carries sensation from the face and jaw, may also be involved in some patients.
In selected cases, the dentist may consider an NTI-TSS night guard, which covers only the front teeth and aims to reduce involuntary muscle activity; the guards fitted at the clinic are made by Glidewell in the United States. It requires regular dental follow-up, because long-term use without monitoring can change the bite, and there is a rare risk of swallowing or inhaling the device. Migraines always call for an assessment by your physician.
Conditions associated with bruxism
Bruxism often occurs together with other conditions. It has been described in connection with sleep disorders such as sleep apnea and restless legs syndrome, with attention disorders, with anxiety and depression, with jaw joint disorders, with acid reflux (GERD) and with chronic migraines. This is why the assessment looks at the whole picture, not only at the teeth, and may involve other physicians or therapists when needed.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
How is bruxism diagnosed?
Diagnosis is based mainly on a careful clinical examination and a detailed conversation with the patient, with additional tests when needed.
1. Clinical examination
The dentist looks for typical signs: wear on the biting surfaces, small cracks in the enamel, enlarged chewing muscles and bite marks on the sides of the tongue or inside the cheeks. The jaw joints are examined and their sounds during movement are noted.
2. Questions about your symptoms
Does your partner hear you grinding at night? Do you wake up with jaw, head or ear pain? Is your jaw tired or hard to open in the morning? The answers help assess the problem and its severity.
3. X-rays when indicated
X-rays do not diagnose bruxism. They are taken only when the information is expected to change treatment, at the lowest reasonable dose (the ALARA principle): for example to check for cracks, decay or the bone supporting the teeth (panoramic X-ray or local X-rays).
4. Additional tests
When a sleep disorder such as sleep apnea is suspected, the dentist may refer you for a sleep study with an appropriate physician. Portable devices that measure chewing muscle activity during sleep (EMG) and questionnaires can complete the picture.
How to stop grinding teeth: bruxism treatment options
Bruxism treatment combines dental, behavioral and sometimes medical approaches, adapted to the severity and the likely causes. The first line is usually a custom night guard (occlusal splint), which protects the teeth and reduces the load on the muscles and jaw joints. Remember: a night guard protects the teeth from wear but does not cure bruxism itself.
- Night guard: the standard protective measure (Manfredini et al., 2015)
- Stress management: relaxation, breathing exercises, cognitive behavioral therapy
- Biofeedback and physiotherapy: a positive effect on grinding episodes in a review of reviews (Soares-Silva et al., 2024)
- Treating contributing conditions: sleep apnea, reflux, medication review with your physician
- Restoring worn teeth: durable restorations when there is significant damage, as part of full mouth rehabilitation if needed
Practical steps that may help you stop grinding teeth at night: avoid caffeine and alcohol in the evening, keep a regular sleep routine, and notice daytime clenching (lips together, teeth apart, jaw relaxed).
Mouth guard for teeth grinding: what it does
A mouth guard for sleeping, or night guard, is a physical barrier that prevents direct contact between the upper and lower teeth. It spreads the forces generated during grinding, reduces muscle tension and limits enamel wear. Hard guards are usually recommended for severe bruxism because they resist wear; softer guards may suit milder cases. Most patients feel comfortable with the guard after a few days. The guard is the standard protective measure, but the evidence for its effect on bruxism itself is limited (Macedo et al., 2007), so it is often combined with other measures.
Botulinum toxin (Botox) injections in the chewing muscles
Botulinum toxin blocks the signal between nerve and muscle and reduces the activity of the chewing muscles. Injections may reduce the intensity of grinding, but this is a symptomatic and temporary treatment that does not address the cause of bruxism, and bruxism is not among the FDA-approved indications of the product. The effect is felt after a few days and wears off, so repeated injections are needed.
It is not suitable for everyone: pregnant or breastfeeding women, people with certain neuromuscular diseases or an allergy to the product are not candidates. Possible side effects include local pain, bruising and, rarely, temporary difficulty chewing or speaking. A review of systematic reviews found a positive effect on grinding episodes, but long-term safety data are still lacking (Soares-Silva et al., 2024).
Hypnosis and behavioral approaches
Hypnosis and other behavioral approaches have been studied for bruxism because grinding is often an unconscious response to stress. The evidence for hypnosis is still limited; if you choose it, combine it with a night guard to protect the teeth and see a qualified practitioner.
Grinding and acid erosion: protecting worn enamel
Dental erosion is the gradual loss of tooth structure caused by acids from food, drinks or medical problems such as reflux. Bruxism often makes the damage worse, because grinding forces act on enamel already weakened by acid.
01
Diet
Limit acidic foods and drinks such as citrus fruits, wine, sodas and juices, preferably keeping them to mealtimes. Do not brush right after an acidic food or drink: rinse with water or chew sugar-free gum instead.
02
Medical factors
Treating acid reflux (GERD) or an eating disorder is essential to stop erosion. Fluoride toothpaste and professional fluoride varnish strengthen enamel, and a night guard protects it from grinding forces.
03
Regular check-ups
Check-ups detect early signs of erosion and wear. When damage is already present, composite restorations, veneers or crowns can restore function and appearance.
Teeth grinding consultation in Jerusalem, in English
Dr Haim Aseriel, a US-trained dentist (DDS, NYU College of Dentistry), examines the signs of grinding, explains the options in English and gives you a written plan and estimate, with itemized receipts you can submit to your insurer. The clinic is at 12 HaTnufa Street in Talpiot, south Jerusalem, open Sun 8:00–19:00 · Mon 9:00–19:00 · Tue–Wed 9:00–21:00 · Thu 8:30–21:00 · Fri 8:00–14:00.
Bruxism: frequently asked questions
Bruxism is the involuntary grinding or clenching of the teeth, during sleep or while awake. According to a systematic review, about 13% of adults report frequent grinding during sleep, and 22% to 31% report clenching or grinding while awake.
Teeth grinding usually has several combined causes. Stress, anxiety and frustration are considered major factors; others include sleep disorders such as sleep apnea, bite problems, some medications, and alcohol, caffeine or tobacco use.
There is no single cure for night grinding. A custom night guard protects the teeth from wear, and managing contributing factors helps: stress reduction, treating a sleep disorder such as sleep apnea, and limiting caffeine and alcohol in the evening. Biofeedback and physiotherapy have shown a positive effect on grinding episodes in reviews of systematic reviews.
A night guard does not cure bruxism itself, but it protects the teeth from wear. It is the standard protective measure, but the evidence for its effect on grinding itself is limited, so it is often combined with treatment of factors such as stress or sleep disorders.
Botulinum toxin injected into the chewing muscles may reduce the intensity of grinding, but it is a symptomatic and temporary treatment that does not address the cause, and bruxism is not among the FDA-approved indications of the product. Data on long-term safety are still lacking.
Sources
- Manfredini D et al., Journal of Orofacial Pain, 2013 – View the study
- Machado E et al., Dental Press Journal of Orthodontics, 2014 – View the study
- Manfredini D et al., Journal of Oral Rehabilitation, 2015 – View the study
- Macedo CR et al., Cochrane Database of Systematic Reviews, 2007 – View the study
- Koh H & Robinson PG, Cochrane Database of Systematic Reviews, 2003 – View the study
- Soares-Silva L et al., Sleep and Breathing, 2024 – View the study
- U.S. Food and Drug Administration, BOTOX Prescribing Information, 2023 – View the document
- Stapelmann H & Türp JC, BMC Oral Health, 2008 – View the study
