Medically reviewed by Brittany Ferri, PhD
Grinding Your Teeth at Night? Common Treatments You Need to Know
There is a common misconception that teeth grinding is inherently abnormal – a disease to be cured. However, research indicates that occasional teeth grinding is quite common, or dare we say, normal. For example, one study found that 60% of the population exhibits some level of rhythmic masticatory muscle activity (RMMA) – jaw clenching and teeth grinding – during sleep, indicating that these jaw movements are a natural, and perhaps even adaptive, physiological response during sleep.
Similarly, occasional jaw clenching while awake is not inherently problematic. The issue arises when these behaviors become so frequent or intense to the extent that they negatively impact health.
With this new mindset, the way to relieve teeth grinding and clenching is by managing symptoms and reducing the factors that seem to increase the grinding behavior, rather than seeking a complete cure.
Below are some intervention approaches that are often recommended :
Mouthguards
Mouth guards, also known as night guards or occlusal splints, are often recommended to protect teeth from grinding damage. They don’t prevent grinding but help shield teeth from harm. Tooth wear can also be caused by diet, medical conditions like acid reflux, and medications, so it’s important to consider these factors as well.
Determining whether you grind your teeth during the day or night can help you decide when to wear your mouth guard for the best results. Some people find temporary relief from grinding with mouth guards, possibly due to a ‘novelty effect,’ where the muscles adjust to the new device. Using mouth guards intermittently, such as one week on and one week off, may help maintain this effect.
Mouth guards vary in cost from several hundred to several thousand pounds, with no evidence suggesting that one type is superior. However, for those with sleep apnea, a specific mouth guard called a Mandibular Advancement Device (MAD) can reduce grinding by improving airflow and reducing sleep disruptions.
For more details, read our articles on mouthguards.
Botox
Botox, commonly used to smooth facial wrinkles, can also relieve pain and headaches from teeth grinding or clenching by temporarily weakening the jaw muscles. This reduces the force of muscle contractions during these episodes, though it doesn’t stop the behavior. Injections are needed every 3-6 months to remain effective.
Research shows that Botox can improve pain levels and jaw movement range. It’s generally safe but can cause short-term side effects like muscle soreness, altered smiles, or chewing difficulties.
Treatment costs range from USD 350 to USD 1,200, depending on dosage and location. There are no standardized protocols for using Botox to treat bruxism, including optimal dosages, injection sites, and preferred brands. For more details, read our guide on Botox for bruxism.
Medications
Clonazepam, an anti-seizure medication, has shown a 40% reduction in jaw motor events in older patients with insomnia-related grinding/clenching. Clonidine, an antihypertensive drug, has also been found to reduce bruxism in several studies.
However, due to limited study subjects and potential side effects, these drugs are not recommended for bruxism management. Other medications, such as amitriptyline, bromocriptine, levodopa, propranolol, and tryptophan, have been tested but are either ineffective or have severe side effects, making them unsuitable for treating sleep bruxism.
Stress Coping Skills
How do stress and anxiety contribute to teeth grinding exactly?
Stress and anxiety are often linked to sleep bruxism, though the relationship is complex and not all studies confirm a direct association. While stress and anxiety can affect neurotransmitters related to sleep and jaw activity, research shows that individuals with sleep bruxism often have higher levels of stress-related chemicals like catecholamines and cortisol, which may contribute to jaw movements during sleep.
Daytime emotions and activities, such as anxiety and jaw-clenching habits, can carry over into nighttime and affect sleep patterns. Additionally, stress and anxiety may lead to increased consumption of substances like alcohol, caffeine, and tobacco, which can worsen sleep bruxism.
Chronic stress can lead to health issues, but effective stress management can improve daily functioning and sleep quality. Techniques like recognizing tension, deep breathing, and muscle relaxation can help manage stress and potentially reduce sleep bruxism.
So is the solution to reduce stress / anxiety?
Stress is an inevitable aspect of our modern life, while anxiety is a common trait among us. While it’s not realistic to completely eliminate stress from our daily lives, we can however:
(1) become more aware of stressors and how our body responds to them (“What is your subconscious response to stress?”)
(2) cultivate habits to help us cope with stress more effectively
Stressors vary greatly between individuals and can include minor activities like driving or working on complex tasks. It’s important to be aware of activities that induce stress and how they affect jaw behavior. Identifying triggers and developing habits to counteract clenching or grinding can help.
For instance, take deep diaphragmatic breaths followed by long exhales when you notice clenching. Regular mini-breaks to stretch and relax your jaw, and practicing relaxation techniques before bed, can reduce muscle tension and improve sleep.
Mental stressors, like worries about the future or past, can be managed through counseling or therapy, particularly Cognitive Behavioral Therapy (CBT), which helps challenge negative thoughts. Mindfulness and a regular self-care routine, including exercise, nature, meditation, journaling, or hobbies, are also beneficial for managing stress.
Biofeedback
Biofeedback is a non-invasive intervention shown to reduce teeth grinding or clenching in both awake and sleep bruxism by allowing individuals to sense and track these behaviors. These devices alert the user when grinding or clenching is detected, and during sleep, feedback does not need to wake the user to be effective.
Biofeedback devices come in various forms, such as beeping headbands, vibrating mouthguards, and forehead patches that give a small jolt. Recent advances focus on comfort, accurate detection, and feedback signals that prevent long-term adaptation, along with data to help identify triggers.
Studies show immediate reduction in teeth grinding with biofeedback use, though effects may diminish without the device. While conclusive evidence on the most effective type of biofeedback is lacking, integrating biofeedback with other treatments is worthwhile due to its noninvasive, reversible nature, and few side effects.
For more details, read our article on biofeedback for bruxism.
Sleep Hygiene
Sleep disruptions can contribute to teeth grinding, which often occurs during light sleep and brief awakenings. To reduce these disruptions, examine and improve your sleep routine and environment.
Ensure your bedroom is cool, dark, and quiet. Minimize disturbances, such as sleeping with pets, partners, or children who move frequently.
Reduce stimulants and avoid over-stimulating activities before bed. Limit caffeine intake after 2 pm, avoid vigorous exercise or late-night work close to bedtime, and reduce smoking and alcohol consumption, as they can affect sleep quality.
Physiotherapy
When your jaw muscle or joint is tender, avoiding movement can lead to further strain. Physiotherapy exercises are designed to gently stretch muscles, reduce tension, and build confidence in moving the jaw, aiding recovery.
Physiotherapy complements stress coping skills by helping you re-learn a relaxed jaw position and proper posture, preventing strain in the head, neck, and shoulders. These exercises also increase awareness of jaw tension, making it easier to catch yourself clenching or grinding.
Jaw and facial muscle stretches can be adapted into brief exercises during mini breaks. Studies show physiotherapy can reduce jaw muscle pain and improve mobility. Common exercises include jaw, neck, and shoulder stretches, tongue positioning techniques, and facial muscle relaxation.
There is no universally accepted physiotherapy regimen for bruxism, as various protocols are effective. Move at a comfortable pace and be consistent. Some initial discomfort is normal and indicates the exercises are targeting affected muscles. Communicate any pain with your physiotherapist to ensure exercises are performed correctly and safely. Progress may take weeks or months to become significant.
Pain Relief
Various methods are available for symptomatic pain relief (jaw pain, headaches).
These include:
- Over-the-counter anti-inflammatory agents (NSAIDs)
- Hot or cold compresses
- Massages
- Acupuncture
- Transcutaneous Electrical Nerve Stimulation (TENS)
Although they don’t directly target teeth grinding, pain management is crucial because pain/discomfort also acts as a stressor, potentially exacerbating muscle tension. By alleviating pain, these treatment options can indirectly help break the cycle of tension and discomfort.
Orthodontics or Surgery
Unfortunately, there are still physicians who believe that teeth grinding is caused by misaligned bites despite decades of research that have conclusively demonstrated that bruxism is primarily driven by the central nervous system, rather than by discrepancies or abnormalities in how your teeth fit together. A comprehensive review of over 40 studies has found no evidence linking dental bite features or the anatomy of the orofacial skeleton to the origins of sleep bruxism.
Given these findings, surgery or orthodontic treatments that create irreversible occlusal changes for teeth grinding concerns is not advisable.
Conclusion
Addressing teeth grinding or jaw clenching starts with recognizing that it’s a normal, adaptive behavior that has unfortunately become a persistent habit. Effective management involves a multifaceted approach, ranging from the use of protective mouthguards to the muscle-relaxing benefits of Botox, as well as holistic methods like biofeedback, stress management, and physiotherapy. There is no universal solution, as the underlying cause and contributing factors vary from person to person.
Finally, it’s crucial to develop awareness of when these behaviors occur—whether during sleep, while awake, or in specific situations—and to identify the underlying triggers. By embracing a combination of these strategies, which is consistent with the multifactorial nature of bruxism itself, individuals can find relief and enhance their quality of life, making teeth grinding a manageable issue rather than a significant health concern.
