Bruxism

What is Bruxism?

Bruxism is repetitive jaw-muscle activity, including clenching or grinding of the teeth and bracing or thrusting of the lower jaw. It can happen during sleep or while awake, and experts now describe these as two separate behaviors.^{[1, 2]}

Common symptoms

Bruxism can cause tooth wear, morning jaw pain, headaches in the temples, damage to teeth and dental work, and restricted movement of the jaw joint.^[1] Other common signs are:

• Grinding or clenching sounds during sleep, often noticed by a partner
• Jaw, face or ear pain and a tired or tight feeling in the jaw muscles
• Worn, flattened or chipped teeth and tooth sensitivity
• Disrupted sleep

Bruxism itself is not a painful disorder, but it can worsen existing headache, particularly when it occurs together with a temporomandibular disorder (TMD), a problem of the jaw joint and chewing muscles.^[3]

Causes and risk factors

The cause is not fully understood. Sleep bruxism is thought to be a centrally mediated phenomenon linked to brief arousals from sleep and activation of the autonomic nervous system.^[1] Genetics, stress, oral habits and changes in the central nervous system have all been proposed as contributors.^[4]

Stress and anxiety are often linked with bruxism, but the research is not settled. A meta-analysis found that adults with sleep bruxism reported higher stress scores, and it rated the quality of evidence as very low.^[5] A later systematic review found an apparent association between bruxism, TMD and psychological factors.^[6]

Sleep bruxism is most common in children, so a child who grinds should be assessed by a dentist or pediatrician.^[1]

How it is diagnosed and treated conventionally

Diagnosis is usually clinical, based on your history and an examination by a dentist or physician, along with a check for sleep disorders and other contributing factors.^[1] There is no single agreed standard for treatment.^[4]

Conventional care combines education, counseling, lifestyle changes and dental appliances.^[1] Physical therapy methods such as exercises, relaxation and electrotherapy are also used, although a systematic review of 24 studies rated the evidence for them as very low quality.^[7]

Why Bruxism calls for a whole-person approach

Bruxism is not only a dental problem. Stress, sleep, breathing during sleep, muscle tension and the jaw joint can each play a part, and treating one may affect the others.^{[1, 3]}

Because the evidence for any single treatment is limited, care that looks at the whole picture is a reasonable complement to dental protection.^[4]

Stress and the nervous system

Stress and anxiety are associated with bruxism in studies of adults, although causation has not been shown.^{[5, 6]} The autonomic nervous system, which controls our stress response, is thought to be involved in sleep bruxism.^[1]

Sleep

Sleep bruxism is linked to brief arousals from sleep, and clinicians look for underlying sleep disorders when assessing it.^[1]

Jaw muscles and the jaw joint

Clenching and grinding can overload the chewing structures and may give rise to typical TMD symptoms, probably under the influence of psychological factors.^[6] Bruxism, TMD and headache often occur together, though whether one causes another is still debated.^[3]

Daily habits

Awake bruxism often involves unnoticed habits of clenching during the day, and counseling and lifestyle changes are part of standard care.^{[1, 4]}

Acupuncture for Bruxism

What the research shows

Research on acupuncture for bruxism itself is very limited. A systematic review of physical therapy for bruxism found only two acupuncture studies among 24 included articles and rated the overall evidence as very low quality because of poor study methods.^[7] A randomized trial of 80 adults compared dry needling, a related needling technique, with botulinum toxin, medication and manual therapy for bruxism-related muscle pain. Outcomes were similar across all four groups over 12 weeks, and the trial had no untreated or sham group, so it cannot show that any of them worked better than no treatment.^[8] Dry needling is not the same as traditional acupuncture.

There is more research on jaw-joint (TMD) pain, which often occurs with bruxism, but it is still weak. A review of seven sham-controlled trials of acupuncture for TMD concluded the evidence was limited.^[9] A review of four trials of myofascial TMD pain found acupuncture performed similarly to occlusal splints and better than placebo acupuncture, although the trials were small and short.^[10] A 2024 review of 52 studies of orofacial pain found that most had a high risk of bias and rated the evidence very low in certainty.^[11] A large network meta-analysis of chronic TMD pain found that acupuncture probably improved physical functioning, while the treatments most effective for pain relief were coping-based and movement-based therapies such as cognitive behavioral therapy and jaw exercises.^[12]

Acupuncture has also been studied for poor sleep. A meta-analysis of 24 trials found it improved sleep quality scores compared with medication, mainly after three or more weeks, though the trials varied a lot.^[13] This is evidence for insomnia, not for bruxism.

How acupuncture may work

For bruxism there is no good research on how acupuncture might work. In practice it is used to relax tense jaw, neck and shoulder muscles and to calm the stress response, which may help with the pain and sleep problems that accompany bruxism. These are proposed explanations, not shown effects on grinding itself.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the face, jaw, neck and limbs, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Acupuncture does not replace a night guard or dental evaluation.

Ayurvedic medicine for Bruxism

The Ayurvedic view

Ayurveda has no classical name that exactly matches bruxism. Grinding of the teeth in sleep is described in traditional texts as dantagharsha, and practitioners often link it with aggravated Vata, the principle said to govern movement and the nervous system. In this traditional framework, worry, irregular routines and poor sleep are thought to aggravate Vata. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to calm Vata, such as warm, regular meals, a steady bedtime and less caffeine and alcohol
• Gentle warm oil massage of the head, neck and jaw (abhyanga and shiro-abhyanga)
• Breathing practices and relaxation, such as pranayama and meditation
• Herbs prescribed individually by a qualified practitioner, such as ashwagandha, traditionally used for stress and sleep
• Panchakarma only where traditionally and medically appropriate

Panchakarma is not appropriate during pregnancy, acute illness or frailty.

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic treatment for bruxism, so we cannot say whether it reduces grinding or clenching. Research exists for ashwagandha in stress, anxiety and sleep, described below under herbal medicine.^{[15, 16]}

Quality matters with Ayurvedic products. About one fifth of Ayurvedic medicines bought online in one study contained detectable lead, mercury or arsenic, so we ask that any product come from a tested source.^[17]

Herbal medicine for Bruxism

Herbs and formulas that have been studied

We found no clinical trials of herbs or Chinese formulas for bruxism. Ashwagandha (Withania somnifera), a traditional Ayurvedic herb, has been studied for stress, anxiety and sleep, which are factors commonly linked with bruxism.^{[15, 16]}

What the research shows

The evidence is for stress and sleep, not for bruxism. A meta-analysis of 12 randomized trials (1,002 participants) found that ashwagandha reduced stress and anxiety scores compared with placebo, but it rated the certainty of the evidence as low and results varied greatly between trials.^[15] A meta-analysis of five trials (400 participants) found a small improvement in sleep, and noted that safety data for long-term use are limited.^[16] A further review of five trials found improvements in anxiety and some sleep measures, and called for larger studies.^[18] Whether easing stress or sleep reduces bruxism has not been shown.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19] Tell us about all your medicines, including sedatives, antidepressants and thyroid medicine, so that any herb can be checked.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[17] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often links jaw clenching with tension or constraint of liver qi and with stress. Researchers studying bruxism look at stress responses, arousals from sleep and autonomic nervous system activity, which loosely parallel this picture.^{[1, 5]}

Ayurveda's aggravated Vata describes restlessness and nervous system overactivity, which may parallel the arousal and autonomic activity seen in sleep bruxism.^[1] No study has shown that a dosha or a TCM pattern corresponds to a specific biological process in bruxism.

How this care fits with your medical care

Integrative care for bruxism is complementary. Keep your dentist and physician, keep using any night guard or dental appliance, and do not stop or change prescribed medicines without your prescriber. We do not diagnose bruxism or its cause, and wear on your teeth or persistent jaw pain should be evaluated by a dentist.

Please bring your diagnosis, any dental or sleep-study reports, a full list of medicines and supplements, and details of any dental appliance or injections you use. Tell us if you snore loudly or stop breathing in sleep, because a sleep disorder may need its own assessment.^[1]

When to seek urgent medical care

Most bruxism is not an emergency, but some symptoms need prompt assessment.

• Jaw locked open or closed, or sudden inability to open the mouth fully
• Severe jaw, face or tooth pain, or a swollen, hot, red face or jaw with fever
• Cracked or broken teeth, or a loose tooth after a bite injury
• Pauses in breathing, gasping or choking during sleep, or severe daytime sleepiness
• Severe sudden headache, or facial numbness or weakness

For a locked jaw, a swollen face with fever, a severe sudden headache, or facial numbness or weakness, call 911 or go to the nearest emergency department. For the other symptoms, contact your dentist or physician promptly.