Bruxism—defined as the habit of clenching or grinding teeth—blurs the line between medical and dental domains, demanding a multidisciplinary approach.
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✅ Signs of Bruxism
Common clinical signs include:
° Teeth grinding or clenching noises, often loud enough to wake a partner.
° Flattened, fractured, chipped, or worn-down enamel; increased tooth sensitivity.
° Jaw soreness, tightness, muscle fatigue, and restricted opening or popping.
° Headaches (especially at the temples), facial pain, earache-like symptoms.
° Hypertrophied jaw muscles, damaged dental restorations and mobility.
Parafunctional Risk Rating System (PRR)
| PRR Level | Risk Description | Clinical Indicators | Recommended Action |
|---|---|---|---|
| PRR-1 (Low Risk) | Mild parafunction | Occasional clenching/grinding, no significant wear, minimal symptoms | Monitor annually, patient education, optional QuickSplint® trial |
| PRR-2 (Moderate Risk) | Early signs of damage | Visible wear facets, jaw muscle tightness, occasional morning discomfort | 4-week QuickSplint® trial, evaluate symptom relief, consider occlusal guard |
| PRR-3 (High Risk) | Active parafunction with clinical damage | Fractured restorations, moderate tooth wear, frequent jaw pain or headaches | Occlusal appliance (custom guard), behavioral therapy, stress management, monitor every 6 months |
| PRR-4 (Very High Risk) | Severe parafunction | Severe enamel loss, multiple fractured crowns, muscle hypertrophy, TMD symptoms | Immediate occlusal appliance, multidisciplinary management (dentist, sleep medicine, psychology, neurology), consider Botox if refractory |
This system allows clinicians to quantify parafunctional risk, monitor progression, and tailor interventions.
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Bruxism is multifactorial, resting at the intersection of oral health, psychology, neurology, and systemic conditions:
° Psychosocial Stress, Anxiety, Personality Traits (e.g. aggressive, competitive, hyperactive): major drivers of awake bruxism; up to ~70% of cases linked to stress.
° Sleep-related factors: micro-arousals, obstructive sleep apnea (OSA), autonomic system activation—especially in sleep bruxism.
° Medications: SSRIs, stimulants, antidepressants, certain neurological drugs may trigger or exacerbate bruxism.
° Lifestyle: Caffeine, alcohol, smoking, recreational drugs like MDMA or stimulants.
° Medical/neurological contributors: GERD, migraines, MS, Parkinson’s, Alzheimer’s, brain injury.
° Genetics: Familial tendency seen in 21–50% of sleep bruxism cases, though specific markers are still unidentified.
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1. Diagnosis & Assessment
° Clinical exam and history: observe wear, muscle tenderness, case of fractured restorations.
° Use of diagnostic aids: dental appliance wear, partner reports, questionnaires, and in some cases polysomnography or EMG.
2. Immediate Intervention
° Dental appliances: Custom occlusal splints or mouthguards protect teeth from further damage but don’t eliminate the habit.
° Desensitization & repair: Crown, reshape teeth, restore occlusal surfaces if worn.
3. Behavioral & Lifestyle Modifications
° Stress management, CBT, relaxation techniques, improved sleep hygiene.
° Avoidance of stimulants (caffeine, alcohol), quitting smoking, and reducing hard or chewy foods.
4. Medical / Adjunct Treatments
° Medications: Muscle relaxants, adjusting causative meds, or substituting SSRIs. Evidence remains limited.
° Botox (BoNT-A): Effective in reducing muscle activity and pain for several months.
° Multidisciplinary referrals: Coordinate with sleep specialists, neurologists, psychologists, and physical therapists.
5. Follow-Up & Monitoring
° Reassess using PRR after a QuickSplint trial; adjust care plan accordingly. Annual monitoring recommended.
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Bruxism defies simple classification: as an oral parafunctional activity, it results in direct dental damage; yet, its driving forces are often rooted in psychological stress, sleep physiology, medications, or systemic illness. Dental professionals can manage the manifestations, while medical specialists address underlying contributing factors. This interplay underpins why bruxism should be viewed as both a dental and medical issue.
✍️ Conclusion
Bruxism should not be siloed—it is simultaneously a dental and medical concern. Optimal management intertwines clinical dental care, behavioral modification, lifestyle adjustment, and, when necessary, pharmacological or specialty intervention. Tools like the PRR guide risk stratification and treatment customization. Early detection and a collaborative, biopsychosocial approach greatly enhance patient outcomes.
📚 References
✔ Lobbezoo, F., et al. (2018). International consensus on the assessment of bruxism as a repetitive masticatory muscle activity with clenching or grinding. Journal of Oral Rehabilitation.
✔ Lal, S. J. (2024). Bruxism Management. In NCBI Bookshelf, StatPearls.
✔ NIDCR. (n.d.). Bruxism. National Institute of Dental & Craniofacial Research.
✔ RDH Magazine. (2020, February 29). Bruxism: A medical or dental issue? RDH Magazine.
✔ Quicksplint.com. (2016). Parafunction Risk Rating Protocol (PRR). Orofacial Therapeutics LP.
✔ Los Angeles Times. (2025, July 17). Bruxism (Teeth Grinding): Causes, Diagnosis and Treatments. Los Angeles Times.
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