Bruxism is a common parafunctional activity characterized by repetitive jaw muscle activity, including clenching or grinding of the teeth. It can occur during sleep (sleep bruxism) or while awake (awake bruxism) and is associated with tooth wear, temporomandibular disorders, and orofacial pain.
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Video 🔽 What are the consequences of bruxism? ... In many cases, the patient does not know that he suffers from bruxism, and is detected when he attends the dentist motivated by another consultation.Among the most widely recommended treatments are night guards, also known as occlusal splints. However, an important clinical question remains: do night guards truly help manage bruxism, or do they simply protect the teeth from its consequences?
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✅ What Is Bruxism?
Bruxism is defined as a repetitive masticatory muscle activity characterized by clenching, grinding, or bracing of the mandible. It is considered a multifactorial condition, influenced by biological, psychological, and neurological factors rather than occlusal discrepancies alone.
Types of Bruxism
▪️ Sleep bruxism: A sleep-related movement disorder associated with micro-arousals.
▪️ Awake bruxism: A behavioral condition often linked to stress or concentration.
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The etiology of bruxism is complex and multifactorial:
▪️ Psychological factors, such as stress, anxiety, and emotional tension
▪️ Central nervous system regulation, including sleep arousal mechanisms
▪️ Medications, particularly selective serotonin reuptake inhibitors (SSRIs)
▪️ Sleep disorders, such as obstructive sleep apnea
▪️ Lifestyle factors, including caffeine, alcohol, and tobacco use
Current evidence indicates that bruxism is centrally mediated, rather than caused by dental occlusion alone.
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Night guards are custom-made or prefabricated intraoral appliances designed to cover the occlusal surfaces of the teeth, usually fabricated from acrylic or thermoplastic materials.
Their primary functions include:
▪️ Redistributing occlusal forces
▪️ Reducing tooth-to-tooth contact
▪️ Protecting dental structures from wear
▪️ Decreasing muscle hyperactivity in some patients
Importantly, night guards do not eliminate bruxism, but they may reduce its harmful effects.
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Scientific evidence supports that night guards:
▪️ Protect teeth from further wear
▪️ May reduce muscle pain and morning discomfort
▪️ Can improve patient awareness of parafunctional habits
However, they do not consistently reduce the frequency of bruxism episodes, particularly in sleep bruxism. Their effectiveness is primarily protective rather than curative.
📊 Comparative Table: Bruxism Treatment Options
| Treatment Approach | Clinical Benefits | Limitations |
|---|---|---|
| Night Guards (Occlusal Splints) | Protect teeth, reduce wear, may decrease muscle discomfort | Do not eliminate bruxism activity |
| Behavioral Therapy | Addresses stress-related and awake bruxism factors | Requires patient compliance and time |
| Botulinum Toxin Injections | Reduces muscle hyperactivity and pain | Temporary effect, invasive, higher cost |
| Pharmacological Management | May help in selected neurological or sleep-related cases | Limited evidence, potential side effects |
Night guards remain a cornerstone in the management of bruxism due to their non-invasive nature and protective benefits. Nevertheless, their role should be clearly explained to patients: they manage the consequences, not the underlying neurological or behavioral causes.
Optimal management often requires a multidisciplinary approach, combining occlusal therapy with behavioral strategies, stress management, and, when indicated, pharmacological or adjunctive therapies.
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▪️ Use custom-fabricated night guards for better fit and compliance
▪️ Combine occlusal splints with behavioral and stress-reduction therapies
▪️ Monitor patients regularly for appliance wear and symptom progression
▪️ Address contributing factors such as sleep disorders or medication use
▪️ Educate patients that night guards protect teeth but do not cure bruxism
✍️ Conclusion
Night guards are an effective and evidence-based tool for protecting teeth and reducing symptoms associated with bruxism. While they do not eliminate the condition itself, they play a critical role in preventing irreversible dental damage. Comprehensive bruxism management should extend beyond occlusal appliances to address the multifactorial nature of the disorder.
📚 References
✔ Lobbezoo, F., Ahlberg, J., Raphael, K. G., Wetselaar, P., Glaros, A. G., Kato, T., & Manfredini, D. (2018). International consensus on the assessment of bruxism. Journal of Oral Rehabilitation, 45(11), 837–844. https://doi.org/10.1111/joor.12663
✔ Manfredini, D., Serra-Negra, J., Carboncini, F., & Lobbezoo, F. (2017). Current concepts of bruxism. International Journal of Prosthodontics, 30(5), 437–438. https://doi.org/10.11607/ijp.5210
✔ Macedo, C. R., Silva, A. B., Machado, M. A., Saconato, H., & Prado, G. F. (2007). Occlusal splints for treating sleep bruxism. Cochrane Database of Systematic Reviews, (4), CD005514. https://doi.org/10.1002/14651858.CD005514.pub2
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