Though an estimated 8% of the population suffers from sleep bruxism and 20% from awake bruxism (Lavigne et al., 2008), research has yet to yield a conclusive cure for the syndrome. Most treatments seek to reduce the frequency and severity of bruxism episodes while some additionally work to reduce the physical symptoms of bruxism such as tooth erosion and facial muscle pain. The former include pharmaceutical treatments and various behaviour modification therapies, while the latter includes occlusal splints or mouth guards.
Drug Therapy
Various psychoactive drugs have been tested in the treatment of teeth grinding and clenching. Successful treatment has been attested with Topiramate (Mowla & Sabayan, 2010), Gabapentin (Madani et al., 2013), and Hydrozine (Ghanizadeh, 2013), but all of these drugs have potential side-effects including dependence, increase in suicidal thoughts, and a range of other psychological complications.
Additionally, research has not shown a significant improvement in bruxism symptoms vis-a-vis a proper control group. In fact, Topiramate was only tested in two participants, while Hydroxyzine had no control group, and Gabapentine was not found to offer significant improvement over the control group wearing dental night guards. These drugs work by suppressing nervous arousal and thus reducing grinding and clenching, but they cannot guarantee full cessation.
In severe cases, medications blocking or reducing REM sleep cycles when bruxism is most likely to occur have also been suggested (Thompson, Blount & Krumholz, 1994). Given the importance of REM sleep to memory, problem solving, and other cognitive functions, such drugs are inadvisable outside of the most severe and intractable cases.
Though improvement may been seen with drug therapies, the research is insufficient and the risk of side-effects too great to recommend drug therapy as a first choice in bruxism treatment.
Behavioural Therapy
Because bruxism is believed to be related to stress and coping strategies, researchers have also investigated the efficacy of behavioural therapies in reducing the symptoms of bruxism.
It is suggested that aversive conditioning or biofeedback may be effective treatments (Shetty et al., 2010; Thompson, Blount & Krumholz, 1994) but there is no definitive research exploring their efficacy. Similarly, Habit Reversal Technique has been employed with reasonable success but symptoms still remain, and the technique has not yet been studied in comparison with either other treatments or a control group (Rosenbaum & Ayllon, 1981).
Though cognitive behavioural treatment has also been frequently recommended for the treatment of bruxism (Orthlieb et al., 2013), it seems to have little effect. Researchers have found that cognitive behavioural therapy offers no significant difference in bruxism improvement as compared to simply wearing a night mouth guard (Ommerborn et al., 2007).
Though most researchers and practitioners advise some sort of behavioural or relaxation therapy for bruxism sufferers, there is minimal evidence to support the effectiveness of these treatments. In fact, any effect these therapies may have is only partial and so is not enough to fully protect tooth enamel or prevent jaw pain and bruxism induced migraines.
Custom Dental Mouth Guards
Though other treatments have been explored, in any study where mouth guards were compared with other treatment techniques, the mouth guard proved equally as effective as the alternative treatment (Madani et al., 2013; Ommerborn et al., 2007). Unlike drug or behaviour therapies which provide only partial reduction or cessation of teeth grinding, a mouth guard is the only treatment which offers continuous protection of the tooth enamel and cushioning for the jaw muscles.
Beyond the protective role of dental night guards, they have also been found to actively reduce the frequency and severity of teeth grinding and clenching episodes (Gianasi et al., 2013). Additionally, there are no known side-effects of wearing mouth guards and, if purchased from an online dental clinic like ProTeethGuard.com, high quality dental night guards are comparatively inexpensive. A single custom mouth guard can last up to 5 years and costs only $100-$200, rather than the costly hassle of regular prescriptions or therapy sessions.
Custom dental night guards are the first suggestion of most dentists as well as the most commonly cited treatment for bruxism in dental and medical research. They are not only a helpful long-term treatment for bruxism, but also provide an immediate solution to tooth degradation and facial pain.
Conclusion
Teeth grinding and clenching can lead to a range of symptoms from migraine headaches to facial pain, insomnia, and tooth erosion. Untreated bruxism can result in expensive dental bills and prolonged physical and psychological suffering. Though there is no known cure, there are a number of treatments available.
Researchers have found success with several psychoactive drugs but only in limited samples and with the risk of damaging side-effects. Behavioural therapies have also shown some promise, but ultimately, the only treatment guaranteed to reduce symptoms and protect tooth enamel is the use of a properly fitted custom dental night guard. Dental night guards reduce the frequency and intensity of teeth grinding and clenching while also providing a durable protective layer between the teeth.
References
Ghanizadeh, A. (2013). Treatment of bruxism with hydroxyzine: preliminary data. European Review for medical and Pharmacological Sciences, 17, 839-841.
Giannasi, L.C., Santos, I.R., Alfaya, T.A., Bussadori, S.K., de Oliviera, L.V.F. (2013). Effect of an occlusal splint on sleep bruxism in children in a pilot study with a short-term follow up. Journal of Bodywork & Movement Therapies, 17, 418-422.
Lavigne, G.J., Khoury, S., Abe, S., Yamaguchi, Y., Raphael, K. (2008). Bruxism physiology and pahtology: An overview for clinicians. Journal of Oral Rehabilitation, 35, 476-494.
Madani, A.S., Abdollahian, E., Khiavi, H.A., Radvar, M., Foroughipur, M., Asadpour, H., Hasanzadeh, N. (2013). The efficacy of gabapentin versus stabilization splint in management of sleep bruxism. Journal of Prosthodontics, 22, 126-131.
Mowla, A., Sabayan, B. (2010). Topiramate for bruxism: Report of 2 cases. Journal of Clinical Psychopharmacology, 30(3).
Ommerborn, M.A., Schneider, C., Giraki, M., Handschel, J., Franz, M., Raab, W.H.-M. (2007). Effects of an occlusal splint compared with cognitive-behavioural treatment on sleep bruxism activity. European Journal of Oral Sciences, 115, 7-14.
Orthlieb, J.-D., Tran, T.-N.-N., Camoin, A., Mantout, B. (2013). Propositions for a cognitive behavioural approach to bruxism management. Journal of Stomatology & Occlusion Medicine, 6, 6-15.
Rosenbaum, M.S., Ayllon, T. (1981). Treating bruxism with the habit reversal technique. Behav. Res. & Therapy, 19, 87-96.
Shetty, S., Pitti, V., Babu, C.L.S., Kumar, G.P.S., Deepthi, B.C. (2010). Bruxism: A literature review. Journal of the Indian Prosthodontic Society, 10(3), 141-148.
Thompson, B.A., Blount, B.W., Krumholz, T.S. (1994). Treatment approaches to bruxism. American Family Physician.