What This Guide Covers and Who It Is For
This guide explains what causes teeth grinding, how to recognize it, and what treatments can help. It is written for adults and parents of children who suspect bruxism may be damaging their teeth or causing jaw pain.
Bruxism is the clinical term for involuntary clenching or grinding of the teeth. It can happen while you are awake (awake bruxism) or during sleep (sleep bruxism). While many people associate grinding with sleep, awake bruxism is actually more common. A 2019 umbrella review of systematic reviews published in the Journal of Oral Rehabilitation found that awake bruxism prevalence was estimated at 22 to 31 percent, while sleep bruxism prevalence was approximately 13 percent. [3] However, sleep bruxism is often harder to detect on your own. [2]
Many people learn they grind their teeth only after a dentist spots worn tooth surfaces, small cracks, or flattened biting edges during a routine exam. Others discover the habit when a partner hears grinding sounds at night or when they wake up with jaw soreness or headaches.
Because bruxism can damage teeth, strain the jaw joint, and disrupt sleep, early recognition and treatment matter. A prosthodontist, a dentist who specializes in restoring and replacing teeth, is often the right specialist when grinding has already caused significant wear or damage. [1]
Causes, Signs, and Risks of Teeth Grinding
Bruxism has several possible causes, and more than one factor is usually involved. Understanding the cause helps guide the right treatment.
Common Causes of Bruxism
Stress and anxiety are among the most frequently cited triggers for teeth grinding. Emotional tension can cause the jaw muscles to tighten during the day and clench during sleep. [2]
Sleep disorders play a significant role as well. Sleep bruxism is closely linked to obstructive sleep apnea (a condition where breathing repeatedly stops and starts during sleep). People with sleep apnea are more likely to grind their teeth, possibly because the brain briefly arouses from deep sleep, triggering jaw muscle activity.
Bruxism is now understood to be primarily regulated by the central nervous system rather than by local factors in the mouth. [4] Historically, bite misalignment (malocclusion) was thought to be a major cause of grinding. However, current research suggests its role is minimal. A 2020 review by Manfredini and colleagues in the Journal of Clinical Medicine concluded that occlusal factors are no longer supported as a primary cause of bruxism. [4] That said, in some individuals, an unstable bite or poorly fitting dental restorations may contribute to jaw muscle strain and discomfort, even if they are not driving the grinding itself. [1]
Certain medications have been associated with bruxism. SSRIs (selective serotonin reuptake inhibitors), a common class of antidepressants, are the most frequently reported medication-related cause. Stimulant medications, high caffeine intake, and recreational drug use have also been linked to grinding.
Signs and Symptoms to Watch For
Because sleep bruxism happens unconsciously, many people miss the early signs. Recognizing them can help you seek treatment before serious damage occurs.
- Waking up with a sore jaw, facial pain, or a dull headache around the temples.
- Teeth that appear flattened, chipped, or have small fracture lines.
- Increased tooth sensitivity, especially to cold or hot foods.
- Indentations on the sides of the tongue or the insides of the cheeks.
- A grinding or clicking sound reported by a sleep partner.
- Tightness or fatigue in the jaw muscles throughout the day.
- Earache-like pain that is not actually caused by an ear infection.
What Happens If Bruxism Goes Untreated
Grinding your teeth night after night puts enormous force on tooth surfaces, the jaw joint, and surrounding muscles. Over time, this force causes real damage.
Enamel, the hard outer layer of the tooth, can wear down to expose the softer dentin underneath. Exposed dentin leads to increased sensitivity and a higher risk of decay. Teeth may crack, fracture, or loosen. In severe cases, teeth grind down so far that they need crowns, veneers, or even extraction and replacement with dental implants. [1]
The temporomandibular joint (TMJ), the hinge joint connecting your jaw to your skull, is also at risk. Chronic clenching can strain the TMJ and surrounding muscles, leading to TMJ disorders (TMD). Symptoms of TMD include jaw pain, difficulty opening the mouth fully, clicking or popping sounds, and locking of the jaw.
Chronic headaches and disrupted sleep are other common consequences. Bruxism can reduce sleep quality for both the person grinding and their partner. [2]
Practical Details About Bruxism Treatment
Treatment for bruxism typically combines a protective dental appliance with strategies that address the underlying cause. Here is what you should know before starting.
Custom Night Guards (Occlusal Splints)
A custom night guard, also called an occlusal splint, is the most common first-line treatment for sleep bruxism. [2] It is a thin, rigid or semi-rigid tray made from dental-grade plastic that fits over your upper or lower teeth. The guard acts as a barrier so your teeth do not grind directly against each other.
Custom guards made by a dentist or prosthodontist are shaped from an impression or digital scan of your teeth. They fit precisely, stay in place, and distribute biting forces evenly. Over-the-counter boil-and-bite guards are available at pharmacies, but they are typically bulkier, less durable, and may not fit well enough to provide reliable protection.
Night guards protect teeth from further wear and can reduce jaw muscle strain. They do not stop the grinding reflex itself. That is why treating the underlying cause alongside wearing a guard gives the best long-term results.
Stress Management and Behavioral Strategies
Because stress is a major driver of bruxism, reducing tension often reduces grinding. Techniques that may help include cognitive behavioral therapy (CBT), progressive muscle relaxation, meditation, and regular physical exercise.
Daytime awareness training can also help with awake bruxism. This involves placing reminders (such as sticky notes or phone alerts) throughout your day to check whether your jaw is clenched. When you notice tension, consciously relax your jaw by placing the tip of your tongue between your front teeth.
Good sleep hygiene supports treatment as well. This includes keeping a consistent sleep schedule, limiting caffeine and alcohol in the evening, avoiding screens before bed, and keeping the bedroom cool and dark.
Medical and Dental Interventions
When bruxism is linked to a sleep disorder like obstructive sleep apnea, treating the sleep disorder is essential. A sleep study may be recommended to confirm the diagnosis. Treatment options for sleep apnea include CPAP therapy (a device that keeps the airway open during sleep) or an oral appliance that repositions the jaw.
If a medication like an SSRI is suspected as the cause, a physician may adjust the dosage or switch to a different medication. Patients should never change medication without consulting their prescribing doctor.
Because bruxism is now understood to be centrally mediated, bite correction alone is unlikely to stop grinding. [4] However, when significant wear or missing teeth have created an uneven bite, restoring proper tooth contacts can relieve muscle strain and improve comfort. This may involve orthodontic treatment, reshaping tooth surfaces (called occlusal adjustment), or replacing missing teeth. A prosthodontist can evaluate whether bite-related factors are contributing to your symptoms and recommend appropriate corrections. [1]
In some cases, botulinum toxin (Botox) injections into the jaw muscles are used to reduce the force of clenching. This approach is typically reserved for severe cases that have not responded to other treatments. Results are temporary, usually lasting three to four months per session.
Bruxism in Children
Teeth grinding is common in children, particularly during the mixed dentition stage when baby teeth and permanent teeth are both present. Many children outgrow the habit as their permanent teeth fully emerge. [2]
Treatment in children is usually conservative. Dentists typically recommend monitoring rather than immediate intervention unless there is significant tooth wear, pain, or disrupted sleep. If grinding persists into the teen years or causes noticeable damage, a night guard or other treatment may be considered.
What to Expect During Diagnosis and Treatment
Getting diagnosed and fitted for a night guard involves a few straightforward appointments. Here is a step-by-step look at the process.
The Diagnostic Exam
Your dentist or prosthodontist will examine your teeth for wear patterns, chips, and fractures. They will check your jaw muscles for tenderness and listen for clicking or popping in the TMJ. [1]
You will be asked about your symptoms, sleep habits, stress levels, and any medications you take. If a sleep disorder is suspected, your dentist may recommend a referral for a sleep study. In some cases, imaging such as X-rays or a panoramic scan is used to assess the jaw joint and bone structure.
Getting Fitted for a Custom Night Guard
If a night guard is recommended, the process typically takes two visits. At the first visit, your dentist takes an impression or digital scan of your teeth. This record is sent to a dental laboratory where the guard is custom-fabricated.
At the second visit, usually one to two weeks later, you try the guard in. Your dentist checks the fit, adjusts the bite surface as needed, and makes sure the guard is comfortable. You will receive instructions on how to wear it, typically every night, and how to clean it.
Most patients adapt to wearing a night guard within one to two weeks. Some initial awareness of the appliance in the mouth is normal. If the guard causes pain or shifts during sleep, contact your dentist for an adjustment.
Follow-Up and Long-Term Management
Your dentist will typically schedule a follow-up visit a few weeks after you start wearing the guard. This check confirms the fit is correct and that symptoms are improving.
Night guards do wear out over time, especially in heavy grinders. Expect to replace a custom guard every two to five years depending on the severity of grinding. Bring your guard to dental checkups so your dentist can inspect it for signs of wear.
Long-term management also means continuing any behavioral or medical strategies. Bruxism can come and go with life changes, stress levels, and sleep quality. Periodic reassessment helps ensure your treatment stays effective.
Cost of Bruxism Treatment
A custom night guard typically costs between $300 and $800. Costs vary by location, provider, and case complexity.
The fee usually includes the impressions or digital scan, laboratory fabrication, fitting appointment, and any initial adjustments. Some dental offices include one or two follow-up visits in the fee. Ask your provider what is included before treatment begins.
Dental insurance plans vary in their coverage of night guards. Some plans cover occlusal splints under preventive or major restorative benefits. Others classify them as medical devices and do not cover them at all. Check with your insurance carrier to understand your specific coverage. If you have medical insurance separately, it may cover a portion if bruxism is linked to a diagnosed medical condition such as TMD or sleep apnea.
Over-the-counter guards cost significantly less, often between $20 and $50. However, they are less durable, may not fit properly, and do not offer the same level of protection. A poorly fitting guard can sometimes shift teeth or worsen jaw symptoms. For patients with moderate to severe grinding, the investment in a custom guard is typically worthwhile.
If bruxism has already caused tooth damage, the cost of restorative treatment such as crowns, veneers, or implants is additional. This is one reason early intervention with a night guard can save significant expense over time. [1]
When to See a Specialist
A general dentist can diagnose bruxism and provide a custom night guard in most straightforward cases. Specialist care is appropriate in specific situations.
Consider seeing a prosthodontist if you have significant tooth wear, multiple cracked or fractured teeth, or if your bite needs reconstruction. Prosthodontists receive additional years of training in restoring worn or damaged teeth, designing complex bite corrections, and fabricating precise occlusal splints. [1]
A referral to a sleep medicine specialist is appropriate if you or your partner notice pauses in breathing, loud snoring, or excessive daytime sleepiness alongside grinding. Treating the sleep disorder often reduces or resolves the bruxism.
If jaw pain, clicking, or limited mouth opening is your primary concern, an oral and maxillofacial specialist or a dentist experienced in TMJ disorders can provide focused evaluation and treatment.
You should also seek professional evaluation if over-the-counter remedies have not helped after several weeks, if you are waking with frequent headaches or jaw pain, or if you notice visible changes in the shape or length of your teeth.
Find a Prosthodontist Near You
If grinding has worn down your teeth or you need a precisely fitted night guard, a prosthodontist can help. Use the directory on the prosthodontics page to search for a qualified specialist in your area and schedule a consultation.
Search Prosthodontists in Your Area