Teeth Grinding and Bruxism at Night: Sleep, Arousal, Stress and Sensible Treatment
Nighttime grinding is often treated as a pure stress problem or as a dental topic. In truth it is a phenomenon of sleep architecture, closely linked to the brain's brief waves of activation during sleep. What the research shows on arousal, stress and sleep apnea, what a splint, Botox and physiotherapy can achieve, and when it is time for a dentist or sleep physician.
Anyone who grinds at night almost always hears the same sentence: "You have too much stress, here is a splint." Neither is wrong, but it falls short. According to the international consensus (Lobbezoo 2018 in Journal of Oral Rehabilitation), sleep bruxism in healthy people is not a disease but a masticatory muscle activity that can be a risk or even a protective factor. It arises as rhythmic masticatory muscle activity in connection with the micro-arousals of sleep (Lavigne 2008 in Journal of Oral Rehabilitation, Kato 2023 in Journal of Oral Biosciences), not simply "because someone is tense." The splint protects the teeth, it does not address the cause. Botulinum toxin may dampen masticatory muscle pain (Chisini 2024 in Journal of Dentistry) without addressing the cause. And the often-claimed close connection with sleep apnea is not scientifically proven in adults (Pauletto 2022 in Sleep). Good bruxism management means: protect the teeth, calm the nervous system and look closely at whether a sleep problem lies behind it.
This spoke is the jaw-and-masticatory-system building block of the sleep cluster. We first clarify what bruxism actually is and why the old disease narrative is outdated. Then we turn to the actual mechanism during sleep (arousal and rhythmic masticatory muscle activity), to the role of stress, to the much-discussed and actually weak sleep apnea connection, to the treatment options from the occlusal splint through botulinum toxin to physiotherapy and stress regulation, to typical misconceptions and to the question of when a dentist and when a sleep physician is needed.
What bruxism is and what it is not
Bruxism denotes the grinding or clenching of the teeth as well as the bracing or protruding of the lower jaw. Two forms are distinguished: sleep bruxism (at night, during sleep) and awake bruxism (during the day, often as unconscious jaw clenching). Both have different mechanisms and should not be lumped together.
In healthy people bruxism is a behavior, not a disease
Guideline Frank Lobbezoo and an international expert panel updated the consensus on the assessment of bruxism in 2018 in Journal of Oral Rehabilitation. Key statements: sleep and awake bruxism are masticatory muscle activities that occur during sleep (rhythmic or non-rhythmic) or while awake (repetitive or sustained tooth contact, bracing or protruding of the lower jaw). In otherwise healthy people bruxism should not be regarded as a disease but as a behavior that can be a risk and/or protective factor for certain clinical consequences. Both self-report and instrumental methods such as electromyography serve for assessment. Rigid thresholds for the number of episodes should no longer be applied in healthy people.
Lobbezoo F, Ahlberg J, Raphael KG, et al. J Oral Rehabil. 2018;45(11):837-844. doi:10.1111/joor.12663 · PMID: 29926505
This shift in the definition is important for practice. It means: not every instance of grinding needs to be treated. The consequences are decisive. Grinding without complaints and without tooth damage is a behavior that can be observed. Grinding with tooth wear, jaw or facial pain, morning headache or disturbed sleep is a reason to take action.
Sleep bruxism
Occurs during sleep, mostly in light non-REM sleep, linked to micro-arousals. Often not noticed by the affected person but heard by the partner. The motor correlate is rhythmic masticatory muscle activity (RMMA).
Awake bruxism
Unconscious jaw clenching or tooth contact during the day, often in phases of concentration or tension. More strongly associated with stress, anxiety and parafunctions than sleep bruxism. Can be well influenced through daytime awareness.
Frequency
Kato 2023 names about 20 percent in children and about 10 percent in adults for sleep bruxism. Lavigne 2008 reports that about 8 percent of adults notice nighttime grinding, often through a hint from the partner.
Possible consequences
Tooth wear, chipped edges and cracks, sensitive teeth, masticatory muscle and jaw joint pain, tension headache, prosthetic complications. These consequences, not the grinding itself, justify a therapy.
The actual mechanism: arousal and rhythmic masticatory muscle activity
The most important and most frequently misunderstood point: sleep bruxism is primarily a phenomenon of sleep regulation, not a pure muscle or tooth problem. During sleep the brain regularly goes through brief waves of activation, so-called micro-arousals. In some people the masticatory system activates along with them.
Grinding follows the micro-arousals of sleep
Review Gilles Lavigne and colleagues described sleep bruxism in 2008 in Journal of Oral Rehabilitation as a "sleep-related movement disorder." The central insight: sleep bruxism is secondary to sleep micro-arousals, which are defined by a rise in autonomic heart and breathing activity and in affected people typically occur 8 to 14 times per hour of sleep. Rhythmic masticatory muscle activity reaches its peak in the minutes before the transition into REM sleep. The role of hereditary factors and of an increased upper airway resistance is being investigated. Evidence for a causal role of tooth position (occlusion), by contrast, is limited.
Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. J Oral Rehabil. 2008;35(7):476-94. doi:10.1111/j.1365-2842.2008.01881.x · PMID: 18557915
RMMA arises from central activation in non-REM sleep
Mechanism review Takafumi Kato and colleagues summarized the pathophysiology from human and animal studies in 2023 in Journal of Oral Biosciences. In people with sleep bruxism, rhythmic masticatory muscle activity occurs significantly more often than in healthy people, above all in light non-REM sleep in connection with transient arousals and cyclic sleep processes. In animal models, similar episodes of rhythmic masticatory muscle activity were observed in non-REM sleep, accompanied by cortical and cardiac activation. Electrical microstimulation of the corticobulbar pathways can trigger such rhythmic patterns. This argues that the masticatory system is activated in non-REM sleep through excitatory inputs onto the central masticatory pattern generator.
Kato T, Higashiyama M, Katagiri A, et al. J Oral Biosci. 2023;65(2):156-162. doi:10.1016/j.job.2023.04.005 · PMID: 37086888
Why this matters in practice: whoever locates the cause in sleep regulation looks for factors that favor arousals. These include alcohol, nicotine and caffeine in the evening, irregular sleep, an overactive stress system and, in some cases, sleep-related breathing disorders. A splint alone addresses none of these points. It protects the teeth while you work on the causes.
The role of stress: a real factor, but not a simple switch
Stress is the most popular explanation for grinding, and it has a true core. However, the connection is more nuanced than everyday logic suggests.
Stress, genetics and the CNS as contributors
Overview Krystian Matusz and colleagues classified the therapeutic approaches for sleep and awake bruxism in 2022 in Neurologia i Neurochirurgia Polska. Among the possible causes they name genetics, stress, oral parafunctions and changes in the central nervous system. According to this overview, awake bruxism is more strongly linked to nervous tension and stress reactions, while sleep bruxism is more closely tied to the sleep-related mechanisms. The authors emphasize that the data are not yet sufficient for a unified, standardized treatment approach, and they advocate education and prevention for at-risk patients.
Matusz K, Maciejewska-Szaniec Z, Gredes T, et al. Neurol Neurochir Pol. 2022;56(6):455-463. doi:10.5603/PJNNS.a2022.0073 · PMID: 36444852
The honest classification: stress can raise the baseline tension of the nervous system and thereby favor the tendency toward arousals during sleep. This makes stress regulation a plausible and sensible building block. But sleep bruxism does not reliably disappear once someone lives more relaxed, because it is not directly "switched on" by stress experienced during the day, but mediated through sleep architecture. Stress work may help, but it is no guarantee. Whoever communicates this honestly avoids disappointment and feelings of guilt in those affected whose grinding remains despite relaxation exercises.
Sleep apnea and bruxism: an overestimated connection
Online and in some practices, grinding is readily portrayed as a warning sign for sleep apnea. The idea behind it: after a breathing pause an arousal occurs, and during it the masticatory system is also activated. The idea is not mechanistically far-fetched, but the data do not support it in adults.
No confirmed apnea-bruxism connection in adults
Systematic review Patrícia Pauletto and colleagues evaluated the evidence on the connection between sleep bruxism and obstructive sleep apnea in a scoping review in 2022 in Sleep. Included were 13 studies in adults and 8 in children. The mean prevalence of co-occurrence was 39.3 percent in adults and 26.1 percent in children. There was considerable methodological heterogeneity. In most studies in adults there was no significant connection. In children a connection appears possible but is not sufficiently proven. The authors' conclusion: a connection between sleep bruxism and sleep apnea in adults cannot be confirmed on the basis of the current literature.
Pauletto P, Polmann H, Conti Réus J, et al. Sleep. 2022;45(7):zsac073. doi:10.1093/sleep/zsac073 · PMID: 35443064
Polysomnography studies deliver contradictory findings
Systematic review Ana Júlia da Costa Lopes and colleagues evaluated 7 polysomnographic studies in 2019 in Sleep and Breathing. Four studies supported a connection (grinding occurs shortly after respiratory events, episodes follow arousals from apnea or hypopnea phases, there is a correlation in frequency). Three studies did not support it (respiratory events are associated with non-specific masticatory muscle activity, grinding episodes are not directly linked to the end of respiratory events, apnea patients did not grind more often than controls). Conclusion: there is no scientific evidence for a conclusive connection, well-designed randomized studies are needed.
da Costa Lopes AJ, Cunha TCA, Monteiro MCM, et al. Sleep Breath. 2019;24(3):913-921. doi:10.1007/s11325-019-01919-y · PMID: 31628624
Nighttime grinding alone justifies neither a sleep apnea diagnosis nor a blanket suspicion of apnea. It is not a reliable marker. The overall picture is decisive: whoever additionally snores loudly, has observed breathing pauses, wakes in the morning with headache and dry mouth and is very tired during the day should be assessed in sleep medicine, but then because of these signs, not because of the grinding alone. More on apnea assessment in the sister spoke on sleep apnea.
Occlusal splint: reliably protective, but does not address the cause
The occlusal splint, also called a night guard or occlusal device, is by far the most common measure. Its proven main benefit is mechanical: it protects the hard tooth substance from further wear, distributes the chewing forces and may relieve masticatory muscle and jaw joint complaints.
The splint tends to reduce events, without a clear advantage of one type
Systematic review Hajime Minakuchi and colleagues evaluated the treatment of sleep bruxism in adults in 2022 in Japanese Dental Science Review, diagnosed by means of polysomnography or electromyography. Splint therapy, cognitive behavioral therapy, biofeedback and pharmacological approaches were examined. Result: splint therapy tends to reduce the number of bruxism events, without a significant difference compared to other splint types. The benefit of cognitive behavioral therapy was not well proven. Biofeedback as well as rabeprazole, clonazepam, clonidine and botulinum toxin type A showed significant reductions of individual bruxism parameters, although partly with side effects. The authors emphasize the need for methodologically better long-term studies.
Minakuchi H, Fujisawa M, Abe Y, et al. Jpn Dent Sci Rev. 2022;58:124-136. doi:10.1016/j.jdsr.2022.02.004 · PMID: 35356038
Practical consequence: the splint is a protective instrument and a pain-relief tool, not a cure for the arousal-driven cause. It should be fitted and monitored by a dentist, because a poorly fitting or persistently wrongly used splint can rather intensify complaints. Whoever wears a splint should work in parallel on sleep hygiene, arousal factors and, if needed, stress regulation.
Botulinum toxin and physiotherapy: what the muscular line achieves
When masticatory muscle pain is in the foreground and conservative measures are not sufficient, muscle-oriented methods come into play: botulinum toxin and physiotherapeutic approaches.
The splint and botulinum toxin reduce masticatory muscle pain comparably
RCT Luiz Alexandre Chisini and colleagues compared the occlusal splint and botulinum toxin type A for masticatory muscle pain in probable sleep bruxism in 2024 in Journal of Dentistry in a randomized equivalence study. 60 patients were randomized, 59 evaluated over 6 months. The primary endpoint was pain reduction (Graded Chronic Pain Scale). Result: no difference between the methods in pain, both achieved a clear reduction after 3 and 6 months. Botulinum toxin performed worse on individual functional parameters (pain-free and maximum mouth opening, protrusion), and about 79 percent of the botulinum toxin group reported mild chewing discomfort. The splint showed slight advantages on individual functional parameters.
Chisini LA, Pires ALC, Poletto-Neto V, et al. J Dent. 2024;151:105439. doi:10.1016/j.jdent.2024.105439 · PMID: 39510242
Botulinum toxin may reduce muscle activity and pain
Systematic review Sinda Yacoub and colleagues evaluated 12 randomized studies on botulinum toxin type A for bruxism in 2025 in Dental and Medical Problems. Bilateral injections into the masseter, temporalis and medial pterygoid muscle were compared with saline injections, occlusal splints and conventional treatment. Of 12 studies, 6 reported a reduction in masticatory muscle activity (measured via rhythmic masticatory muscle activity and electromyography), 3 a significant decrease in pain intensity. The authors rate botulinum toxin as effective for symptom reduction but point to heterogeneity and methodological differences and call for long-term studies with larger samples.
Yacoub S, Ons G, Khemiss M. Dent Med Probl. 2025;62(1):145-160. doi:10.17219/dmp/186553 · PMID: 40035138
Classification: botulinum toxin may temporarily dampen the muscular component and the pain, the effect is time-limited and the evidence is heterogeneous. It is an option for pronounced, treatment-resistant masticatory muscle pain, not a routine first-line agent. Physiotherapy, masticatory muscle stretching and self-massage may additionally help in case of muscular tension and have few side effects, even though the specific evidence on sleep bruxism is limited.
The 4 PNEI lenses on nighttime grinding
In Clinical Psychoneuroimmunology I look not only at the jaw but at the systems that regulate the nighttime level of activation. Four lenses help to put the grinding into context.
Nervous system
At its core, sleep bruxism is an arousal phenomenon (Lavigne 2008, Kato 2023). A chronically overactivated autonomic nervous system with high sympathetic tone can help determine the frequency of the micro-arousals and thereby the tendency to grind. Vagal tone and evening calming are the adjusting screws here.
Stress system
A persistently high baseline tension (HPA axis, cortisol rhythm) increases the nighttime excitability. Stress thus acts indirectly via sleep regulation, not as a direct switch. Stress regulation during the day can lower the level of activation, but a certain end to the grinding is not promised by this.
Breathing and sleep
An increased upper airway resistance is discussed as a possible contributing factor (Lavigne 2008). Even though the apnea connection is not proven in adults (Pauletto 2022), a look at snoring, nasal breathing and sleep quality is worthwhile as part of the overall picture.
Lifestyle triggers
Alcohol, nicotine and caffeine in the evening can favor sleep arousals and thereby grinding. Irregular sleep times and late screen use disturb sleep architecture. These factors are the most easily influenced levers.
What does not work: typical misconceptions
The occlusal splint protects the teeth and may relieve pain (Minakuchi 2022), but it does not address the arousal-driven cause. Whoever expects the grinding to stop with the splint is often disappointed. The splint is protection and pain relief, not a reset of the cause. It belongs in combination with work on sleep and the level of activation.
In adults a connection between sleep bruxism and obstructive sleep apnea is not scientifically proven (Pauletto 2022, da Costa Lopes 2019). Interpreting grinding wholesale as an apnea warning sign is not justified. An apnea assessment follows from apnea signs such as snoring with breathing pauses and daytime sleepiness, not from the grinding alone.
The evidence for a causal role of occlusion in sleep bruxism is limited (Lavigne 2008). Elaborate occlusal corrections solely to treat the grinding are therefore not supported by strong evidence. The mechanism sits predominantly centrally, in sleep regulation, not in the biting surface.
Stress regulation is sensible, but sleep bruxism is mediated through sleep architecture and not directly "switched on" by daytime stress. Relaxation exercises can lower the level of activation and thereby help, but they are not a guaranteed switch. Those affected whose grinding remains despite relaxation bear no guilt for it.
Protect the teeth, calm the nervous system, check the sleep.
The splint protects against damage, work on arousal factors and stress can lower the level of activation, and a targeted look at sleep clarifies whether more lies behind it. Three lines instead of one narrative.
Three concrete levers for the coming weeks
Reduce arousal factors in the evening
Lower everything that favors the nighttime micro-arousals: alcohol, nicotine and caffeine in the hours before sleep, late screen use and irregular sleep times. Because sleep bruxism is linked to the arousals (Lavigne 2008, Kato 2023), this is the most direct lifestyle lever. It is free and may make a difference in subjective perception within weeks.
Secure the teeth and have consequences assessed
If you notice tooth wear, chipped edges, sensitive teeth or morning jaw pain, have the dental status checked and, if needed, a protective splint fitted. The splint does not address the cause of grinding, but it protects the hard tooth substance and may relieve pain (Minakuchi 2022). Protection first, while you work on the causes.
Lower the level of activation and observe sleep
Build in stress regulation during the day (breathing exercises, movement, consciously releasing tooth contact) and observe your sleep: do you snore loudly, are there observed breathing pauses, are you very tired during the day, do you wake up with headache and dry mouth? If so, a sleep medicine assessment is sensible, because an independent sleep problem may lie behind it.
When to see a dentist and when to see a sleep physician
The two points of contact answer different questions. Dentistry assesses the consequences for the masticatory system and protects the teeth. You belong here in case of: visible tooth wear, chipped edges or cracks, sensitive teeth, morning jaw or facial pain, clicking or pain in the jaw joint, frequent morning tension headaches, or if a partner regularly hears loud grinding.
Sleep medicine clarifies whether a sleep-related disorder lies behind the grinding or accompanies it. This is sensible if there are additional signs such as loud snoring with observed breathing pauses, pronounced daytime sleepiness, unrefreshing sleep or morning headaches with dry mouth. Since grinding is not a reliable apnea marker in adults (Pauletto 2022), the overall picture always decides, not the grinding alone.
For children, a separate logic applies: sleep bruxism is more common and often transient. If a grinding child additionally snores loudly, shows breathing pauses, breathes through the mouth or is conspicuously tired, a medical assessment is worthwhile, also with a view to enlarged tonsils. For symptom-free children without these signs, observation rather than immediate treatment is usually appropriate.
Safety note and classification
- This text is general information and does not replace a medical, dental or sleep medicine examination.
- Sudden, one-sided or severe jaw or facial pain, a locked jaw or neurological symptoms should be assessed by a physician promptly.
- Botulinum toxin is a prescription procedure with possible side effects and belongs in experienced hands. It is not a self-treatment.
- Splints should be fitted by a dentist. Over-the-counter splints can intensify complaints if the fit is wrong.
- The measures named here may relieve complaints and protect the teeth, but they do not promise an end to the grinding.
Frequently asked questions about teeth grinding and bruxism at night
Is nighttime teeth grinding a disease?
According to the international consensus by Lobbezoo 2018 in Journal of Oral Rehabilitation, bruxism in otherwise healthy people is not a disease but a masticatory muscle activity that can be a risk or even a protective factor for certain clinical consequences. Sleep bruxism is defined as rhythmic or non-rhythmic masticatory muscle activity during sleep, and awake bruxism as repetitive or sustained tooth contact or bracing of the lower jaw while awake. The distinction is important: grinding without consequences needs no therapy, while grinding with consequences such as tooth wear, jaw or facial pain, headache or sleep disturbance can make treatment sensible. The old fixed thresholds for the number of episodes per hour should no longer be applied rigidly in healthy people; instead the activity is viewed on a continuum.
Why do I grind my teeth specifically at night?
Sleep bruxism is closely linked to sleep architecture. Lavigne 2008 in Journal of Oral Rehabilitation describes sleep bruxism as secondary to sleep micro-arousals, brief activations with a rise in autonomic heart and breathing activity, which in affected people typically occur several times per hour of sleep. Kato 2023 in Journal of Oral Biosciences shows: rhythmic masticatory muscle activity (RMMA), the motor correlate of grinding, occurs above all in light non-REM sleep in connection with transient arousals and cyclic sleep processes, often in the minutes before the transition into REM sleep, accompanied by cortical and cardiac activation. Put simply: during sleep the body regularly goes through brief waves of activation, and in some people the masticatory system switches on along with them. This explains why grinding is often not consciously noticed.
Is teeth grinding connected with stress?
Stress and psychological tension are considered risk factors, above all for awake bruxism. Lavigne 2008 in Journal of Oral Rehabilitation names stress and anxiety as risk factors but emphasizes that the precise physiology has not yet been conclusively clarified. Matusz 2022 in Neurologia i Neurochirurgia Polska lists genetics, stress, oral parafunctions and changes in the central nervous system among the possible causes. In sleep bruxism the connection with stress experienced during the day is less direct than often assumed, because grinding is primarily linked to sleep arousals. Nevertheless, a high baseline tension of the nervous system can favor the tendency toward arousals and thereby indirectly favor grinding. Stress regulation can therefore be a sensible building block, but it is not a guaranteed switch.
Is teeth grinding a sign of sleep apnea?
This link is frequently claimed, but the evidence in adults is thin. Pauletto 2022 in Sleep evaluated 13 studies in adults and 8 in children in a scoping review and concludes that, on the basis of the current literature, no confirmed connection between sleep bruxism and obstructive sleep apnea in adults can be established, while in children it appears plausible but is so far not sufficiently proven. da Costa Lopes 2019 in Sleep and Breathing evaluated 7 polysomnographic studies and found contradictory findings: some support the idea that grinding occurs shortly after respiratory events, others do not. Conclusion: grinding is not a reliable marker for sleep apnea. But if additional signs are present such as loud snoring, observed breathing pauses, pronounced daytime sleepiness or morning headaches, a sleep medicine assessment is sensible.
What does an occlusal splint do and does it stop the grinding?
The occlusal splint (night guard, occlusal device) is the most commonly used measure. Its most important proven benefit is protecting the hard tooth substance from further wear and distributing the chewing forces. Minakuchi 2022 in Japanese Dental Science Review summarizes that splint therapy tends to reduce the number of bruxism events, without a significant difference compared to other splint types. The splint therefore does not address the underlying arousal-driven cause but protects against the consequences and may relieve complaints. In the randomized study by Chisini 2024 in Journal of Dentistry, the occlusal splint clearly reduced pain scores in patients with masticatory muscle pain and even performed somewhat better than botulinum toxin on individual functional parameters. Important: a poorly fitted or persistently wrongly worn splint can cause problems, so the fitting belongs in dental hands.
Does Botox help against teeth grinding?
Botulinum toxin type A, injected into the masticatory muscle (masseter, and if needed temporalis), may reduce muscle activity and thereby pain and grinding intensity. Yacoub 2025 in Dental and Medical Problems evaluated 12 randomized studies in a systematic review: 6 showed a reduction in masticatory muscle activity, 3 a significant decrease in pain intensity. The randomized study by Chisini 2024 in Journal of Dentistry found that botulinum toxin and an occlusal splint reduce masticatory muscle pain comparably, with the splint performing slightly better on individual functional parameters such as pain-free mouth opening, while under botulinum toxin some of those treated reported mild chewing discomfort. Botulinum toxin is therefore an option for pronounced masticatory muscle pain that does not respond to conservative measures, but the effect is time-limited and the evidence is heterogeneous. It does not address the cause of grinding but temporarily dampens the muscular component.
What can I do myself against nighttime grinding?
Several approaches can be combined, even though none promises a certain end. First, sleep hygiene and arousal reduction: regular sleep times, reducing alcohol, nicotine and caffeine in the evening, since these can favor sleep arousals and thereby grinding. Second, stress regulation during the day: breathing exercises, relaxation methods and movement can lower the baseline tension of the nervous system. Minakuchi 2022 in Japanese Dental Science Review reports that biofeedback was able to reduce specific bruxism parameters in individual studies, while the benefit of cognitive behavioral therapy is not well proven. Third, daytime awareness of jaw clenching: many people clench during the day as well, where consciously releasing tooth contact can help (lips together, teeth apart, tongue relaxed). Fourth, physiotherapy and self-massage of the masticatory muscles in case of tension. And always: in case of tooth wear or pain, a dental assessment and, if needed, a protective splint.
When should I see a dentist or sleep physician about teeth grinding?
You belong at the dentist if you notice signs of consequences: visible tooth wear, chipped tooth edges or cracks, sensitive teeth, morning jaw or facial pain, clicking or pain in the jaw joint, frequent morning tension headaches, or if a partner hears loud grinding. Dentistry checks the dental status, can fit a protective splint and assess jaw joint complaints. A sleep medicine assessment is sensible if there are additional signs of a sleep disorder: loud snoring with observed breathing pauses, pronounced daytime sleepiness, unrefreshing sleep or morning headaches with dry mouth. Since grinding is not a reliable apnea marker (Pauletto 2022 in Sleep), the overall picture decides. This text does not replace a medical or dental examination.
Do children grind their teeth too, and is it dangerous?
Yes, sleep bruxism is more common in children than in adults. Kato 2023 in Journal of Oral Biosciences names a frequency of about 20 percent in children compared to about 10 percent in adults. In many children the grinding is transient and resolves over time, especially in connection with the change of teeth. Unlike in adults, a connection between sleep bruxism and obstructive sleep apnea appears plausible in children, but according to Pauletto 2022 in Sleep it is not yet sufficiently proven. In practical terms: for grinding children with loud snoring, breathing pauses, mouth breathing or conspicuous daytime sleepiness, a medical assessment is worthwhile, also with a view to enlarged adenoids or tonsils. For symptom-free children without these signs, observation rather than immediate treatment is usually appropriate. The assessment belongs in pediatric and, if needed, sleep medicine hands.
More from the cluster "Treating Sleep Disorders Holistically"
- Pillar: Sleep Disorders Holistically
- Spoke 10: Recognizing and Treating Sleep Apnea
- Spoke 20: Teeth Grinding and Bruxism at Night (you are here)
Connections to other topics
The pillar article places nighttime grinding within the overall picture of sleep architecture, arousal regulation and nervous regulation.
In adults grinding is not a reliable apnea marker. Here you can read which signs really argue for a sleep medicine assessment.
Sources and further reading
- Lobbezoo F, Ahlberg J, Raphael KG, et al. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil. 2018;45(11):837-844. doi:10.1111/joor.12663 · PMID: 29926505 [Authority document]
- Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil. 2008;35(7):476-94. doi:10.1111/j.1365-2842.2008.01881.x · PMID: 18557915 [Review]
- Kato T, Higashiyama M, Katagiri A, et al. Understanding the pathophysiology of sleep bruxism based on human and animal studies: A narrative review. J Oral Biosci. 2023;65(2):156-162. doi:10.1016/j.job.2023.04.005 · PMID: 37086888 [Mechanism review]
- Matusz K, Maciejewska-Szaniec Z, Gredes T, et al. Common therapeutic approaches in sleep and awake bruxism - an overview. Neurol Neurochir Pol. 2022;56(6):455-463. doi:10.5603/PJNNS.a2022.0073 · PMID: 36444852 [Overview]
- Pauletto P, Polmann H, Conti Réus J, et al. Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review. Sleep. 2022;45(7):zsac073. doi:10.1093/sleep/zsac073 · PMID: 35443064 [Systematic review]
- da Costa Lopes AJ, Cunha TCA, Monteiro MCM, et al. Is there an association between sleep bruxism and obstructive sleep apnea syndrome? A systematic review. Sleep Breath. 2019;24(3):913-921. doi:10.1007/s11325-019-01919-y · PMID: 31628624 [Systematic review]
- Minakuchi H, Fujisawa M, Abe Y, et al. Managements of sleep bruxism in adult: A systematic review. Jpn Dent Sci Rev. 2022;58:124-136. doi:10.1016/j.jdsr.2022.02.004 · PMID: 35356038 [Systematic review]
- Chisini LA, Pires ALC, Poletto-Neto V, et al. Occlusal splint or botulinum toxin-a for jaw muscle pain treatment in probable sleep bruxism: A randomized controlled trial. J Dent. 2024;151:105439. doi:10.1016/j.jdent.2024.105439 · PMID: 39510242 [RCT]
- Yacoub S, Ons G, Khemiss M. Efficacy of botulinum toxin type A in bruxism management: A systematic review. Dent Med Probl. 2025;62(1):145-160. doi:10.17219/dmp/186553 · PMID: 40035138 [Systematic review]
- Bornhardt T, Iturriaga V. Sleep Bruxism: An Integrated Clinical View. Sleep Med Clin. 2021;16(2):373-380. doi:10.1016/j.jsmc.2021.02.010 · PMID: 33985661 [Overview]