Long regarded as a harmless “tic”, bruxism is now recognised as a frequent and potentially damaging disorder, affecting oral, joint and general health. Recent estimates put its worldwide prevalence at around 22% across all forms combined, with roughly 21% for sleep bruxism and 23% for awake bruxism. In children, the reported figures range from 14 to 30% depending on the assessment methods used, while it is estimated at around 8% in adults under 60 and 3% after 60. Put another way, close to one adult in ten and close to one child in five clench or grind their teeth on a regular basis.
Reducing bruxism to a harmless nocturnal parafunctional movement is a persistent misconception. When it becomes established, the repercussions extend well beyond the dental sphere: premature enamel wear, fractures of cusps or restorations, pain and clicking of the temporomandibular joint (TMJ), tension headaches, neck pain, and disturbed sleep both for the person concerned and for those around them. Bruxism is also closely linked to other disorders such as obstructive sleep apnoea syndrome (OSA) or gastro-oesophageal reflux disease (GORD), which makes it a genuine multidisciplinary marker that warrants careful assessment.
1. Definition: clenching, grinding, awake and sleep
Bruxism refers to the repetitive activity of the masticatory muscles characterised by clenching or grinding of the teeth, outside the normal functions of chewing and swallowing. The American Academy of Sleep Medicine (AASM) distinguishes two quite different clinical entities, which may coexist in the same patient but respond to partly distinct mechanisms.
Clenching or grinding
Clenching corresponds to a static, sustained contraction of the muscles that raise the mandible, without any notable lateral movement of the dental arches. It is often silent and can go unnoticed for a long time. Grinding combines clenching with an excursive movement of the mandible that rubs the arches against one another and produces the characteristic noise perceived by those nearby. Both modes can be seen by day as well as by night, in isolation or in combination.
Awake bruxism or sleep bruxism
Awake bruxism occurs during the day, generally in the form of daytime clenching linked to concentration, driving, screen work or situations of stress. The patient is sometimes aware of it when their attention is drawn to it. Sleep bruxism, on the other hand, occurs during the night, through repeated episodes of rhythmic muscular activity associated with micro-arousals. It is defined by the AASM as an oral parafunction characterised by grinding or clenching of the teeth during sleep, associated with intense arousal activity.
This distinction is central, because the therapeutic levers differ: managing awake bruxism rests largely on awareness, stress regulation and behavioural management, whereas sleep bruxism often benefits from wearing an occlusal splint and from a broader exploration of sleep.
2. Prevalence in children and in adults
A frequent reality, but underestimated in adults
In adults, recent systematic reviews put the prevalence of sleep bruxism at around 8% before the age of 60, and that of awake bruxism at often higher levels (up to 22 to 23% depending on the study). Bruxism is rarely isolated here: it is frequently associated with anxiety disorders, sleep disorders, the use of certain medications, or an underlying OSA. Its prevalence falls with age, but its consequences (wear, fractures, TMJ disorders) accumulate and often become visible from the forties onwards.
In children, an often transient phase
In children, bruxism is far more frequent than in adults. Estimates lie between 14 and 30% depending on the age group and the methods used, with a peak between 4 and 10 years of age. One essential characteristic sets childhood bruxism apart from that of adults: in the great majority of cases it is transient and benign.
This transient nature is explained in part by the phases of dental eruption and replacement. The eruption of the milk teeth and then the appearance of the permanent teeth continually alter the occlusion, creating unusual sensations that the child unconsciously seeks to soothe through grinding. In most cases, bruxism subsides spontaneously between 6 and 9 years of age, once the mixed dentition stabilises. This does not mean that it should be ignored: bruxism that persists, is noisy, or is associated with signs of wear, pain or sleep disorders deserves assessment, particularly if a malocclusion or nocturnal breathing disorders are suspected.
3. Aetiologies: a multifactorial disorder
Bruxism is now regarded as a multifactorial disorder, in which central factors play a predominant role, without peripheral factors being overlooked for all that. Added to this is a set of comorbidities that can worsen its expression or favour its appearance.
Central factors
Stress and anxiety are the best-documented factors. Phases of psychological tension often translate into increased parafunctional activity, both awake and nocturnal. Sleep disorders form a second major axis: sleep bruxism is associated with repeated micro-arousals and with instability of REM sleep.
Certain medications are also implicated in the appearance or worsening of what is known as secondary bruxism. Selective serotonin reuptake inhibitors (SSRIs), prescribed for anxiety and depressive disorders, are regularly cited, as are certain antipsychotics, amphetamines and several psychoactive substances (alcohol, cocaine, ecstasy). Excess caffeine and nicotine also feature among the aggravating factors.
Peripheral factors
Peripheral factors, once considered the main cause, have seen their importance reassessed. Malocclusion (an unfavourable dental occlusion, premature contacts, poorly compensated class II or III) is no longer considered decisive in adults, but it can maintain or worsen established bruxism, particularly in the growing child. It is in this context that an orthodontic assessment has its place.
Comorbidities to look for
Several comorbidities should be systematically looked for in the face of persistent or severe bruxism.
- Obstructive sleep apnoea syndrome (OSA): one patient in four with OSA is thought to present with nocturnal bruxism. The dominant pathophysiological hypothesis links bruxism to the arousal response following an episode of apnoea or hypopnoea. The activation of the masseter and temporalis muscles may contribute to the reopening of the upper airways. When OSA is treated (notably by continuous positive airway pressure), bruxism can fall significantly.
- Gastro-oesophageal reflux disease (GORD): nocturnal acidity appears to increase the frequency of sleep bruxism episodes, and GORD also shares many mechanisms with OSA.
- Anxiety disorders, chronic pain syndromes and bruxism secondary to neurological conditions complete the picture.
This range of aetiologies justifies a multidisciplinary approach, which is not confined to the dental practice alone.
4. Clinical signs: the traces bruxism leaves behind
Bruxism expresses itself through a range of clinical signs that the dentist is able to recognise, and that the patient or those close to them can spot themselves.
On the teeth and restorations
- Flat, shiny wear facets, particularly on the canines and incisors.
- Thinned enamel on the occlusal surfaces of the premolars and molars.
- Fractures of cusps, vertical cracks, chips of enamel.
- Loosening, fractures or abnormal wear of restorations (composites, crowns, veneers).
- Dentine sensitivities, particularly to cold and to brushing.
- Gum recession and wedge-shaped lesions at the enamel-cementum junction.
On the muscles and the joint
- Visible hypertrophy of the masseter muscles, giving a square appearance to the angle of the mandible.
- Pain or stiffness of the masticatory muscles on waking.
- Temporomandibular joint pain, jolting, clicking or limitations of mouth opening.
Associated general signs
- Tension headaches, particularly temporal and in the morning.
- Neck pain and tension in the trapezius muscles.
- Grinding noises perceived by the bed partner.
- Tiredness on waking and a feeling of unrefreshing sleep, which should suggest an associated sleep disorder.
The combination of several of these signs constitutes a sufficient body of evidence to open a structured clinical discussion.
5. Diagnosis in the practice: history-taking, examination, photographs
The diagnosis of bruxism rests above all on clinical findings. In routine practice there is no simple reference test: polysomnography remains the most precise examination for sleep bruxism, but it is reserved for particular situations.
Targeted history-taking
The practitioner explores the personal and family history, lifestyle habits (consumption of caffeine, alcohol, tobacco), current treatments (SSRIs, antipsychotics, stimulants), the quality of sleep, the level of stress, morning or nocturnal pain, as well as any grinding noises possibly reported by those around the patient.
Clinical examination
The examination includes the analysis of dental wear (location, depth, polishing of the facets), the inspection of the mucosa (white lines on the inner surface of the cheeks, indentations on the edges of the tongue), the palpation of the masseter, temporalis and pterygoid muscles, the assessment of mandibular kinematics (range, lateral movements, clicking), and the analysis of the occlusion.
Photographic documentation and impressions
Documentation through intra-oral photographs and the optical impression make it possible to quantify the wear, to define a starting point and to follow its evolution objectively over time. These tools are particularly useful for distinguishing active bruxism from old, stabilised bruxism, and for guiding therapeutic decisions.
6. Management in adults
Managing bruxism in adults has three aims: to protect the teeth and restorations, to reduce parafunctional muscular activity, and to treat the aggravating factors (stress, OSA, GORD, medications).
Occlusal splint: role, types and care
The occlusal splint, or occlusal orthosis, is the reference device for sleep bruxism. Made to measure from an optical impression, it takes the form of a rigid acrylic plate covering an entire arch, most often the maxillary arch. Its thickness generally lies between 1.5 and 3 mm.
Its role is multiple: to protect the dental surfaces from wear and fractures, to distribute the occlusal forces, to disengage harmful tooth-to-tooth contacts, and to reduce the activity of the masticatory muscles. There are full rigid splints (the most widely used), soft splints (reserved for specific indications, such as certain situations in children), and specific devices (repositioning splints, mandibular advancement splints in cases of associated OSA).
Care is simple but essential: daily cleaning with a soft brush and soap or a dedicated product, careful rinsing, drying before storage in a ventilated box, and regular checking at the practice to assess the wear of the splint itself. A correctly used orthosis has a typical lifespan of three to five years.
Stress management, physiotherapy, behaviour
The splint does not act on the causes. When bruxism is associated with significant stress, with muscular pain or with TMJ disorders, it is useful to combine it with complementary management: relaxation techniques, sophrology, cognitive behavioural therapies, maxillofacial physiotherapy, self-massage and stretching exercises. Awareness of daytime clenching (visual reminders, dedicated apps) constitutes a major lever for awake bruxism.
Suspected OSA: do not miss it
In the face of noisy sleep bruxism associated with snoring, daytime sleepiness, hypertension or excess weight, the possibility of OSA should be considered and a referral to a sleep doctor discussed. Appropriate treatment of OSA can, on its own, significantly reduce bruxing activity.
Botulinum toxin and restorative care
In severe and disabling forms, injections of botulinum toxin into the masseter muscles may be discussed, on a symptomatic basis, to reduce the force of the contractions. Finally, when wear or fractures are already established, prosthetic rehabilitation (overlay composites, onlays, veneers, crowns) makes it possible to restore function and aesthetics, ideally after the bruxism has stabilised and under the protection of an orthosis.
7. Management in children
In children, the philosophy of management differs appreciably from that of adults. The general rule is one of observation and reassurance, bearing in mind the largely transient nature of paediatric bruxism.
Observation and information for parents
In the majority of cases, childhood bruxism requires no active treatment. The role of the dentist is to explain the mechanisms at work to the parents (dental eruptions, changes in occlusion, sleep), to reassure them, and to monitor the dentition during regular check-ups.
Soft splint on a case-by-case basis
When wear becomes significant or when the symptoms (pain, morning headaches, occlusal discomfort) are marked, a soft splint may be offered, taking account of growth and of the evolution of the arches. Its indication is decided with caution: a device that is too rigid or poorly adapted can interfere with the growth of the bony bases.
Orthodontics and underlying malocclusion
In the child with mixed dentition, persistent bruxism may form part of the context of a malocclusion (crowding, crossbite, marked class II or III, exclusive mouth breathing). An assessment by an orthodontist makes it possible to determine whether early intervention is useful, both to treat the cause of the occlusal discomfort and to prevent long-term complications. At Chantepoulet Dental Clinic, these paediatric assessments are carried out in collaboration with Dr Gaia Toson, orthodontist within the team.
Looking for associated factors
As in adults, certain factors deserve to be looked for: sleep disorders and obstruction of the upper airways (habitual snoring, breathing pauses, restless sleep), attention disorders, anxiety, significant life events. A referral to a paediatrician or a sleep doctor may be necessary in these situations.
8. When to seek a consultation without delay
While isolated bruxism does not, in itself, constitute a medical emergency, certain situations warrant a prompt consultation, without waiting for the next check-up visit.
- A visible dental fracture or acute and persistent toothache.
- Significant temporomandibular joint pain, painful clicking, locking of mouth opening or closing.
- Severe and daily morning headaches, particularly accompanied by neck pain.
- Suspected sleep apnoea (loud snoring, observed breathing pauses, daytime sleepiness, marked tiredness).
- In children: rapid wear of the milk or permanent teeth, pain on waking, very disturbed sleep.
In every case, a dental consultation makes it possible to reach a diagnosis, to rule out differential diagnoses and to offer structured management.
9. At Chantepoulet Dental Clinic
Located at Rue de Chantepoulet 21, 1201 Geneva, around 300 metres from Cornavin station, Chantepoulet Dental Clinic offers comprehensive management of bruxism in adults and in children. The dedicated Bruxism page sets out the protocols used.
A multidisciplinary team
The team brings together general dental practitioners, specialists (orthodontics, oral surgery) and dental hygienists. In the context of bruxism, this configuration makes it possible to combine:
- A complete clinical assessment and occlusal examination by the dental practitioners.
- An orthodontic assessment by Dr Gaia Toson, particularly in paediatric cases linked to an underlying malocclusion, drawing on the tools presented on the Orthodontics and Invisalign page.
- Monitoring of hygiene and periodontal health by the hygienists Aurelie Phan, Emilie Gross and Aurelie Lagin, who play a key role in the early detection of signs of wear and gum recession.
- Specific management of the child, from the appearance of the first milk teeth, presented on the Paediatric dentistry page.
Custom occlusal splints by optical impression
The clinic uses the digital optical impression for the design of occlusal splints. This approach, without traditional impression paste, improves patient comfort, reduces the risk of nausea, and allows a high degree of precision in the final orthosis. The splint is made of rigid acrylic resin, calibrated according to the thickness and the occlusal scheme suited to the patient.
Follow-up and coordination of care
When the assessment suggests a sleep disorder or a comorbidity (OSA, GORD, anxiety), the clinic refers the patient to the relevant medical colleagues for coordinated management. Any restorative care for the damage linked to bruxism (composites, onlays, veneers, crowns) is planned at a later stage, once the bruxing activity has stabilised and the splint is in place.
Practical information
- Address: Rue de Chantepoulet 21, 1201 Geneva, 3rd floor.
- Telephone: +41 22 547 44 44.
- Email: info@gedentiste.ch.
- Opening hours: Monday to Friday from 8am to 7pm, Saturday from 8am to 5pm, closed on Sunday.
- Access: 300 metres from Cornavin station.
For any suspicion of bruxism, in yourself or in your child, or for an assessment of dental wear and joint pain, an appointment can be booked directly with the clinic. Early management remains the best way to preserve the dentition, joint comfort and the quality of sleep over the long term.
