Bruxism is one of the most destructive factors for dental health. Learn about its impact, how to detect it and how to treat it in the context of oral rehabilitation.
What is bruxism?
Bruxism is an oral parafunction consisting of involuntary clenching or grinding of teeth. It can occur during sleep (nocturnal bruxism, the most common and generally the most destructive) or during the day (diurnal bruxism, frequently related to stress).
It is estimated that between 8% and 31% of the population has some degree of bruxism. It is significantly more prevalent in people with high levels of stress or anxiety, in those taking certain medications or substances, and it carries an important genetic component.
How does bruxism destroy teeth?
The force generated during bruxism can be 3 to 10 times greater than normal chewing forces. That extraordinary force, applied repeatedly for hours every night, produces:
- Severe wear of the enamel, exposing dentin and causing sensitivity
- Fractures and cracks in teeth and restorations
- Gum recession and bone loss
- Muscle pain and fatigue (trismus)
- Temporomandibular dysfunction (pain in the jaw joint)
- Headaches, especially in the temporal region
- Premature loss of restorations, veneers, crowns and even implants
Bruxism and dental implants: a critical relationship
Bruxism is one of the most important risk factors for dental implant failure. Excessive forces can generate:
- Loss of the implant through occlusal overload during osseointegration
- Fracture of the implant screw or the abutment
- Fracture of the crown or prosthesis
- Peri-implantitis accelerated by overload
This does not mean patients with bruxism cannot have implants. It means bruxism must be effectively controlled before and during implant treatment.
Diagnosing bruxism
Bruxism can be diagnosed clinically by observing dental wear, hypertrophy of the masseter muscles, dental fractures with no apparent cause, and the patient's clinical history. In complex cases, polysomnography (a sleep study) can be used to confirm the diagnosis.
Treating bruxism
- Night guard: the first line treatment. It is an acrylic device worn at night that redistributes the forces, protecting the teeth and the joints.
- Botulinum toxin (Botox): in severe cases, applying botulinum toxin to the masseter muscles significantly reduces clenching force.
- Stress management: relaxation techniques, psychotherapy, or medical management of stress and anxiety.
- Occlusal rehabilitation: in cases where the wear has already happened, rebuilding the vertical dimension and the occlusion is a fundamental part of treatment.
Frequently asked questions
▸Can I get implants if I clench or grind my teeth?
Yes, but bruxism changes the planning and it has to be known beforehand, not afterwards. The force of a bruxist patient can be several times that of a normal bite, and that load falls on the implant and on the prosthesis. It is compensated with the number and position of the implants, the prosthetic material and a protective night guard.
▸How do I know if I have bruxism if I do not notice it?
Most bruxist patients clench while asleep and have no idea. The signs you can check yourself: jaw pain or fatigue when waking up, morning headaches around the temples, teeth that look shorter or flatter over time, cold sensitivity, and someone telling you they heard you grinding at night. In the practice it is confirmed by the wear pattern, which is characteristic.
▸Can bruxism damage an implant that is already placed?
The most frequent outcome is not losing the implant, it is the prosthesis taking the damage: ceramic fractures, wear, or the screw that joins the crown to the implant coming loose. That last one is solved by torquing the screw, meaning tightening it with the force the manufacturer specifies, in a short appointment. This is why check-ups matter more in a bruxist patient.
▸Is the protective night guard charged separately?
No. The guard is always included, in any treatment, it is not an add-on. Many clinics charge for it separately, and for the patient that difference is the signal that the work is looked after once it is finished. In a patient with bruxism it is not optional: it is what protects the investment.
▸Can bruxism be cured or only controlled?
It is controlled, and in most cases that is enough. Bruxism has a stress component, a sleep component and sometimes a bite component, so treatment combines the guard, correcting how the teeth contact each other and, when needed, addressing the underlying cause. What can be stopped is the damage: the wear that already happened does not reverse on its own.
Dra. Carolina Macareno
Rehabilitadora Oral · Especialista en Implantes
Oral Rehabilitation specialist from Universidad CES. Over 17 years transforming smiles in Medellín, Colombia.
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