Medically reviewed guide · Last updated: 1 August 2026 · Reading time: approx. 9 min

Teeth Grinding (Bruxism): Splints, Stress and the Role of Medication

Sleep bruxism and awake bruxism compared

The causes in detail

Why bruxism is not a disease

In professional terms, bruxism is today described as a behaviour of the chewing muscles — not as a disease. That sounds like hair-splitting, but it has consequences: not every bit of chewing-muscle activity needs treating. Many people clench or grind at times without it ever becoming a problem. It only needs treatment once the consequences become noticeable: loss of tooth substance, pain, an impact on everyday life.

That is why the first question at the practice is not “Do you grind your teeth?” but “What is it doing?” — and the second: “At night or during the day?”

Sleep bruxism: the night-time pattern

During sleep, chewing-muscle activity runs in short, rhythmic episodes, clustered in the phases when the body briefly “revs up” anyway — so-called arousals. You notice nothing of it yourself; it becomes obvious through the noise that whoever shares your bed hears, or through what the dental practice finds.

The link with breathing is particularly important: in sleep apnoea, breathing repeatedly stops during the night and the body answers with arousals — and chewing-muscle activity clusters around them. So if you grind and also snore loudly, are observed to have pauses in breathing, or are markedly tired during the day, you should have your sleep investigated. A splint would only protect the teeth here, while the actual cause went untreated.

Other factors are alcohol in the evening, nicotine, a high caffeine intake, restless sleep and certain medicines — there is a separate section on those further down.

Awake bruxism: the silent clenching

During the day bruxism looks different: instead of rubbing, many people simply hold their rows of teeth together and clench — quietly, inconspicuously, often for hours. Typical situations are concentrated work at a screen, driving in a traffic jam, physical effort in sport, or moments of irritation and deadline pressure.

Because it happens silently, awake bruxism usually goes unnoticed — until someone points it out or your cheek aches in the evening. The good news: precisely because the behaviour is semi-conscious, awareness training can influence it considerably. With the night-time form that is not possible.

Tension and everyday life

Sustained tension raises muscle tone and encourages clenching and grinding. That does not mean bruxism is “all in the mind”. The relationship works both ways: poor sleep and constant strain promote chewing-muscle activity, and the pain that follows makes sleep and resilience worse still. If you are troubled by marked inner restlessness, that is worth raising as well — not as a substitute for dental treatment.

The consequences — graded honestly

Not every consequence is equally serious. From harmless to needing treatment:

• No consequences — the most common case. Noise without damage, without pain. Keeping an eye on it is enough.
• Muscular problems — a feeling of tension in the cheek and temple, aching jaw muscles on waking, often with headaches in the morning and neck pain. Responds well to treatment.
• Sensitive teeth — a twinge with cold and sweet things, because enamel has been worn away. It can show up as diffuse toothache.
• Loss of hard tooth substance — flattened chewing surfaces, shiny worn facets, thinning incisal edges. Substance does not grow back, which is why protecting it makes sense.
• Damage to fillings and crowns — chipped corners, cracks in a tooth.
• Involvement of the jaw joint — pain on movement, restricted mouth opening. Needs a dental assessment.

Self-tests: first clues at home

These observations do not replace a diagnosis — grinding at night cannot be proven reliably at home in any case. But they give you good pointers for the conversation at the practice.

• The tongue-edge test: Stick your tongue out and look in the mirror. Wavy imprints of your teeth along the edge of the tongue suggest that you push your tongue against your teeth and tense your jaws regularly.
• The morning test: Does your jaw feel as though you have been to the gym when you wake up? Is your mouth stiffer to open in the morning than in the evening? Both point to activity at night.
• The wear check: Are your canines or incisal edges noticeably flat or polished shiny? A sign of substance loss that has been going on for some time.
• The daytime check: Set yourself a reminder three times a day and check: are my rows of teeth touching right now? At rest they should not be.
• Asking someone else: Ask whoever shares your bed whether they notice noises, pauses in breathing or loud snoring. That information is worth more than any self-assessment.

Warning signs: when not to wait

• Locked jaw: your mouth suddenly will not open wide
• Severe, persistent pain in the jaw, at the temple or in the face
• Loose teeth or a changed bite
• Chipped corners of teeth, cracked teeth or loosened crowns
• Swelling, redness or fever around the jaw and cheek
• Observed pauses in breathing during sleep, or loud snoring with marked daytime sleepiness
• Grinding that started shortly after a new medicine was begun

The treatment pathway: step by step

What gets treated are the consequences and the triggers, not the noise itself. As a rule the route runs in stages, with reversible measures first.

1. Establish the findings. A dental examination looking at wear, tooth necks, fillings, the chewing muscles and the jaw joint. Photographs or models make it easier later to judge whether the loss of substance is progressing.
2. Sort out the causes. Night or day? Signs of disturbed breathing during sleep? New medicines? Alcohol, nicotine, caffeine? This sorting decides everything that follows.
3. Protect your teeth. A custom-made, hard occlusal splint protects the chewing surfaces and distributes the forces. Ready-made night guards from the chemist often fit poorly and can change your bite unfavourably.
4. Train awake bruxism. Reminders through the day, consciously letting your teeth come apart, tongue resting loosely on the palate, lips closed. For the daytime form, the single most effective measure.
5. Relaxation techniques and biofeedback. Progressive muscle relaxation lowers your baseline muscle tone. Biofeedback makes tension visible and supports relearning; the evidence is better for the daytime form than for the night-time one.
6. Sleep hygiene and an evening routine. Regular times, less alcohol and nicotine in the evening, caffeine limited from the afternoon onwards. If sleep disorders persist, they need treating in their own right.
7. Physiotherapy. Worth it when the muscles are markedly involved and there are neck problems, with an exercise programme for home.
8. Reserve options. For very severe grinding that resists treatment, botulinum toxin into the chewing muscles is occasionally considered. It weakens the muscle temporarily, works for only a few months, has to be repeated and brings risks of its own — not a first-line treatment, but a case-by-case decision in experienced hands.

The medication angle: the underrated trigger

That medicines can cause or worsen bruxism is barely known outside professional circles. If grinding or clenching appears newly or clearly gets worse, it is always worth looking at your medication plan and at when it was last changed.

Antidepressants: SSRIs and SNRIs

The link is best described for antidepressants from the groups of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs), among them sertraline, citalopram, venlafaxine and duloxetine. Typically it appears in the first few weeks after treatment starts or after a dose increase; sometimes it settles by itself over time.

That is no reason to question an effective and necessary treatment — but it is a reason to raise the subject, instead of spending years only replacing splints. For dealing with unwanted effects in general, the guide side effects of medications helps.

Antipsychotics and stimulants

Antipsychotics too can encourage movement disorders of the chewing and facial muscles through their effect on the dopamine system — from jaw clenching through to involuntary movements. Observations like these belong with the practice treating you, promptly.

Amphetamine-like stimulants are another well-known trigger: jaw clenching is a typical accompanying effect. With prescribed active ingredients such as methylphenidate it is considerably less frequent than with substances used in a way they were not intended for, but it is described — and here too the rule is: raise it rather than stop it.

Everyday substances: caffeine, nicotine, alcohol

These three are the easiest to influence. A high caffeine intake in the afternoon and evening disturbs sleep and encourages arousals. Nicotine is stimulating and is associated with more frequent sleep bruxism. Alcohol may make you sleepy, but it breaks up the second half of the night and worsens disturbed breathing during sleep — unfavourable on both counts. If you take medicines regularly, you will find the most important rules in the guide medications and alcohol.

Magnesium and other supplements — honestly placed

Hardly any remedy is recommended as often for teeth grinding as magnesium. The evidence, though, is thin: on current knowledge there is no reliable proof that it works against bruxism. Where a deficiency has been demonstrated, taking it makes sense; beyond that it is an attempt with limited expectations — the main side effect being loose stools. The same applies to herbal preparations: defensible, but no substitute for protecting your teeth, having your sleep assessed and looking for the triggers.

How to prevent the consequences of grinding

• Practise the resting position — teeth apart, lips closed, tongue resting loosely on the palate. Check several times a day; for awake bruxism the single most effective measure.
• Take the load off your evening — less alcohol and nicotine, caffeine limited from the afternoon onwards, fixed bedtimes. This works on the night-time form.
• Actually wear the splint — it only protects on the nights it is in your mouth. Wear marks are not a defect but proof that it is working.
• Note down changes to your medication — with the date. A new product and the start of the grinding in the same month is a reason for a conversation, and only a record makes that visible.
• Have your sleep investigated — if you snore loudly, have observed pauses in breathing or are very tired during the day. This is often where the real cause lies.

Link your medicines and your symptoms — with brite

A digital medication plan, reminders and your health history in one place. Free of charge.

Start free now