What Is Bruxism? When Teeth Are Under Pressure at Night

Many people grind their teeth at night without noticing. Only morning jaw pain, tense muscles, or worn tooth surfaces draw attention to the problem. This unconscious clenching or grinding of the teeth is called bruxism. A splint protects the teeth; depending on the cause, additional steps may be needed, such as TMD treatment or relaxation techniques.
In this article, you will learn what bruxism is, what causes it, and how orthodontic treatment can help.

What does bruxism mean exactly?

The term bruxism describes the involuntary grinding or clenching of teeth, which usually occurs at night during sleep – but sometimes also during the day, for example in stressful situations or during intense concentration.
According to the international consensus of 2018 and the German S3 guideline, bruxism is a recurring activity of the masticatory muscles. In otherwise healthy people, it is not automatically considered a disease; it becomes in need of treatment when teeth, muscles, or jaw joints are damaged or pain develops.

Two forms are distinguished:

• Sleep bruxism: unconscious grinding or clenching during sleep

• Awake bruxism: clenching or tensing the jaw during the day, usually unnoticed, for example when concentrating at a screen

Both variants can place significant stress on the teeth, the temporomandibular joint, and the muscles.

How does bruxism develop?

Bruxism has several triggers, often working together. You can identify which causes are likely in your case with our article Zähneknirschen Ursachen: 7 Gründe.

Stress and psychological strain

Emotional tension, performance pressure, or worries often go hand in hand with bruxism; a systematic review from 2025 found a connection with stress, anxiety, and depression in several studies. Clenching is often described as a valve for inner tension – the connection is documented, not the exact mechanism. This connection is most evident in daytime clenching; in sleep grinding, processes during sleep itself also play a role.

Misalignment of teeth or jaw

An uneven bite can lead to the upper and lower jaw not meeting harmoniously. The masticatory muscles are then loaded unevenly. How large the role of the bite in grinding is remains professionally debated; however, a misalignment can intensify the consequences of grinding on individual teeth.

Sleep disorders or certain medications

Restless sleep, sleep apnea , or the use of medications (such as antidepressants) can promote bruxism.

Habits and posture

Jaw clenching while working at the computer or during intense concentration occurs more frequently than many people think. Poor posture can also disrupt the interaction between the jaw and muscles.

What symptoms occur with bruxism?

Bruxism often remains undetected for a long time, as the grinding usually occurs during sleep. Nevertheless, there are typical signs that indicate overload:

• Ground down or flattened tooth edges

• Sensitive teeth or tooth pain

• Jaw, facial, or neck pain

• Tense chewing muscles, especially in the morning

• Jaw popping or restricted mouth opening

• Headaches, especially in the temple area

• Sleep problems or daytime fatigue

How is bruxism diagnosed?

Usually the suspicion arises from your information and the examination by your dentist or orthodontist: wear marks on the teeth, strong and pressure-sensitive masticatory muscles, or tooth impressions on the tongue and cheeks make bruxism likely. Sleep bruxism can only be reliably detected by measuring muscle activity during sleep, for example in a sleep laboratory. For treatment, the clinical findings are usually sufficient.

For detailed assessment, we use:

• Clinical examination of teeth, bite, and muscles

• Analysis of jaw movement and joint function

• 3D scan or functional diagnostics

• If necessary, interdisciplinary collaboration with ENT, pain medicine, or sleep medicine specialists

This allows us to determine whether an orthodontic misalignment or functional cause is present.

How can bruxism be treated?

Treatment is based on the specific cause. The goal is to protect the teeth, relieve the muscles, and, where possible, address the triggers.

Bite guard or night guard

A custom-made splint made of transparent plastic rests on a row of teeth and prevents the teeth from grinding directly against each other. It protects against further wear and can relieve the masticatory muscles. Most people wear it at night; those who clench during the day discuss with us whether a second wearing period makes sense. You can read what such a splint costs in our overview What does a dental splint cost?

This is how the splint is made with us: We scan both rows of teeth with the intraoral scanner, determine the position of the lower jaw, and plan the splint on the computer. It is printed in our own laboratory in the same building — between the scan in the treatment room and the finished splint, there are no postal routes, just a hallway. After delivery, we check the fit and effect of the splint. The digital manufacturing process has been described by Dr. Steinmaier (née Funke) as co-author of a professional publication.

What the splint does not do: It does not eliminate the cause of grinding. That is why treatment always includes the question of what is behind the grinding.

Whether statutory health insurance covers the splint depends on the diagnosis and type of splint. The uniform assessment standard (BEMA) provides separate positions for splint treatment in temporomandibular joint disorders — for a bite splint with and without adjusted surface. Whether a splint becomes a covered service therefore depends on the diagnosis, not on the wish. The extended scope of our DMD bite splint after digital temporomandibular joint measurement is partially billed privately depending on the diagnosis and usually ranges between 1,500 and 3,000 euros. This range does not apply to the simple night guard. We clarify this with you before fabrication. For private services, installment payment up to 18 months interest-free is possible directly through the practice.

Orthodontic treatment

If there is also a misalignment of the teeth or jaw that overloads individual teeth or the temporomandibular joints, orthodontic correction — with aligners or fixed braces — can be part of the treatment plan.

Relaxation and behavioral therapy

For stress-related bruxism, relaxation techniques such as progressive muscle relaxation, breathing exercises, or biofeedback can help.
Physical therapy can also be beneficial to correct postural issues.

Comprehensive approaches

In some cases, we work with other specialties—such as physical therapy, osteopathy, or pain management—to treat the temporomandibular joint and muscles comprehensively.

What happens if bruxism goes untreated?

If severe grinding or clenching remains untreated for a longer period, the symptoms mentioned above can become entrenched: the chewing surfaces continue to wear down, cracks can develop in the enamel, and masticatory muscles and temporomandibular joints remain permanently stressed.

That is why early evaluation is important—especially if you regularly wake up with a tense jaw or your partner notices nighttime grinding.

Bruxism and TMD—how are they connected?

Bruxism and temporomandibular disorder (TMD) often occur together; however, bruxism is not necessarily a precursor to TMD.
TMD involves a functional disturbance between the temporomandibular joint, musculature, and bite.
Frequent clenching or grinding can overload joints and muscles, contributing to pain, popping, or restricted movement.

If the jaw pops, mouth opening is restricted, or pain radiates to the temples and neck, we examine the temporomandibular joints more closely: palpation of the muscles, measurement of mouth opening, and, where necessary, three-dimensional recording of jaw movement with the DMD system.

Can bruxism be prevented?

Bruxism cannot always be completely prevented, but you can do a lot to reduce the risk:

• Make sure to take regular breaks and relaxation time in daily life

• Avoid caffeine, alcohol, and nicotine before bedtime

• Pay attention to ergonomic posture

• Do not habitually chew on objects or fingernails

• Have tension treated early

An early orthodontic examination can help identify functional causes in time.

Evaluation at JUST KFO in Cologne-Rodenkirchen

If you suspect that you grind your teeth or frequently have jaw pain in the morning, have the cause evaluated. After booking your initial consultation appointment, you will receive a link by text or email to our digital health history form “Nelly”; this allows us to use the appointment for the examination. You can find us in Cologne-Rodenkirchen, Hauptstr. 50, phone 0221 93 53 020.

Feel free to book an appointment – we take time for you and your questions.

Frequently asked questions about bruxism

What is the difference between sleep bruxism and awake bruxism?

Sleep bruxism occurs unconsciously during sleep, while awake bruxism occurs during the day, usually unnoticed as well, for example as clenching during concentration or stress.

Can bruxism permanently damage the teeth?

Yes, untreated bruxism can lead to wear of the tooth structure, cracks in the enamel and even tooth loosening, which severely affects oral health.

What role does stress play in the development of bruxism?

Stress is among the most frequently described influences. However, it is rarely the only one: sleep disorders, certain medications, caffeine, alcohol, or nicotine can also contribute to bruxism.

How can an occlusal splint help with bruxism?

The appliance acts as a protective layer between the rows of teeth: the teeth no longer rub directly against each other, and the chewing muscles can relax. It does not eliminate the cause of grinding; therefore, we additionally investigate what is behind it.

When should you see a dentist or orthodontist about bruxism?

If you wake up in the morning with a tense jaw or pain , your partner notices nocturnal grinding, or you experience signs such as sensitive teeth or jaw popping, professional evaluation is recommended.

How long do I need to wear a night guard?

That depends on whether the cause can be treated. Some people need the appliance only during stressful phases, others permanently as protection for the teeth. We monitor the appliance and teeth regularly and discuss with you whether it is still necessary.