Institute for Continuing Education

Bruxism: The Sleep Disorder

Course Objectives

Upon successful completion of this module, you will be able to:

• Differentiate between sleep bruxism and awake bruxism, understanding the distinct definitions per the International Classification of Sleep Disorders (ICSD-3) and consensus statements, including diagnostic criteria (repetitive jaw muscle activity characterized by clenching or grinding of teeth and/or bracing/thrusting of the mandible during sleep), prevalence across age groups, and the bidirectional relationship between sleep and wake bruxism manifestations in contemporary sleep medicine as of 2025.
• Analyze the multifactorial pathophysiology of sleep bruxism, synthesizing knowledge of central nervous system mechanisms (microarousals, autonomic activation, sleep stage relationships), genetic predisposition and familial aggregation, neurochemical pathways (dopaminergic, serotoninergic, GABAergic systems), psychological factors (stress, anxiety, personality traits), and peripheral factors (occlusal relationships, temporomandibular disorders), recognizing that sleep bruxism represents a centrally-mediated behavior rather than a primary dental or occlusal disorder.
• Evaluate the clinical consequences and associated conditions of sleep bruxism including dental effects (tooth wear, fractures, restorations failure, tooth sensitivity), orofacial pain and temporomandibular disorders (TMD), masticatory muscle hypertrophy and pain, headaches (particularly tension-type and morning headaches), sleep disruption for patients and bed partners, and the relationships between sleep bruxism and other sleep disorders (obstructive sleep apnea, REM sleep behavior disorder, periodic limb movements), understanding both the direct effects of bruxism and comorbid associations.
• Apply assessment methodologies for sleep bruxism including clinical examination (dental wear patterns, masseter and temporalis muscle tenderness, mandibular range of motion), patient and bed partner history (self-reported grinding, witnessed events, morning symptoms), diagnostic questionnaires and screening tools, polysomnography with video and audio recording plus masseter and/or temporalis EMG for definitive diagnosis, and portable EMG devices for home-based assessment, understanding the strengths, limitations, and appropriate applications of each assessment method.
• Synthesize current evidence regarding treatment and management approaches for sleep bruxism including behavioral interventions (stress management, sleep hygiene, biofeedback, cognitive-behavioral therapy), occlusal appliances (oral splints/night guards, mandibular advancement devices), pharmacological approaches (muscle relaxants, botulinum toxin injections, medications affecting neurotransmitter systems), treatment of comorbid conditions (OSA, anxiety disorders, medication-induced bruxism), and multidisciplinary collaborative care, critically evaluating the evidence base, clinical indications, limitations, and patient-centered decision-making for each approach.
• Integrate knowledge of sleep bruxism into polysomnography practice, demonstrating proficiency in technical aspects including masseter/temporalis EMG electrode placement and monitoring, recognition of bruxism events on PSG (rhythmic masticatory muscle activity, phasic vs. tonic vs. mixed patterns), scoring and quantification of bruxism episodes and bursts per AASM guidelines and research criteria, correlation with sleep stages and other physiological events (arousals, respiratory events), and appropriate documentation and reporting of sleep bruxism findings to referring clinicians.
• Communicate effectively with patients, dental professionals, and multidisciplinary team members about sleep bruxism, providing patient education on the condition's etiology, consequences, and management options, facilitating collaboration between sleep medicine and dental professionals for comprehensive care, recognizing scope of practice boundaries (sleep technologists provide technical expertise and education but do not diagnose or prescribe treatment), and advocating for integrated, evidence-based, patient-centered approaches addressing both sleep and dental aspects of bruxism.

Course Information

Bruxism is listed in the International Classification of Sleep Disorders (ICSD.) In fact, the ICSD suggests that bruxism is the third most common form of sleep disorder right behind sleep talking and snoring. In this course, you will the definition of the term, its etiology, pathology, methods of diagnosis, and treatments.

Bruxism is also closely associated with other sleep disorders. Research has discovered that people who brux are more likely to snore, suffer from breathing pauses during sleep and be victims of sleep apnea. As is the case in many sleeping problems, stress is a major cause of bruxism. Even during the day, it’s not unusual to clench or grind the teeth when angry or nervous. The use of tobacco, alcohol or caffeine tends to aggravate the problem. It’s a disorder that can affect people of all ages, men and women. It does seem to decrease with age, and the worst cases occur in the 19 to 44 year age group.