Currently, bruxism is recognized as a common condition encountered in dental practice. It is associated with repetitive activity of the masticatory muscles, characterized by clenching and/or grinding of the teeth and mandibular thrusting (¹). Its etiology is multifactorial and involves pathophysiological factors such as genetics, parafunctional habits (lip or object biting, onychophagia), gastroesophageal reflux, airway obstruction, mouth breathing, alcohol and added sugar consumption, medication use, and smoking (¹, ²). Other psycho- logical factors include stress, anger, frustration, and anxiety (³).

Bruxism can be classified according to circadian manifestation (sleep or awake), medical causes (primary or secondary), and the harmful effects on the stomatognathic system (physiological or pathological) (³,⁴,⁵). To establish an accurate diagnosis, three fundamental aspects must be considered: anamnesis, clinical examination, and diagnostic aids (⁵,⁶). The anamnesis aims to evaluate sleep quality, diet, medication, parental/ caregiver reports (in children) of dental grinding, complaints of muscle pain, headaches, sleep routines, and airway characteristics (²). The clinical examination involves an intraoral assessment to identify non-functional wear facets, fractures in teeth and restorations, dental hypersensitivity, pulpal changes, audible occlusal sounds, morning tooth mobility, and occlusal interferences (dental component); as well as traumatic ulcers, linea alba on the buccal mucosa, tongue indentations, and gingival recessions. An extraoral examination is also conducted to evaluate the presence of muscle pain in the head or neck, muscle hypertrophy, muscle fatigue (muscle component), and joint-related signs such as joint noises, pain, or restricted mouth opening (joint component) (⁷).

Electromyography to detect bruxism during wakefulness and sleep, and polysomnography inclu- ding electroencephalogram, electrocardiogram, airflow monitoring, and video/audio recordings during sleep are useful diagnostic tools (¹). Additionally, self-assessment questionnaires have been used to evaluate significant associations between bruxism and psychological conditions such as stress and anxiety or parafunctional habits (¹).

Cruz Fierro et al. (⁸) conducted a study using the Perceived Stress Scale (PSS-14) alongside a self-reported bruxism questionnaire (CBA) in two groups of 50 individuals, one with clinical and self-reported bruxism and one without. Internal consistency reliability, factorial structure, and convergent validity between the PSS-14 and CBA were evaluated. Results showed internal consis- tency across the 11 items (α=.88). Confirmatory factor analysis for a single factor showed acceptable fit indices (χ2/df=1.461; GFI=.916; AGFI=.857, CFI=.967, RMSEA=.068). A positive correlation was found between the PSS-14 and CBA scales (r=.27; p=.001). The findings from the CBA showed strong reliability, consistent internal structure, and adequate correlation between items, confirming the questionnaire’s convergent validity.

Clinical management of bruxism involves identifying and controlling its underlying factors and mechanisms (²). Due to its multifactorial nature, an interdisciplinary approach is required, including psychological care for self-care and emotional self-regulation techniques, physiotherapeutic care through myofascial manual therapy promoting muscle relaxation, and specialized dental care using occlusal splints to prevent dental wear or fractures and soft tissue injuries, as well as the use of neuromodulators like botulinum toxin (¹,⁵,⁷). Additionally, low-level laser therapy and LED photobiomodulation therapy have been reported as alternative treatments to alleviate symptoms and signs (⁹). LED light emission generates a biostimulation process in the masticatory muscles, promoting blood circulation and producing analgesic and anti-inflammatory effects (¹⁰).

Kobayashi et al. (¹⁰) compared the effects of infrared LED photobiomodulation therapy with occlusal splint therapy in children with electromyographically diagnosed sleep bruxism in masseter and anterior temporal muscles. An increase in resting activity of the right masseter muscle was observed following photobiomodulation, whereas elevated electromyographic activity of the right and left temporalis muscles, as well as the left masseter, was noted only in children who used occlusal splints.

Da Consolac et al. (¹¹) conducted a study involving 76 children aged 6 to 12 years, divided into four groups: G1 (bruxism + laser therapy applied to acupuncture points; λ=786.94 nm, 20 seconds per point, fluence=33.5 J/cm², energy=1 J, 12 points); G2 (bruxism+occlusal splint therapy); G3 (bruxism+placebo laser therapy); and G4 (control group without bruxism). The laser treatment comprised 12 sessions, delivered twice a week, using the Therapy EC-DMC device. Clinical indicators-such as bite marks on the oral mucosa, headache reports, bite force (BF), and salivary cortisol levels (as a stress biomarker)-were evaluated before and after treatment. Statistical analyses included ANOVA and normality tests.

The results showed that children with bruxism responded favorably to photobiomodulation therapy, with reductions in both bite force and the frequency of headaches. Significant differences in headache occurrence were found pre- and post- treatment in both G1 and G2. Notably, G1 showed the lowest bite force bilaterally after treatment, indicating muscle relaxation and reduced tissue damage from intense muscle contractions.

Acupuncture has also been used for bruxism treatment, demonstrating decreased activity in the masseter and anterior temporalis muscles. Stimu- lating specific acupuncture points can modulate blood circulation and promote muscle relaxation, thereby alleviating spasms, inflammation, and pain. Stimulation methods include needles, infrared radiation, electrical currents, or lasers the latter being especially suitable for pediatric patients due to its painless application and shorter exposure time per point (¹²).

In conclusion, bruxism is a multifactorial disorder encompassing various genetic, parafunctional, and psychological aspects. Dentists must be able to identify the most effective strategies for their management, considering the individual needs of each case and promoting an interdisciplinary approach. Patient education and prevention are essential to prevent the progression of this disorder. Occlusal splints remain one of the main strategies for bruxism treatment; however, analgesics and muscle relaxants can be useful for symptomatic relief in acute pain cases. A notable advancement is the use of botulinum toxin, which has proven effective in reducing prolonged muscle activity in severe bruxism, alongside acupuncture, low-level laser therapy, and photobiomodulation.

One future perspective of this work is to conduct new studies comparing available diagnostic methods, evaluating their accuracy and clinical utility to improve early detection and treatment of bruxism.

Conflict of interest

None.

Author contribution statement

Conceptualization and design: C.C.M.L and A.M.M.R. Literature review: C.C.M.L, A.M.M.R.Writing-original draft preparation: C.C.M.L and A.M.M.R.Writing-review & editing: M.C.C.P and J.H.W.V. Supervision: M.C.C.P and J.H.W.V.