Biofeedback Therapy for Bruxism Management

Bruxism, the involuntary grinding or clenching of teeth, is a common condition that can lead to various dental issues and discomfort. While traditional treatments like mouthguards are often used, a newer approach gaining attention is biofeedback therapy.


Biofeedback for bruxism technique offers a promising avenue for managing bruxism by utilizing the body’s own responses to control the harmful habit. It is borne out of a new approach to teeth grinding as a behavior that must be unlearned instead of a medical condition.


The use of biofeedback devices in managing behavior opens up a fascinating realm of possibilities, showing the potential to provide individuals with a unique opportunity to take control of their condition in a novel way.


Bruxism and its Two Main Types


Bruxism, a common habit characterized by unconsciously grinding or clenching of the teeth constantly, manifests in two primary forms: awake bruxism and sleep bruxism.


    • Awake bruxism occurs during the day and is often associated with activities such as stress, concentration, or intense focus.
    • Sleep bruxism happens during the night and is more involuntary, making it a habit and behavior that is harder to control.

Both awake and sleep bruxism can lead to various issues, including tooth wear, jaw pain, and discomfort in the temporomandibular joint.

Primary sleep bruxism (when it is a problem itself and not a result of another condition,) in particular, poses unique challenges as individuals are unaware of their actions while asleep. This is why the grinding of teeth at night is mostly first detected by the patient’s bed partner, in the case of adults or their parents, in children. This unconscious grinding can result in disrupted sleep patterns and morning headaches and might only be detected when the tooth wear and pain become too severe to ignore.


However, understanding the differences between these two types of bruxism is crucial for effective diagnosis and treatment to help individuals alleviate symptoms and prevent further complications.


We should add that a new consensus has emerged from the last decade or so of research into this, as more and more studies show that bruxism should be defined more as a risky behavior that can lead to further complications, as stated by Lobbezoo et al. (2018) here.


This might not mean much in terms of the known risk factors, symptoms, and how we diagnose it, but it does open the door for a broader range of treatments. What is going to be treated is changing.


Risk factors and Symptoms of Bruxism


Let’s first make a quick overview of what patients with bruxism might go through on average and how they got there. 

Amidst the multifaceted nature of bruxism, various risk factors and symptoms play a crucial role in identifying and addressing this common parafunctional habit. Bruxism can be influenced by factors such as: 


    • Stress
    • Anxiety
    • Sleep disorders
    • Malocclusion or misaligned bite.
    • Temporomandibular Joint Disorders (TMJ.)
    • Individuals with hyperactive jaw muscles or abnormal jaw muscle responses are also at higher risk.

While the condition is more common in children, in both its forms, bruxism in adults is still present in almost 10% of the under-65 adult population. Other epidemiological studies have it at around 10% to 13% for primary sleep bruxism and 22% to 31% for awake bruxism.


But one or several bruxism events during a lifetime are even more common, with almost 90% of the entire population reporting grinding and clenching their teeth unconsciously at least once. 


When it comes to symptoms, most patients with bruxism report one or more of the following on top of tooth grinding or clenching: 


    • Worn tooth enamel.
    • Abnormal tooth wear.
    • Temporomandibular disorders (can be either a cause or symptom.)
    • Jaw muscle soreness and pain.
    • Headaches during the day or when waking up.
    • Facial pain.
    • Disturbed sleep patterns.

How is it diagnosed? Clinical trials have shown that the assessment of bruxism can involve examining the wear patterns on teeth, evaluating jaw muscle tenderness, and observing the range of motion of the jaw.


Understanding these risk factors and symptoms is essential for early detection and effective management of bruxism.

However, it must be noted that not all those who grind their teeth will feel the symptoms immediately, with some not even seeing any, ever, while others might get severe headaches with moderate teeth grinding. Nonetheless, by recognizing the signs and addressing them promptly, healthcare providers can help individuals mitigate the potential negative consequences associated with this condition.



Biofeedback for Teeth Grinding: What is it?


Biofeedback therapy is a non-invasive treatment approach that aims to increase awareness and control over physiological processes. Understanding the potential treatment options, particularly biofeedback therapy, is crucial for any effective management of bruxism.


In the case of bruxism in adults, biofeedback therapy focuses on monitoring muscle activity, particularly the masseter muscle, which is commonly involved in teeth grinding and clenching at night.


During biofeedback therapy sessions, devices with sensors are placed on the facial muscles or masseter muscle to detect muscle tension levels.


Patients with bruxism are then provided with real-time feedback, such as visual or auditory cues, to help them learn to recognize and control muscle tension associated with bruxism. Through this process, individuals can develop strategies to relax the masseter muscle consciously, reducing the frequency and intensity of teeth-grinding episodes.

Although clinical trials and real-world applications of biofeedback therapy are used in both night and daytime teeth grinding, the recent focus has mostly been on using a biofeedback device on sleep bruxism patients. Sleep bruxism events are the hardest to treat or even report, with a majority of primary sleep bruxism patients completely unaware of their behavior. It’s why employing the device on sleep bruxism patients is seen as the best use of this new technology.

This is why using biofeedback for sleep bruxism has become the main focus of this new therapeutic approach and can be a valuable component of a comprehensive treatment plan for bruxism in adults.


Benefits of Managing Bruxism with Biofeedback

Implementing biofeedback therapy for bruxism management offers individuals a proactive approach to enhancing self-regulation of muscle activity. Instead of something that can be cured, it’s something that can be unlearned. 

The evidence suggests that biofeedback therapy can help individuals become more aware of their oral parafunctional habits and learn to control muscle tension in the jaw.


By providing real-time feedback on muscle activity, biofeedback devices assist individuals in developing healthier muscle patterns and reducing the frequency and intensity of bruxism episodes. Overall, the use of biofeedback in the treatment of bruxism shows promising results and offers a treatment that is: 


    • Non-invasive
    • Drug-free
    • Address the root cause or behavior.
    • Teaches people to better control their behaviors.

How Most Biofeedback Devices Work

Biofeedback devices are designed to provide individuals with real-time feedback on their muscle activity during sleep and alert them of teeth grinding and clenching.


How do these devices work? Although there are many variations of these devices, both on the market and still in clinical trials, they mainly work via these three steps: 


    1. Jaw Muscle Activity Monitoring: Biofeedback devices can detect and measure muscle contractions in the jaw area, alerting the individual when excessive muscular activity associated with bruxism is occurring.
    2. Immediate Feedback: By providing real-time feedback, these devices allow individuals to recognize the precise moments when grinding and clenching are happening, helping them develop strategies to prevent or stop the jaw muscle activity in sleep bruxism.
    3. Behavior Modification: Through continuous use, biofeedback devices assist individuals in modifying their sleep patterns by promoting relaxation techniques and muscle activity retraining, ultimately leading to better management of sleep bruxism and treatment outcomes.

One common version of biofeedback technology you’ll see currently are devices like a biofeedback splint, headbands, headphones, and others that are similar to night guards but are used to monitor muscle motor activity during sleep.


What Studies Say About the Effectiveness of Biofeedback


Research studies have demonstrated the efficacy of biofeedback therapy, especially in the management of sleep bruxism, by providing individuals with valuable real-time feedback on their muscular activity during sleep.

One study published in the Journal of Oral Rehabilitation in 2018 found that biofeedback therapy can be an effective treatment for bruxism. The systematic review and meta-analysis study demonstrated that individuals who received biofeedback treatment showed significant improvements in reducing teeth grinding and clenching compared to those who did not undergo biofeedback therapy after five sessions.


“The meta-analysis indicated a non-significant difference in electromyographic-measured SB episodes per hour after one night of contingent electrical stimulation (CES) compared with placebo control, yet a significant difference was shown after five nights of CES.”


Another study, titled “Effectiveness of Biofeedback in Individuals with Awake Bruxism Compared to Other Types of Treatment: A Systematic Review,” is a recent one from 2023. It found a reduction in “phasic events of the masticatory muscles” in both night and daytime teeth-grinding thanks to auditory biofeedback when applied for two or more consecutive days of the week. Visual biofeedback, it stated, reduced jaw (both the left masseter and temporalis muscles) electromyographic or motor activity in individuals treated once a week for three weeks.


Another study from 2014 in Japan conducted a longitudinal analysis to evaluate the long-term effectiveness of tonic biofeedback in managing bruxism. The study followed 12 individuals with bruxism disorder over a duration of 3 weeks. The findings revealed sustained improvements in muscle relaxation and a decrease in bruxism-related myofascial pain and dental damage in the participants who received biofeedback therapy.


These studies highlight the positive outcomes and impact of biofeedback therapy in alleviating bruxism symptoms and improving the overall well-being of affected individuals



Other Treatment of Bruxism Options


Exploring additional avenues on top of biofeedback for bruxism is important, especially for finding relief for the most severe symptoms, like jaw muscle pain or severe tooth damage, which sometimes can’t wait for the biofeedback therapy to take full effect.


Night Guards and Mouth Guards


Night guards and mouth guards are commonly recommended as effective tools for managing primary sleep bruxisms. When considering these options, individuals often seek reviews to guide their decision-making process.

Here are three key aspects to keep in mind when using night guards and mouth guards:


    • Comfort: Ensure the guard fits well and is comfortable to wear throughout the night. For this reason, the preferred option is always soft custom night guards.
    • Durability: Opt for a durable material that can withstand the intense pressure and jaw activity in sleep bruxism.
    • Effectiveness: Look for a guard that effectively prevents teeth grinding and clenching, providing relief from most bruxism symptoms.

Stress and Anxiety Management and Therapy


Individuals experiencing bruxism may benefit from exploring stress and anxiety management and therapy as additional treatment options to address the underlying causes of teeth grinding and clenching. Stress and anxiety are commonly linked to the development and exacerbation of bruxism.


Managing stress through relaxation techniques, cognitive-behavioral therapy, or mindfulness practices can help alleviate the pressure on teeth and jaws. Understanding the diagnostic criteria for bruxism and identifying stress triggers can aid in developing personalized stress management plans.


Taking time to address the root causes of stress and anxiety can contribute to reducing bruxism episodes and improving overall oral health.


Muscle Relaxation Medication


One effective approach in managing bruxism involves the utilization of muscle relaxation medication as a treatment option to alleviate the symptoms associated with teeth grinding and clenching. Muscle relaxants works by reducing muscle tension, promoting relaxation, and preventing involuntary muscle contractions that contribute to primary sleep bruxism.


Healthcare providers often prescribe this type of medication in conjunction with other bruxism management approaches to achieve optimal results. When considering muscle relaxation medication as part of the treatment plan for bruxism, individuals should consult with a healthcare professional to determine the most suitable medication and dosage based on their specific needs and medical history.


Adherence to the prescribed treatment treatment is crucial for maximizing the benefits of muscle relaxation medication in alleviating bruxism symptoms.


Talk to Your Healthcare Provider to See if Biofeedback Treatment is For You


Biofeedback therapy has shown to be an effective method for managing bruxism by providing patients with real-time feedback on their muscle activity and helping them learn to control and relax their jaw muscles.

Studies have demonstrated the benefits of using biofeedback devices for bruxism treatment, making it a promising alternative to traditional methods.


With further research and advancements in technology, biofeedback therapy could potentially become a widely utilized approach for bruxism management. If you think this option is best for you, or other treatments have not worked, contact your healthcare provider or oral specialist and ask about biofeedback technology to improve your quality of life.


Frequently Asked Questions


Can Biofeedback Therapy Be Used in Combination With Other Treatments for Bruxism?


Yes, biofeedback therapy can be effectively combined with other treatment methods for bruxism to enhance overall management. Integrating biofeedback therapy with traditional approaches like oral appliances (a mouth guard, an occlusal splint, etc) or behavioral therapies may offer a comprehensive solution for individuals with bruxism.


Are There Any Potential Side Effects or Risks Associated With Using Biofeedback for Bruxism Management?


When considering the potential side effects or risks of utilizing biofeedback therapy for bruxism management, it is essential to assess individual sensitivity to the therapy, the qualifications of the practitioner, and the appropriateness of the treatment plan.


How Long Does It Typically Take to See Results From Biofeedback Therapy for Bruxism?


Results from biofeedback therapy for bruxism can vary based on individual factors like severity of the condition and consistency of treatment. Typically, noticeable improvements may be observed within a few weeks to a few months of starting therapy.


Is Biofeedback Therapy a Permanent Solution for Bruxism, or Does It Require Ongoing Maintenance?


Biofeedback therapy can offer long-term benefits for managing bruxism by helping individuals become more aware of and control their teeth-grinding habits. However, ongoing maintenance, such as regular monitoring and reinforcement of techniques, may be necessary.


Are There Any Specific Lifestyle Changes or Habits That Can Enhance the Effectiveness of Biofeedback Therapy for Bruxism?


To enhance the effectiveness of biofeedback for bruxism, individuals may benefit from incorporating stress-reduction techniques, maintaining proper sleep hygiene, avoiding caffeine and alcohol before bedtime, and practicing relaxation exercises to promote overall well-being and reduce jaw clenching.

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