Condition guide
Teeth clenching and grinding (bruxism) is when the chewing muscles work more than they need to, during sleep or during the day. It affects roughly one in four or five people worldwide, and most people do not notice it. Its effects are not limited to the teeth: the jaw joint, neck muscles, sleep and headaches can also be affected. In this guide we explain bruxism from start to finish, like a lesson.
On this page
About this guide. Our author İhsan Eren learned the approach in this guide from Physical Medicine and Rehabilitation specialist Prof. Dr. Cihan Aksoy (Cihan Hoca), one of the pioneers in Türkiye in the field of jaw joint disorders and teeth clenching, with studies published in international journals since 2005. Cihan Hoca developed an approach that brings dentistry, psychiatry and other specialties together in bruxism and sets out which treatment is medically appropriate in which situation. On this page we include two studies that Cihan Hoca co-authored.
According to the 2018 international consensus, bruxism is chewing-muscle activity that occurs during sleep or while awake, and it has two separate forms. A person can have bruxism without grinding their teeth, simply by clenching or by pushing the lower jaw.
According to the consensus, in otherwise healthy people bruxism is not a disease in itself but a behaviour; however, it can be a risk factor for consequences such as tooth wear and chewing-muscle and jaw joint pain. Whether bruxism is present is assessed at three levels:
According to a 2024 meta-analysis combining 176 populations, bruxism affects about 22% of people worldwide: sleep bruxism 21%, awake bruxism 23%. In other words, roughly one in four people may clench their teeth during the day. Awake bruxism was reported about twice as often in women as in men (17% vs 8%); no significant difference was found between continents.
Normally the teeth do not touch all day: at rest the lips are closed, the teeth slightly apart and the tongue rests on the roof of the mouth. In clenching, however, the muscles can press the teeth together for hours.
Summary for everyone
Thinking of teeth clenching only as a dental problem means seeing half the picture. The dashed lines show that the effect can spread like a chain from the jaw to the joint and neck muscles.
Bruxism is now regarded as a behaviour mainly regulated by the brain; the bite and the structure of the jaw play only a small role. In a study of patients with sleep bruxism, in 79% of clenching episodes an arousal-like increase in brain waves was seen about 4 seconds before the muscle activity, with an acceleration of heart rate just before it. In other words, clenching during sleep often appears together with a brief lightening of sleep (micro-arousal). Complaints associated with teeth grinding also include disrupted sleep (yours or your bed partner's) and headache. Snoring and pauses in breathing during sleep (sleep apnoea) have also been found to be associated with bruxism.
Chewing muscles that are clenched for long periods tire and ache; pain in the jaw joint, limited mouth opening and a clicking sound can occur. According to the international headache classification, after tooth pain, jaw joint problems are the most common cause of facial pain. A painless click is common and does not need treatment on its own; if there is pain, locking or limited mouth opening, an assessment is needed. For more detail, see the jaw joint disorders guide.
Clenching and grinding can lead to tooth wear, sensitivity to hot and cold, broken fillings and teeth, cracks in the teeth and problems with dentures. There are clues inside the mouth too: in a 2026 study of 98 patients in Türkiye, among those with bruxism confirmed by a sleep study, 65.3% had tooth marks on the edges of the tongue and 75.5% had a white line on the inside of the cheek along the level of the teeth. The dentist examines tooth wear and the bite (occlusion); however, the bite is no longer seen as the main cause of bruxism.
It is not only the jaw muscles that work when you clench: in a muscle activity study in healthy people, the activity of the front neck muscles rose markedly during maximum clenching. Jaw joint problems are also more common in people with neck pain: in a 2026 meta-analysis that reviewed nine studies, people with neck pain were about 3.6 times more likely to have a jaw joint problem (very low certainty evidence).
My personal clinical observation
Many people turn to one treatment after another for complaints such as waking up tired, morning headaches, and neck and shoulder pain; in clinic I see that teeth clenching can sometimes turn out to be behind these complaints. In advanced cases that do not settle, I also come across pain that spreads from the neck to the arm and resembles nerve root compression but is not true root compression. You can read what nerve root compression is in the cervical disc herniation guide. I share this as my own observation, not as a research finding; not everyone may respond in the same way.
Jaw joint and chewing-muscle problems often occur together with other diagnoses, and their symptoms can overlap. For this reason, in someone being assessed for headache, widespread body pain or neck pain, the jaw joint and chewing muscles should also be examined.
Related guides: headache, fibromyalgia, neck pain.
Bruxism has no single cause; several factors play a part together. It used to be thought that problems with how the teeth meet were the main cause; today these factors are accepted as playing a small role, and bruxism is regarded as mainly regulated by the brain.
In a study co-authored by Cihan Hoca that examined 273 patients attending a multidisciplinary jaw joint clinic, being female, insufficient social support and muscle-related facial pain increased the likelihood of anxiety or depression. The authors recommended that anxiety and depression be considered alongside muscle and joint problems when planning treatment. For coping with stress, see the what can you do in stressful moments? page.
A night guard (mouth guard) is an appliance made by a dentist and usually worn at night. By keeping the teeth apart it helps prevent wear and can reduce the clenching sensation and pain. However, a night guard has not been shown to reduce the clenching behaviour.
The dentist assesses tooth wear, fractures and cracks, and how the teeth meet (occlusion), and decides whether a night guard is needed and which type.
At present no treatment anywhere in the world has been shown to eliminate teeth clenching for good. In reviews, night guards, biofeedback and botulinum toxin did not show definite effectiveness in the short term; although some medicines reduced clenching episodes during sleep, caution is needed because of side effects, and the reliability of these reviews is very low. So the aim is to protect the teeth, joint and muscles, reduce the triggers and ease the symptoms. This often requires several specialties to work together.
The schematic drawing below shows the two muscles used for botulinum toxin injections in teeth clenching. The dots are only to show the area; the physician decides the actual injection points and dose.
Exercises
Do the movements slowly, within a pain-free range. If the pain increases, stop and talk to a physiotherapist or physician.
Keep your lips closed and your teeth slightly apart, with the tip of your tongue resting on the roof of your mouth just behind your upper front teeth. Whenever you notice yourself clenching your teeth during the day, go back to this position.
Check it often throughout the dayClench your teeth to find the chewing muscle in your cheek, then relax. Press gently on this muscle with your fingertips, making small circles. Doing it with a warm towel can be soothing.
1–2 minutes, 2–3 times a dayPlace the tip of your tongue on the roof of your mouth, behind your upper front teeth. Keeping your tongue there, slowly open and close your mouth. Make sure your jaw moves in a straight line without drifting to the side; it can help to do this in front of a mirror.
6–10 reps, 3 times a dayPlace your fist or two fingers under your chin. Try to open your mouth slightly while gently resisting with your hand; hold for 3–5 seconds, then relax. Using half your strength is enough, and it should not increase your pain.
5–6 reps, twice a daySit up straight, looking straight ahead. Without tilting your head, draw your chin straight back, as if making a double chin. Feel the back of your neck lengthen; hold for 5 seconds, then relax.
10 reps, 2–3 times a daySit comfortably; relax your shoulders and jaw, and keep your teeth from touching. Breathe in calmly through your nose and breathe out slowly. As you breathe out, feel the muscles on both sides of your face and your temples soften.
5–10 breaths, several times a dayTeeth grinding can also occur in children. It usually appears after the baby teeth or adult teeth first come through and usually stops once the adult teeth have fully developed. If you are concerned, especially if it is affecting your child's sleep, see a physician; if there is tooth wear or pain, a dentist can also assess it.
Past to present
Teeth grinding has been known since ancient times. It was given a name in the 20th century; for many years the bite was considered the main cause. In the last 25 years, however, it has become clear that bruxism is a behaviour mainly regulated by the brain.
Usually not. A Cochrane review of five studies did not find enough evidence that a night guard reduces sleep bruxism; a night guard may mainly protect the teeth against wear. Because clenching may continue, the load on the muscles and joint can persist. So a night guard is considered not on its own but together with stress management, changing habits and muscle work. Your dentist decides the type of night guard and when to wear it.
It may. In a 2026 study of 98 patients in Türkiye, 65.3% of those with bruxism confirmed by a sleep study had tooth marks on the edges of the tongue, compared with 34.7% of those who only reported clenching themselves. A white line on the inside of the cheek along the level of the teeth was seen in 75.5% and 42.9% respectively. These signs do not make a diagnosis on their own; they are assessed together with a dental examination.
A click may be related to the disc inside the jaw joint shifting as the mouth opens and closes. A painless click is common and does not need treatment on its own. If the sound comes with pain, limited mouth opening or catching, it should be assessed. Clenching can be a risk factor for chewing-muscle and jaw joint pain; for more detail, see the jaw joint disorders guide.
Stress and anxiety are among the most commonly cited factors. In a systematic review of six studies (three in the meta-analysis), people with stress were about twice as likely to have bruxism (OR 2.07); however, the certainty of the evidence was low. In a study co-authored by Cihan Hoca that examined 273 patients attending a jaw joint clinic, being female, insufficient social support and muscle-related facial pain increased the likelihood of anxiety or depression; the authors recommended that anxiety and depression be considered when planning treatment.
Botulinum toxin is an injection given only by physicians, and for clenching it is injected into the chewing and temple muscles. In a 2025 overview of 14 systematic reviews, a reduction in pain was reported in 10, in clenching episodes in 7 and in maximum bite force in 5. However, the reliability of all the reviews was low or critically low, and no firm conclusion could be drawn. Your physician decides whether it is suitable.
Most people do not. A Cochrane review of medicines for sleep bruxism did not find enough evidence in seven small studies that medicines are effective; side effects were seen with some medicines. Gabapentin, a medicine used for nerve pain, reduced night-time chewing-muscle activity as much as a night guard in a small study of 20 people. The only publication we could include for pregabalin, from the same group of medicines as gabapentin, is a case report of a single patient with an anxiety disorder who clenched during the day. These medicines are used only with a specialist physician's prescription and supervision; do not use them on your own. Ask your physician which one is suitable.
Teeth grinding can also occur in children. It usually appears after the baby teeth or adult teeth first come through and usually stops once the adult teeth have fully developed. If you are concerned, especially if it is affecting your child's sleep, see a physician; if there is tooth wear or pain, a dentist can also assess it.
At present no treatment anywhere in the world has been shown to eliminate teeth clenching for good. In reviews, night guards, biofeedback and botulinum toxin did not show definite effectiveness in the short term; although some medicines reduced clenching episodes during sleep, caution is needed because of side effects, and the reliability of these reviews is very low. Because bruxism is a behaviour mainly regulated by the brain, the aim is to protect the teeth, joint and muscles, reduce the triggers and ease the symptoms. This often requires several specialties to work together.
See a physician or dentist in the following situations; how urgent each is, is shown at the start of each group.
Call 112 immediately:
See a physician or dentist the same day:
See a physician or dentist within a few days:
Sources
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