How to Stop Grinding Teeth and Clenching Your Jaw at Night

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How to stop grinding teeth has two answers, because bruxism is two behaviors with the same name. The international consensus statement led by Lobbezoo and colleagues in 2018 defines bruxism as repetitive activity of the jaw muscles, and separates it by the clock: sleep bruxism occurs during sleep, awake bruxism during waking hours. The distinction matters for everything that follows. Awake bruxism is mostly sustained clenching, it is accessible to awareness, and it responds to habit work. Sleep bruxism is centrally regulated, often linked to arousals during sleep, and it is not something anyone talks themselves out of overnight.

The same consensus makes a second point worth knowing before you start worrying. In otherwise healthy people, the authors propose that bruxism is not in itself a disorder but a behavior that can be a risk factor, and in some circumstances even a protective one, for particular clinical outcomes. That reframing takes the moral weight off it. The clinically relevant questions are about consequences: worn or cracked teeth, failed restorations, jaw muscle pain, morning headaches, a locking or clicking joint, a partner woken by the sound. Where there are no consequences, there may be nothing to treat.

That is why the dentist comes first, not last. Only a dental examination can tell you whether there is damage, whether existing work is at risk, and whether a night guard makes sense for your mouth. A guard is armor rather than a cure: it puts a layer between the surfaces, and the muscle activity continues underneath. The evidence for guards is also narrower than their popularity suggests. A Cochrane review by Macedo and colleagues in 2007 concluded there was not sufficient evidence to state that occlusal splints are effective for treating sleep bruxism, while still leaving them a sensible way to protect teeth. The consensus also grades assessment: self-report alone gives possible bruxism, a clinical exam makes it probable, and only instrumental recording makes it definite.

Stress is the part people assume and researchers argue about, so here is the honest version. Manfredini and Lobbezoo reviewed the psychosocial literature in 2009 and found that associations with stress, anxiety and personality variables appear fairly consistently for awake bruxism and self-reported grinding, and much less consistently for sleep bruxism measured instrumentally in a sleep laboratory. In plain terms: the daytime clenching that follows a difficult week is well supported, and the claim that your night grinding is simply stress leaving the body is not. Working on stress is still worth doing. Expecting it to resolve sleep bruxism by itself usually disappoints.

The most reliable self-directed gain is in awake bruxism, and the method is habit reversal, described by Azrin and Nunn in 1973 for nervous habits and adapted since to oral habits. It has two halves. First, awareness: you cannot interrupt a clench you never notice, so you set checks that arrive without you remembering, taped to the monitor, on the steering wheel, as a repeating alarm. Second, a competing response. The standard instruction is lips together, teeth apart: lips closed, tongue resting lightly behind the upper front teeth, and a few millimeters of space between the molars, which is the jaw's natural rest position and is incompatible with clenching.

There is also direct evidence that the behavioral route is worth taking. Ommerborn and colleagues randomized 57 patients with sleep bruxism in 2007 to twelve weeks of a cognitive behavioral treatment or to an occlusal splint, and reported significant reductions in bruxism activity, in self-assessed grinding, and in psychological distress in both groups, with more positive coping at follow-up. The trial had no untreated control group, so the authors described it as a first comparison and called for a three-arm design. Read it as encouraging rather than conclusive: the behavioral work performed at least as well as the standard dental appliance.

Several everyday inputs plausibly feed the activity, and each is testable on yourself in a fortnight. Caffeine late in the day, alcohol in the evening and smoking all appear in the risk literature for sleep bruxism, and alcohol has the additional problem of fragmenting the second half of the night. Some medications, including certain antidepressants, have been associated with jaw muscle activity; that is a conversation for the prescriber who wrote the prescription, never a reason to adjust or stop a dose on your own. Keep one change at a time so you can tell which one did anything.

Sleep is the other lever, because sleep bruxism clusters around arousals. A fixed wake time, a dark and cool room, screens off well before bed and a wind-down that is actually a wind-down do more than any gadget sold for grinding. The Sleep Hygiene Checklist covers the standard set. One pattern deserves a specific mention: if you snore heavily, wake unrefreshed, or someone has seen you stop breathing in your sleep, ask a clinician about screening for sleep apnea, since sleep-disordered breathing and grinding often travel together and treating the breathing is the thing that matters.

For the jaw itself, relaxation work targets the muscles doing the damage. Progressive muscle relaxation builds the skill of noticing tension and releasing it, which transfers directly to the masseter and temporalis muscles that have been gripping all afternoon; the Progressive Muscle Relaxation guide runs the full sequence, and an abbreviated version for the face and jaw takes two minutes. Warmth on the muscle, gentle opening and closing within a comfortable range, and avoiding gum, hard foods and nail biting during a painful flare are standard self-care. Sharp pain, locking or a joint that will not open fully is a reason to be assessed rather than stretched.

What this plan is not: a diagnosis, a treatment for jaw joint disorders, or a reason to delay a dental appointment. It is the behavioral half of a problem whose other half belongs to a dentist, and it is at its strongest on daytime clenching and at its weakest on severe sleep bruxism, where instrumental assessment and dental protection carry the load. If grinding is tangled with a stress load you cannot change on your own, the Stress Management Worksheet is the companion to this one, and a therapist is a reasonable step when the tension is a symptom of something larger than your jaw.

Reviewed by Michael Callans, MSW
Checked that the page sends readers to a dentist before any self-help, separates sleep from awake bruxism as the 2018 consensus does, and does not overstate the stress link for sleep bruxism.

References

1. Lobbezoo F, Ahlberg J, Raphael KG, et al. International consensus on the assessment of bruxism: report of a work in progress. Journal of Oral Rehabilitation. 2018;45(11):837-844. https://doi.org/10.1111/joor.12663
2. Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. Journal of Orofacial Pain. 2009;23(2):153-166. https://pubmed.ncbi.nlm.nih.gov/19492540/
3. Ommerborn MA, Schneider C, Giraki M, et al. Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity. European Journal of Oral Sciences. 2007;115(1):7-14. https://doi.org/10.1111/j.1600-0722.2007.00417.x
4. Macedo CR, Silva AB, Machado MAC, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database of Systematic Reviews. 2007;(4):CD005514.
5. Azrin NH, Nunn RG. Habit-reversal: a method of eliminating nervous habits and tics. Behaviour Research and Therapy. 1973;11(4):619-628.
6. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine; 2014.

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