Knowledge7 min read
Bruxism: what the new guideline means for you
Bruxism is the unconscious clenching or grinding of teeth, by day or by night, often without those affected noticing it themselves. The German Society for Functional Diagnostics and Therapy (DGFDT) and the German Society of Dentistry and Oral Medicine (DGZMK) have updated their S3 guideline on the diagnosis and treatment of bruxism; the new version is dated January 2026. Dear patients, in this article we will use the new guideline to look at what bruxism is, how you can recognise it, and what helps against it. Those of you who would rather not swot up on guidelines, who are already growing impatient and simply want to know what helps against bruxism, can jump straight to the section "What helps against bruxism?".
How would I notice that I grind or clench?
Everyone knows the expression "to grit your teeth". What most people are not aware of is that the upper and lower rows of teeth do not touch at all when the jaw is relaxed. When you moisten your lips or swallow, for example, the lower jaw takes up a position relative to the upper jaw that is individual to you, entirely without tooth contact. We have to bring the lower jaw up to the upper jaw actively, using muscle effort. For patients who grind or clench, by contrast, that contact position feels like their normal one. How long the position is held, and at what time of day, varies from person to person.
The guideline distinguishes between sleep bruxism (SB) and awake bruxism (AB), and it makes one thing clear: a certain amount of jaw muscle activity, by day as well as by night, is normal in healthy people, and therefore physiological.
What forms of bruxism are there?
A further distinction is made by cause and by the type of muscle activity.
In primary bruxism, no recognisable reason, trigger or pre-existing condition can be identified. Secondary bruxism has an underlying condition, or it arises as a side effect of medication, through psychotropic substances such as nicotine and alcohol, or as a consequence of a disorder of the central nervous system.
By muscle activity, a distinction is made between tonic bruxism, meaning sustained muscle contractions lasting more than two seconds, and phasic bruxism: short, repeated contractions lasting under two seconds.
Who is affected?
Bruxism begins when the first teeth come through and is found well into old age. It is most common among adolescents and young adults, and becomes less frequent after that. According to the guideline, the relationship between bruxism and sex has not yet been clearly established: studies come to differing conclusions. One point is clearer, however: bruxism in childhood raises the risk of grinding or clenching as an adult as well.
How does bruxism make itself felt?
Constant activity of the jaw muscles leads to tension or pain in the head and neck area. The jaw joints, the muscles or the teeth may be affected, by day or by night. At night, grinding is naturally hard to notice yourself. Some patients report that their lower jaw feels heavy for a few minutes in the morning, while others only learn about their night-time grinding, or the clicking of their jaw joints, from a family member.
During an examination at the dental practice there are many signs that point to bruxism: pronounced cheek muscles, whitish impression lines in the lining of the cheek, wear facets on the teeth, as well as cracks and damage to teeth, fillings and crowns.
What are the causes?
The precise physiological causes of bruxism are not yet fully understood and remain the subject of further research. According to current knowledge, genetic factors play a greater role than previously assumed: twin studies show a clear hereditary component, and disturbances affecting neurotransmitters or the brainstem are also under discussion. A link between emotional stress, in children as well as adults, and bruxism can likewise be shown. Psychotropic substances such as nicotine, alcohol or certain medicines can also trigger or encourage bruxism, as can accompanying conditions such as sleep disorders, reflux disease or intensive competitive sport.
One point has changed markedly with the new guideline. It concerns occlusion, that is, the way the teeth of the lower and upper jaw meet.
A less-than-perfect bite is no longer considered a cause of bruxism.
Earlier assumptions about the link between bite and bruxism are therefore out of date.
How does the dentist find out whether I am affected?
Diagnosis starts with the DGFDT questionnaires and the clinical examination at the practice; both reveal initial tendencies. Anyone who wants to know more precisely can have movements of the lower jaw and grinding sounds recorded in a sleep laboratory by means of polysomnography. Alternatives include wearable EMG devices (electromyography) for measuring muscle activity, splints with a colour scale that make the wear pattern visible, and app-supported self-observation.
If bruxism causes severe pain in the jaw muscles or the jaw joints, or a functional disturbance of the occlusion, this is referred to as craniomandibular dysfunction (CMD), a condition in its own right that we will give more space in a later article.
What helps against bruxism?
The basis of any treatment is explanation: the patient needs to be informed about the condition, because many no longer consciously register the permanent muscle tension at all. A good first step is self-observation during everyday life. Put coloured stickers in places where you often spend time, in the office or the car for instance. They will remind you again and again. For stress-related bruxism, relaxation and breathing exercises help as well. Why not ask yourself: How do the muscles of my face feel right now? How do the muscles of my forehead, neck and cheeks feel right now? What happens when I moisten my lips or make a swallowing movement? And where is my lower jaw then? Reducing risk factors such as sleep disorders or nicotine should be considered too.
The direct dental treatment is splint therapy. A splint protects the teeth, the jaw joint and any dental work, and it can reduce muscle activity. There are various types, from the classic Michigan splint and the JIG splint through to bimaxillary splints, in soft, thermoplastic or hard materials. In children, splint therapy is used only within narrow limits and, during the mixed dentition phase, is restricted to a few months.
Splint therapy is often supplemented by physiotherapy, with physical measures such as hot rolls, ultrasound or ice. Injecting botulinum toxin into the affected muscle can also reduce muscle activity for three to six months. With biofeedback, a wearable device alerts the patient to their own muscle activity by means of an acoustic signal.
As you can see, bruxism is a complex subject with no single road map. We will find the right treatment together, individually for you and your situation. I hope this article helps you to understand and make sense of grinding and clenching.
This article provides general information and does not replace individual dental advice.
Sources
- German Society for Functional Diagnostics and Therapy (DGFDT) and German Society of Dentistry and Oral Medicine (DGZMK). S3-Leitlinie „Diagnostik und Behandlung von Bruxismus" (S3 guideline on the diagnosis and treatment of bruxism), AWMF register number 083-027, version 2.1, dated January 2026, valid until January 2031. register.awmf.org
- DGZMK. Diagnostik und Behandlung des Bruxismus (S3), announcement of the update on 6 May 2026; first version 2019. dgzmk.de
- zm-online. Update Bruxismus-Leitlinie: Das ist neu!, 1 July 2026, summary of the changes compared with the 2019 version. zm-online.de
Last updated: August 2026
Illustrations: photograph by Johannes Fernandes. Cover image and ring diagram by Claude Opus 5, using the blog's graphics generator (style V3 and a free composition). The graphics are labelled in German.
The draft of this article was produced with AI support (original text: Gemini Flash 3.5 Lite; research, source verification and revision: Claude Sonnet 5) and has been reviewed, revised and taken responsibility for by Johannes Fernandes. How this blog is made
