Personal Notes on Bruxism and Temporomandibular Joints

I suffer from sleep bruxism. That is, while sleeping, I excessively clench my jaw and grind my teeth. Humans have an average bite force of 830-1100 kPA, and people with bruxism often build these muscles and will exert that force directly into their teeth, gums, bones, and jaw. In 2026, my bruxism has become markedly worse, causing dental damage. During a particularly stressful spell in September 2026, my gums began receding, and I’m here documenting my efforts to stop and manage this condition.

While attempting to cite and reference medical journals and papers where relevant and possible, documentation of these conditions seems poor, and a lot of it seems to be associated with the organisations creating dental appliances. It falls between arthrology and dentistry. Unfortunately, the study of the masticatory system – gnathology – is a rather niche field. Orofacial is a wider field, but there seems to be more coverage on treatment rather than advancement of the field. One of the major impacts of bruxism is the impact on the temporomandibular joints (TMJ), which connect the jaw to the skull – the mandible to the temporal.

I practise good dental hygiene: I brush twice a day with an electric toothbrush, I floss, and I receive regular dental checkups. None of this does me any good for clenching and grinding my teeth through the night. It is infuriating knowing that I’m doing the damage but being unable to control my body in my sleep. I have long had a hypermobile jaw and the temporomandibular joint problems that are associated with such a condition, which doesn’t help things.¹

Progression

I first became aware of my bruxism in 2016/2017 when on a family holiday. One morning after waking, my family noted that I had been grinding my teeth extremely loudly. At that point I was completely unaware of it happening, and it had no discernible impact on my life, so I didn’t push it at all. It wasn’t until 2020 that it began to become a problem, with my jaw causing me some pain when opening and closing it.

In December 2020 I got a consultation at a dental sleep centre. Following an MRI, I was informed that both my TMJs had ‘anterolateral articular disc displacement’. This means that my articular disc – the small pad between joints – sits forwards and to the side (anterolateral). It was noted that when I open my mouth ‘there is a normal anterior translation and recapture of the disc’, which is what the popping sound I hear from my jaw is. My articular disc pops back into place. Thankfully, it was noted that there is no indication of arthrosis (bone degeneration, arthritis, wear-and-tear on the joint surfaces/bones, etc).

‘Superior compartment effusion with synovitis’ was also noted. The superior compartment is the space above the disc, effusion is collection of fluid, and synovitis is inflammation of the synovium, which is the membrane lining the joint capsule and which produces the lubricating synovial fluid. In essence, the displacement was causing inflammation which my body was trying to address by producing lubricating joint fluid in excess. TMJ issues were noted as being more severe on the right side.

I was given three jaw exercises which I performed for a while and some suggestions on how to alleviate pain; however, the pain eventually subsided on its own, and I returned to ignorance of it. Childhood bruxism is known to self-resolve.

In March of 2026 I had a regularly scheduled dentist appointment where my dentist felt my jaw and noticed unreasonable strength in my temporomandibular muscles but largely brushed over it. During a stressful period in late September of 2026, I noticed I was feeling tired, that my jaw ached (very slightly to the point of almost being improvable), and that my gums were discolouring and beginning to recede. Immediately consulting a dentist, I was informed that my bruxism was causing issues.

Taking pictures while asking me to move my jaw in various ways and into assorted positions, she then showed me the pictures. She indicated where my teeth had chipped and grooves had been worn by my aggressive night grinding. She also informed me that I have a thin front gum, something that is apparently common and which has made the recession worse. Throughout October, my bruxism became worse, and I found myself waking up with my jaw uncomfortably clenched and with a day-long aching jaw.

Symptoms

In addition to gum recession and tooth damage, bruxism and its effects on the temporomandibular joints have knock-on impacts. I’ve personally experienced:

• Headaches.
• Jaw soreness.
• Jaw clicking.
• Waking up tired.

Bruxism and sleep apnoea are well linked. It is suggested that clenching is a reflex to open one’s airways. Thus, avoiding sleeping on one’s stomach can prove advantageous. I’ve also experienced insatiable hunger – something that is linked to sleep apnoea disrupting hunger-regulating hormones such as ghrelin and leptin. The former, which is responsible for hunger, is often raised, while the latter, which is responsible for fullness, is often lowered.

Management

There exists no ‘cure’ or definite measures. Clenching and grinding are both exacerbated by stress, so the typical advice is to ‘stop being stressed’. While, yes, one can minimise the stress in their life, one cannot just ‘stop being stressed’.

Frustratingly, sleep bruxism is not something that can be easily controlled. Much like how one cannot just turn off stress, one can’t just stop an action from occurring in their sleep. If you snore, why not just stop snoring? If you have a depression, why not just be happy? If you have anxiety, why not just calm down? I find peace and relaxation in videos showcasing the restoration of fine mechanicals, like watches, and in ASMR, though I’m not sure if these videos actually reduce my bruxism. Instead, there are more reasonable, actionable options.

For awake bruxism, proper mouth posture is important: lips together, teeth close but not touching, tongue resting on the roof of the mouth behind the front teeth. It is hard to reform a habit – especially one as subtle and subconscious as mouth and tongue position – but it does make a marked difference. It is suggested that awake bruxism is likely linked to sleep bruxism too, so reducing awake bruxism is optimal all around, and this is one of the easiest actionable methods to do so.

A night guard can be used to stop typical damage, preventing teeth from directly grinding and redistributing forces. However, like with clear dental retainers, guards can promote further grinding and clenching. Many people naturally grind or clench harder just for having the guard in their mouth, especially if the guard is soft. Hard stabilisation splints are designed for this purpose, distributing and dissipating forces effectively.

Trays which prevent back molars from touching can stop the nociceptive trigeminal inhibition reflex, which can cause forceful contraction. These trays are called NTI-TSS (Nociceptive Trigeminal Inhibition Tension Suppression System) and, while often effective, can also inflict damage by means of inoptimal distribution of force through other teeth. An anterior bite plane works upon the same principle with the same potential shortcoming.

Electromyography (EMG) biofeedback devices can be used to identify activity in muscles and then notify a user that they are clenching or grinding so they can stop. Obviously this is good for prompting people to stop grinding when they’re doing it subconsciously while otherwise conscious and able to stop. In one’s sleep, though, it has little impact or effect. It is valuable in sleep, though, for tracking and identifying grinding activity. Products like the AesyBite exist specifically for this purpose.

Lifestyle changes also have effect. Intake of stimulants can be reduced or stopped, or they can be taken earlier in the day, so as to have worn off by time for sleep. However, one must be careful if applying the latter, because the half-life of many stimulants is seemingly under-reported, and there is evidence that caffeine has influences on sleep regardless of when in the day it is consumed. Alcohol intake also has effect, as does sugar intake, so reducing intake before sleep is advantageous. Posture is found to have impact on the TMJ. Slouching with forward head posture puts strain on the neck, which obviously connects to the head and can influence the jaw.

Exercises and massages also have influence. The goal of many TMJ exercises is to reduce pain and strengthen the muscles that handle jaw function. In the case of bruxism, the goal is to relax the muscles so that your body does not clench or grind. Generally, this means targeted massage. In my case, I’ve been advised against some exercises or told to modify them to avoid causing damage or issue due to my jaw’s hypermobility. Usually this just means doing exercises while opening my mouth only to the extent that is typical, though it also includes taking care not to over-extend my jaw in other situations, such as by placing my fist under my chin to stop wide opening when yawning. ‘Joint stabilisation’ is the typical focus rather than stretching or strengthening. A plethora of exercises can be found online, many of which focus on opening the jaw in a controlled way with some resistance.

The heaviest solution is injection of botulinum neurotoxin (Botox) into the masseter and temporalis muscles to weaken them enough to mitigate damage from bruxism – though not enough to impact speech or mastication. There is good scientific evidence to support the efficacy of the approach, and results typically last three to six months post injection.

Dry needling has also shown comparable efficacy. Comparison of the effectiveness of botulinum toxin, dry needling, pharmacological treatment, and manual therapy for bruxism-induced myalgia: a prospective randomized study placed the three methods it covered as leading to similar outcomes.

On the less invasive side, various muscle relaxants such as cyclobenzaprine and baclofen are proven to be successful. Expanding the Therapeutic Profile of Topical Cannabidiol in Temporomandibular Disorders: Effects on Sleep Quality and Migraine Disability in Patients with Bruxism-Associated Muscle Pain and other studies indicate that Cannabidiol (CBD) can be applied to reduce muscle tension and the effects of bruxism.

Due to sleep apnoea being so thoroughly linked to bruxism by means of one’s body adjusting for airway obstruction, there are a number of sleep-related treatments. A sleep study can identify obstructive sleep apnoea and lead to treatments for the problem. In the case of bruxism, the cause is often that the mandible is thrust forward to open the collapsing airway. There are a few treatments for this, including a Continuous Positive Airway Pressure (CPAP) device or a Mandibular Advancement Device (MAD), which fits similarly to a retainer but has a connector between the upper and lower trays which holds one’s jaw in a specific location. In more severe cases, surgical expansion of the airways can be a solution.

Footnotes

1. Starting in mid-2017, I had a Herbst appliance which I wore for an extended period. This was completely botched by my orthodontist due to his inability to understand my jaw’s ability to open more than is typical. It was a long and drawn-out treatment that ultimately didn’t achieve the results it should have. For a period I was returning to the orthodontist weekly to have problems addressed.

   While studies seem to find no link between the appliance and TMJ disorders, there are many anecdotal stories of people beginning to experience jaw problems following treatment with the Herbst appliance. Some studies have found links in some cases. ↩