You wake up with tired jaws and a headache at the temples. The dentist has told you your teeth are worn. Or you notice it during the day: you are concentrating at the computer and find your teeth clenched without knowing for how long.
Bruxism is common and comes in two different forms. Knowing which one is yours changes what is worth doing.
Two forms, two paths
Sleep bruxism. It happens during the night and the person is almost always unaware of it: they find out from their partner, from the dentist who sees the wear on the teeth, or from the symptoms on waking. It is associated with stress, sleep-related breathing disorders, certain substances and certain medications. A systematic review went through the management options for sleep bruxism in adults: it is a chapter led mostly by dentists.
Awake bruxism. It is not grinding but clenching, silently, during concentration, driving, work at the computer or moments of tension. It is the form where you can intervene the most, because it works through awareness.
Many people have both. But the fact that the causes are different is why a single remedy does not cover everything.
Who handles what
It is worth being clear here, because confusion is frequent.
The dentist deals with bruxism as such: assesses tooth wear, prescribes the occlusal splint when needed, considers other dental options. It is the main point of reference, and it cannot be replaced.
The physiotherapist deals with the muscle and joint consequences: jaw pain, difficulty or noise when opening the mouth, tension on the sides of the head, headache on waking, the neck pain that so often comes with the picture.
The doctor comes in when there is a suspicion of a sleep-related breathing disorder behind it, or when the bruxism appeared after starting a medication.
On the splint, an honest clarification
The splint protects the teeth from wear, and that is the main reason it is prescribed. On this there is no doubt.
On pain, the picture is more nuanced than it is usually presented. A Cochrane review from 2024 examined occlusal interventions in managing temporomandibular disorders: knowing its conclusions avoids giving the splint a job it does not have, and concluding that it "does not work" when the muscle pain remains.
In practice: if you have the splint and your teeth are protected but your jaw still hurts, it is not the splint that has failed. It is that muscle pain follows its own course.
What works on the consequences
Here the literature is more direct.
Therapeutic exercise has been assessed by a systematic review with meta-analysis on pain and mouth opening in temporomandibular disorders, with favourable results on both. It is the mainstay of the work.
The comparison between techniques is the subject of a network meta-analysis from 2026, which compared manual therapy, exercise, low-level laser, ultrasound and TENS for pain and mouth opening in temporomandibular joint disorders. Having a direct comparison between the options is rare and useful: it stops you choosing a technique just because it is the one available to you.
The neck needs to be looked at together with the jaw. In practice this is almost a rule: people who arrive with jaw pain often have neck muscles that are just as tight, and treating only the jaw leaves half the problem in place.
The three things to start today
1. The reminder about the resting position. For most of the day your teeth should not be touching: lips closed, teeth slightly apart, tongue resting on the palate. This is the resting position. Set a recurring reminder or a visible cue on your desk, and each time you see it, check where your jaw is. It is simple and it works precisely because awake bruxism goes unnoticed.
2. The habits to drop. Chewing gum for hours, biting pens, resting your jaw on your hand while you read, opening things with your teeth. These are extra loads on a system that is already overworked.
3. The quality of sleep. This is not generic advice: sleep bruxism gets worse in the phases where sleep is poorer, and if you snore heavily or wake up unrested it is worth talking to your doctor.
Getting followed
Bruxism is handled on two fronts: the dentist protects the teeth, and whoever works on movement addresses the muscles and joint that are paying the price. They are complementary, not alternatives.
With Ri-Hub the first consultation is free: a physiotherapist on the Italian professional register assesses mouth opening, the chewing and neck muscles, and sets up the work on the consequences, telling you clearly what instead needs to go to the dentist. Follow-up sessions cost 29,90€.
If the pain mainly concerns the jaw joint and its connection with the neck, read Neck and jaw: the link with the TMJ.
If the symptom that weighs on you most is headache, the dedicated chapter is Cervicogenic headache: when the pain starts in the neck.
Wondering how much it would cost to be followed? The cost depends on how many sessions are needed, not on the single rate: you will find the figures in How much physiotherapy for neck pain costs.
Sources
- Managements of sleep bruxism in adult: A systematic review, The Japanese dental science review, 2022
- Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis, Clinical rehabilitation, 2023
- Occlusal interventions for managing temporomandibular disorders, The Cochrane database of systematic reviews, 2024
- Effectiveness of manual therapy, exercise, low-level laser therapy, ultrasound, and transcutaneous electrical nerve stimulation in reducing pain and improving mouth opening in temporomandibular joint disorders: A network meta-analysis of randomized controlled trials, Medicine, 2026
Sources last checked: September 2026.
