Teeth Grinding Treatment Munich | Dentist Christina Dickel

Psycho-emotional stress is considered the most important trigger for bruxism. Professional pressure, private conflicts, performance expectations, and underlying anxieties cause tension to be "processed" through the masticatory muscles — often unconsciously and especially at night. Studies show a clear correlation: the higher the stress level, the stronger the grinding activity. Anxiety disorders, depression, and burnout are also significantly associated with bruxism.

When the upper and lower jaws do not meet correctly — for example due to a crossbite, open bite, or missing teeth — the masticatory system may attempt to compensate for the misalignment through grinding and clenching. Occlusal disorders can also be triggered or worsened after dental treatments (fillings that are too high, poorly fitting crowns). Precise analysis of the bite position is therefore a central component of our diagnostics.

Bruxism frequently occurs together with sleep disorders — particularly with obstructive sleep apnea (OSA). In sleep apnea, repeated breathing pauses occur during sleep, triggering micro-arousals (brief awakening reactions). These arousals are frequently accompanied by grinding and clenching episodes. If you snore, feel tired during the day, and grind your teeth at the same time, a sleep medicine evaluation should be conducted.

Certain medications can trigger or worsen bruxism — particularly:

• SSRI antidepressants (sertraline, fluoxetine, paroxetine): among the most common medication-related triggers
• Amphetamines and stimulants (including ADHD medication such as methylphenidate)
• High doses of caffeine (more than 4–5 cups of coffee daily)
• Alcohol (evening consumption in particular intensifies nocturnal grinding)
• Recreational drugs (ecstasy/MDMA, cocaine)

If you take any of these medications and suffer from bruxism, this should be considered as part of our functional analysis — in consultation with the prescribing physician, a change of medication may be considered.

The clinical functional analysis is the basic examination when bruxism and TMD are suspected. It includes:

• Muscle palpation: Systematic examination of the masticatory muscles — m. masseter, m. temporalis, m. pterygoideus medialis and lateralis — for tenderness, indurations (trigger points), and hypertrophy. Tense and thickened masticatory muscles are a clear sign of chronic bruxism.
• Jaw joint examination: Palpation and auscultation of the jaw joints during mouth opening and closing. We check for clicking, grinding (crepitation), pain, and movement restrictions.
• Bite position and occlusion: Analysis of how the upper and lower jaws relate to each other. Are the teeth loaded evenly? Are there premature contacts (teeth that meet first) or gliding interferences during lateral movements?
• Abrasion patterns: Examination of the chewing surfaces for wear patterns that provide information about the intensity and direction of grinding. Typical signs are mirror-smooth ground surfaces (facets) on the canines and posterior teeth.

For complex findings or to plan splint therapy, we perform an instrumental functional analysis:

• Facebow registration: A facebow transfers the spatial position of the upper jaw relative to the jaw joint onto an articulator (chewing simulator). This allows us to precisely reproduce jaw movements outside the mouth.
• Articulator mounting and bite registration: The jaw models are mounted in the articulator and the jaw joint movements are simulated. This enables detailed analysis of the occlusal relationships and is the basis for producing a precise, custom occlusal splint.

When the clinical examination indicates structural changes in the jaw joint — such as clicking, grinding noises, or limited mouth opening — we supplement the diagnostics with a CBCT scan (Cone Beam Computed Tomography). The three-dimensional X-ray image shows the bony structures of the jaw joint in high resolution: flattening of the joint surfaces, osteophytes (bony projections), erosions, or changes in the position of the condyle can be detected early and incorporated into therapy planning.

The Aqualizer is a prefabricated water-cushion splint used as an immediate measure for acute jaw joint discomfort, muscle tension, and headaches. It consists of two water-filled cushions placed between the posterior teeth that automatically bring the jaw into a relaxed position — the hydrostatic principle immediately compensates for load imbalances.

The Aqualizer is an excellent diagnostic tool: if your symptoms improve within a few minutes with the Aqualizer, this is a strong indication that an occlusal disorder is the cause — and that individual splint therapy promises success. The Aqualizer is also used as a bridge until the custom splint is completed.

The custom occlusal splint is manufactured in the dental laboratory based on the functional analysis and precise jaw impressions (or digital scans). It is made of transparent, high-quality acrylic and is usually worn on the upper jaw.

The splint has several therapeutic functions:

• Tooth protection: It forms a barrier between the upper and lower teeth and prevents direct tooth contact — the wear occurs on the splint material, not on your teeth.
• Muscle relaxation: The altered bite position on the splint relaxes the overactive masticatory muscles. Trigger points resolve, and headaches and neck tension decrease.
• Jaw joint relief: The splint guides the lower jaw into a physiologically favorable position (centric relation) and relieves the jaw joint.
• Proprioceptive effect: Wearing the splint changes the sensory feedback in the mouth and measurably reduces grinding intensity.

The Michigan splint (also: stabilization splint) is the gold standard of splint therapy for bruxism and TMD. It features a special design of the chewing surface: in the so-called canine guidance, the posterior teeth are immediately separated during lateral movements — only the canines guide the movement. This corresponds to the natural, physiological masticatory function and significantly reduces the muscle activity of the masticatory muscles.

The Michigan splint is produced in the articulator based on the instrumental functional analysis and requires several adjustment and follow-up appointments until the splint fits perfectly and the bite position is optimally set.

Splint therapy is not a one-time procedure but a dynamic process. In regular follow-up sessions (initially after 1–2 weeks, then at longer intervals), we check:

• Wearing comfort and fit of the splint
• Even contacts of all posterior teeth on the splint
• Correct canine guidance during lateral movements
• Wear patterns on the splint (showing intensity and direction of grinding)
• Development of symptoms (muscle pain, headaches, jaw joint)

If necessary, the splint is adjusted or refined. With heavy wear, the splint needs to be replaced after 1–3 years. Most patients report noticeable improvement of symptoms within a few days to weeks.

For patients with pronounced hypertrophy of the m. masseter (enlarged masticatory muscle that makes the face appear wider) and severe grinding symptoms, botulinum toxin (Botox) injection has become an established treatment option. Botox inhibits signal transmission between nerve and muscle, leading to a controlled weakening of the masticatory muscle — grinding is not eliminated but the forces involved are significantly reduced.

Procedure: In a brief treatment (approx. 10–15 minutes), Botox is injected at several points into the m. masseter on both sides. The effect sets in after approx. 3–7 days and typically lasts 3–6 months. The treatment is repeated as needed. Many patients also report an aesthetic slimming of the lower face in addition to reduced grinding.

Important: Botox does not treat the cause of bruxism but reduces muscular forces and associated symptoms. It is particularly useful as a complementary measure for patients who continue to suffer from severe muscle pain, headaches, or jaw joint problems despite splint therapy.

Biofeedback is a behavioral therapy approach in which the unconscious muscle activity of the masticatory muscles is measured via sensors and reported back to the patient in real time — for example through an acoustic or vibrating signal. The goal is to learn conscious control over grinding and clenching.

Biofeedback is particularly effective for awake bruxism: the patient is immediately alerted during daily life when they clench their teeth and can consciously release and relax. For nocturnal bruxism, biofeedback devices are used that deliver a mild stimulus during grinding activity, reducing grinding intensity without disturbing sleep.

Bruxism affects not only the teeth but the entire craniomandibular system — the jaw joint, masticatory muscles, neck, shoulders, and cervical spine are functionally connected. Osteopathy and manual physiotherapy are important complements to dental treatment:

• Releasing muscular tension and trigger points in the masticatory, neck, and shoulder muscles
• Mobilization of the jaw joint and cervical spine
• Craniosacral therapy for relaxation of the entire head-neck system
• Learning stretching exercises and home exercises

We work with experienced physiotherapists and osteopaths in Munich and are happy to provide you with appropriate contacts.

Since stress is the main cause of bruxism, behavioral therapy or structured stress management can achieve the greatest long-term therapeutic success. Approaches such as Progressive Muscle Relaxation according to Jacobson, Autogenic Training, mindfulness exercises (Mindfulness-Based Stress Reduction), and cognitive behavioral therapy have shown significant reduction in bruxism activity in studies.

In our practice, we advise you comprehensively about these options and support the interdisciplinary approach — we treat the dental consequences while specialized therapists work on the causes.

In abrasion dentition, the chewing surfaces of the teeth are extensively worn down by chronic grinding. The teeth become shorter, the bite height decreases (bite collapse), and the face can appear optically "shortened." The exposed dentin layers are softer than tooth enamel and wear down even faster — a vicious cycle. Additionally, the teeth become temperature-sensitive and more susceptible to cavities.

The restoration of abraded teeth is performed using various methods depending on the extent of damage:

• Composite build-ups: For mild to moderate substance loss, the chewing surfaces and incisal edges can be directly built up with high-quality composite (tooth-colored resin). The method is minimally invasive, preserves tooth substance, and can be completed in a single session.
• Veneers: Wafer-thin ceramic shells are bonded to the visible tooth surfaces — ideal for front teeth that have been shortened or chipped by grinding. Veneers offer excellent aesthetics and longevity.
• Crowns and partial crowns: For severe substance loss affecting the entire chewing surface, all-ceramic crowns or partial crowns are the treatment of choice. They cover the entire visible tooth and restore stability, function, and aesthetics. Thanks to CEREC technology, we produce ceramic crowns digitally and often in a single session.

A crucial principle: Before elaborate restorations (veneers, crowns) are made, bruxism must be under control. Otherwise, the new restorations will be destroyed just as quickly as the natural teeth. This means:

1. Diagnose bruxism (functional analysis, investigation of causes)
2. Treat bruxism (splint therapy, possibly Botox, stress management)
3. Wait for symptom relief and stability (several months of monitoring)
4. Restorative phase (build-ups, veneers, crowns) — followed by splint protection for the new restorations

Even after restoration, wearing an occlusal splint remains important — it protects your veneers, crowns, and natural teeth from renewed wear.

The GKV covers the following services as part of bruxism treatment:

• Occlusal splint: The production of a simple occlusal splint is covered by insurance — after dental prescription and approval by the health insurance fund. The co-payment is 0 EUR. However, the insurance-covered version is a simple grinding splint that does not meet the standard of an individually adjusted Michigan splint.
• Clinical functional analysis: Partially covered by the GKV, usually as part of TMD diagnostics.

Not covered by the GKV are:

• Instrumental functional analysis (facebow, articulator mounting): approx. 200–500 EUR
• Individually adjusted Michigan splint (additional cost beyond the insurance-covered version)
• Botox therapy: approx. 300–600 EUR per session (bilateral m. masseter)
• Biofeedback therapy
• Osteopathy and specialized physiotherapy (partial reimbursement possible through supplementary insurance)

Reimbursement by private health insurers varies depending on the plan. PKV plans typically reimburse:

• Instrumental functional analysis — usually in full
• Individually adjusted occlusal splints — usually in full
• Botox therapy — depending on the plan and medical indication
• CBCT diagnostics — included in most plans

We prepare a detailed treatment and cost plan in advance for submission to your insurer and advise you transparently about the expected costs and reimbursement options.

For private services and co-payments, we offer flexible installment payment plans. Optimal treatment should not fail due to financing — please ask us about this during the consultation.