Bruxism – Treatment

Introduction

The treatment of musculoskeletal symptoms of bruxism, especially focused on reducing muscle spasms and pain, requires a structured and evidence-based approach to address the complexities of this multifactorial disorder.
The treatment is divided into two main clinical phases: an initial phase of pain and muscle spasm inhibition, where the primary goal is to reduce the hypersensitivity of the masticatory muscles and restore basic functionality; and a phase of readaptation and functional strengthening, aimed at reinforcing and optimizing the musculature to handle the loads associated with mandibular activity. This comprehensive approach combines manual techniques, minimally invasive procedures, and therapeutic exercises to achieve sustained improvement and prevent relapse into chronic pain or dysfunction.

First Phase of Bruxism Treatment: Inhibition of Muscle Spasms and
Pain

The first phase of musculoskeletal treatment for bruxism primarily aims to relieve pain and reduce muscle spasms through specific interventions based on scientific evidence and a personalized approach. This phase not only seeks immediate symptom control but also lays the foundation for progressive functional recovery and prevents complications such as chronic temporomandibular joint dysfunction or worsening of myofascial
alterations.

Orofacial Manual Therapy: Orofacial manual therapy is a key intervention in this phase, including massage techniques and mobilizations targeting the masticatory muscles, as well as myofascial stretching. These techniques not only reduce muscle tone but also improve local blood circulation and release fascial adhesions that may contribute to pain and mandibular stiffness.
Studies have shown that manual therapy applied to the masseter, temporal, and pterygoid muscles can significantly reduce pain levels and increase mandibular range of motion. For instance, in patients with sleep bruxism and temporomandibular disorders, a decrease in electromyographic activity of the masticatory muscles has been observed after multiple sessions of massage and myofascial stretching. These techniques are also beneficial in reducing the sensitivity of myofascial trigger points, which are areas of muscle tension frequently found in bruxism patients. Well-designed manual interventions can relax these points, improving masticatory function and alleviating associated symptoms such as headaches or referred pain.

Ultrasound-Guided Dry Needling: Dry needling is a minimally invasive technique widely used in managing myofascial pain. In the case of bruxism, this technique is particularly effective for deactivating trigger points in the superficial and deep masseter muscles and the medial pterygoid muscle.
Ultrasound guidance in this practice is essential for improving precision and avoiding complications, such as unnecessary puncturing of the parotid gland or other adjacent sensitive structures. Ultrasound guidance allows for detailed identification of the involved muscles’ anatomy and monitoring of needle insertion, ensuring that it is directed exclusively to the target tissue. This precision is particularly important for the medial pterygoid, a muscle located near the parotid gland and other critical neurovascular structures. Studies have shown that ultrasound-guided dry needling significantly reduces pain and improves mandibular range of motion with minimal risk of adverse effects.
con un mínimo riesgo de efectos adversos.

Neuromodulation of the Auriculotemporal Branch of the Trigeminal Nerve: Neuromodulation of the auriculotemporal branch of the trigeminal nerve represents an innovative therapeutic option for managing bruxism-associated pain. This technique is based on transcutaneous electrical stimulation aimed at modulating the nerve activity of the auriculotemporal branch, which innervates much of the musculature and structures involved in mandibular movement. The application of techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) has demonstrated a significant reduction
in pain levels and muscle tension in patients with temporomandibular dysfunction and bruxism. Additionally, stimulation of this trigeminal branch may have beneficial effects on the muscle hyperactivity associated with bruxism by interrupting pain signals and promoting reflex relaxation of the involved muscles.

SuperInductive System: The SuperInductive System, a technology based on high- intensity electromagnetic fields, has emerged as an innovative tool in treating muscle spasms associated with bruxism. This system stimulates deep muscle fibers, facilitating muscle relaxation and reducing spasms without the need for invasive interventions. Moreover, it can target deep muscle groups, such as the deep masseter or pterygoid, which are often more challenging to treat with manual techniques or other modalities. Recent studies have shown that this technique can improve mandibular mobility, reduce pain intensity, and decrease muscle spasm episodes in patients with bruxism and temporomandibular dysfunctions. Its application is well-tolerated by patients and offers sustainable results after a treatment cycle of several sessions.

Buteyko-Based Breathing Exercises: Breathing exercises inspired by the Buteyko method are an effective tool for modulating sympathetic activity of the autonomic nervous system, which is often hyperactivated in bruxism patients. This methodology is based on slow and controlled breathing techniques, focusing on gentle exhalation and maintaining functional nasal breathing. This approach helps reduce hyperventilation and improves gas exchange efficiency, promoting a more balanced state of the nervous system. In the context of bruxism, Buteyko breathing helps decrease sympathetic activation that may contribute to muscle tension and spasms. Deep diaphragmatic breathing techniques, combined with controlled breathing pauses, can lower heart rate and promote overall relaxation, creating a more favorable environment for resolving musculoskeletal symptoms.

Second Phase of Bruxism Treatment: Functional Readaptation and Strengthening

The second phase of bruxism treatment focuses on the functional readaptation and strengthening of masticatory muscles, a critical process for restoring the strength, tone, and endurance needed to handle the loads associated with bruxism.
This phase is essential not only for preventing relapses into dysfunctional patterns but also for ensuring sustained improvement in the patient’s quality of life. The interventions are based on a progressive and individualized approach, utilizing advanced diagnostic and therapeutic tools to monitor and optimize outcomes.

The Six-Minute Chewing Test: This test is a functional diagnostic tool used to evaluate the endurance and efficiency of the masticatory muscles under sustained conditions. During this test, the patient continuously chews a standard material (such as gum) for six minutes while parameters such as fatigue, muscle symmetry, and coordination are observed. The six-minute chewing test helps identify specific weaknesses or asymmetries in muscle activity and provides a foundation for designing a tailored rehabilitation program. Test results are often analyzed through a subjective patient assessment and may be supported by surface electromyography (EMG). EMG allows real-time monitoring of muscle activity, detecting imbalances or dysfunctions in key muscles such as the masseter or temporalis. This information is crucial for personalizing therapeutic exercises and tracking progress throughout the treatment.

Isometric and Concentric Therapeutic Exercises: Therapeutic exercises form the cornerstone of this strengthening phase. Two primary modalities are prioritized:

1. Isometric Exercises: Isometric exercises involve static contraction of the masticatory muscles without mandibular movement, promoting increased muscle tone and endurance. These exercises are particularly effective for strengthening weakened muscles without overloading the temporomandibular joint, thus reducing pain and enhancing overall functionality. Scientific evidence supports the use of isometric exercises to improve muscle strength and decrease myofascial pain in patients with temporomandibular dysfunctions and bruxism. Moreover, these exercises contribute to stabilizing the temporomandibular joint, ensuring better long-term functional capacity.
2. Concentric Exercises: Concentric exercises involve controlled movements of jaw opening, closing, and lateral movements under resistance. These activities are beneficial for improving muscle coordination and efficiency and restoring masticatory function. Combining isometric and concentric exercises has proven effective in reducing muscle weakness and enhancing the quality of mandibular movement.

Progressive Work with Chewing Resistance Bands: Functional readaptation also includes the use of chewing resistance bands with variable levels of resistance, which allow for progressive and safe training of the masticatory muscles. These bands help gradually increase the workload on the muscles in a controlled manner, tailored to the specific needs of each patient. Initial resistance levels are determined using the six- minute test and EMG to establish optimal levels of muscle activation and prevent overloading.
During sessions, simultaneous biofeedback enables the patient to monitor real-time muscle activation, correct asymmetries, and improve the efficiency of the chewing exercises. This progressive training process facilitates neurophysiological adaptation, ensuring that the muscles can handle functional loads without triggering pain or spasms.

Conclusión

The combination of strategies such as the six-minute chewing test, isometric and concentric exercises, and progressive resistance training with chewing bands provides a solid foundation for the functional readaptation and strengthening of the masticatory muscles. This multimodal approach not only reduces immediate bruxism symptoms but also enhances quality of life and prevents relapses, ensuring sustainable functional recovery.

Physiotherapist ColFiCat: 4545 / Osteopath DO MROE: 544
Miembro de la Sociedad Española del Sueño (SES)
Miembro de la Sociedad Española del Sueño (SES)

Bibliografia

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