Sergey woke up every morning with a dull ache in his temples, as if someone had clamped his head in a vice all night. He took painkillers, saw a neurologist, had an MRI. Everything was normal. Only a casual remark from his wife, «you were grinding your teeth again in your sleep», led him to the answer. The dentist made the diagnosis in seven minutes: classic bruxism with pronounced wear of incisal edges and muscle spasm of the temporalis muscle.

A week after the Michigan splint was fitted, the morning migraine was gone. Sergey simply started sleeping properly again. He told me at the follow-up: «Doctor, I thought it was psychosomatic. Actually my jaws were clamping like a vice all night.»

Bruxism is involuntary clenching or grinding of teeth. Studies estimate 8 to 31 percent of adults are affected. Most don't know for years, because it happens during sleep. Usually noticed by partners or dentists at examinations.

How to tell if you have bruxism

The challenge: patients usually don't feel bruxism. it happens during sleep. But the body leaves evidence.

🦷 Dental signs: worn-down incisal edges, increased sensitivity, enamel cracks, chipped crowns or veneers

🤕 General symptoms: jaw muscle pain in the morning, tension headaches at the temples, TMJ clicking, tinnitus

⚕️ Medical term: CMD (craniomandibular dysfunction). bruxism is one of its main causes

Michigan splint: the gold standard

The primary treatment in Germany is an Aufbissschiene (occlusal splint). The standard is the Michigan splint, named after the university where it was developed in the 1960s. It's a hard acrylic guard for the upper jaw that doesn't just protect teeth from wear. it reprograms the jaw position and reduces joint stress.

What GKV covers. and what you pay

GKV covers a basic Aufbissschiene when the diagnosis is confirmed. approximately €150–200. The Michigan splint costs €800–2,000. The difference is your Eigenanteil.

Functional analysis (€150–300) is not a covered Kassenleistung. Splint replacement due to wear: once a year at the insurer's expense; additional replacements are out of pocket.

Botox for bruxism: effective, but not covered

Botulinum toxin injections into the masseter muscle weaken it and reduce bruxism intensity. Effect lasts 3–6 months. Cost: €300–600 per session. GKV classifies this as off-label use and does not reimburse it. Exceptions are extremely rare.

What else helps

The splint treats symptoms, not the cause. Additional measures: physical therapy for jaw muscles and cervical spine, relaxation techniques, in some cases psychotherapy and biofeedback. If bruxism is linked to sleep apnea, a sleep medicine consultation is warranted.

Causes of bruxism

Modern dentistry distinguishes two types:

  • Sleep bruxism (night). The most common, happens during sleep. Causes: stress, sleep disorders (apnea), neurochemical factors (dopamine, serotonin), genetics. Link with SSRI antidepressants confirmed.
  • Awake bruxism (daytime). Clenching during concentration or stress. Often accompanies anxiety disorder. Occurs in 22-31 percent of adults.

In my experience, 70 percent of bruxism patients have chronic stress. It's not a diagnosis but a factor. Bruxism is a physical response to psychological tension.

What bruxism does to teeth and body

Untreated, the consequences accumulate:

  • Enamel wear. Teeth get shorter, flat incisal edges. Over 5-10 years bite height decreases by 1-2 mm.
  • Tooth cracks. Overloaded enamel cracks. Cracks are invisible externally but detected with transillumination. Can lead to root canal or extraction.
  • CMD (craniomandibular dysfunction). The TMJ inflames, starts clicking or locking. Neck, shoulder, headache pain.
  • Gum recession. Tooth overload causes gum retraction, neck exposure. Cold-hot sensitivity.
  • Loose teeth. Severe bruxism plus periodontitis: accelerated tooth loss.
  • Sleep. Often accompanies sleep apnea. You wake up exhausted, don't get rested sleep, lose concentration during the day.