Bruxism

Bruxism is a parafunctional activity characterized by the involuntary or habitual grinding, clenching, or gnashing of teeth that occurs outside of normal functional movements such as chewing and swallowing. The condition is classified as either sleep bruxism, which occurs during sleep and is considered a sleep-related movement disorder, or awake bruxism, which occurs during waking hours and is often associated with stress, concentration, or anxiety. The forces generated during bruxism episodes can be several times greater than those produced during normal mastication, subjecting the teeth, periodontal structures, temporomandibular joints, and masticatory muscles to excessive mechanical loading. Clinical signs of bruxism include worn occlusal surfaces, flattened cusps, fractured teeth and restorations, cervical abfraction lesions, scalloped tongue margins, and hypertrophy of the masseter muscles.

The consequences of untreated bruxism extend beyond tooth wear to include temporomandibular joint dysfunction, chronic facial pain, headaches, and accelerated failure of dental restorations. Teeth subjected to chronic bruxism forces are at increased risk of crack propagation, which can lead to split teeth requiring extraction. Existing restorations, particularly porcelain crowns and large composite fillings, may fracture prematurely under the repeated stress. Management of bruxism focuses on protecting the dentition from further damage, with the fabrication of a custom occlusal guard or nightguard being the most common intervention. Behavioral modification, stress management, and in some cases pharmacological approaches may be used to address the underlying cause, though the etiology of sleep bruxism is multifactorial and not always responsive to behavioral therapy alone.

From a billing standpoint, bruxism generates revenue through both the fabrication of protective appliances and the restorative treatment required to repair the damage it causes. Occlusal guards have a dedicated CDT code and are generally covered by dental benefit plans, though some plans classify them as a major service subject to higher cost-sharing. The restorative treatment necessitated by bruxism, including crowns, onlays, and composite restorations, is billed under standard restorative codes but requires thorough documentation linking the wear damage to the bruxism diagnosis. Billing teams should ensure that clinical notes describe the occlusal wear pattern, document the bruxism diagnosis, and include photographic or radiographic evidence to support claims for multiple restorations on teeth damaged by parafunction, as payers may question the necessity of treating numerous teeth simultaneously.