Review Article   https://doi.org/10.70084/mru/pmrcc/00044.P24

The missed diagnosis and over-treatment of symptoms related to bruxism

 Khaled Chokri Asaad¹, Kheder Mohammed Altayep², Hussain Gadelkarim Ahmed³

Affiliations

1Joele Clinics, Jeddah, Saudi Arabia. 2Royal Commission Hospital, Yanbu, Saudi Arabia. 3Prof Medical Research Consultancy Center, El-Obeid, Sudan

Correspondence to: Khaled Chokri Asaad, Email: khaled_assad11@hotmail.com

Cite: Assad, et al. The missed diagnosis and over-treatment of symptoms related to bruxism. Medical Research Updates Journal 2026;4(4):15-24. https://doi.org/10.70084/mru/pmrcc/00044.P24

ABSTRACT

Bruxism is a common oral parafunctional activity characterized by repetitive activity of the jaw muscles, such as clenching or grinding of teeth and bracing or thrusting of the mandible. It can occur during sleep or during wakefulness and can be accompanied by dental, muscular, temporomandibular, otologic, and headache symptoms. Bruxism is often underdiagnosed or diagnosed late because of the overlap of its clinical manifestations with migraine, tension-type headache, temporomandibular disorders, otalgia, sinus pain, and odontogenic disease. Such a diagnostic void can result in recurrent consultations, unnecessary investigations, inappropriate pharmacologic therapy, irreversible dental procedures, and treatment targeting secondary symptoms rather than the underlying behavior or contributing factors. In contrast, bruxism per se may be overtreated when mild or incidental findings are interpreted to be pathological. This review discusses the missed diagnosis of bruxism-associated symptoms, overtreatment patterns, differential diagnosis, clinical evaluation, and evidence-based management. A balanced approach that highlights careful history, dental examination, screening for sleep and psychosocial comorbidities, conservative therapy, and interdisciplinary care may reduce unnecessary treatment and improve patient outcomes.

Keywords: bruxism, missed diagnosis, overtreatment, sleep bruxism, awake bruxism, headache, migraine, temporomandibular disorders, orofacial pain, dental wear

 

Output an image of a clean medical journal graphical abstract on bruxism. Central illustration: simplified human head in side view with highlighted jaw muscles and teeth clenching/grinding. Left panel titled “Overlapping Symptoms” showing icons for headache, ear pain, temporomandibular joint pain, tooth wear, muscle tenderness, and sinus or odontogenic pain. Middle panel titled “Diagnostic Gap” showing branching arrows from bruxism to misdiagnosis, delayed diagnosis, unnecessary investigations, inappropriate medication, and irreversible dental procedures. Right panel titled “Balanced Management” showing icons for careful history, dental examination, sleep and psychosocial screening, conservative therapy, occlusal splint, behavioral management, and interdisciplinary care. Use professional blue, teal, white, and light gray colors, minimal text, vector-style medical infographic, high resolution, suitable for publication graphical abstract.