“Your patients don’t just grind their teeth—they grind through life without realizing their airway is part of the problem.”
Sleep bruxism used to be seen as a minor issue. A nighttime habit. A nuisance that wore down enamel and cracked crowns. But we now know it’s more than that.
Sleep bruxism is one of the earliest, most visible signs of sleep-disordered breathing—and yet it’s still overlooked in too many practices. And that’s a problem.
Because when bruxism is brushed off as “just stress,” we miss the chance to identify something far bigger: a compromised airway. We miss the opportunity to intervene early. And we miss the chance to help our patients get the kind of sleep that actually heals.
At Ohl Practice Consulting, we help dental practices rethink the way they approach bruxism—not as a standalone condition, but as a red flag for dental sleep medicine. When we stop seeing nightguards as the end of the conversation, and start viewing sleep bruxism as part of a bigger picture, we elevate both our clinical care and our patient impact.
This article walks through the connection between sleep bruxism and sleep-disordered breathing, the role dentists play in identifying it, and how to treat it through a modern, airway-focused lens.
What Is Sleep Bruxism?
Sleep bruxism is a sleep-related movement disorder where a patient involuntarily grinds or clenches their teeth during sleep. It’s different from awake bruxism, which tends to be more of a daytime, stress-related habit.
Patients with sleep bruxism may wake up with sore jaws, headaches, tooth sensitivity, or tight facial muscles. Over time, the grinding wears down enamel, damages restorations, causes gum recession, and contributes to TMJ issues. But what’s more concerning is what causes the grinding in the first place.
Bruxism is now understood to be a protective mechanism—the body’s way of reacting to changes in breathing, oxygen saturation, and sleep arousal. In other words, it’s a response to instability. And more often than not, that instability is coming from the airway.
The Link Between Sleep Bruxism and Airway Disorders
Studies show a strong connection between sleep bruxism and obstructive sleep apnea (OSA). In fact, many patients with OSA grind their teeth during episodes of airway obstruction. The clenching acts as a reflex, temporarily reopening the airway. It’s the brain’s way of saying, “Breathe!”
That’s why bruxism shouldn’t just be managed—it should be investigated.
When a dentist sees flattened cusps, cracked teeth, or signs of muscular hyperactivity, they’re not just looking at dental damage. They may be looking at the mouth’s way of signaling distress. And when that signal gets missed, the patient is often left wearing a nightguard for years while the root cause—disordered breathing—goes untreated.
Dental sleep medicine changes that equation. It gives dental professionals the framework to recognize these patterns, collaborate with sleep physicians, and move patients toward treatment that actually solves the problem.
The Problem with Treating Bruxism in Isolation
For decades, the go-to solution for bruxism has been the nightguard. Custom, over-the-counter, flat-plane, soft, hard—you name it. But if the grinding is linked to sleep-disordered breathing, then putting a guard in the patient’s mouth without evaluating the airway may make things worse.
Some nightguards can alter tongue posture or jaw position in a way that further restricts the airway. Patients may report new snoring, increased fatigue, or more headaches after starting appliance use—not because the guard is faulty, but because it wasn’t made with airway mechanics in mind.
This is where dental sleep medicine steps in. When we evaluate the airway first—before choosing a treatment device—we provide smarter care. We move from symptom management to root cause resolution. And that’s when patients really start to improve.
Screening for Sleep-Disordered Breathing in the Dental Chair
One of the biggest advantages dentists have is access. We see patients regularly. We spend time in their mouth. And we often hear about symptoms other providers never ask about.
When a patient mentions morning headaches, jaw soreness, dry mouth, or trouble sleeping, it’s an opportunity—not just for education, but for airway screening. With simple tools like sleep questionnaires, Mallampati scoring, and visual airway assessments, dental teams can identify patients who may be grinding as a result of breathing disturbances.
From there, the next step is referral. Patients should be guided toward a home sleep test (HST) or in-lab sleep study, followed by evaluation with a sleep physician. Dentists trained in dental sleep medicine can’t diagnose sleep apnea—but they can detect the signs and start the process.
Once a diagnosis is confirmed, treatment decisions can be made together.
Treating Sleep Bruxism Through Dental Sleep Medicine
When sleep bruxism is linked to OSA, treating the airway becomes the priority. For patients who can’t tolerate CPAP—or who have mild to moderate apnea—oral appliance therapy is often the best solution.
Unlike traditional nightguards, airway appliances are designed to reposition the jaw and tongue to keep the airway open during sleep. They still protect the teeth, but they also help the patient breathe better. This reduces clenching, improves sleep quality, and often leads to fewer symptoms across the board.
Patients report waking up with less tension, feeling more rested, and experiencing better focus and mood during the day. And because the appliance is custom-made, titratable, and comfortable, they actually use it. Night after night. Year after year.
At Ohl Practice Consulting, we help practices implement full workflows around appliance therapy—from screening and referral to appliance selection, titration, and follow-up sleep testing. This isn’t just about devices. It’s about systems that work for the patient and the team.
Changing the Conversation in Dentistry
Sleep bruxism is no longer just a dental issue. It’s an airway issue. It’s a neurological response to stress—sometimes emotional, often physiological. And it’s a conversation that needs to happen in every operatory.
When dental teams treat bruxism as an entry point to airway care, they help patients in ways that go far beyond tooth protection. They help them sleep better. Heal faster. And understand their bodies more fully.
That’s not just good medicine. It’s good business.
At Ohl, we partner with dental teams who want to lead that conversation. Who want to integrate dental sleep medicine in a way that’s legal, ethical, and impactful. Because when patients sleep better, everyone wins.
