Bruxism Decoded: A Case Report Revealing the Invisible Signs

Bruxism is characterized by involuntary movements involving teeth grinding or clenching. It is perceived as a parafunctional activity, and it can lead to instability and various consequences such as dental wear, musculoskeletal pain, masseter hypertrophy, persistent fatigue, and tension headaches. According to the time of occurrence, it can be classified as awake bruxism and/or sleep bruxism. This case report describes a 19-year-old woman, who presented to her family doctor with shoulder pain, headaches, and persistent tiredness despite apparent adequate sleep. She reported no other symptoms and denied any trauma or physical exertion. Her past medical history included anxiety disorder, treated with a selective serotonin reuptake inhibitor (SSRI), and irregular follow-ups with psychology and psychiatry throughout the years. The only relevant findings on the physical examination were cervical and shoulder tenderness, without functional impairment, along with noticeable wear on dental surfaces, consistent with bruxism. Further history of overall behaviour was compatible with both sleep and awake bruxism, exacerbated during periods of increased anxiety. The SSRI dose was increased, and a muscle relaxant was prescribed. A referral was made to both psychology and dentistry. After two weeks, a reduction in anxiety, headaches, and musculoskeletal pain was observed, with only sporadic use of the muscle relaxant. A dental splint was prescribed following dental evaluation, resulting in significant clinical improvement: better anxiety control, improved sleep quality, occasional musculoskeletal complaints, and reduced headaches. Although the patient did not initially complain of bruxism, the presence of rhythmic masticatory muscle activity with repetitive contractions and increased muscle tension highlighted the need to identify this condition as a clinical target for intervention and treatment. Early diagnosis is essential to minimize complications and prevent symptom dispersion. Otherwise, bruxism may be overlooked as a central diagnosis, and treatment opportunities may be missed. Given its multifactorial aetiology, management must be multidisciplinary, as demonstrated in this case.