Navigating the assessment of sleep-related bruxism: Clinical guidance for applying the 2023 ICSD-3-TR criteria

Dentists with expertise in sleep medicine play a growing role in screening patients for sleep disorders, particularly sleep-disordered breathing (SDB) and insomnia, while concurrently evaluating and managing sleep bruxism (SB). Once SB is identified, dentists typically focus on mitigating oral complications, like as tooth wear, managing grinding sounds, and addressing associated orofacial pain. In contrast, SB may often be encountered by sleep physicians as an incidental finding during sleep recording performed for the evaluation of other sleep disorders, including SDB, insomnia, periodic limb movement disorder, and REM sleep behavior disorder (RBD). The International Classification of Sleep Disorders, Third Edition - Text Revision (ICSD-3-TR), published in 2023 by the American Academy of Sleep Medicine (AASM), provides a standardized framework for the identification and classification of sleep disorders in medical settings. While this classification reflects international consensus among clinician-scientists in sleep medicine, its adaptation to dental clinical and research contexts remains complex. This paper aims to support clinicians and researchers across disciplines in a consistent interpretation and application of the ICSD-3-TR criteria for SB. We highlight key definitional changes in the revised criteria, examine diagnostic challenges arising from the inclusion of ambiguous signs and symptoms, and discuss conceptual divergences between dental and medical approaches to SB, especially regarding the distinction between SB as a jaw motor behavior or a sleep-related movement disorder. A shared understanding of ICSD-3-TR terminology and limitations is essential to promote interdisciplinary collaborations and to optimize the management of SB, both as an isolated (jaw) motor phenomenon and when it co-occurs with other sleep disorders.