Psoriasis and Teeth Grinding: The Joint Problem Beneath the Skin

Do you feel pain in your jaw muscles when you wake up in the morning? Could you be clenching or grinding your teeth throughout the night? If you have psoriasis, the cause of these complaints may not be just stress—there may be much more specific medical reasons behind them. Unfortunately, many doctors overlook this connection, and patients are often dismissed for years with the advice to “just wear a night guard.”

What Is Bruxism and Why Is It So Important?

Bruxism is the involuntary clenching, grinding, or overuse of the jaw muscles during sleep or while awake. This condition not only damages the teeth but can also lead to:

• Permanent damage to the temporomandibular joint (TMJ)
• Chronic head and neck pain
• Significant deterioration in sleep quality
• Social withdrawal due to embarrassment from jaw noises
• Loss of chewing function

So why is this condition different in patients with psoriasis?

Psoriasis and Psoriatic Arthritis: The Joint Problem Beneath the Skin

Psoriasis Is Not Just a Skin Disease

How many doctors know that psoriasis is not merely a skin condition? Psoriatic arthritis develops in 30% of psoriasis patients and may also involve the temporomandibular joint (TMJ).

Psoriatic Arthritis in the TMJ: Specific Findings

Asymmetric Joint Involvement:
One side may be more affected than the other. This leads to imbalanced chewing habits.

Enthesitis:
Inflammation develops at muscle–bone attachment points. Tenderness and pain appear where jaw muscles attach to the bone.

Progressive Joint Damage:
If untreated, permanent damage occurs. Cartilage erosion and bone changes may develop in the joint.

Impact on Daily Life:

• Chewing predominantly on one side (the healthier side)
• Increasing limitation in mouth opening
• Food choices becoming restricted (only soft foods)
• Aesthetic concerns (jaw asymmetry)
• Avoiding eating at social gatherings
• Jaw fatigue during long conversations

How Do We Identify Bruxism in Psoriatic Patients?

In bruxism related to psoriasis, the following findings stand out:

• Pronounced morning stiffness: the first 30–60 minutes are the hardest
• Asymmetric involvement: one side is more painful
• Parallel course with systemic disease activity: jaw pain increases when skin lesions worsen
• Similar symptoms in other joints: especially hands and feet
• Enthesis-related findings: tenderness at muscle–bone attachment points
• Nail changes: a hallmark of psoriatic arthritis

Revolutionary Treatment Approaches

1. Treat the Underlying Cause First!

Optimization of Psoriatic Arthritis Treatment:

• Control systemic inflammation: monitor CRP and ESR
• DMARDs (methotrexate, sulfasalazine): reduce disease activity
• Biological agents (TNF blockers): infliximab, etanercept, adalimumab
• IL-17 and IL-23 inhibitors: secukinumab, ustekinumab
• TMJ intra-articular injections: reduce local inflammation
• Coordination with dermatology: control of skin lesions is essential

2. Concurrent Protective Therapies

Stabilization Splint (Night Guard):

• Should be made of hard acrylic material
• Soft splints may increase muscle activity
• Follow-up every 3–6 months
• Nighttime use is sufficient
• Special design may be required for asymmetric involvement

Physiotherapy and Exercises – Daily Routine:

• Morning: 5 minutes of jaw massage (reduces morning stiffness)
• Noon: Neck stretching exercises
• Evening: Warm compress application
• Night: Relaxation techniques
• Special: Exercises to correct asymmetry

3. Advanced Treatment Options

Botulinum Toxin A (Botox):

• Indication: Severe cases resistant to conservative treatment
• Application: Masseter and temporalis muscles
• Dose: 50–100 units total (depending on muscle size)
• Duration: 3–6 months
• Results: 80–90% reduction in pain, 60–70% reduction in muscle activity

In Asymmetric Involvement:
Higher doses may be applied to the more affected side.

Who Should Consider Botox?

• Patients whose symptoms persist despite splint therapy
• Those with significant masseter hypertrophy
• Patients experiencing severe pain affecting daily life
• Patients whose systemic disease is under control
• Individuals with marked asymmetry and functional loss

Nutritional Supplements: An Evidence-Based Approach

Vitamin D and Calcium

Who Should Receive It?

• Those with 25-OH vitamin D < 30 ng/ml
• Individuals with chronic pain complaints
• Patients presenting with muscle cramps
• Most psoriasis patients (vitamin D deficiency is common)

Correct Dosage:

• Vitamin D: 1000–4000 IU/day
• Calcium: 1000–1200 mg/day (with meals)
• Magnesium: 200–400 mg/day

Magnesium: The Forgotten Mineral

Magnesium plays a critical role in muscle relaxation:

• Regulates the muscle contraction–relaxation cycle
• Optimizes neural transmission
• Improves sleep quality
• Reduces stress hormones

Omega-3 Fatty Acids

Especially important for psoriatic arthritis patients:

• Powerful anti-inflammatory effect
• Reduces joint pain
• Improves skin lesions
• Reduces overall disease activity
• Recommended dose: 2–3 g/day EPA + DHA

Anti-Inflammatory Diet

Special recommendations for psoriasis patients:

• Mediterranean diet
• Avoid processed foods
• Gluten-free diet if gluten sensitivity is present
• Reduce sugar intake
• Probiotic supplementation

Warning Signs: When Is Emergency Intervention Needed?

Acute TMJ Locking:

• Inability to open the mouth
• Accompanied by high fever
• Rapidly developing swelling
• Difficulty swallowing

Psoriatic Arthritis Flare:

• Extensive joint swelling
• Sudden increase in movement limitation
• High fever
• Eye involvement (uveitis)
• Rapid increase in skin lesions

Treatment Algorithm: Step-by-Step Guide

1. Evaluation Phase (First 2 Weeks)

Laboratory Tests:

• CRP, ESR
• RF, anti-CCP
• HLA-B27 (if needed)
• 25-OH vitamin D
• Total and ionized calcium
• Liver and kidney function tests

Imaging:

• TMJ panoramic X-ray
• TMJ MRI if necessary
• Imaging of other joints (for comparison)

2. Emergency Correction (2–4 Weeks)

• Control of psoriatic arthritis flare
• Optimization of immunosuppressive/anti-inflammatory therapy
• Acute pain management
• Vitamin D and calcium replacement

3. Protective Therapies (1–3 Months)

• Preparation and adjustment of splint
• Initiation of physiotherapy
• Lifestyle modifications
• Nutritional supplementation
• Anti-inflammatory diet

4. Advanced Therapies (3–6 Months)

• Botox evaluation
• Intra-articular injections
• Change of biological agent (if needed)
• Surgical consultation (in advanced deformities)
• Psychiatric support (for chronic pain)

Biological Agents and the TMJ: Important Information

Biological agents used to treat psoriatic arthritis are also effective in TMJ involvement.

TNF Blockers:

• Etanercept, adalimumab, infliximab
• Reduce TMJ inflammation
• Improvement begins in 2–3 months

IL-17 Inhibitors:

• Secukinumab, ixekizumab
• Particularly effective in the presence of enthesitis
• Rapid improvement in skin lesions

IL-23 Inhibitors:

• Ustekinumab, guselkumab
• Provide long-term remission
• Show good results in TMJ involvement

Success Story: Real Patient Experience

Ms. Ayşe (48):
“I had psoriasis for 20 years, but I never thought my jaw pain was related to it. My dermatologist referred me to a rheumatologist, and I was diagnosed with psoriatic arthritis. After starting anti-TNF treatment, both my skin lesions and jaw pain improved. Now I can eat and talk comfortably. I wish I had known this connection years ago!”

Tips for Improving Quality of Life

Daily Lifestyle Adjustments:

• Switch to a soft diet (during flare periods)
• Stress management techniques
• Regular sleep schedule
• Quit smoking (critical for psoriasis)
• Reduce alcohol consumption
• Avoid chewing hard gum

Jaw-Friendly Nutrition:

• Small bites
• Well-cooked vegetables
• Soft proteins
• Smoothies and soups
• Avoid hard foods like nuts and walnuts

Social Life Tips:

• Research restaurants in advance
• Prefer soft menu options
• Explain your condition in social settings
• Small, frequent meals

Prevention Strategies

Early Diagnosis Is Critical

Recognize signs of psoriatic arthritis in psoriasis patients:

• Morning stiffness
• Joint swelling
• Nail changes
• Enthesitis findings
• TMJ pain

Regular Follow-Up

• Dermatology check-up every 3–6 months
• Rheumatology consultation if joint symptoms occur
• Annual dental examination
• Monitoring inflammation through blood tests

Psoriasis and Teeth Grinding Conclusion

In psoriasis patients, bruxism is not simply “stress-related teeth grinding.”
Psoriatic arthritis can affect the temporomandibular joint and requires specialized treatment approaches.

If you have psoriasis and are experiencing jaw problems, do not rely solely on a night guard. Seek treatment from a team that understands how your disease affects jaw health and works in coordination with dermatology, rheumatology, and dentistry.

Remember: Early diagnosis + multidisciplinary treatment = a pain-free life

Psoriasis is not just a skin disease—it can affect your joints as well. Knowing this connection can dramatically improve your quality of life!

Gain confidence in your health with Dr. Tansu Uzel Clinic! Follow our Instagram page to see testimonials from our satisfied patients.