Heart Rate Variability Biofeedback in the Management of TMD and Bruxism: Case Report

Background Sleep bruxism (SB) and temporomandibular dysfunction (TMD) are frequently managed with oral orthotic occlusal devices (OOOD). While these devices protect the teeth, they do not address the underlying autonomic or physiological contributors to SB and TMD. In patients with comorbid obstructive sleep apnea (OSA), OOOD may even be contraindicated, and their overall clinical efficacy remains uncertain.Case Presentation A 34-year-old male presented with jaw and temporomandibular joint (TMJ) pain, sleep bruxism, and chronic headaches persisting for over 20 years. He also experienced frequent nocturnal awakenings (four nightly) and symptoms consistent with dysfunctional breathing and autonomic imbalance. Because the patient also reported hypersensitivity to foreign objects, he declined OOOD therapy and pursued a noninvasive intervention involving heart rate variability biofeedback (HRVBF) and resonance frequency breathing biofeedback (RFBBF). Clinical findings included signs of dental attrition in lateral excursions. Initial Beck Anxiety Inventory (BAI) score was 16 (moderate anxiety). Following the biofeedback regimen, the patient’s symptoms resolved, and his BAI score decreased to 5 (minimal anxiety).Conclusion This case demonstrates the potential of HRVBF and RFBBF as noninvasive alternatives to OOOD in managing SB and TMD, particularly in patients with stress-related autonomic dysregulation and breathing dysfunction. Although the outcome in this case was favorable, further research is warranted to confirm and extend these findings.