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Bruxism

Grinding of the Teeth

Bruxism is a condition, characterized by excessive grinding or clenching of teeth. The condition has 2 forms: Sleep bruxism, one that occurs during sleep, and awake bruxism, which occurs during periods of wakefulness.


Presentation

Manifestations of temporomandibular joint problems are the major development in individuals with bruxism [7]. The condition presents with the following signs and symptoms:

  • Grinding and clenching of the teeth, which becomes so noisy, that it can disturb and awaken sleep partner
  • Increase in tooth sensitivity
  • Headache that originates in the temporal region
  • Development of indentations
  • Jaw muscles become tight and tired
  • Tooth enamel worn outs and the deep layers of the tooth are exposed
  • Teeth become flattened and begin to chip or loosen [8]
Bruxism
  • There are 2 forms of bruxism: sleep bruxism and awake bruxism. Cause: The exact cause of bruxism is unknown. However, interplay of several factors, is known to trigger bouts of teeth clenching and grinding.[symptoma.com]
  • RESULTS: Sleep bruxism was reported by 21.0% of women and by 12.5% of men, awake bruxism by 2.0% of women and by 2.8% of men, and both sleep and awake bruxism by 7.2% of women and by 3.2% of men.[ncbi.nlm.nih.gov]
  • Family members with bruxism. Sleep bruxism tends to occur in families. If you have bruxism, other members of your family also may have bruxism or a history of it. Other disorders.[mayoclinic.com]
  • Among the parents/guardians of children without bruxism, 81.9% were unaware of some possible cause versus 18.1% of those with bruxism (p 0.011).[ncbi.nlm.nih.gov]
  • […] with TMDs and/or bruxism (question 3).[ncbi.nlm.nih.gov]
Jaw Pain
  • We can also recommend small lifestyle changes or practices that will help you relax and release your jaw pain.[mansfielddental.com]
  • . — Korin Miller, SELF, "5 Causes of Jaw Pain That You Need to Know," 13 Jan. 2018 Doctors aren’t totally sure what causes bruxism, but stress is a major risk factor, according to the Mayo Clinic. — Korin Miller, SELF, "5 Causes of Jaw Pain That You Need[merriam-webster.com]
  • However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain.[nlm.nih.gov]
  • If you wake up with jaw pain, tension headaches, or facial pain, you may be suffering from bruxism.[smilefortworth.com]
Dental Caries
  • Clinical oral evaluations of the children to determine dental caries, traumatic dental injuries, malocclusion and tooth wear were performed by two researchers who had undergone a training exercise (interexaminer Kappa: 0.70 to 0.91; intraexaminer Kappa[ncbi.nlm.nih.gov]
  • Improper tooth cleaning during splint use can lead to dental caries, and, in some cases, appliance use may result in temporomandibular disorders (TMD). A less significant complication is the staining of teeth.[emedicine.medscape.com]
  • Tao Ye, Dongliang Sun, Guangying Dong, Guangjie Xu, Ligang Wang, Jinjin Du, Pengcheng Ren and Shibin Yu, The effect of methamphetamine abuse on dental caries and periodontal diseases in an Eastern China city, BMC Oral Health, 18, 1, (2018). David A.[doi.org]
  • If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity.[en.wikipedia.org]
Tooth Erosion
  • Citation : Social anxiety increases the risk of bruxism, tooth erosion, and jaw pain (2015, May 5) retrieved 13 May 2019 from This document is subject to copyright.[medicalxpress.com]
Headache
  • Bruxism in children elicits consequences such as headache, orofacial pain, and pain related to awakening.[ncbi.nlm.nih.gov]
  • […] gender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache[ncbi.nlm.nih.gov]
  • He had frequent jaw aches, headaches and swallowing difficulty. Examination demonstrated the presence of dysarthria with jaw clenching and tooth grinding, producing persistent high pitch and loud squeaky sounds.[ncbi.nlm.nih.gov]
  • However, in some people, bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems.[mayoclinic.com]
  • It can also lead to ear ache, jaw ache and headaches. The exact cause of bruxism is unknown. The interplay of various factors has been known to play foul.[symptoma.com]

Workup

A preliminary physical examination, consisting of carefully studying the signs and symptoms of the condition is carried out. Several visits to the dentist will often be required to diagnose the condition. The following tests will be required to diagnose bruxism:

Joint Space Narrowing
  • Yeon-Hee Lee, Il Ki Hong and Jung-Sub An, Anterior joint space narrowing in patients with temporomandibular disorder Einengung des Gelenkraumes bei Patienten mit Craniomandibulärer Dysfunktion, Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie[doi.org]

Treatment

Mild cases of bruxism do not require treatment. Children with bruxism do not require treatment, and the condition gets corrected by itself. In severe cases, the following methods are employed to treat the condition:

  • Splints: Use of splints or mouth guard, help in keeping the teeth separated, which in a way, prevents damage to the teeth that occur due to clenching.
  • Dental correction: This is used in cases, when there is poor alignment of teeth. Braces or oral surgery may sometimes be required for dental correction.
  • Behavior therapy: Individuals with bruxism, are advised to undergo behavior therapy, that would teach them proper mouth and jaw position.
  • Stress management: If stress is the cause, then various relaxation techniques can be followed, to appropriately manage the condition.
  • Biofeedback: This is used when individuals cannot successfully change their habits. This is a type of complementary medicine, which utilizes various techniques to teach individuals, to control jaw and muscle movements [10].
  • Medications: Certain medications, such as muscle relaxants, and Botox injections are also very effective in controlling bruxism. Muscle relaxants are prescribed for short duration, which is taken prior to sleeping. Botox injections are the method of choice, when other treatment regimes fail to yield desired effect [11].

Prognosis

Prognosis of the condition is not very favorable, as treatment methods are not very effective to significantly reduce the discomfort associated with the symptoms. However, if no kind of treatment is employed, then bruxism can cause permanent teeth damage. It can also lead to ear ache, jaw ache and headaches [6].

Etiology

The exact cause of bruxism is unknown. The interplay of various factors has been known to play foul. In the past, some theories have suggested an association between general malocclusion and bruxism; this has however not been approved. The following are some of the factors, which are thought to play a role in causation of bruxism:

Epidemiology

According to the statistics provided by ICSD-R, about 85 to 90% of population has the habit of grinding teeth during some point of time in life. However, only 5% of these will develop any disorder related to it. Sleep bruxism occurs during adolescence years, and about 60% of elderly population is affected by it. Overall incidence of bruxism is about 8 to 31.4% [4].

Sex distribution
Age distribution

Pathophysiology

Anatomically, the process of mastication is controlled by the muscles, which are located on both sides, and work together to enable movement of the mandible. Mastication, is a complex neuromuscular process, which is significantly controlled by subconscious and conscious processes.

Under normal conditions, the teeth are not in contact, except for certain activities, such as eating, speaking or swallowing. In the condition of bruxism, the unconscious movement of muscles occurs repeatedly, and is rhythmic with bit forces lasting for a fraction of second, or in some cases lasting for 1 to 30 seconds [5].

Prevention

Preventing the development of trigger factors can to a certain extent reduce the development of bruxism. Keeping stress away, and practicing relaxation techniques, can also prevent bouts of bruxism.

Summary

Bruxism is considered to be a parafunctional activity, which means it is different from the normal functions of eating and talking [1]. Individuals, who suffer from bruxism, are known as bruxers or bruxists. Sleep bruxism equally affects both the sexes, whereas the other form of bruxism is more prevalent amongst the women population. Several treatment regimes have been designed to effectively manage the condition; however, these have little effect on bruxism [2].

Patient Information

Definition: Bruxism is a condition, characterized by repetitive, and rhythmic unconscious contraction of the muscles of mastication. It is a disorder, wherein the affected individuals, clench and grind their teeth. There are 2 forms of bruxism: sleep bruxism and awake bruxism.

Cause: The exact cause of bruxism is unknown. However, interplay of several factors, is known to trigger bouts of teeth clenching and grinding. Factors such as stress, underlying disease conditions, certain medications, ear ache, coping strategies adopted to deal with certain stressful situations, and malocclusion, are known to play foul in causation of bruxism.

Symptoms: Symptoms of bruxism include teeth grinding and clenching, which is so loud that it can awaken sleeping partner, increase in sensitivity of tooth, jaw muscle tightening, headache, ear ache and development of indentations in tongue. Bruxism can also predispose an individual to develop temporomandibular joint (TMJ) problems.

Diagnosis: Bruxism is diagnosed through a preliminary physical examination, to carefully study signs and symptoms. The dentist would also conduct several other tests, to check for signs of underlying diseases of teeth, and to also determine abnormalities.

Treatment: Treatment for bruxism includes splints, dental guards, and adopting strategies to correct dental problems. If stress is the underlying condition, then various behavioral therapies would also be adopted for relieving stress. Medications, such as muscle relaxants, and botox injections, can also help relieve the symptoms. Biofeedback is a type of complementary medicine, which makes use of several monitoring methods to control the muscle activity.

References

Article

  1. Mehta NR, Scrivani SJ, Correa L, Matheson JK. Sleep-Related Bruxism. In: Therapy in Sleep Medicine, Barkoukis TJ, Matheson JK, Ferber R, Doghramji K. (Eds), Elsevier, 2012.
  2. Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep.Dent Clin North Am. Oct 2001;45(4):657-84.
  3. Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain. spring/2009;23(2).
  4. Shilpa S, et al. Bruxism: a literature review. J Indian Proshodont Soc. 2010/09;10(3):141-148.
  5. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil. July/2008;35(7):476-494.
  6. Lobbezoo F, van der Zaag J, van Selms MK, Hamburger HL, Naeije M. Principles for the management of bruxism. J Oral Rehabil. Jul 2008;35(7):509-23.
  7. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109:e26.
  8. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997; 8:291.
  9. Hoz Aizpurua J, Díaz Alonso E, LaTouche Arbizu R, Mesa Jiménez J . Sleep bruxism. Conceptual review and update. Med Oral Patol Oral Cir Bucal. 2011;16(2):e231-238.
  10. Foster PS. Use of the Calmset 3 biofeedback/relaxation system in the assessment and treatment of chronic nocturnal bruxism. Appl Psychophysiol Biofeedback. Jun 2004;29(2):141-7.
  11. Monroy PG, Da Fonseca MA. The use of botulinum toxin-a in the treatment of severe bruxism in a patient with autism: a case report. Spec Care Dent. 2006;26:37-39.

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Last updated: 2019-07-11 22:51