Bruxism

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]

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:

• Dental examination to check for other abnormalities
• X-rays to determine underlying damage to the bones and teeth
• Tests to determine ear infections
• Dental abnormalities such as poor teeth alignment or missing tooth [9]

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 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].

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:

• Emotional triggers such as stress, anxiety or anger [3]
• Certain types of personality defined by aggressive or competitive behavior
• Sleep disorders
• Side effects of certain medications
• Diseases such as Parkinson disease or Huntington's disease
• Ear ache or tooth ache

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].

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].

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.

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].

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.

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