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]

• Pain

  Among women, report of awake bruxism increased the risk for TMD pain and TMJ pain on jaw movement. Reporting stress as a perpetuating factor for TMD pain increased the risk for both sleep and awake bruxism in both genders. [ncbi.nlm.nih.gov]

  However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain. [nlm.nih.gov]

  Comparison of pain and quality of life in bruxers and patients with myofascial pain of the masticatory muscles. J Orofac Pain 8: 350 -356. Google Scholar Medline Dao TTT, Lund JP, Lavigne GJ ( 1995 a). [cro.sagepub.com]

• Bruxism

  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]

  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]

  Awake bruxism is found more in females as compared to males while sleep bruxism shows no such gender prevalence. Etiology of bruxism can be divided into three groups psychosocial factors, peripheral factors and pathophysiological factors. [doi.org]

• 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]

  Many common symptoms can seem sporadic, such as occasional jaw pain near the ear, headaches, tooth sensitivity or muscle spasms. [drfeuer.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]

  Caries Dental caries is the medical term for tooth decay or cavities. It is caused by acid erosion of tooth enamel. [colgateprofessional.com]

  The exclusion criteria were: dental caries, early tooth loss, systemic and/or mental developmental disorders (including diseases of the endocrine and metabolic systems) and use of medications that could interfere with the central nervous system. [bmcoralhealth.biomedcentral.com]

  caries.35 Stimulants such as amphetamine, 3,4‐methylenedioxymethamphetamine (MDMA, ecstasy) and cocaine exert their effects by enhancing norepinephrine and/or dopamine.36 Amphetamine‐related oral health complications37 include broken or missing teeth [onlinelibrary.wiley.com]

  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]

• 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]

• Musculoskeletal Pain

  A 44-year-old woman, who was suffering from widespread musculoskeletal pain, fatigue, and sleep disorder, was diagnosed as fibromyalgia. There was no apparent organic disease. Duloxetine therapy was introduced with a dose of 60 mg/day at bedtime. [ncbi.nlm.nih.gov]

  The pain adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69: 683 -694. Google Scholar Crossref Medline ISI Lund JP, Stohler CS, Widmer CG ( 1993 ). [cro.sagepub.com]

• Otalgia

  Postauricular erythema and swelling; tenderness over mastoid process Otitis externa Pruritus, pain, and tenderness of the external ear Erythema and edema of external auditory canal Otitis media Fever; malaise; otalgia Tympanic membrane dull, bulging, [aafp.org]

  […] which may get worse during chewing or other jaw movement.[7] Trismus (restricted mouth opening).[10] Pain or tenderness of the temporomandibular joints,[10] which may manifest as preauricular pain (in front of the ear), or pain referred to the ear (otalgia [en.wikipedia.org]

• Denial

  'denial of guilt', 3. 'distraction', 4. 'substitute gratification', 5. 'situation control', 6. 'reaction control', 7. 'positive self-instructions', 8. 'need for social support', 9. 'avoidance', 10. 'escape', 11. 'rumination', 12. 'resignation', 13. [head-face-med.com]

• Headache

  Bruxism in children elicits consequences such as headache, orofacial pain, and pain related to awakening. [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]

  As a result, you will: sleep better (and you won’t wake your partner with the grinding noises) eliminate morning headaches stop jaw pain save your teeth [wqdental.com]

• Dysesthesia

  A new clinical approach to the treatment of temporomandibular dysfunction and orofacial dysesthesia: natural history and comparisons with similar chronic pain conditions. J Craniomandib Disord 6: 56 -63. [cro.sagepub.com]

• Possibly Dementia

  A 62-year-old woman was referred for SPECT brain blood flow study with a diagnosis of possible dementia or depression. [ncbi.nlm.nih.gov]

• Neurologic Manifestation

  Rusyniak, Neurologic Manifestations of Chronic Methamphetamine Abuse, Neurologic Clinics, 10.1016/j.ncl.2011.05.004, 29, 3, (641-655), (2011). T. STRAUSZ, J. AHLBERG, F. LOBBEZOO, C. C. RESTREPO, C. HUBLIN, K. AHLBERG and M. [doi.org]

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]

• 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]

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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