Bruxism is an excessive toothbrush or clenched jaw. This is oral parafunctional activity; that is, it is not related to normal functions such as eating or speaking. Bruxism is a common behavior; Prevalence reports range from 8-31% in the general population. Some of the symptoms are commonly associated with bruxism, including hypersensitivity teeth, diseased jaw muscles, headaches, tooth wear, and damage to dental restorations (eg crowns and patches) on teeth. But symptoms may be minimal, without the patient's awareness of the condition.
There are two main types of bruxism: one occurs during sleep (sleep bruxism) and one during awake (bruxism awake). Tooth decay may be similar in both types, but sleeping bruxism symptoms tend to get worse when wake up and improve during the day, and symptoms of awake bruxism may not be present at all when waking up, and then worsening during the day. The cause of bruxism is not fully understood, but may involve many factors. Beware bruxism is more common in women, whereas men and women are affected in the same proportion as sleeping bruxism. Awake bruxism is thought to have different causes of sleeping bruxism. Some treatments are in use, although there is little evidence of strong efficacy for certain treatments.
Video Bruxism
Signs and symptoms
Most people who are brux are not aware of the problem, either because there are no symptoms, or because the symptoms are not understood in terms of packing and grinding issues. The symptoms of sleep bruxism are usually most intense as soon as they wake up, and then slowly subside, and the symptoms of grinding habits that occur especially when awake tend to worsen throughout the day, and may not be present during waking hours. Bruxism can cause various signs and symptoms, including:
- Excessive tooth wear, especially friction, that flattens the occlusal surface (biting), but also possibly other tooth types such as abfraction, where notch forms around the tooth neck in the gum line.
- Tooth fracture, and repeated failure in dental restorations (fillings, crowns, etc.).
- Hypersensitive teeth, (eg, toothache during cold drinking) caused by loss of thickness of the dentine and enamel isolation layer around the dental pulp.
- Inflammation of the dental periodontal ligament, which can make them sick to bite, and possibly also the degree of loosening of the teeth.
- Sound milling or tapping during sleep, sometimes detected by spouse or parent. This noise can be very loud and unpleasant, and can wake a sleeping partner. Noise is rarely associated with awake bruxism.
- Other parafunctional activity that may occur along with bruxism: cheek biting (which can manifest as morsicatio buccarum and/or linea alba), and/or biting the lips.
- Burning sensation on the tongue (see: glossodynia), may be related to adjacent parafunctional "tongue thrusting" activity.
- Indents of teeth on the tongue ("tongue cries" or "toothed tongue").
- Hypertrophy of the chewing muscles (increasing the size of the muscles that move the jaw), especially the masseter muscle.
- Tenderness, pain or fatigue of mastication muscles, which can be worse during chewing or other jaw movements.
- Trismus (limited mouth opening).
- Temporomandibular joint pain or pain, which may manifest as preauricular pain (in front of the ear), or pain referring to the ear (otalgia).
- Clicking on the temporomandibular joint.
- Headaches, especially pain in the temples, are caused by muscle pain associated with temporalis muscle.
Bruxism is usually detected due to the effects of the process (most often wearing teeth and pain), rather than the process itself. The large forces that can be produced during bruxism can have detrimental effects on the components of the mastication system, namely the teeth, the periodontium and the articulation of the mandible with the skull (temporomandibular joint). The mastery muscles that function to move the jaw can also be affected because they are used above and above the normal function.
Wear your teeth
Many publications include dental wear as a consequence of bruxism, but some report a lack of a positive relationship between dental wear and bruxism. The use of teeth caused by tooth-to-tooth contact is called attrition. This is the most common type of tooth that occurs in bruxism, and affects the occlusal surface (biting surface) of the tooth. The exact location and friction pattern depends on how bruxism occurs, for example, when the canine teeth and incisors of the opposite arch are transferred to each other laterally, by the action of the medial pterygoid muscle, this can cause wear incisal of the incisal tooth. To grind the front teeth, most people need their front mandibular posture, unless there is an end to end, a class III incisal connection. People with bruxism can also grind their posterior teeth (back teeth), which wear the underside of the occlusal surface. After the teeth progress through the enamel layer, the open dentin layer is softer and more susceptible to wear and tooth decay. If enough of the tooth is worn or decayed, the tooth will effectively become weak, and may break below the increased strength that occurs in bruxism.
Abfraction is another type of dental wear argued to occur with bruxism, although some still argue whether this type of tooth is a reality. The abfraction cavity is said to occur usually on the facial aspect of the tooth, in the cervical area as a V-shaped defect caused by the elasticity of the tooth under the occlusal force. It is said that a similar lesion can be caused by a strong toothbrush. However, the fact that the V-shaped cavity does not indicate that the damage is caused by tooth abrasion, and some abfraction cavities occur below the level of the gum line, ie in areas protected from toothbrush abrasion, supporting the validity of this mechanism of wearing the tooth. In addition to erosion, erosion is said to be synergistically contributing to dental wear on some bruxists, according to some sources.
Dental mobility
The view that occlusal trauma (as may occur during bruxism) is a contributing factor in gingivitis and periodontitis is not widely accepted. It is thought that periodontal ligaments may respond to an increase in the occlusal force (bite) by supporting a portion of the bone from the alveolar peak, which may result in increased tooth mobility, but this change may be reversed if the occlusal force is reduced. Tooth movement that occurs during occlusal loading is sometimes called fremitus. It is generally accepted that increasing occlusal forces can increase the rate of progression of pre-existing periodontal disease (gum disease), but primary treatment remains a plaque control rather than a complicated occlusal adjustment. It is generally accepted that periodontal disease is a much more common cause of dental mobility and pathologic migration than bruxism, although bruxism may be much less involved in both.
Pain
Most people with bruxism will not experience pain. The presence or level of pain is not always correlated with the severity of grinding or clenching. The pain in the chewing muscles caused by bruxism can be likened to muscle pain after exercise. Pain can be felt on the corner of the jaw (masseter) or in the temple (temporalis), and can be described as a sore head or jaw. Most (but not all) bruxisms include the clenching forces provided by masseter and temporalis muscle groups; but some bruxers clench and grind the front teeth only, which involves minimal action of masseter and temporalis muscle. The temporomandibular joint itself can also be painful, which is usually felt right in front of the ear, or inside the ear itself. Clicking on the jaw joint can also occur. The force given to the tooth is more than the periodontal ligament that is biologically designed to be handled, so that inflammation can occur. Teeth can be painful to bite, and further, dental wear can reduce the width of enamel and dentine insulation that protects the dental pulp and leads to hypersensitivity, for example. for cold stimulation.
The bruxism relationship with temporomandibular joint dysfunction (TMD, or temporomandibular pain dysfunction syndrome) is debated. Many suggest that sleep bruxism may be a contributing factor for pain symptoms in TMD. Indeed, TMD symptoms overlap with those of bruxism. Others suggest that there is no strong relationship between TMD and bruxism. A systematic review investigating relationships that may conclude that when self-reported bruxism is used to diagnose bruxism, there is a positive relationship with TMD pain, and when strict diagnostic criteria for bruxism are used, the association with TMD symptoms is much lower. In severe and chronic cases, bruxism can cause myofascial pain and arthritis in the temporomandibular joint.
Maps Bruxism
Cause
Mastication muscles (temporalis muscle, masseter, medial and lateral pterygoid) are paired on both sides and work together to move the mandible, which hinges and shifts around double articulation with the skull on the temporomandibular joint. Some muscles work to remove the mandible (cover the mouth), and the other is also involved in lateral movement (side to side), protrusive or retraction. Mastication (chewing) is a complex neuromuscular activity that can be controlled either by the subconscious process or by the conscious process. In individuals without bruxism or other parafunctional activity, the maxillary jaw is generally rested and the tooth is not touching, except when speaking, swallowing or chewing. It is estimated that the tooth touches less than 20 minutes per day, mostly during chewing and swallowing. Usually during sleep, the voluntary muscles are inactive due to physiological motor paralysis, and the jaw is usually open.
Some bruxism activity is rhythmic with a pulse-bite force of a tenth of a second (like chewing), and some have a longer pulse bite force of 1 to 30 seconds (clenched). Some individuals clench without significant lateral movement. Bruxism can also be regarded as a disorder of repetitive and unconscious muscle contraction. This usually involves the masseter muscles and the anterior temporalis (large outstretched flesh), and lateral pterygoids, the relatively small bilateral muscles that act together to do side grinding.
The cause of bruxism is largely unknown, but it is generally accepted to have several possible causes. Bruxism is a parafunctional activity, but it is debatable whether this represents a subconscious or completely unconscious habit. The relative importance of various possible contributing factors is also debated.
Sad bruxism is usually considered semivoluntary, and is often associated with stress caused by family responsibilities or workplace pressures. Some suggest that in children, bruxism can sometimes represent a response to ear or dental pain. Caution of bruxism typically involves clenching (sometimes the term "awakened clenched" is used instead of awake bruxism), but may also be grinding, and is often associated with other semivoluntary oral habits such as cheek bites, nail biting, pennies or absent minded pencils, or tongue thrusting (where the tongue is pushed forward by force).
There is evidence that sleep bruxism is caused by mechanisms associated with the central nervous system, involving sleep disturbances and neurotransmitter abnormalities. Underlying these factors may be psychosocial factors including daytime stress that interferes with peaceful sleep. Sleep bruxism is mainly characterized by "rhythmic chewing muscle activity" (RMMA) at a frequency of about once per second, and also with occasional grinding of teeth. It has been shown that the majority (86%) of episodes of sleeping bruxism occur during periods of sleeping arousal. One study reported that an experimental arousal sleep induced by sensory stimulation in sleep bruxists triggers episodes of sleeping bruxism. Sleeping feeling is a sudden change in the depth of the sleep stage, and may also be accompanied by increased heart rate, respiratory changes and muscle activity, such as leg movement. Initial reports have suggested that sleep episodes of bruxism may be accompanied by gastroesophageal reflux, decreased esophageal pH (acidity), swallowing, and decreased salivary flow. Another report shows the relationship between episodes of sleeping bruxism and the supine sleeping position (lying face up).
Dopaminergic system disorders in the central nervous system have also been suggested to engage in the etiology of bruxism. The evidence for this comes from observing the effects of modifying drugs that alter dopamine release in bruxing activities, such as levodopa, amphetamine or nicotine. Nicotine stimulates the release of dopamine, which is postulated to explain why bruxism is twice as common in smokers as compared to non-smokers.
Many studies have reported significant psychosocial risk factors for bruxism, particularly stressful lifestyles, and this evidence is evolving, but it is still inconclusive. Some people regard emotional stress as the main trigger factor. It has been reported that people with bruxism respond differently to depression, hostility and stress than people without bruxism. Stress has a stronger relationship to evoke bruxism, but the role of stress in sleeping bruxism is less clear, with some stating that there is no evidence for a relationship with sleeping bruxism. However, children with sleeping bruxism have been shown to have a greater anxiety level than other children. 50-year-olds with bruxism are more likely to be single and have higher education. Job-related stress and irregular work shifts may also be involved. Personality traits are also frequently discussed in publications about the causes of bruxism, eg. aggressive, competitive or hyperactive personality types. Some suggest that anger or frustration is suppressed can contribute to bruxism. Tense periods such as examination, family death, marriage, divorce, or relocation have been suggested to intensify bruxism. Beware of bruxism often occurs during periods of concentration such as when working on a computer, driving or reading. Animal studies also suggest a link between bruxism and psychosocial factors. Rosales et al. electrically surprised lab rats, and then observed a high level of bruxism-like activity in mice who were allowed to watch this treatment compared to mice that did not see it. They proposed that mice that witnessed electric shocks from other mice were under emotional distress that might have led to such behavior-bruxism.
Genetic factors
Several studies have shown that there may be a degree of inherited susceptibility to developing sleeping bruxism. 21-50% of people with sleep bruxism have immediate family members who experience sleep bruxism during childhood, indicating that there are genetic factors involved, although no genetic markers have been identified. The offspring of those who have sleeping bruxism are more likely to also have sleep bruxism than children of people who do not have bruxism, or those with bruxism awake rather than sleep bruxism.
Drugs
Certain medications, including prescribed and recreational drugs, are considered by some to lead to the development of bruxism, but others argue that there is insufficient evidence to draw such conclusions. Examples may include dopamine agonists, dopamine antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors, alcohols, cocaine, and amphetamines (including those taken for medical reasons). In some cases reported where bruxism is thought to have been initiated by selective serotonin reuptake inhibitors, reducing the dose of resolving side effects. Other sources suggest that selective serotonin reuptake inhibitory reports cause bruxism rarely, or only with long-term use.
Specific examples include levodopa (when used in the long term, as in Parkinson's disease), fluoxetine, metoclopramide, lithium, cocaine, venlafaxine, citalopram, fluvoxamine, methylenedioxyamphetamine (MDA), methylphenidate (used in attention deficit hyperactive disorder), and gamma - hydroxybutyric acid (GHB) and gamma-aminobutyric acid inducing analogs such as phenibut. Bruxism can also be exacerbated by excessive consumption of caffeine, such as in coffee, tea or chocolate. Bruxism has also been reported to occur generally comorbid with drug addiction. Methylenedioxymethamphetamine (MDMA, ecstasy) has been reported to be associated with bruxism, which occurs immediately after taking the drug and for several days thereafter. Wearing teeth in people taking ecstasy is also often much more severe than in people with bruxism who are not associated with ecstasy.
Occlusal Factor
Occlusion is defined as simply "tooth contact", and is a tooth encounter during biting and chewing. This term does not imply any illness. Malocclusion is a medical term that refers to the less ideal position of the upper teeth relative to the lower teeth, which can occur either when the maxilla is ideally proportional to the mandible, or where there is a difference between the size of the maxilla. relative to the lower jaw. Such a malocclusion is so common that the concept of "ideal occlusion" is questioned, and it can be considered "normal to abnormal". Occlusal disorders may refer to problems that interfere with normal bite pathways, and are usually used to describe local problems with the position or shape of a single tooth or group of teeth. A premature contact is one part of the bite encounter faster than the other, meaning that the remaining tooth meets later or is held open, for example, new dental restorations on the teeth (eg crowns) that have a shape or position slightly different from the original tooth can contact too quickly in the bite. Defective contact/interference is a bite disorder that alters the normal bite path. A common example of deflection disorders is the eruptive top teeth that erupt, often because lower wisdom teeth have been removed or impacted. In this example, when the jaw is united, the lower back teeth contact the upper wisdom teeth that stand out before the other teeth, and the mandible must move forward to allow the rest of the tooth to meet. The difference between premature contact and deflective interference is that the latter shows a dynamic abnormality in the bite.
Historically, many believe that problems with bites are the single cause for bruxism. It is often said that one will grind in a disturbing area in the subconscious mind, the instinctive attempt to wear this down and "self equiliberate" their occlusion. However, occlusal disorders are very common and usually do not cause problems. It is unclear whether people with bruxism tend to pay attention to problems with bites due to their clenching habits and grinding, or whether this acts as a contributing factor in the development of the condition. In sleep bruxism in particular, there is no evidence that the removal of occlusal disorders has an impact on these conditions. People with no teeth at all who wear dentures can still suffer from bruxism, although dentures also often alter the original bite. Most modern sources state that there is no relationship, or at least a minimal relationship, between bruxism and the occlusal factor. The finding of one study, which uses self-reported tooth grinding rather than clinical examination to detect bruxism, suggests that there may be more links between occlusal factors and bruxism in children. However, the role of the occlusal factor in bruxism can not be completely discounted due to insufficient evidence and problems with the study design. A small number of researchers continue to claim that various adjustments to the bite mechanism are able to cure bruxism (see occlusal adjustment/reorganization).
Possible associations
Some associations between bruxism and other conditions, usually neurological or psychiatric disorders, are rarely reported, with varying degrees of evidence (often in the form of case reports). Examples include:
Diagnosis
The initial diagnosis of bruxism is beneficial, because of the possibility of possible damage and adverse effects on quality of life. The diagnosis of bruxism is usually made clinically, and is primarily based on a person's history (eg a milling sound report) and the presence of distinctive signs and symptoms, including tooth mobility, tooth wear, mass hypertrophy, tongue curvature, hypersensitive teeth (which can be misdiagnosed as reversible pulpitis ), pain in the mastication muscles, and clicking or locking the temporomandibular joint. Questionnaires can be used to filter bruxism in both clinical and research settings.
For a dental grinder that lives in the same house as another person, the diagnosis of milling is very easy: Housewife or family member will suggest a recurring grinding bruxer. The self-resident grinders can also use the activated voice recorder. To confirm the condition of the clench, on the other hand, bruxers can depend on devices such as Bruxchecker, Bruxcore, or beepe beet-bearing beeplate.
Individual (Personal) Dental Index was developed to measure objective levels of objective tooth wear objectively, unaffected by the number of missing teeth. Bruxism is not the only cause of tooth wear. Another possible cause of tooth decay is acid erosion, which can occur in people who drink lots of acidic liquids such as concentrated fruit juice, or in people who often vomit or regurgitate stomach acid, which in itself can occur for various reasons. People also show normal tooth wear levels, associated with normal functioning. The presence of teeth only indicates that it has happened at some point in the past, and does not necessarily indicate that the loss of tooth substance is underway. People who clench and perform minimal grinding also will not show much tooth decay. Occlusal splints are commonly used as a treatment for bruxism, but they can also be used for diagnosis, eg. to observe the presence or absence of wear on the splint after a certain period of wearing it at night.
The most common trigger in sleep bruxism that causes a person to seek medical or dental advice is being informed by the sleeping partner of an unpleasant grinding sound during sleep. The diagnosis of sleep bruxism is usually immediate, and involves the exclusion of dental diseases, temporomandibular disorders, and rhythmic jaw movements that occur with seizure disorders (eg epilepsy). This usually involves dental examination, and possibly electroencephalography if a seizure disorder is suspected. Polysomnography shows increased activity of muscle masseter and temporalis during sleep. Polysomnography can involve electroencephalography, electromyography, electrocardiography, airflow monitoring and audio-video recording. May be useful to help get rid of other sleep disorders; However, due to the cost of using the sleep lab, polysomnography is largely of relevance to the research rather than the routine clinical diagnosis of bruxism.
Dental clothing can be brought to the attention of people during routine dental examinations. With the awake bruxism, most people will initially refuse to clench and grind because they are unaware of the habit. Often, the person can re-attend immediately after the first visit and report that they have now become aware of such habits.
Several devices have been developed that aim to measure the activity of bruxism objectively, whether in terms of muscle activity or bite force. They have been criticized for introducing possible changes in swiping habits, whether to increase or decrease them, and therefore less representative for genuine bruxing activities. This is largely relevant to research, and is rarely used in routine clinical diagnosis of bruxism. Examples include "Bruxism-Bruxcore Device Monitoring" (BBMD, "Bruxcore Plate"), "intra-splint force detector" (ISFD), and electromyography devices to measure masseter or temporalis muscle activity (eg "BiteStrip", and "Grindcare").
ICSD-R diagnostic criteria
ICSD-R registered diagnostic criteria for sleep bruxism. Minimum criteria include both of the following:
- A. dental or teeth teething symptoms while sleeping, and
- B. One or more of the following:
- Abnormal tooth wear
- Milling sound
- Jaw muscle discomfort
With the following criteria that support the diagnosis:
- C. polysomnography shows both:
- Jaw muscle activity during sleep
- No related epilepsy activity
- D. There are no other medical or mental disorders (eg, sleep-related epilepsy, which can cause abnormal movement during sleep).
- E. Other sleep disorders (eg, obstructive sleep apnea syndrome).
Definition
Bruxism is derived from the Greek ??????? ( brykein ) "bite, or to chew, grind teeth". People who suffer from bruxism are called bruxists or bruxers and their own verb is "brux". There is no widely accepted definition of bruxism, but some suggested definitions include:
"Bruxism is a recurrent jaw-muscle activity characterized by clenching or grinding the teeth and/or by strengthening or pushing the mandible.Bluxism has two different circadian manifestations: it can occur during sleep (indicated as sleeping bruxism) or during awakening (indicated as awake bruxism ) "
All forms of bruxism require a strong contact between the tooth surface of the upper and lower teeth. In grinding and tapping these contacts involves the movement of the lower and unpleasant sounds that can often awaken the sleeping partner and even the people sleeping in adjacent rooms. Clenching (or clamping), on the other hand, involves unheard, sustained, and strong dental contact without being accompanied by a mandible movement.
"Mastication system movement disorder characterized by grinding teeth and clenching during sleep and awake."
"Non-functional contact of the mandibular and maxillary teeth resulting in shrinking teeth or teeth due to repetitive and unconscious masseter and temporalis muscle contractions."
"Parafunctional tooth grinding or oral habits consisting of non-functional rhythmic or spasmodic swings are inactive, grinding or closing the teeth other than the mandibular chewing motions that can cause occlusal trauma."
"Sweating repeated periodically or hardened rhythmically from the teeth."
Classification by temporal pattern
Bruxism can be divided into two types based on when parafunctional activity occurs - during sleep ("sleep bruxism"), or when waking up ("wake up bruxism"). This is the most widely used classification since sleep bruxism generally has different causes for wake bruxism, although the effects on dental conditions may be the same. Treatment also often depends on whether bruxism occurs during sleep or when awake, for example, the occlusal splint used while sleeping on someone who only bruxes when waking up may not be beneficial. Some even suggest that sleep bruxism is a completely different disorder and unrelated to the awake bruxism. Beware bruxism is sometimes abbreviated AB, and also called "diurnal bruxism", DB, or "bruxing daylight". Sleep bruxism is sometimes abbreviated as SB, and is also called "sleep-related bruxism", "nocturnal bruxism", or "nocturnal tooth grinding". According to the International Classification of Sleep Disorders Revised Edition (ICSD-R), the term "sleep bruxism" is most appropriate because it occurs specifically during sleep rather than being associated with a certain time of day, ie, if a person sleeping with bruxism is to sleep in the afternoon day and stay awake at night then condition will not happen at night but during the day. The ICDS-R defines sleeping bruxism as "a stereotypical movement disorder characterized by grinding or closing teeth during sleep", classifying it as parasomnia. The second edition (ICSD-2), however, classifies bruxism to "related sleep-related disorders" rather than parasomnia.
Classification by reason
Alternatively, bruxism can be divided into primary bruxism (also called idiopathic bruxism), where the disorder is not related to other medical conditions, or secondary bruxism, where the disorder is associated with other medical conditions. Secondary bruxisms include iatrogenic causes, such as side effects of prescribed medications. Another source divides the causes of bruxism into three groups, namely central or pathophysiological factors, psychosocial factors and peripheral factors. International Organization International Classification 10 Revised Diseases do not have an entry called bruxism, instead of a list of "grinding teeth" under the somatoform disorder. To describe bruxism as a pure somatoform disorder does not reflect the main modern view of this condition (see cause).
Classification by severity
The ICSD-R describes three different severities of sleeping bruxism, defines mild as it occurs less than nightly, without damage to teeth or psychosocial disorders; as is the case every night, with mild psychosocial disorders; and severe as it happens every night, and with tooth decay, tempormandibular disorders and other physical injuries, and severe psychosocial damage.
Classification by duration
ICSD-R also describes three different types of sleep bruxism according to the duration of this condition, which is acute, lasting less than a week; subacute, lasting for more than a week and less than a month; and chronic that lasts for more than a month.
Management
Treatment for bruxism revolves around repairing tooth decay that has occurred, and also often, through one or more of several available methods, tries to prevent further damage and manage symptoms, but no widely accepted best treatment. Because bruxism is not life-threatening, and there is little evidence of treatment efficacy, it has been recommended that only conservative treatment that can be reversed and who have low-risk morbidity should be used. The main treatments described in bruxism are awake and sleep are described below.
Dental care
Bruxism can cause significant tooth decay if severe, and sometimes dental restorations (crowns, patches etc.) are damaged or lost, sometimes repeatedly. Therefore, most dentists prefer to keep dental care in people with very simple bruxism and only carry it out when important, because any dental work is likely to fail in the long run. Dental implants, dental ceramics such as Emax crowns and complex bridgework eg are relatively contraindicated in bruxists. In terms of crowns, the strength of restoration becomes more important, sometimes with aesthetic considerations. For example. the full-scaled gold crown, which has a degree of flexibility and also involves less disappearance (and therefore less weakening) of the underlying natural teeth may be more appropriate than other types of crowns that are primarily designed for aesthetics rather than durability. Porcelain veneers in the incisors are particularly susceptible to damage, and sometimes the crown may be punctured by occlusal clothing.
Occasions and occlusal splints
Occlusal splints (also called dental guards) are commonly prescribed, especially by dentists and dental specialists, as a treatment for bruxism. Proponents of its use claim many benefits, but when evidence is critically examined in a systematic review of the topic, it is reported that there is insufficient evidence to show that occlusal splints are effective for sleep bruxism. Furthermore, occlusal splints may not be effective for awake bruxism, as they tend to be only worn during sleep. However, occlusal splints may be useful in reducing tooth wear that may accompany bruxism, but by protecting the teeth mechanically rather than reducing the activity of bruxing itself. In a minority of cases, sleep bruxism can be aggravated by occlusal splints. Some patients will periodically return with splints with holes worn through them, either due to bruxism compounded, or unaffected by the presence of splints. When tooth-to-tooth contact is possible through a hole in the splint, it does not offer tooth wear protection and needs to be replaced.
Occlusal splints are divided into partial splints or full coverage according to whether they match some or all of the teeth. They are usually made of plastic (eg acrylic) and can be hard or soft. The lower tool can be used alone, or combined with the top tool. Usually lower splints are more tolerable in people with sensitive vomiting reflexes. Another problem with wearing a splint is the stimulation of the flow of saliva, and for this reason some suggest to start wearing a splint about 30 minutes before bedtime so this does not cause trouble falling asleep. As an additional measure for sensitive teeth in bruxism, desensitizing toothpastes (eg containing strontium chloride) can be applied initially in the splint so that the material comes into contact with the tooth throughout the night. This can continue until there is only a normal level of sensitivity of the tooth, although it must be remembered that sensitivity to thermal stimulation is also a symptom of pulpitis, and may indicate tooth decay rather than just hypersensitive teeth.
Splints can also reduce muscle tension by allowing the upper and lower jaws to move easily against each other. Treatment goals include: limiting bruxing patterns to avoid damage to temporomandibular joints; stabilize occlusion by minimizing gradual changes to the position of the tooth, preventing tooth decay and revealing the extent and pattern of bruxism through examination of marks on the splint surface. A gatekeeper is usually worn during sleep every night for the long term. However, the meta-analysis of occlusal splints (dental guards) used for this purpose concluded "There is not enough evidence to suggest that occlusal splints are effective for treating sleeping bruxism."
A repositioning splint is designed to alter patient occlusion, or bite. The efficacy of these devices is debatable. Some authors propose that irreversible complications may result from long-term use of mouthguard and reposition splints. Randomized controlled trials with this type of device generally show no benefit compared to other therapies. Another partial splint is the nociceptive trigeminal inhibition tension suppression system (NTI-TSS) of the dental guard. This splint is only attached to the upper front teeth. It theorized to prevent tissue damage primarily by reducing bite strength from attempts to close the jaw usually into a front rotating front forearm. The goal is that the brain interprets the sensation of the nerve as something that is unwanted, automatically and unconsciously reduces the clenching force. However, there may be potential for NTI-TSS devices to act as Dahl tools, holding the posterior teeth out of occlusion and causing their excessive eruptions, damaging occlusion (ie can cause the tooth to move position). Therefore, continuous follow-up is recommended.
The mandibular progression device (usually used for the treatment of obstructive sleep apnea) may reduce sleeping bruxism, although its use may be associated with discomfort.
Given the strong relationship between awake bruxism and psychosocial factors (the relationship between sleeping bruxism and psychosocial factors is unclear), the role of psychosocial intervention can be said to be central to management. Therefore, the simplest form of care is the assurance that the condition does not represent a serious illness, which can act to reduce the stress that contributes. Other interventions include relaxation techniques, stress management, behavior modification, habitual reversal and hypnosis (self hypnosis or with hypnotherapy). Cognitive behavioral therapy has been recommended by some for the treatment of bruxism. In many cases, the build up of bruxism can be reduced by using reminder techniques. Combined with this protocol sheet can also help to evaluate which bruxism situation is most prevalent.
Medication
Many different drugs have been used to treat bruxism, including benzodiazepines, anticonvulsants, beta blockers, dopamine agents, antidepressants, muscle relaxants, and others. However, there is little, if any, evidence for the efficacy of each and is comparable with each other and when compared with placebo. A systematic review is underway to investigate evidence for drug treatment in sleeping bruxism.
Specific drugs that have been studied in sleeping bruxism are clonazepam, levodopa, amitriptyline, bromocriptine, pergolide, clonidine, propranolol, and l-tryptophan, with some showing no effects and others seem to have promising early results; however, it has been suggested that further safety testing is required before evidence-based clinical recommendations can be made. When bruxism is associated with the use of selective serotonin reuptake inhibitors in depression, added buspirone has been reported to resolve side effects. Tricyclic antidepressants have also been suggested to be preferred to selective serotonin reuptake inhibitors in people with bruxism, and can help with pain.
Botox
Botulinum toxin (Botox) is used as a treatment for bruxism, but only one randomized controlled trial has reported that Botox reduces the symptoms of myofascial pain. This scientific study is based on thirty people with bruxism who received Botox injections into mastication muscles and a control group of people with bruxism who received placebo injections. Usually some experiments with larger cohorts are needed to make assertions about the efficacy of treatment. In 2013, an advanced random control trial investigating Botox in bruxism begins. There is also little information available about the safety and long-term follow-up of these treatments for bruxism.
Botulinum toxin causes muscle paralysis/atrophy by inhibiting the release of acetylcholine at the neuromuscular junction. Botox injections are used in bruxism on the theory that aqueous solutions of toxins paralyze the muscles and reduce their ability to forcibly clench and grind the jaw while aiming to maintain adequate muscle function to allow for normal activities such as talking and eating. This treatment usually involves five or six injections into the masseter and temporalis muscles, and less frequently into the lateral pterygoids (given the possible risk of decreased swallowing ability) takes several minutes per side. The effect may be seen the next day, and they can last for about three months. Occasionally, side effects can occur, such as bruises, but this is quite rare. The toxic dose used depends on the person, and higher doses may be needed in people with stronger mastication muscles. With temporary and partial muscle paralysis, unused atrophy may occur, which means that the required dose in the future may be smaller or the length of time the last effect can be increased.
Biofeedback
Biofeedback is a process or device that allows one to become aware, and alters physiological activity with the aim of improving health. There is no evidence for long-term use and safety of biofeedback in bruxism management. Monitoring of electromyography of muscles with automatic warning during periods of clenching and grinding has been prescribed for awake bruxism. Dental appliances with capsules that break down and release a flavor stimulus when enough strength is applied have also been described in sleep bruxism, which will wake people from sleep in an attempt to prevent episodes of bruxism. Unfortunately, "large-scale, double-blind trials, which confirm the effectiveness of this approach have not been done."
Occupational splitting/reorganization
As an alternative to only reactively repairing tooth decay and adjusting to existing occlusal schemes, sometimes some dentists will try to rearrange the occlusion in the belief that this can redistribute forces and reduce the amount of damage inflicted on the teeth. Sometimes called "occlusal rehabilitation" or "occlusal balance", this can be a complicated procedure, and there is much disagreement between the proponents of this technique in most aspects involved, including indications and objectives. This may involve orthodontics, restorative dentistry or even orthognathic surgery. Some people criticize this occlusal reorganization because it has no evidence base, and permanently damages teeth on the damage already caused by bruxism.
Epidemiology
There is wide variation in epidemiological data reported for bruxism, and this is largely due to differences in the study's definition, diagnosis and methodology. For example. some studies have used self-reported bruxism as a measure of bruxism, and since many people with bruxism are unaware of their habits, self-reported tooth grinding and self-exfoliating practices may be a poor measure of actual prevalence.
The ICSD-R states that 85-90% of the general population grind their teeth to levels at some point during their lifetime, although only 5% will develop clinical conditions. Some studies have reported that conscious bruxism affects women more often than men, while in sleep bruxism, men and women are affected equally.
Children reportedly experienced brux as are generally adults. The possibility for sleep bruxism occurs as early as the first year of life - after the first tooth (deciduous tooth decay) erupts into the mouth, and the overall prevalence in children is about 14-20%. ICSD-R states that sleep bruxism can occur in more than 50% of normal babies. Often sleep bruxism develops during adolescence, and the prevalence at age 18 to 29 years is about 13%. The overall prevalence in adults is reported to be 8%, and people over the age of 60 tend to be less affected, with prevalence falling to about 3% in this group.
A systematic review of the 2013 epidemiological report of bruxism concluded a prevalence of approximately 22.1-31% for awake bruxism, 9.7-15.9% for sleeping bruxism, and an overall prevalence of about 8-31.4% of bruxism in general. This review also concludes that overall, bruxism affects men and women equally, and affects elderly people less commonly.
History
"La bruxomanie" (French term, translated to
Society and culture
Grinding teeth is generally displayed by humans and other animals as a display of anger, hostility or frustration. It is thought that in humans, tooth grinding may be an evolutionary instinct for displaying teeth as a weapon, thus threatening an opponent or a predator. The phrase "gritting your teeth" is gritting or clenching your teeth in anger, or accepting a difficult or unpleasant situation and dealing with it in a sure way.
In the Bible there are several references to "gnashing of teeth" both in the Old Testament, and the New Testament, where the phrase "laments and gnashing of teeth" is used to describe the fate of sinners in hell (
In David Lynch's 1977 film Eraserhead, the Henry Spencer ("Mary X") couple was seen rolling and twisting in his sleep, and biting his jaws roughly and noisily, describing sleeping bruxism. In Stephen King's 1988 novel "The Tommyknockers", brother of the central character Bobbi Anderson also has bruxism. In the 2000 movie Requiem for a Dream, the character Sara Goldfarb (Ellen Burstyn) started taking an amphetamine-based diet pills and developed bruxism. In the 2005 film Beowulf & amp; Grendel , modern reworking Anglo-Saxon poem Beowulf, Selma the wizard tells Beowulf that the name of the Grendel troll means "tooth grinder", stating that "he has a nightmare", a possible allusion to Grendel traumatically witnessed the death of his father as a child, in the hands of King Hrothgar. The Geats (the soldiers who chase trolls) or translate the name as "male bone grinder" to disfigure their prey. In George R. R. Martin's series A Song of Ice and Fire, King Stannis Baratheon brushed his teeth regularly, so loudly it could be heard "half the castle going".
In rave culture, the use of recreational ecstasy is often reported to cause bruxism. Among people who have enjoyed ecstasy, while dancing, it is common to use a pacifier, lollipop or gum in an attempt to reduce tooth decay and prevent jaw pain. Bruxism is considered to be one of the contributing factors in "meth mouth", a condition potentially linked to long-term methamphetamine use.
References
External links
Source of the article : Wikipedia
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