BRUXISM(TEETH GRINDING)

                        

                          What is Bruxism ?

Bruxism is derived from greek word 'Brukein' meaning bite/gnash. Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It is a common problem. It is a parafunctional oral habit. It may develop at any age. People suffering from bruxism are called Bruxists/Bruxers and the act is called Brux.

Classification of Bruxism

1. Classification by temporal pattern

a) Sleep Bruxism

Also called Sleep related bruxism or Nocturnal tooth grinding. Occurs while asleep. Equal gender distribution. Mostly clenching and grinding occurs.

b) Awake Bruxism

Also called Diurnal bruxism or Daytime bruxism. Occurs while awake. Mostly seen in females. Usually clenching occurs. Occassionally both clenching and grinding occurs.

2. Classification by cause

a) Primary Bruxism/ Idiopathic Bruxism

This disorder is not related to any other medical condition.

b) Secondary Bruxism

This disorder is associated with other medical conditions.

Eg: Iatrogenic causes, Central/Pathophysiological factors, Psychosocial factors, Peripheral factors etc.

3. Classification by severity

a) Mild Bruxism

Occuring less with no damage to teeth or psychosocial impairment.

b) Moderate Bruxism

Mild impairment of psychosocial functioning.

c) Severe Bruxism

Damage to teeth, temporomandibular joint and psychosocial impairment.

4. Classification by duration

a) Acute Bruxism

Lasts for less than 1 week

b) Subacute Bruxism

Lasts for more than a week and less than 1 month

c) Chronic Bruxism

Lasts for over a month

Signs and Symptoms of Bruxism

                 

•  Headaches (most common)
•  Grinding or tapping noise during sleep
• Tooth fractures/tooth mobility
•  Hypersensitive teeth
•  Aching jaw muscles
•  Excessive tooth wear (attrition or abfraction)
•  Damage to dental restorations (crowns and fillings)
•  Pain/tenderness/clicking of TMJ
•  Cheek /lip biting
• Burning sensation on the tongue
•  Hypertrophy of muscles of mastication
•  Trismus
•  Ear pain
•  Sleep disorders
•  Stiffness of shoulders and neck
•  Swelling (occassionally) on the side of lower jaw

Causes of Bruxism

Cause is largely unknown but is generally accepted to have multiple causes

                                    

•  Often associated with stress caused by responsibilities or work pressure
•  In children, bruxism may occassionally represent a response to ear ache/teething                                              
• Other semi-voluntary oral habits such as cheek biting, nail biting, chewing a pen or pencil absent mindedly or tongue thrusting
•  Obstructive sleep apnea
•  Disturbance of dopaminergic system in CNS
•  Genetic factors
•  Medications
• Occlusal factors ( impacted /over erupted wisdom tooth)
•  Neurological/psychiatric disorders

Diagnosis of Bruxism

Diagnosis is usually made clinically and is based on the person's history and also based on the presence of typical signs and symptoms. Questionnaires can be used for screening. Diagnosis of sleep bruxism is usually in the form of unpleasant grinding noises during sleep. Tooth wear maybe brought to the person's attention during routine dental examination.

Some methods and devices have been developed for routine clinical diagnosis of bruxism.

They are

 Polysomnography (this includes electroencephalography, electromyography, electrocardiography, air flow monitoring, audio-video recording)

 Bruxcore Bruxism Monitoring Device (BBMD)

 Intra splint force detector (ISFD)

 Bite strip

 Grindcare

Management of Bruxism

Since bruxism is not life-threatening, conservative treatment should be used.

1. Dental treatment

i) Dental guards and occlusal splints

This is effective for sleep bruxism. It is worn during sleep, every night. They mechanically protect teeth rather than reducing the bruxing activity itself. Occlusal splints are either partial or full

coverage according to whether they fit over some or all of the teeth. They are typically made of acrylic and can be soft or hard. Lower splints are better tolerated in people with a sensitive gag reflex. For hypersensitive teeth, desensitising toothpaste (eg. containing strontium chloride) can be applied inside the splint so that the material is in contact with the teeth all night.

Treatment goal of occlussal splints

•  constraining bruxism pattern to avoid damage to teeth and TMJ
• stabilizing the occlussion by minimising gradual changes to positions of teeth
• revealing the extent and pattern of bruxism through examination of markings on  splint's surface

ii) Repositioning splint

Designed to change patient's occlusion

iii) Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-TSS) dental guards

                    

It is a type of partial splint. It snaps onto upper front teeth only. It prevents tissue damage by reducing bite force from attempts to close the jaw into a forward twisting of lower front teeth.

iv) Mandibular advancement device

It can reduce sleep bruxism but may be associated with discomfort.

v) Occlusal adjustment/ re-organisation

It reorganises the occlusion in the belief that this may redistribute the forces and reduce the amount of damage inflicted on the dentition. It may include orthodontics, restorative dentistry, orthognathic surgery. Dental implants and bridgework are contraindicated. Full coverage gold crown may be appropriate than other types of crown. These occlusal re-organisations have been criticized as it may irreversibly damage the dentition on top of the damage already caused by bruxism.

2. Psychosocial interventions

 Reassurance that the condition does not represent a serious disease. This may act to alleviate contributing stress

 Relaxation techniques

 Stress management

 Behavioral modification

 Habit reversal

 Hypnosis (self hypnosis or with a hypnotherapist)

 Cognitive behavioral therapy

3. Medications

                                            

 Benzodiazepines

 Anti-convulsants

 Beta blockers

 Anti-depressants

 Muscle relaxants

4. Biofeedback

Biofeedback refers to a process/device that allows an individual to become aware of and alter physiological activity with the aim of improving health. Electromyographic monitoring of the muscles with automatic alerting during periods of clenching and grinding has been described for awake bruxism.

Dental appliances with capsules that break and release a taste stimulus when enough force is applied have been described for sleep bruxism. This would wake the person from sleep in an attempt to prevent bruxism episodes.

Expected duration of bruxism

            

Of all children who brux between the ages of 3 and 10, more than half will stop on their own by age 13.

In teenagers and adults it depends on its cause. Eg: If related to stress, bruxism can last for many years. If caused by a dental problem, it should stop when the teeth are repaired and re-aligned.

Possible complications of Bruxism

 Depression

 Eating disorders

 Insomnia

 Increased dental or TMJ problems

 Fractured teeth

 Receeding gums

Some tips to prevent Bruxism

1. Avoid or cut back on foods and drinks that containe caffeine (eg- colas, chocolate, coffee etc)

2. Avoid alcohol. Grinding tends to intensify after alcohol consumption

3. Do not chew pens or pencils

4. Avoid chewing gums as it allows jaw muscles to get more

used to clenching and grinding of teeth

5. During the day if one notices clenching or grinding, position the tip of the tongue between the teeth. This trains jaw muscles to relax

6. Relax the jaw muscles at night by holding a warm washcloth against the cheek in front of the ear lobe

7. Drink plenty of water

8. Massage and stretching exercises can be done which relaxes the muscles

9. Regular dental check ups.