Bruxism
Sleep bruxism (SB) is a movement disorder characterized by grinding and clenching of teeth. Although often asymptomatic, frequent bruxism may become clinically significant when it interferes with sleep or results in tooth wear or jaw discomfort.
There are three groups of etiology of bruxism: psychosocial, peripheral, and pathophysiological factors.
The prevalence of bruxism during sleep peaks in childhood progressively declines with age, and is more common in females.
Bruxism itself does not require treatment. However, when problems arise due to bruxism, the sleep bruxer might require management.
Definition
Bruxism is the involuntary clenching or grinding of the upper and lower teeth without food in the mouth. It is a more harmful non-physiological movement of the stomatognathic system, characterized by clenching or grinding of the teeth due to contraction of the masseter, temporal, and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations, hypersensitive or painful teeth, and loss of periodontal support. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake). Bruxism during sleep is often a bigger trouble due to control issues.
Classification
According to the bruxer's age, bruxism in children and adults are two categories.
According to the time of occurrence, awake bruxism and sleep bruxism are two categories.
According to its characteristics, bruxism has the following modes: clenching, grinding, and mixed mode (both clenching and grinding).
Epidemiology
Based on cross-sectional survey studies and self-report, sleep-related bruxism affects 15-40% of children and 8-10% of adults. Typically, bruxism in children occurs after the front teeth eruption. Awake bruxism is found more in females than males, while sleep bruxism shows no such gender prevalence. In older adults, it reduces with aging. According to some studies, the incidence of bruxism in adults aged over 65 is about 3%.
🔍 Causes
The etiologies of bruxism are complicated. Currently, several factors cause it, including a combination of heredity, neurologic, occlusal, neuromuscular dysfunction of the stomatognathic system, somatic diseases, psychosocial and lifestyle factors, etc.
According to observations among family members and gene analysis studies, SB may occur due to environmental and genetic factors.
Malocclusion caused by any long-term reason can cause occlusal disorders and bruxism.
Local Stimulation Factors. The incidence of bruxism in periodontitis patients is 50%. The bruxism symptoms may disappear or improve during periodontitis treatment.
Bruxism may be related to an imbalance in centrally acting neurotransmitters (e.g., dopamine, serotonin). Moreover, some neurological and psychiatric diseases, such as epilepsy, Parkinson's, and schizophrenia, can cause bruxism. Psychiatric medications like acetylcholine and sedatives may also cause bruxism.
Other Factors Related to Somatic Diseases. Variations in blood pressure may also cause bruxism. Other factors include blood glucose, blood calcium concentration, diseases such as gastrointestinal disorders, sleep apnea, and intestinal parasitic infection.
Many psychosocial factors—such as anxiety, depression, stress, and maladaptive coping strategies—may also increase the risk for SB. Students during the exam period, females during menstruation, and people under extreme work stress or suppressed emotions may have teeth clenching during the day or while sleeping.
Lifestyle factors like smoking, alcohol, and caffeine intake can also increase the risk of SB.
🔍 Symptoms
The clinical manifestations of bruxers vary, with the primary manifestations including teeth grinding during sleep or involuntary teeth clenching during the day. Awake bruxism is closely associated with life and work stress and primarily manifests as clenching or grinding teeth. Sleep bruxism is related to sleep-awakening, the main manifestation is involuntary teeth grinding during sleep. Awake bruxers suffer more pain than sleep bruxers; they may usually have long-term headache and distraction and etc. Grinding can wear down the teeth and put pressure on the muscles, tissues, and other structures around the jaw. Symptoms of bruxism include:
Teeth are flat, cracked, chipped, or loose. The enamel wears away, exposing deeper layers of the tooth. tooth pain, or increased sensitivity.
Bruxism is the common etiology of occlusal trauma and may cause gingivitis, periodontitis, loose teeth, and displaced teeth.
Clenching causes damage to the inside of the cheek. Maxillofacial muscle tension or fatigue may occur in the morning. There may be muscle tenderness and even accompanied muscle pain in the neck, back, and so on in the long term.
Some bruxers may have symptoms of temporomandibular joint disorders: Preauricular joint area popping, pain, abnormal mandibular movement, etc.
It feels like an earache, but it is not an ear problem, pain or soreness in the jaw, neck, or face, a dull headache starting at the temples.
Some bruxers can have mental symptoms such as headaches, poor sleep, anxiety, tension, depression, and dysthymia.
Another symptom includes grinding or clenching teeth loudly enough to wake up with the sleeping partner. Sleep bruxers can impact other sleepers and cause fear and irritability of others in the shared living spaces. In turn, the sleep disturbance to others may aggravate the psychological burden of sleep bruxers.
🔍 Diagnosed
The most reliable diagnostic evidence stems from a history of tooth grinding during sleep and corroboration by parents, caregivers, or bed partners. In the case of uncertain diagnosis, bruxers reports, clinical interviews, clinical examination, intraoral appliances, or recording of muscle activity can help diagnose sleep bruxism.
Ⅰ.Formal criteria for sleep-related bruxism according to the International Classification of Sleep Disorders, Third Edition (ICSD-3), as followings:
The presence of regular or frequent tooth-grinding sounds occurs during sleep.
The presence of one or more of the following clinical signs:
ⅰ.Abnormal tooth wear is consistent with the above reports of tooth grinding during sleep.
ⅱ.Transient morning jaw muscle pain or fatigue, and/or temporal headache, and/or jaw locking upon awakening are consistent with above reports of tooth grinding during sleep.
Ⅱ.Physicians should ask the bruxers about risk and exacerbating factors, including poor sleep quality signs and symptoms of obstructive sleep apnea symptoms of obstructive sleep apnea (e.g, loudly snoring, witnessed pauses in breathing during sleep) and excess caffeine or alcohol intake. The doctor should evaluate the medication list for potential contributors, including antipsychotic and serotonergic drugs.
Ⅲ.A dentist will likely check for signs of bruxism during regular dental exams. Moreover, they might check tenderness in the individual's jaw muscles, and some obvious dental abnormalities include broken or missing teeth and other damage to the teeth, the underlying bone, and the inside of the cheeks.
IV.Auxiliary Examinations.
Oral devices of radio transmitter. The devices records the bruxer’s upper and lower teeth contact time is significantly longer than in normal people.
Maxillofacial Electromyography Examination. This examination can record the potential of bilateral masseter muscles and temporalis muscles is higher than normal levels in bruxers during sleep. Furthermore, the frequency of rhythmic masticatory muscle activity per hour during sleep is at least six times higher than normal.
Polysomnography.This test is an insightful examination, it determines if the clinical history suggests a comorbid sleep disorder that may exacerbate bruxism episodes.
🔍 Treatments
Many individuals with sleep-related bruxism do not need any specific treatment. Occasional bruxism is common—particularly during childhood—and often asymptomatic. There are various therapies for bruxism. Treatment options for frequent or symptomatic sleep-related bruxism include various therapies, such as Psychological and Behavioral Therapy, muscle relaxation therapy, biofeedback therapy, occlusal therapy, pharmacotherapy and local treatment. The principle of treatment mainly aim to eliminate bruxism symptoms, reduce muscle tension, and protect the function of the stomatognathic system.
A. Psychological and Behavioral Therapy.
There are many effects of behavioral and psychological factors causing excessive tension of the jaw muscle during bruxism. Reducing the brain excitement treatment before going to bed includes resting and relaxing, doing appropriate gymnastics, avoiding excitatory food and smoking, and improving the sleep environment.
B. Muscle Relaxation.
Physical therapy, masticatory muscle topical spray, muscle pain-point-blockade biofeedback therapy, muscle relaxants, and other therapies can relax local muscles and relieve their tension.
C. Biofeedback Therapy.
Through biofeedback, the arousal stimulation during sleep can wake the subject by the sound and other electrical signals at the time of tooth grinding to pause it，such as taste biofeedback.
D. Dental Care.
Bruxers with sleep-related should receive routine dental care to monitor for tooth wear and intervene when necessary. Occlusal plat is one of the most common techniques to cure bruxism.
E. Medication.
In cases of drug-induced sleep-related bruxism, symptoms may vanish after adjusting dose, switching medication or pausing medication.
🔍 Intervention
Many preventive measures can be applied to avoid bruxism:
Social Support
Parents should help their kids relax before bedtime — they might take a warm bath or shower, listen to a few minutes of soothing music, or read.
Parents ask about what is upsetting their kids and find a way to help. For instance, a kid away for a first camping trip might need reassurance that mom or dad will be nearby if needed.
If the issue is more complicated, such as moving to a new town, talk to the child to ease any apprehensions.
Behavior Management
Treatment goals are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible. The following self-care tips may help relieve pain:
Applying ice or wet heat to sore jaw muscles.
Avoiding to eat hard or dense foods like nuts, candies, and steak.
Correcting any bad habits such as unilateral mastication, pencil chewing, betel nut chewing, and gum chewing.
Mastering the correct brushing method, adhere to the morning and evening brushing, and rinse after meals. Each individual should have a toothbrush and cup to avoid cross-infection.
Relaxing the face and jaw muscles throughout the day should be a habit.
Getting plenty of sleep and adjusting bad sleep positions are vital. For instance, lateral or prone sleep may incur bruxism.
Massaging the neck muscles, shoulders, and face is important. Looking for small, painful nodules called trigger points that can cause pain throughout the head and face.
Learning physical therapy stretching exercises to help the muscles and joints on each side of the head get back to normal.
Reducing daily stress and learning relaxation techniques are valuable behavioral management techniques.
Monitoring Diary
During the bruxism treatment, doctors usually conduct an efficacy assessment each month. They monitor the bruxer's condition through medical history, degree of tooth abrasion, and imaging examinations if necessary. Bruxers with temporomandibular joint-related symptoms require additional attention.
Prevention
Relieving pressure, relaxing mood, and adjusting attitude can help prevent bruxism. Avoid getting too excited during the day, watch less exciting TV shows, and strive to relax, especially before falling asleep. Doing some gymnastics, hot bubble baths, listening to light music, etc. is appropriate.
Avoiding stimulatory foods and smoking, including drinking or eating caffeine, such as coffee, chocolate, cola, etc., and improve the sleep environment.
Adding supplementing calcium to the daily diet and eat more vitamin-rich food. Perform deworming regularly.
Applying a hot compress to the lower jaw to relax the occlusal muscles. Abnormal occlusal stimulus should be eliminated to establish a stable occlusal relationship. Keeping the mouth at a healthy rest during the day, that is, keep the teeth loose.
Always brushing your teeth before bed and avoiding a full dinner are helpful prevention methods.
Protecting teeth from abrasion alleviates temporomandibular joint injury in the preauricular area and prevents temporomandibular joint disorders.
🔍 Complications
Bruxism is the common etiology of occlusal trauma and may cause gingivitis, periodontitis, loose teeth, and even displaced teeth. It is not a dangerous disorder. However, it can cause permanent damage to the teeth and create uncomfortable jaw pains, headaches, or ear pain.
Severe bruxism can cause complications, including depression, eating disorders, insomnia, increased dental or temporomandibular joint problems, fractured teeth, and receding gums. Moreover, Nightly grinding can create sounds that may awaken roommates or sleeping partners.
Sources:- shuteye