Bruxism

Bruxism

Definition

Bruxism is the habit of clenching and grinding the teeth. It most often occurs at night during sleep, but may also occur during the day. It is an unconscious behavior or habit perhaps performed to release anxiety , aggression, or anger.

Description

Bruxism is one of the oldest disorders known, and approximately one in four adults experience it. It can occur in children and adolescents as well; cases of bruxism in children as young as 24 months have been reported. Most people are not aware of the disorder until their teeth have been damaged.

Causes & symptoms

While bruxism is typically associated with stress , it may also be triggered by abnormal occlusion (the way the upper and lower teeth fit together) or crooked or missing teeth. Symptoms of bruxism include: dull headaches; sore and tired facial muscles; earaches; sensitive teeth; and locking, popping, and clicking of the jaw. During a dental examination, a dentist may recognize damage resulting from bruxism, including: enamel loss from the chewing surfaces of teeth; flattened tooth surfaces; loosened teeth; and fractured teeth and fillings. Left untreated, bruxism may lead to tooth loss and jaw dysfunction.

Bruxism also appears to be associated with Rett syndrome, an X-linked neurodegenerative disorder that occurs almost exclusively in girls. It is not known as of 2003 why children with this disorder frequently develop bruxism.

Diagnosis

Medical and dental histories, examinations, and x rays are usually necessary to differentiate bruxism from other conditions that may cause similar pain , such as ear infections , dental infections, and temporomandibular joint syndrome (TMJ). In many cases, untreated bruxism can lead to chronic TMJ due to the stress that prolonged grinding places on the jaw and the temporomandibular joint.

Wearing away of the tooth surface is generally regarded as the most important clinical sign of bruxism. Although there is no universally accepted scale for measuring the degree of tooth wear, a 2002 Dutch study reported on a five-point scale that appears to be a reliable instrument for diagnosing bruxism. The five points are as follows:

• 0 = no wear.
• 1 = visible wear within the tooth enamel.
• 2 = visible wear with dentine exposure and loss of crown height.
• 3 = loss of crown height between 1/3 and 2/3.
• 4 = loss of crown height greater than 2/3.

Treatment

Stress management and relaxation techniques, such as hypnosis and guided imagery , may be useful in breaking the habit of jaw clenching and teeth grinding. Tight jaw muscles are often relaxed by applying warm compresses to the sides of the face. Acupuncture may relieve the jaw tension associated with both bruxism and TMJ. Massage therapy and deep tissue realignment, including rolfing , can also assist in releasing the clenching pattern.

Anti-spasmodic herbal preparations which also contain central nervous system relaxant properties, such as chamomile (Matricaria chamomilla ), may be prescribed before bed to prevent grinding while asleep.

Biofeedback , which teaches an individual to control muscle tension and any associated pain through thought and visualization techniques, is also a treatment option for bruxism. In biofeedback treatments, sensors placed on the surface of the jaw are connected to a special machine that allows the patient and healthcare professional to monitor a visual and/or audible readout of the level of tension in the jaw muscles. Through relaxation and visualization exercises, the patient learns to relieve the tension and can actually see or hear the results of their efforts instantly through the sensor readout on the biofeedback equipment. Once the technique is learned and the patient is able to recognize and differentiate between the feelings of muscle tension and muscle relaxation, the biofeedback equipment itself is no longer needed and the patient has a powerful, portable, and self-administered treatment tool to deal with pain and tension.

Allopathic treatment

To prevent further damage to the teeth and jaw, bruxism is treated by placing a removable custom-fitted plastic appliance called a night guard between the upper and lower teeth. Although the clenching and grinding behavior may continue, the teeth wear away the plastic instead of each other.

In some cases, abnormal occlusion may be adjusted and high spots removed so that the teeth fit together in a more comfortable position. Missing teeth may be replaced and crooked teeth may be straightened with orthodontic treatment to eliminate possible underlying causes of bruxism. In cases where jaw muscles are very tight, a dentist may prescribe muscle relaxants.

Expected results

Bruxism may cause permanent damage to teeth and chronic jaw pain unless properly diagnosed and promptly treated. It is considered a major risk factor for the failure of dental implants. The behavior may be eliminated if its underlying causes are found and addressed.

Prevention

Increased awareness in patients prone to anxiety, aggression, or anger may prevent the habit of bruxism from developing.

Resources

PERIODICALS

Baba, K., T. Haketa, S. Akishige, et al. "Validation of Diagnostic Criteria for Sleep Bruxism." Journal of Oral Rehabilitation 29 (September 2002): 872.

Coyne, B. M., and T. Montague. "Teeth Grinding, Tongue and Lip Biting in a 24-Month-Old Boy with Meningococcal Septicaemia. Report of a Case." International Journal of Paediatric Dentistry 12 (July 2002): 277-280.

Lobbezoo, F., W. J. Groenink, A. A. Kranendonk, et al. "A Reliability Study of Clinical Occlusal Tooth Wear Measurements." Journal of Oral Rehabilitation 29 (September 2002): 881-882.

Lynch, C. D., and R. J. McConnell. "The Cracked Tooth Syndrome." Journal of the Canadian Dental Association 68 (September 2002): 470-475.

Magalhaes, M. H., J. Y. Kawamura, and L. C. Araujo. "General and Oral Characteristics in Rett Syndrome." Special Care in Dentistry 22 (July-August 2002): 147-150.

Misch, C. E. "The Effect of Bruxism on Treatment Planning for Dental Implants." Dentistry Today 21 (September 2002): 76-81.

ORGANIZATIONS

Academy of General Dentistry. Suite 1200, 211 East Chicago Avenue, Chicago, IL 60611.(312)440–4300. <www.agd.org>. agdjournal@agd.org.

American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611. (312)440–2500. <www.ada.org>.

Association for Applied Psychophysiology and Biofeedback. Suite 304, 10200 W. 44th Ave., Wheat Ridge, CO 80033–2840. (303)422–8436. <www.aapb.org>.

Patience Paradox