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>. [email protected].
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
Bruxism
Bruxism
Definition
Bruxism is the habit of clenching and grinding the teeth. It most often occurs at night during sleep, but it may also occur during the day. It is an unconscious behavior, perhaps performed to release anxiety, aggression, or anger.
Description
Bruxism is one of the oldest disorders known, and approximately one in four adults experiences it. Most people are not aware of it before their teeth have been damaged.
Causes and 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.
Diagnosis
Medical and dental histories and examinations are necessary to differentiate bruxism from other conditions that may cause similar pain, such as ear infections, dental infections, and temporomandibular joint (TMJ) dysfunction. However, uncommonly worn-down teeth strongly suggest a diagnosis of bruxism.
Treatment
To prevent further damage to the teeth, 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.
KEY TERMS
Enamel— The hard outermost surface of a tooth.
High spot— An area of a tooth or restoration that feels abnormal or uncomfortable because it hits its opposing tooth before other teeth meet.
Night guard— A removable, custom-fitted plastic appliance that fits between the upper and lower teeth to prevent them from grinding against each other.
Occlusion— The way upper and lower teeth fit together during biting and chewing.
Rolfing— Based on the belief that proper alignment of various parts of the body is necessary for physical and mental health, rolfing uses deep tissue massage and movement exercises in an attempt to bring the body into correct alignment.
Temporomandibular joint (TMJ)— The jaw joint formed by the mandible (lower jaw bone) moving against the temporal bone of the skull.
Alternative treatment
Stress management and behavior modification techniques may be useful to break the habit of clenching and teeth grinding. Tight jaw muscles may be relaxed by applying warm compresses to the sides of the face. Herbal muscle relaxants also can be helpful. Massage therapy and deep tissue realignment, including rolfing, can assist in releasing the clenching pattern. This is a more permanent alternative treatment for bruxism.
Prognosis
Bruxism may cause permanent damage to teeth and chronic jaw pain unless properly diagnosed and promptly treated. 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
ORGANIZATIONS
Academy of General Dentistry. Suite 1200, 211 East Chicago Ave., Chicago, IL 60611.(312) 440-4300. 〈http://www.agd.org〉.
American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.
Bruxism
Bruxism
Definition
Bruxism is a habitual grinding or clenching of the teeth. The behavior is usually unconscious, occurs most often during sleep, and is a reaction to periods of stress in the patient's life.
Description
Bruxers often unknowingly grind their teeth. Pencils, their fingernails, and the insides of their cheeks may be bitten. This habitual tooth gritting, grinding or clenching can lead to facial pain and tooth abrasion. Bruxism is common—as many as one in three people is a bruxer. The condition affects both adults and children. However, it often goes unrecognized until tooth damage is noticed by a dentist.
Causes and symptoms
Personality type may place a patient at risk for bruxism. People who are anxious, angry or stressed are more likely to succumb to the habitual grinding and clenching. Another cause of bruxism is an abnormal dental occlusion, which can cause the teeth to grind more easily due to their positioning. Clenching and grinding the teeth can cause jaw area tissue alterations.
Bruxism causes the teeth to wear and become flat at the tips. The teeth can become so severely worn that the dentin is exposed and sensitive. Bruxism can lead to temporomandibular joint pain and, as a result, the jaw might begin popping and clicking. Some bruxers have tongue indentations—another sign of bruxism.
Diagnosis
To diagnose bruxism, the dentist looks for signs of damage, such as chipped enamel, usual tooth wear and tear, radiographic bone changes, and sensitivity. Asking relevant questions can also help dentists make the diagnosis. The questions can include asking patients if their teeth or jaws hurt upon awakening in the morning and if they suffer from worry or stress. The dental exam helps to determine whether the grinding is caused by misaligned teeth or psychological forces.
Treatment
Often, treatment is aimed at getting bruxers to change their behavior. This might involve relaxation training and other stress management techniques. If relaxation doesn't suffice, dentists might recommend a plastic mouth appliance to relax the facial muscles and protect the teeth from the grinding and clenching. Another method of treatment is biofeedback. New treatments for bruxism, especially for nocturnal bruxers, are being studied. In some cases, psychological assessment or psychotherapy might be recommended.
Prognosis
Childhood grinding and clenching of the teeth are often outgrown by adolescence. By making an effort not to grind or clench their teeth, some people can address the problem successfully. Dental intervention to protect the teeth or correct misalign teeth, as well as attempts at stress and anxiety relief, often solve the problem.
Health care team roles
The first signs of bruxism, as well as its related problems, might be noticed by the dental hygienist during professional maintenance care; the patient may be referred to the dentist. Education of the patients about bruxism and options for treatment can be accomplished by the dental hygienist. If the patient comes to his or her primary health care provider complaining of jaw pain, the diagnosis may occur in the clinic or office setting. The patient would be referred to a dentist for a dental appliance.
Prevention
Bruxism precipitated by stress and anxiety can be avoided if patients treat their stress with proper management techniques.
KEY TERMS
Biofeedback— A training technique used to gain control over autonomic body functions.
Bruxers— People who grind and clench their teeth.
Dentin— The hard material of the main part of the tooth, situated beneath the enamel and contain the pulp.
Occlusion— Contact between the surfaces of the upper and lower teeth when the mouth is closed.
Temporomandibular joint— One of a pair of joints connecting the mandible in the lower jaw to the temporal bone in the skull.
Resources
ORGANIZATIONS
Academy of General Dentistry, 211 East Chicago Ave., Chicago, IL 600611. (312) 440-4800. 〈http://www.agd.org〉.
American Dental Assistants Association, 208 North LaSalle Street, Suite 1320, Chicago, IL 60601-1225 (312) 541-1550 (March 15, 2001) 〈http://www.dentalassistant.org〉.
OTHER
InteliHealth: Merriam-Webster Medical Dictionary 1996–2001. 〈http://www.intelihealth.com〉 (March 15, 2001).
KidsHealth for Parents by the Nemours Foundation. "Bringing Bruxism to a Grinding Halt" (March 15, 2001) 〈http://www.kidshealth.org〉.
Methodist Health Care System. "Bruxism." (March 15, 2001) 〈http://www.methodisthealth.com/oralhealth/bruxism.htm〉.