|
 
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| REVIEW ARTICLE |
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| Year : 2021 | Volume
: 6
| Issue : 2 | Page : 43-45 |
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Sleep bruxism
V Vasundhara
Senior Lecturer, Department of Conservative and Endodontics, Raja Rajeshwari Dental College and Hospital, Bengaluru, Karnataka, India
| Date of Submission | 03-Dec-2020 |
| Date of Acceptance | 11-Dec-2020 |
| Date of Web Publication | 27-Jul-2021 |
Correspondence Address:
Dr. V Vasundhara
Department of Conservative and Endodontics, Raja Rajeshwari Dental College and Hospital, Ramohalli Cross, Mysore Road, Bengaluru - 560 060, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmo.ijmo_12_20
Activities of the masticatory system can be divided into functional, which includes chewing and speaking, as well as parafunctional, which includes clenching or grinding of the teeth. Sleep bruxism (SB) is the abnormal, nonfunctional contact of the teeth and if ignored leads to the breakdown of dentition and orofacial pain. Hence, early diagnosis and treatment are considered to be of utmost importance. SB has multifactorial causes that have to be identified and managed by various treatment modalities. As bruxism events bring about tooth and restoration damage, it is of major concern for the dentists.
Keywords: Clenching, sleep bruxism, teeth grinding
How to cite this article:
Vasundhara V. Sleep bruxism. Int J Med Oral Res 2021;6:43-5 |
| Introduction | |  |
Bruxism is defined as a “repetitive jaw–muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible” with “two distinct circadian manifestations, either occurring during sleep (sleep bruxism [SB]) or during wakefulness (awake bruxism).”[1] SB may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, and hypersensitive or painful teeth.[2],[3],[4],[5] The excessive forces on the teeth can contribute to alveolar bone resorption, which may be visible radiographically as generalized widening of the periodontal ligament space and increased mobility which may be transient or permanent. In the presence of periodontal disease, the trauma from the occlusion may increase the rate of disease progression. Occlusal trauma cannot induce periodontal pocketing or attachment loss in the teeth with a healthy periodontium.[6] Investigations into the effects of SB on dental implants and implant-retained prostheses have found no increase in biological complications (for example, peri-implantitis) but increased risk of mechanical complications (for example, fracture of implants/prostheses).[5]
| Etiology of Sleep Bruxism | | |
The exact etiology of SB is still not known and probably multifactorial in nature. Originally, it was attributed to peripheral (morphological) factors including malocclusion and occlusal interferences [Table 1].[7]
| Diagnosis of Sleep Bruxism | | |
A diagnosis of bruxism may be made by the following:
- Patient report and clinical interview
- Clinical examination
- Intraoral appliances
- Recording of muscle activity
- Electromyography
- Polysomnography.
| Clinical Features | | |
Although SB is a parafunctional oromotor activity in which extremely intense force vectors are sometimes developed, most bruxers present no pathological clinical signs or symptoms.[1] In those cases where the bruxist parafunctional forces exceed the tolerance threshold of the masticatory system, the functional equilibrium of the stomatognathic system may be altered, at which time clinical symptomatology and signs of functional limitation appear, as shown below:
Symptoms
- Grinding of teeth, accompanied by a characteristic sound that may even awaken the bruxer's bed partner
- Pain in the TMJ
- Pain in the masticatory and cervical muscles
- Headache (especially in the temporal zone when the patient wakes up in the morning)
- Hypersensitive teeth
- Excessive tooth mobility
- Poor sleep quality, tiredness.
Signs
- Abnormal tooth wear
- Tongue indentations
- Linea alba along the biting plane
- Gum recession
- Presence of torus maxillaris and/or mandibularis
- Increase in muscle activity (this is recorded by the polysomnography)
- Hypertrophy of masseter muscles
- Reduction of salivary flow
- Breakage of fillings and/or teeth
- Limitation of mouth-opening ability.
| Management of Sleep Bruxism | | |
It is important to note that SB itself does not require treatment; management is only indicated where problems arise as a result of SB. There is little high-quality evidence available on which to base SB management.[8]
Occlusal splints
Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding. Evidence for their effects on muscle activity is conflicting, with some studies finding reduction in muscle activity during their use[9],[10] and others finding an increase in some subjects.[11] Oral splints are also used in the management of temporomandibular disorders, where their therapeutic effect may be independent of their effect on SB.
Behavioral intervention
A variety of behavioral strategies have been useful, including biofeedback, relaxation, and improvement of sleep hygiene.
Pharmacological interventions
Drug therapy includes the use of benzodiazepines, anticonvulsants, beta-blockers, serotonergic and dopaminergic agents, anti-depressants, muscle relaxants, and a number of others.[12],[13] A Cochrane review found insufficient evidence to support the use of this approach,[14] and it is recommended that this should only be considered when other conservative strategies have failed and in conjunction with medical practitioners.[12]
| Conclusion | | |
SB is a parafunctional oromotor habit with a high prevalence in the general population. Because of its clinical implications, it has been and continues to be a point on which great attention is focused by odontology. At present, a multifactor etiological model is accepted that includes genetic, neurophysiological (central neurotransmitters, sleep structure, autonomic nervous system), psychoemotional, and pharmacological factors. At present, there is no effective treatment to eliminate SB permanently. Therefore, the therapeutic approach is steered toward attempting to prevent damage and treating the pathological effects SB has on the structures of the masticatory system.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Paesani D. Bruxism Theory and Practice. Chicago: Quintessence Publishing Co. Inc.; 2010. |
| 3. | Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil 2012;39:489-501. |
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| 10. | Dube C, Rompre PH, Manzini C, Guitard F, de Grandmont P, Lavigne GJ. Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. J Dent Res 2004;83:398-403. |
| 11. | van der Zaag J, Lobbezoo F, Wicks DJ, Visscher CM, Hamburger HL, Naeije M, et al. Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism. J Orofac Pain 2005;19:151-8. |
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| 14. | Macedo CR, Macedo EC, Torloni MR, Silva AB, Prado GF. Pharmacotherapy for sleep bruxism. Cochrane Database Syst Rev 2014;10:CD005578. |
[Table 1]
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