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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 43-45

Sleep bruxism


Senior Lecturer, Department of Conservative and Endodontics, Raja Rajeshwari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission03-Dec-2020
Date of Acceptance11-Dec-2020
Date of Web Publication27-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
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_12_20

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  Abstract 


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

How to cite this URL:
Vasundhara V. Sleep bruxism. Int J Med Oral Res [serial online] 2021 [cited 2022 Jul 6];6:43-5. Available from: http://www.ijmorweb.com/text.asp?2021/6/2/43/322472




  Introduction Top


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 Top


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]
Table 1: Etiological factors for sleep bruxism

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  Diagnosis of Sleep Bruxism Top


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 Top


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

  1. Grinding of teeth, accompanied by a characteristic sound that may even awaken the bruxer's bed partner
  2. Pain in the TMJ
  3. Pain in the masticatory and cervical muscles
  4. Headache (especially in the temporal zone when the patient wakes up in the morning)
  5. Hypersensitive teeth
  6. Excessive tooth mobility
  7. Poor sleep quality, tiredness.


Signs

  1. Abnormal tooth wear
  2. Tongue indentations
  3. Linea alba along the biting plane
  4. Gum recession
  5. Presence of torus maxillaris and/or mandibularis
  6. Increase in muscle activity (this is recorded by the polysomnography)
  7. Hypertrophy of masseter muscles
  8. Reduction of salivary flow
  9. Breakage of fillings and/or teeth
  10. Limitation of mouth-opening ability.



  Management of Sleep Bruxism Top


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 Top


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 Top

1.
Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: An international consensus. J Oral Rehabil 2013;40:2-4.  Back to cited text no. 1
    
2.
Paesani D. Bruxism Theory and Practice. Chicago: Quintessence Publishing Co. Inc.; 2010.  Back to cited text no. 2
    
3.
Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil 2012;39:489-501.  Back to cited text no. 3
    
4.
Fernandes G, Franco AL, Goncalves DA, Jose GS, Bigal ME, Comparis CM, et al. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain 2013;27:14-20.  Back to cited text no. 4
    
5.
Lobbezoo F, Koyano K, Paesani D. Sleep Bruxism: Diagnostic Considerations. In: Kryger M, Roth T, Dement W, editors. Principles and Practice of Sleep Medicine. Philadelphia: Elsevier; 2017. p. 1427-34.  Back to cited text no. 5
    
6.
Lindhe J, Niklaus PL, Karring T. Clinical Periodontology and Implant Dentistry. Oxford UK: Blackwell MunksGaard; 2008.  Back to cited text no. 6
    
7.
Yap AU, Chua AP. Sleep bruxism: Current knowledge and contemporary management. J Conserv Dent 2016;19:383-9.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Manfredini D, Ahlberg J, Winocur E, Frank L. Management of sleep bruxism in adults: A qualitative systematic literature review. J Oral Rehab 2015;42:862-74.  Back to cited text no. 8
    
9.
Stapelmann H, Turp JC. The NTItss device for the therapy of bruxism, temporomandibular disorders, and headache – Where do we stand? A qualitative systematic review of the literature. BMC Oral Health 2008;8:22.  Back to cited text no. 9
    
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.  Back to cited text no. 10
    
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.  Back to cited text no. 11
    
12.
Lobbezoo F, Van der Zaag J, Van Selms MK, Hamburger HL, Naeije M. Principles for the management of bruxism. J Oral Rehab 2008;35:509-23.  Back to cited text no. 12
    
13.
Winocur E, Gavish A, Voikovitch M, Emodi-Perlman A, Eli I. Drugs and bruxism: A critical review. J Orofac Pain 2003;17:99-111.  Back to cited text no. 13
    
14.
Macedo CR, Macedo EC, Torloni MR, Silva AB, Prado GF. Pharmacotherapy for sleep bruxism. Cochrane Database Syst Rev 2014;10:CD005578.  Back to cited text no. 14
    



 
 
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Abstract
Introduction
Etiology of Slee...
Diagnosis of Sle...
Clinical Features
Management of Sl...
Conclusion
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