The condition of clenching and grinding of teeth when the individual is not chewing or swallowing is known as bruxism. It is also noted as the most common of the many parafunctional habits of the dentofacial system.
Recently, an international expert commission redefined bruxism as a repetitive jaw muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible that can occur whilst awake (i.e., awake bruxism) or during sleep (i.e., sleep bruxism).
Awake bruxism is usually seen jaw-clenching habit that appears in response to stress and anxiety. Sleep bruxism represents sleep-related rhythmic masticatory activity generally associated with arousal (from sleep).
Awake bruxism is more common in females, whereas males and females are affected in equal proportions by sleep bruxism.
Bruxism activity is of major concern the dentists as it leads to tooth wear and damage, restoration fractures, temporal headache, and temporal mandibular joint disorders.
Risk factors for bruxism
- Age: Bruxism is more common in young children.
- Stress: Increased stress and anxiety can cause bruxism.
- Personality: Aggressive, competitive, and hyperactive types of behavior and personalities can increase the chance of teeth grinding.
- Family history: Sleep bruxism tends to give a family history i.e other family members may also have teeth grinding or a history of it.
- Medications and habits: Certain antidepressants can result in bruxism as an uncommon side effect. Habits like smoking, tobacco chewing, and drinking caffeinated beverages may increase the risk of bruxism.
- Other factors- Bruxism can be associated with medical problems like epilepsy, sleep-related disorders, dementia, Parkinson’s disease, and gastroesophageal reflux disorder.
Signs and Symptoms of Bruxism
1. Pain in the teeth and sensitivity to heat and cold.
2. Chronic muscular facial pain with tension headaches, caused by intense muscle contraction.
3. The noise noticed by parents, friends or relatives occurs as the teeth are ground together.
4. An abnormal alignment of the teeth, caused by uneven tooth wear.
5. Flattened and worn tooth surfaces, which may reveal the underlying yellow dentine layer.
6. Microfractures of the tooth enamel.
7. Broken or chipped teeth
8. Loose teeth with possible damage to the tooth sockets
9. Stiffness and pain in the jaw joint (temporomandibular joint or ‘TMJ’) that cause restricted opening and difficulty in chewing.
10. Earache.
Management of Bruxism
Treatment of bruxism is based on the etiology, signs observed during the clinical examination and symptoms described by patients.
Different treatment modalities (behavioral techniques, intraoral devices and medications) have been applied.
A clinical evaluation is needed to differentiate between awake bruxism and sleep bruxism and rule out any medical disorder or medication that could be behind its appearance (secondary bruxism).
Sleep hygiene measures combined with relaxation techniques:
The starting point for treatment is aimed at decreasing psychological stress, using relaxation exercises, massage, and physiotherapy, coupled with counseling the patient about sleep hygiene. This includes abstaining from smoking and drink of coffee or alcohol and limiting physical or mental activity before going to bed and ensuring good bedroom conditions (quiet and dark).
Occlusal therapy:
Occlusal therapy includes occlusal adjustment and occlusal splints/bite guard fabrication and placement.
Occlusal adjustment is carried out to minimize damages caused by teeth grinding.
Occlusal splints (also termed bite guards) have been considered an important strategy for preventing dental grinding noise and tooth wear in sleep bruxism. In general, the design of the device is simple, covers the whole maxillary or mandibular dental arch, and is well tolerated by the patient. Bite guards are to be worn at night during sleep.
Pharmacological therapy:
Many different medications have been used to treat bruxism, including benzodiazepines, anticonvulsants, beta-blockers, dopamine agents, muscle relaxants, and others. However, there is little, if any, evidence for their respective and comparative efficacies, with some showing no effect and others appearing to have promising initial results; however, it has been suggested that further safety testing is required before any evidence-based clinical recommendations can be made.
Bruxism as an adverse effect of medications:
A large number of clinical case reports have described the appearance of bruxism as an adverse effect of medications. Several people with psychiatric disorders develop awake and/or sleep bruxism a few weeks after starting the medication. Second-generation antidepressants have been the more cited drugs prone to cause (or exacerbate in some cases) bruxism, further followed by antipsychotics or bupropion.
Regarding clinical management, patients should be observed for a month because spontaneous remission may occur. If the problem persists, a reduction of dose or change of medication may alleviate or even resolve the problem, although a definitive cessation of bruxism might be expected with drug withdrawal.
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