Bruxism is periodically occurring episodes of involuntary contraction of the masticatory muscles, accompanied by jaw clenching and gnashing of teeth. In addition to the main symptom – grinding teeth, bruxism can lead to pathological erasability and hyperesthesia of teeth, the formation of wedge-shaped defects, periodontal and TMJ pathology, pain in the masticatory muscles, headache, etc. Disease is detected on the basis of complaints of the patient and his relatives, characteristic changes in teeth, polysomnographic examination, electromyography. Psychotherapy, massage, physiotherapy, botulinum therapy, wearing protective mouthguards are used in the treatment of bruxism.
Meaning
Bruxism is a paroxysmal gnashing of teeth, resulting from a spasm of the masticatory muscles, clenching of the jaws and their intense movement relative to each other. During the period of milk bite (from the moment of teething to 7 years), bruxism occurs in about half of children; the prevalence of the problem among adults is 5-10%. Disease in children and adults is spoken of if the creaking and gnashing of teeth occurs during sleep; if these manifestations occur during the daytime, this condition is regarded as bruxiomania. Pathology and bruxiomania refer to parafunctions of the masticatory muscles (oral parafunctions).
Causes
Since the development of bruxism may be based on a complex of different causes and their combination, this problem is studied not only in dentistry, but also in psychology, neurology, otolaryngology, gastroenterology. Let’s consider the main etiological prerequisites of bruxism.
- According to psychological theory, bruxism is a reflection of emotional distress, stress, overload, frequent affective states, overstrain, causing involuntary muscle contractions and gnashing of teeth. Disease is sometimes called the “disease of businessmen” experiencing constant psycho-emotional overload, but short-term episodes of bruxism in a dream can also occur in people with a positive emotional attitude.
- The neurogenic theory of bruxism considers the problem from the point of view of disruption of the central and peripheral systems, leading to neurological and motor disorders. It has been noted that disease is often combined with sleep disorders (somnambulism, snoring, nightmares, sleep apnea), tremor, enuresis, epilepsy. In addition, conditions such as trism and bruxism can develop due to tonic tension of the masticatory muscles when the motor neurons of the trigeminal nerve are affected.
- The dental theory is based on the fact that various deviations in the structure and functioning of the maxillary system contribute to the occurrence of bruxism: malocclusion, dental anomalies (adentia, super-complete teeth), poorly selected dentures or braces, poor-quality dental treatment, osteoarthritis and TMJ arthritis, etc.
- From the point of view of osteopathic theory, bruxism is interpreted as an attempt by the neuromuscular system to eliminate the blockage of cranial sutures and restore the disturbed craniosacral rhythm. These phenomena in children can occur due to the complicated course of labor and birth injuries, dental anomalies, malocclusion, etc.; in adults – with improperly performed prosthetics of teeth, osteochondrosis of the cervical spine, etc.
Other theories of disease, which are not widely accepted and reliable scientific evidence, associate cutting teeth with impaired nasal breathing (adenoids, curvature of the nasal septum, frequent rhinitis), gastroesophageal reflux disease, helminthiasis (ascariasis, enterobiosis, etc.), malnutrition, chewing gum abuse, etc.
People suffering from Parkinson’s disease and Huntington’s chorea are prone to gnashing their teeth. Bruxism in children can occur during periods of teething and changing teeth. Recent traumatic brain injury, alcohol abuse, nicotine, caffeine, sleeping pills, antidepressants can act as cofactors of bruxism.
Bruxism symptoms
Episodes of bruxism, as a rule, last about 10 seconds, but they can be repeated many times during the night, accompanied by the sound of grinding or clicking teeth. Usually these symptoms are noticed by close patients (parents, spouses), because during sleep a person does not control his condition and does not wake up from the grinding of teeth. Attacks of gnashing teeth are often accompanied by changes in breathing, blood pressure and pulse.
In the morning, patients often note facial myalgia, toothache, jaw pain, headache, daytime drowsiness, dizziness. With a prolonged course of bruxism, pathological tooth erasure, hyperesthesia of teeth, wedge-shaped defects, chipped and cracked enamel, fractures of the crowns of teeth can develop. The consequence of injury to the parotid tissues in bruxism is inflammation in periodontal tissues (periodontitis), loosening and loss of teeth. Excessive uncontrolled load on teeth can cause chipping of restorations and fillings, chipping of ceramics on artificial crowns, breakage of dentures.
Long-term consequences of bruxism and bruxiomania can be musculoskeletal dysfunction of the TMJ: hypertrophy of the masticatory muscles, restriction of jaw movement, pain in the temporomandibular joints, shoulder joints, neck. Constant traumatization of the oral mucosa in some patients with bruxism leads to gingivitis, lichen planus, fibromas of the oral cavity, scalloped (toothed) tongue, abrasions under removable dentures.
Diagnostics
The fact of bruxism is usually established on the basis of subjective complaints of the patient and his relatives, as well as indirect signs detected by the dentist during an examination of the oral cavity. The method of objective diagnosis of bruxism is the use of so–called Brooks checkers – special mouthguards made on the basis of a cast and a model of the patient’s jaw and allowing to determine the presence of occlusive obstacles. After night wear, the mouth guard is transferred to the clinic for analysis; the study of the Brooks checker allows the dentist to determine which teeth are experiencing overload.
Pathological activity of the masticatory muscles can be registered during electromyography or polysomnography. A much more difficult task is to identify the causes of bruxism in a patient, which often requires the involvement of a number of related specialists: neurologists, psychologists, otolaryngologists, osteopaths, gastroenterologists.
Bruxism treatment
The methods of therapy of bruxism depend on its causes and degree. In young children, bruxism usually does not require special treatment and comes on its own by the age of 6-7. In adult patients, the maximum effect of the treatment of bruxism is achieved with an integrated approach using psychotherapeutic, medicinal, physiotherapeutic and dental techniques.
With bruxism caused by psychogenic factors, cognitive behavioral psychotherapy comes to the fore: biofeedback, relaxation and self-control methods, trainings, etc. Drug therapy of bruxism is aimed at reducing the convulsive activity of the masticatory muscles during sleep and may include the appointment of mild sedatives and hypnotics, magnesium, calcium, B vitamins, injections of botulinum toxin, etc. In some cases, with bruxism, osteopathic treatment, manual therapy and massage sessions, setting warm wet compresses on the jaw area may be indicated.
Dental treatment of bruxism is carried out with the participation of various specialists: therapist, dentist, orthopedist, orthodontist, periodontist. It involves the manufacture and use of special protective mouthguards made of soft plastic or rubber, according to indications – selective grinding of teeth, correction of bite with orthodontic treatment, replacement of missing teeth with dentures or dental implants.
It is necessary to start correcting aesthetic defects of teeth (restoration of wedge-shaped defects, setting fillings, installing veneers, setting crowns, treating periodontitis, etc.) only after eliminating the causes and phenomena of bruxism.
Prognosis and prevention
Attempts to cope with bruxism on their own, as a rule, are unsuccessful and often lead to disastrous consequences. If you are aware of this problem, you should seek professional advice from a dentist. Conducting a comprehensive diagnosis and choosing an adequate treatment method allows you to get rid of this obsessive pathological habit forever, prevent or eliminate the consequences of bruxism.
Prevention of bruxism involves normalization of the psycho-emotional state, getting rid of bad habits, training in self-relaxation and self-massage techniques. An important link in the prevention is the timely elimination of diseases of the teeth and nervous system.
Literature
- Kaushik S. K., Madan R., Gambhir A., Prasanth T. Aviation stress and dental attrition // IJASM. — 2009. — № 1. — P. 6–10.
- Lurie O., Zadik Y., Einy S. et al. Bruxism in military pilots and non-pilots: tooth wear and psychological stress // Aviat Space Environ Med. — 2007. — № 2. — Р. 137–139. link
- Slavicek R., Sato S. Bruxism — a function of the masticatory organ to cope with stress // Wien Med Wochenschr. — 2004. — № 23–24. — Р. 584–589.
- Lavigne G. J., Khoury S., Abe S. Bruxism physiology and pathology: an overview for clinicians // J Oral Rehabil. — 2008. — № 7. — Р. 476–494.link