bruxism in dentistry

8/12/2019 bruxism in dentistry

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Journal club presentation

Presentation by guided by

Dr. Sai Kumar Dr. AnamChandrasekar


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J Indian Prosthodont Soc (July-Sept 2010)10(3):141148

BRUXISM: A LITERATUREREVIEW


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CONTENTS Introduction

Etiology

Diagnosis

Managementocclusal splintsbiofeedback

pharmacological

Conclusion

References


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INTRODUCTION The term parafunction was introduced by Drum.

Parafunctional activities are non functional

oromandibular or lingual activities that includesjaw clenching, bruxism, grinding, tooth tapping,

cheek biting, lip biting, object biting etc. that can

occur alone or in combination and are different

from functional activities like chewing, speaking

and swallowing.


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The term la bruxomanie was first introduced byMarie Pietkiewicz in 1907 .

GPT-8 defines bruxism as parafunctional grindingof teeth or an oral habit consisting of involuntary

rhythmic or spasmodic non functional gnashing,

grinding or clenching of teeth in other than

chewing movements of the mandible which may

lead to occlusal trauma.


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Classification: Awake Bruxism (AB) or Diurnal Bruxism (DB).

Sleep Bruxism (SB).

SB is an oromandibular behavior that is defined

as a stereotyped movement disorder occurringduring sleep and characterized by tooth grinding

and/or clenching.

Prevalance:


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ETIOLOGY1. Central or Pathophysiological Factors- arousal

response, It is hypothesized that the direct

and indirect pathways of the basal ganglion,

a group of five subcortical nuclei that are

involved in the coordination of movements is

disturbed in bruxer.

2. Psychosocial Factors

3. Peripheral Factors


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DIAGNOSIS1. Questionnaire for detecting bruxer-(symptoms)

Has anyone heard you grinding your teeth at

night?

Is your jaw ever fatigue or sore on awakening inthe morning?

Are you teeth or gums ever sore on awakening in

the morning?

Do you ever experience temporal headache onawakening in the morning?

Are you ever aware of grinding your teeth during

the day?

Are you ever aware of clenching your teeth during


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2. Clinical Findings/Evaluation-

Clinical Examination-Report of tooth grinding or

tapping sounds .

Presence of tooth wear seen within normal range of

jaw movements or at eccentric position.

Presence of masseter muscle hypertrophy onvoluntary contraction.

Complain of masticatory muscles discomfort, fatigue

or stiffness in the morning (occasionally, headache in

temporal muscle region).

Tooth or teeth hypersensitive to cold air or liquid.

Clicking or locking of temporomandibular joint.

Tongue on cheek indentation.


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3. Tooth Wear-

First, the extent of incisal or occlusal wear for asingle tooth was evaluated by the following four-

point scale:

0: no wear or negligible wear of enamel;

1: obvious wear of enamel or wear through the

enamel to the dentine in single spots;

2: wear of the dentine up to one-third of the crown

height;

3: wear of the dentine up to more than one-third of

the crown height; excessive wear of tooth

restorative materialor dental material in the crown

and bridgework, more than one-third of the crownhei ht.


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Then, the individual (personal) tooth-wear index(IA) was calculated from the scores of incisal or

occlusal wear for each tooth of that individual.

IA = 10 * G1 + 30 * G2 + 100 * G3/G0 + G1 + G2+ G3


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4. Bruxism activity can be evaluated using theintra-oral appliance and is classified into two

groups:

(i) observation of wear facets of the intra-oral

appliance(ii) measurement of bite force loaded on the intra-

oral appliance


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Bruxcore Plate- The Bruxcore Bruxism-Monitoring

Device (BBMD) is an intra-oral appliance that was

introduced as a device for measuring sleep

bruxism activity objectively and the Bruxcore plate

evaluates bruxism activity by counting the

number of abraded microdots on its surface and

by scoring the volumetric magnitude of abrasion.

Pieree and Gale in their study did not find any

significant co relation between the duration of

bruxism analyzed with the EMG data and thatwith the bruxcore plate scores.


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Detection of Bite Force-

Takeuchi et al. developed a recording device for

sleep bruxism, an intra-splint force detector(ISFD)

this transducer is best at detecting rapid changesin force, not static forces.


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Masticatory MuscleElectromyographic Recording The EMG recording has been commonly used to

measure actual sleep bruxism activity directly.

Portable EMG Recording Device-

Miniature Self-Contained EMG Detector

Analyser- Bitestrip and Grindcare.

Polysomnography


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0no sleep bruxism

(125 events)E - error

ELECTROCHEMICAL DISPLAYINDICATOR LIGHT


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polysomnography


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MANAGEMENT OF BRUXISM Occlusal Therapy-

Occlusal Interventions

Occlusal Appliances

BiofeedbackBruxism During Wakefulness/Daytime

Sleep bruxism

Pharmacological Approach


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Occlusal appliance occlusal guard, bite guard, night guard or occlusal

appliance

These splints are made of hard acrylic resins,

worn in maxillary arch.

Hard splints are generally preferred over soft

splints for practical reasons (e.g. soft splints are

more difficult to adjust than hard ones), to preventinadvertent tooth movements, and because hard

splints are suggested to be more effective inreducing bruxism activity than soft splints.


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The following reasons justify the use of occlusal

splints-

1. To protect the teeth in bruxing patients.

2. To protect the cheek and/or tongue in patients

with oral parafunctions.

3.To stabilize unstable occlusion.

4. To promote jaw muscle relaxation in patients

with stress related pain symptoms like tension

headache and neck pain of muscular origin.

5. To test the effect of changes in occlusion on theTMJ and jaw muscle function before extensive

restorative treatment.

6. To eliminate the effect of occlusal interferences


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Types:

According to Okeson

1) Muscle relaxation appliance/ stabilization

appliance used to reduce muscle activity

2) Anterior repositioning appliances/ orthopedic

repositioning appliance

Other types:

Anterior bite plane

Pivoting appliance Soft/ resilient appliance


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According to Dawson:

1. Permissive splints/ muscle deprogrammer

2. Directive splints/ non-permissive splints

3. Pseudo permissive splints (e.g Soft splints,Hydrostatic splint)


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MAXILLARY OR MANDIBULARSPLINT? Most splints are maxillary- more stable

more retentive

less likely to break

increased stability because allmandibular contacts are

on flat surfaces.

mandibular splintmore esthectic and easier for

the patient to speak with it in place.


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Before any permanent therapy is begun, oneneeds to be aware that there are six generalfeatures common to all devices that may beresponsible for decreasing muscle activity andsymptoms.

1. Alteration of the occlusal condition

2. Alteration of the condylar position

3. Increase in the vertical dimension

4. Cognitive awareness

5. Placebo effect: 40% of the patients suffering from

certain TM disorders respond favorably to suchtreatment.

6. Increased peripheral input to the CNS: Anychange at the peripheral input level seems tohave an inhibitory effect on this CNS activity


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Biofeedback Biofeedback is based on the principle that

bruxers can unlearn their behaviour when a

stimulus makes them aware of their adverse jawmuscle activities (aversive conditioning).

Awake bruxism- Mittleman described an EMG

technique that provides the daytime clencher with

auditory feedback from his/her muscle activityletting him know the degree of muscle activity orrelaxation that is taking place.


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For the use of biofeedback in the management ofsleep bruxism, Cherasia and Parks published a

prescription.

Their technique used contingent arousal from

sleep with actual awakenings

Nissani used a taste stimulus to awaken the

patient. This stimulus was caused by the bruxism-

related rupture of capsules, filled with an aversive

substance (agreed upon with the patient) in the

dental appliance.

A sound blast was applied as the aversivestimulus.


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Pharmacological approach Drugs that have paralytic effect on the muscles

through an inhibition of acetylcholine release at the

neuromuscular junction (botulinum toxin)decreases

bruxism activity especially in severe cases with

comorbidities like coma, brain injury, amphetamineabuse, Huntingtons disease and autism.

Many of the studies showed that the catecolamine

precursor L-dopa exerted a modest attenuating

effect on sleep bruxism.

Antidepressant drugs.


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Conclusion

Bruxism is a sleep related, centrally mediateddisorder with the psychosocial factors having a

little role in its etiology.

There are no reliable methods for assessing it

clinically.

Many devices have been proven to be useful

clinically but in the absence of definitive evidence,

bruxism can be managed by occlusal appliances,

counselling, change in lifestyle andpharmacological interventions.


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References

1. Bruxism: A Literature Review- J Indian Prosthodont Soc(July-Sept 2010) 10(3):141148

2. TMJ Disorders and Occlusal Splint TherapyA ReviewInternational journal of dental clinics: 2 (2):22-29

3. Dental erosion and bruxism. A tooth wear analysis fromSouth East Queensland- Australian Dental Journa1998;43:(2):117-27

4. Principles for the management of bruxism-Journal ofOral Rehabilitation 2008 35; 509523

5. Bruxism :theory and practice- Daniel paesani

6. Functional occlusion from TMJ to Smile design- Dawson,333 and 379

7. Treatment of functional disturbances of masticatorysystem- Okesson, pg- 507

bruxism in dentistry

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