AUSTRALIAN DENTAL ASSOCIATION INC.

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Dentine

ruxism is excessive clenchingor grinding of the teeth that isnot a part of normal chewing

movements. It can lead to excessive

wear on the teeth and may causepermanent damage to the teeth and thejaw joints.

Excessive clenching and grinding ofthe jaws are not healthy actions. Insome adults and children, clenchingand grinding may occur during the dayor at night. During sleep, they have noconscious control over this excessive

clenching and grinding.

Muscle groupsThree of the main muscle groups thatare associated with bruxism are shown

in the illustration. The temporalis andmasseter muscles bring the jawstogether. The lateral pterygoid musclesmove the jaw from side to side.

Healthy teeth

Conjunctahj \tissue

Cementum

Root

Jaw bone —

Bloodvessels

The hard enamel layer protects the tooth. Ifenamel is badly damaged due to bruxism andthe dentine is exposed, the tooth is at risk. Ifthe pulp (which contains nerves and bloodvessels) is damaged and becomes infected, thetooth will die. Root canal treatment will be

needed to save the tooth.

Wornenamel

Exposeddentine

Bruxed teeth

Severely bruxed teeth are often sensitive toheat and cold, painful and discoloured oncethe dentine is exposed.

Edition number: 2

BruxismCauses of bruxismThe causes of bruxism are still beingstudied.

A combination of physical andpsychological factors are believed tocontribute to bruxism:

• physical stress such as illness, nutri-

tional deficiencies or dehydration,particularly in children

I psychological stress, anxiety and

tension in adults and children

I studies have shown that night

bruxism is a sleep disorder

I other abnormal anatomy of the

teeth or jaws (including "high spots"on fillings) that can cause animproper occlusion (also called"bite") and lead to bruxism

behaviour.

The

Muscle Groups

ine temporalis, masseter and lateralpterygoid muscles of the jaw contributeto clenching and grinding actions.

The signs and symptoms of bruxism^1 ^he signs and symptoms of bruxismUJvary according to the nature,frequency, duration and strength ofexcessive clenching and grinding. Signsand symptoms may include:• pain in the teeth and sensitivity to

heat and cold

• chronic facial pain with tensionheadaches, caused by intensemuscle contraction

• the noise, noticed by partners,friends or relatives, that occurs asthe teeth are ground together

• flattened and worn tooth surfaces,

which may reveal the underlyingyellow dentine layer

• microfractures of the tooth enamel

• broken or chipped teeth

M loose teeth with possible damage to

the tooth sockets

• stiffness and pain in the jaw jointmuscles; this can cause restrictedopening and difficult chewing.Sometimes, the temporomandibularjoint (TMJ or jaw joint) may sufferdamage that is slow to heal. Refer tothe ADA patient educationpamphlet Common Disorders of theJaw Joint, available from your dentist

• earache or pain in the jaw joint.

The variation in signs andsymptoms reflects the strength ofclenching and grinding involved inbruxism.

People who clench their teethtightly may experience tension-relatedheadaches, but may have little or nodamage to the teeth or jaw joint.

Those who experience severegrinding may have damaged teeth andjaw joint problems.

People with mild tooth grindingmay have worn tooth surfaces but nojaw joint pain or tooth sensitivity.These individuals may not realise thatthey suffer from bruxism.

Temporomandibularjoint (TMJ)

Bruxism may affect the temporomandibularjoint, causing significant discomfort or pain.

AUSTRALIAN DENTAL ASSOCIATION INC.

Before treatment^our dentist needs to know yourLlmedical history to plan the best

treatment. Fully disclose any healthproblems you may have had. Tell thedentist if you have had:• an allergy or bad reaction to

antibiotics, anaesthetics, or othermedicines

• previous treatment related to bruxism

or Jaw surgery

• psychological distress or psychiatricillness.

Give the dentist a list of ALL medicines

you are taking or have recently taken.Include medicines prescribed by yourfamily doctor and those bought "overthe counter" without prescription.

Diagnosis of bruxismAccurate diagnosis is important to

ensure the correct treatment.

Before starting treatment, your dentistwill diagnose your condition based onclinical examination and your medicaland dental history. The dentist will note:• the location of the pain, stiffness or

soreness

• range of jaw movement

• any noises in the jaw joint

• your bite, tooth wear and movementof teeth.

To assist diagnosis, your doctor mayrecommend:

• plaster moulds of your teeth to see ifyour bite is correctly balanced

H an X-ray examination

• for some patients, completion of aquestionnaire and pain diagram toassess how your symptoms affectyour quality of life.

Treatment of bruxismIf your dentist suspects that you have

general health problems, he or shemay recommend an examination by amedical practitioner.

Your dentist may recommendcounselling, stress management orrelaxation methods for stress-related

causes of bruxism.

Treatment aims to:

• remove the causes of bruxism

• change the behaviour that causesbruxism

• repair the damage that bruxismoften causes.

Your dentist may prescribe:• painkillers for muscular facial pain,

headaches and jaw joint painI muscle relaxant medication to help

relax the jaw muscles.

Changing bruxismbehaviour^ ^herapy aims to achieve changes in

behaviour by teaching the patienthow to rest the mouth.

• An occlusal splint (also called anight guard) is an option forsomeone with mild to severe

grinding behaviour. Worn at night,the splint is made from mouldedhard plastic that fits over the upperor lower teeth. It prevents furtherwear of the tooth surfaces.

• Biofeedback is a treatment optionfor people who primarily clenchtheir teeth during the day.Biofeedback techniques useelectronic monitors to measure

tension in the jaw muscles. Peopleuse the monitors to leam how to

This pamphletis a summary ofinformationabout bruxism. !t does not contain allknown facts about bruxism or its

treatment and is not a substitute foradvice from your dentist. Read thispamphlet carefully. Some technicalterms are used but don't let this deter

you from reading the information.

The decision to have treatment: A

decision about treatment should bemade only after discussion with yourdentist. Make a decision only whenyou are satisfied with the information you have received and believeyou have been well Informed. Your

Talk to your Dentistdentist will be

pleased to discuss the benefits

and risks of treatment. A teamapproach by your dentist and otherprofessionals may be required to treatthis sometimes difficult problem.

Fully discuss with your dentist thetreatment to be done, the reasonswhy, and the likely outcome youshould expect.

We encourage you to seek the opinion of another dentist if you areuncertain about the advice you havereceived. This pamphlet should onlybe used in consultation with yourdentist.

relax their muscles and reduce

tension. Newer biofeedback

techniques are under developmentto treat night-time clenching.

• Patients with severe tooth grindingproblems often use a combination ofsplint and biofeedback techniques.

• Some patients may require musclerelaxant tablets at night.

Repair of damage toteethrri reatment may be necessary toX repair damaged teeth. Dental

fillings, crowns or inlays can replacedamaged tooth surfaces. Root canaltreatment may be required where toothfractures extend into the pulp. Inextreme cases, extraction of badlydamaged teeth may be the only option.

Partial dentures, dental bridges ordental implants can replace missingteeth. Orthodontic treatment can

realign misplaced and crooked teeth.

An occlusal splint may be recommended toprotect upper and lower teeth. To increasecomfort and effectiveness, it is custom made tosuit each person's own teeth and bite.

Costs of Treatment

Your dentist can advise you abouttreatment costs and coverage by

private health insurance. Ask for anestimate of fees and any other costs.

Remember this is only an estimatebecause the actual treatment may differfrom that proposed.

The final cost may be different fromthe original estimate. Discuss costsbefore treatment rather than afterwards.

Your Dentist

This pamphlet, or portions of it, should not be photocopied and handed out or reproduced in any electronic format.