A post on bruxism (Part 1)
From Contemporary oral medicine 2019
Bruxism is a repetative jaw muscle activity characterised by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. Sleep (SB) and awake (AB) bruxism are separate in their presentation and pathophysiology however they may overlap in some individuals.
AB tends to occur in the form of clenching and bracing or thrusting of the mandible. Grinding can be seen but it is milder than that seen in SB unless the patient has a neurological condition. There seems to be a female predilicition with rations M:F between 2:3 and 1:3. AB is associated with stress, depression, addictions, neurological disorders such as Huntington's disease and congitive impairments such as in Rett's syndrome, Down syndrome and ASD. It is also significantly influenced by lifestyle. Management of AB is initially based of the recognition of awake clenching. This may involve lifestyle changes, habit reversal training, relaxation, hypnosis and biofeedback therapy with the aim of reducing emotional stress.
SB seems to have a multifactorial cause. A traditional cause and effect model doesn't appear to explain SB and the paradigm is shifting towards diagnosis of individual phenotypes based on a precision medicine model. Classifying SB patients purely on clinical signs is flawed as it cannot distinguish between current and past bruxism or SB and AB. Based on the ICSD-3 from the AASM the diagnosis of SB must include:
1. Presence of regular of frequent tooth grinding sounds occurring during sleep
2. Presence of one or more of: Abnormal tooth wear consistent with sleep grinding and transient morning jaw muscles pain or fatigue and/or temporal headache and/or jaw locking upon awakening consistent with sleep grinding.
Classifying SB by the motor activity in the masticatory muscles can be achieved with PSG. The motor activity of the masseter and/or temporalise muscles is referred to as rhythmic masticatory muscle activity (RMMA). This can be divided into Phasic/grinding (rhythmic), Tonic/clenching
(sustained) and mixed. RMMA events in SB are usually phasic or mixed and rarely tonic.
Etiologically, SB can be separated into Primary or idiopathic SB and secondary bruxism which is related to an underlying psychological and/or medical condition such as a movement, sleep, neurologic or psychiatric disorder, side effect of medication or adverse effect of illicit drug use.
Bruxism is a repetative jaw muscle activity characterised by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. Sleep (SB) and awake (AB) bruxism are separate in their presentation and pathophysiology however they may overlap in some individuals.
AB tends to occur in the form of clenching and bracing or thrusting of the mandible. Grinding can be seen but it is milder than that seen in SB unless the patient has a neurological condition. There seems to be a female predilicition with rations M:F between 2:3 and 1:3. AB is associated with stress, depression, addictions, neurological disorders such as Huntington's disease and congitive impairments such as in Rett's syndrome, Down syndrome and ASD. It is also significantly influenced by lifestyle. Management of AB is initially based of the recognition of awake clenching. This may involve lifestyle changes, habit reversal training, relaxation, hypnosis and biofeedback therapy with the aim of reducing emotional stress.
SB seems to have a multifactorial cause. A traditional cause and effect model doesn't appear to explain SB and the paradigm is shifting towards diagnosis of individual phenotypes based on a precision medicine model. Classifying SB patients purely on clinical signs is flawed as it cannot distinguish between current and past bruxism or SB and AB. Based on the ICSD-3 from the AASM the diagnosis of SB must include:
1. Presence of regular of frequent tooth grinding sounds occurring during sleep
2. Presence of one or more of: Abnormal tooth wear consistent with sleep grinding and transient morning jaw muscles pain or fatigue and/or temporal headache and/or jaw locking upon awakening consistent with sleep grinding.
Classifying SB by the motor activity in the masticatory muscles can be achieved with PSG. The motor activity of the masseter and/or temporalise muscles is referred to as rhythmic masticatory muscle activity (RMMA). This can be divided into Phasic/grinding (rhythmic), Tonic/clenching
(sustained) and mixed. RMMA events in SB are usually phasic or mixed and rarely tonic.
Etiologically, SB can be separated into Primary or idiopathic SB and secondary bruxism which is related to an underlying psychological and/or medical condition such as a movement, sleep, neurologic or psychiatric disorder, side effect of medication or adverse effect of illicit drug use.
- Sleep disorder: SB may be seen with sleep related movement disorders such as PLMS, RLS SDB, and rhythmic movement disorders. In REM behaviour disorder tooth tapping rather than grinding is the predominant feature
- Neurologic disorder: epilepsy, cerebellar hemorrhage and brainstem infarct, olivopontocerebellar atrophy, Shy-Drager syndrome, Whipple's disease
- Psychological disorder: Somatisization, depression and anxiety. Adult SB patients tended to be perfectionist and have tendancy towards anger, aggression, depression and stress sensitivity. Psychotropic drugs (L-Dopa, psychostimulants) can induce SB and antidepressants such as SSRIs and SNRI, antihistamines can induce SB. Amphetamines and cardioactive drugs e.g CCBs and antiarrhythmic medications can inside SB.
- Alcohol> 4 standard drinks
- Cigarette smoking
- Caffeine >6 cups a day
- Medications: SSRI, Haloperidol, amphetamines
- Illicit drugs: Methamphetamine, cocaine, ecstacty
- SDB: Snoring, UARS, OSA
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