BRUXISM
Bruxism - causes, symptoms and treatment:
Bruxism is the habit of clenching and/or grinding the teeth. Such activity generally takes place during sleep, often involuntarily, and commonly during periods of high stress and tension. Sometimes it can also occur during the day rendering the treatment more difficult.
It is a “parafunctional activity” because it is not part of proper “function” of the mouth, like other habits of everyday life: chewing gums, nail biting, biting of the lips, biting of pens and pencils. Most of the people are not even aware of such habits, still they can cause severe damage to various structures of the body.
The structures involved are: the teeth, the supporting tissue of the teeth (the maxillary and mandibular bones and the gums), the muscles of mastication and the temporomandibular joints (TMJs).
Grinding of the teeth, that means grating the teeth between each other with lateral, or backward and forward movements, creates a severewear of the teeth. Conversely, if clenching of the teeth is prevalent, that means the activity of clamping hard the teeth together without moving them, wear is usually not so evident; however the teeth show fissures, that means small lines of breakdown of the enamel. Fractures of teeth and prostheses, or loss of fillings and decementation of crowns and bridges can also occur.
The load that bruxing movements generate on the teeth, is transmitted to the supporting structures, that are the maxillary and mandibular bones (were the teeth are “seated”), and the gums. With time such structures can give up and the teeth become mobile.
Bruxism mostly creates a major fatigue to the muscles of mastication not giving them time to relax. In fact, the muscles of mastication should be active for about 1, 2 hours a day to chew the food during meals, in addition to a minimal activity during the rest of the day to speak and swallow. For the rest of the time they should rest. But people suffering from bruxism continuously activate such muscles, especially at night when they are supposed to rest, therefore, as any other muscles of the body, they become fatigued and tender. Such fatigue can also spread to the muscles of the neck and shoulders, giving headache especially on waking up.
Forces developed during bruxism episodes also affect the temporomandibular joints (TMJs), which can become inflamed and painful. Otherwise they can result in displacement of the articular discs with consequent dysfunctions like “clicking” or “popping” of the jaw joint while opening and closing the mouth, deviations or limitation of mouth opening. Such risk is higher if dental malocclusion is present, because it also can excessively affect both the temporomandibular joints and the muscles of mastication.
The cause of bruxism is unknown, but some theories on its origin exist.
One theory (although the most recent studies do not support it) hypothesizes that interferences in dental occlusion can trigger such activity as an attempt of the body to eliminate them by grinding. In fact, in the past, dentists used to suggest treatments to eliminate these interferences, like orthodontic treatment, or occlusal adjustment of the teeth (it means “grinding” of the teeth with a bur to allow a more even contact), but such therapies rarely achieve satisfying results.
Some studies suggest that bruxism is related to stress, and for some people this seems to be true because they also notice such association. Obviously, in those cases the use of relaxing techniques, like yoga, meditation and autogenic training, but even a relaxing walk in open spaces or spending time with the favourite hobby are very useful to decrease stress and therefore reduce bruxism.
There are also some neurologic disorders that cause the onset of involuntary movements, and also increase the activity of the muscles of mastication, and consequently bruxism. In such cases the involvement of the neurologist is necessary.
As a last hypothesis we must consider that some medications can give side effects involving muscle activity, causing bruxism, like some neuroleptics and antidepressants. If this happen, it is appropriate to talk with the doctor who made the prescription to evaluate the possibility of substituting the medication with another one, or changing the dose.
Independently from the cause of bruxism it is possible to control it, and avoid, or at least reduce, the damage that it can produce to the different structures of the mouth.
Obviously it is not possible to consciously control night-time bruxism, because it occurs while sleeping. But it is possible to use an occlusal appliance, that means a resin removable transparent device (also known as splint, night-guard, orthotic) inserted on the teeth, usually the upper teeth, that allows to reduce the effects of bruxism (see figures).
First of all it avoids dental wear and damage to the teeth, because it avoids that the teeth come in contact, allowing just the contact between the teeth and the resin appliance. The appliance is not as hard as the teeth, therefore with time it will wear down, but the teeth will not. At the same time it reduces the load to the supporting structures of the teeth.
By the use of occlusal appliances it is also possible to change the position of the mandible, if it is altered, improving muscle activity, and the rapports of the structures of the temporomandibular joints.
Distributing the tooth contacts on the appliance it is also possible to decrease the strength used to grind, or clench the teeth, thus reducing the damage that these activities can cause to the structures of the mouth, and promoting relaxation of the muscles of mastication.
One theory (although the most recent studies do not support it) hypothesizes that interferences in dental occlusion can trigger such activity as an attempt of the body to eliminate them by grinding. In fact, in the past, dentists used to suggest treatments to eliminate these interferences, like orthodontic treatment, or occlusal adjustment of the teeth (it means “grinding” of the teeth with a bur to allow a more even contact), but such therapies rarely achieve satisfying results.
Some studies suggest that bruxism is related to stress, and for some people this seems to be true because they also notice such association. Obviously, in those cases the use of relaxing techniques, like yoga, meditation and autogenic training, but even a relaxing walk in open spaces or spending time with the favourite hobby are very useful to decrease stress and therefore reduce bruxism.
There are also some neurologic disorders that cause the onset of involuntary movements, and also increase the activity of the muscles of mastication, and consequently bruxism. In such cases the involvement of the neurologist is necessary.
As a last hypothesis we must consider that some medications can give side effects involving muscle activity, causing bruxism, like some neuroleptics and antidepressants. If this happen, it is appropriate to talk with the doctor who made the prescription to evaluate the possibility of substituting the medication with another one, or changing the dose.
Independently from the cause of bruxism it is possible to control it, and avoid, or at least reduce, the damage that it can produce to the different structures of the mouth.
Obviously it is not possible to consciously control night-time bruxism, because it occurs while sleeping. But it is possible to use an occlusal appliance, that means a resin removable transparent device (also known as splint, night-guard, orthotic) inserted on the teeth, usually the upper teeth, that allows to reduce the effects of bruxism (see figures).
First of all it avoids dental wear and damage to the teeth, because it avoids that the teeth come in contact, allowing just the contact between the teeth and the resin appliance. The appliance is not as hard as the teeth, therefore with time it will wear down, but the teeth will not. At the same time it reduces the load to the supporting structures of the teeth.
By the use of occlusal appliances it is also possible to change the position of the mandible, if it is altered, improving muscle activity, and the rapports of the structures of the temporomandibular joints.
Distributing the tooth contacts on the appliance it is also possible to decrease the strength used to grind, or clench the teeth, thus reducing the damage that these activities can cause to the structures of the mouth, and promoting relaxation of the muscles of mastication.
If bruxism also occurs during the day it is important to learn to control it. In fact it is not reasonable the use of an appliance during the day, unless it is for a limited period of time. If there is the tendency to clench or grind the teeth only in some specific moments (for example during stressful work or while driving), it is important to identify such moments in order to pay particular attention and avoid bruxism. Otherwise, if this tendency occurs unpredictably during the all day, it is possible to use a little trick to try to remind to reduce it as much as possible. Stickers and Post-its can be used attaching them everywhere, for example on the computer, on the mirror in the bathroom, on the steering-wheel, etc., so that looking at them you can remember to avoid grinding and clenching of the teeth, keeping a rest position: lips together and teeth apart.