What is Bruxism?
Bruxism what is it about.
Imagine Hitting two rocks together
- Types of Bruxism
- Causes and Symptoms
- Treatment
Awake Bruxism occurs while your awake, it has a higher incidence in females then males. It is mainly associated with nervous tic and reactions to stress. The exact cause and mechanism of Awake Bruxism is unknown, although stress and anxiety are considered to be risk factors.
Sleep Bruxism occurs at night-time while you sleep,it has a similar incidence in both females and males. It has been associated with peripheral factors such as tooth interference in dental occlusion, psychosocial influences such as stress or anxiety and central or pathophysiological causes involving brain neurotransmitters or basal ganglia
A patient can have Wear Facets of Intra-oral Appliance (Retainers, Nightguards/Occlusal Splints), Tooth wear, jaw pain and may even have symptoms linked to TMD. May have chipping or even fractures of teeth, fillings and dental crowns. There may be pain in the affected muscles and joints (Associated with the TMJ), cheek bite marks and your teeth may become sensitive to biting.
The cause of Bruxism is considered to involve multiple factors:
These are the factors relating to the interrelation of social factors, individual thought and behaviour. There are numerous studies discussing the role of psychosocial factors in the cause of bruxism but none are conclusive as there is a lack of long term trials. The psychosocial factors which are reported to influence bruxism is the presence of depression, increased levels of hostility and an individual’s stress sensitivity. One multifactorial large scale population study of sleep bruxism revealed highly stressful life as a significant risk factor. As result the possible relationship between bruxism and various psychosocial factors is growing but not yet conclusive.
These are the factors related to the dental occlusion and jaw support. This is a controversial factor as there are studies that show that there is no or hardly any relationship between clinically established bruxism and occlusal factors in adults. Although it should be noted that there is still a lack of methodological sound studies to definitely refute the importance of occlusal factors in the cause of bruxism.
These are factors in the brain that may be influencing bruxism. There are many different types of factors, but more and more are coming to light with more research on sleep studies. One area of interest is related to the Arousal response. This is a sudden change in the depth of the sleep during which the individual either arrives in the lighter sleep stage or actually wakes up. There are studies that have shown a possible link between arousal response and bruxism. There are also theories that the basal ganglion is involved and that increased levels of dopamine may influence bruxism. This is based on studies that have shown that have use of Amphetamine which increases the dopamine concentration has been linked with increased bruxism. Furthermore, cigarette smokers have been reported to have twice the amount of bruxers than non-smokers which may be linked to nicotine stimulating the central dopaminergic response. However, this still needs further research to fully conclude a direct cause and effect relationship, currently these are theories.
This category seeks to achieve a harmonic interaction between occluding surfaces, but many Dentists and researchers disagree with this. The use of 'real' occlusal therapies including equilibration, rehabilitation, and orthodontic alignment in the treatment of bruxism has received minimal support in the literature. Future research on this type of bruxism management options may be impractical, given current insights into the cause of bruxism, which show that the disorder is mostly governed centrally rather than peripherally.
The second category of occlusal management strategies for bruxism contains the frequency used occlusal appliances. These splints go by a variety of names (e.g., occlusal bite guard, bruxism appliance, bite plate, night guard, occlusal device) and have slightly variable appearances and qualities, but they're all hard acrylic-resin stabilising appliances that are worn mostly in the upper jaw. Hard splints are recommended over soft splints to prevent inadvertent tooth movements. The main aim of occlusal splints is not to solve the cause of bruxism but more the result of bruxism. It is used to prevent or limit the dental damage that is possibly caused by the bruxism.
Biofeedback is based on the principle that bruxers can ‘unlearn’ their behaviour when a stimulus makes them aware of their adverse jaw muscle activities (‘aversive conditioning’). This approach has been used to treat bruxism both during the day and at night. Using auditory or visual input from a surface EMG, patients can be taught to control their jaw muscle movements while awake. Auditory, electrical, vibratory, and even taste stimuli can be employed to provide feedback for sleep bruxism. During the day, a splint can be worn to remind the patient to avoid tooth contact. When a patient is bruxing at night, a sound stimulus can be utilised to wake them awake. However, such techniques have the problem of causing major side effects such as increased daytime sleepiness. There is no evidence to support the long-term use of biofeedback in the treatment of bruxism. Furthermore, the potential repercussions of repeated awakenings, must be addressed before this strategy may be used safely to treat bruxism patients.
The pharmacological management of bruxism has been studied increasingly over the past decades. Although currently the results are mixed and as a result although some pharmacological approaches for bruxism seem promising, they all need further efficacy and safety assessments before clinical recommendations could be made.
Easier said than done but reducing the stressful events and habits may be helpful in limiting the possible psychosocial factor. There are numerous destressing websites and information out there for you to access and as a result we will not go into them here.
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This page provides general information about dental topics. It does not contain all the known facts of this subject and is not intended to replace personal advice from your dentist. If your not sure about anything on this site, contact us or speak to your local oral health practitioner. Make sure you give your local oral health practitioner your complete medical history and dental history.
A selection of the references used:
Behr, M., Hahnel, S., Faltermeier, A., Bürgers, R., Kolbeck, C.,
Handel, G., & Proff, P. (2012). The two main theories on dental
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Glaros, A. G., & Rao, S. M. (1977). Bruxism: a critical review.
Psychological Bulletin, 84(4), 767.
Shetty, S., Pitti, V., Satish Babu, C. L., Surendra Kumar, G. P.,
& Deepthi, B. C. (2010). Bruxism: a literature review. The Journal
of Indian prosthodontic society, 10(3), 141-148.
LOBBEZOO, F., Van Der Zaag, J., Van Selms, M. K. A., Hamburger, H.
L., & Naeije, M. (2008). Principles for the management of bruxism.
Journal of oral rehabilitation, 35(7), 509-523.
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