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This chapter has discussed the important aspects of nocturnal bruxism and its relation to disorders of the masticatory system and headaches. Bruxism is believed to be a stress-related sleep disorder, occurring in both men and women, in children, and in adults. In most patients, bruxism results only in minor tooth wear; however, it can become extremely severe with damage occurring in essentially every part of the masticatory apparatus. Nocturnal bruxism should not be overlooked as an etiologic factor in muscular headaches. Short-term acute therapy may involve physical therapy, nocturnal electromyographic biofeedback, and medication to relieve anxiety and improve sleep. Long-term management usually includes some form of stress reduction, change in lifestyle, and an occlusal splint or nightguard to protect the teeth and masticatory system.
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PMID:Nocturnal bruxism and temporomandibular disorders. 327 46

Age and sex characteristics of different signs and symptoms of mandibular dysfunction were studied in 600 randomly selected urban persons. With regard to mandibular mobility marked differences were observed between the sexes, and a steady decrease parallel with ageing. Against this, the percentages of the objective dysfunction signs of impaired mobility and TMJ-sounds, as well as those of the pooled percentages of all the objective signs (Di-I + II + III), increased parallel with ageing. The percentages of headache occurrence peaked in different age groups for men and women. Statistically significant correlations were found between headache, parafunctions, stress, age, the existence of a preferred chewing side, as well as several dental-occlusal factors, and the prevalence of mandibular dysfunction; between Ai and Di according to Helkimo, and between excessive tooth wear and parafunctions.
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PMID:An epidemiologic study of mandibular dysfunction dependence on different variables. 347 2

Bruxism, or the grinding and clenching of teeth, occurs in approximately 15 percent of children and in as many as 96 percent of adults. The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Because of its nonspecific pathology, bruxism may be difficult to diagnose. In addition to complaints from sleep partners, signs of teeth grinding include masticatory pain or fatigue, headaches, tooth sensitivity and attrition, oral infection and temporomandibular joint disorders. Signs of bruxism include tooth wear and mobility, as well as tender or hypertrophied masticatory muscles and joints. Children with bruxism are usually managed with observation and reassurance. Adults may be managed with stress reduction therapy, alteration of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation. If significant tooth attrition, mobility or fracture occurs, dental referral is mandatory.
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PMID:Treatment approaches to bruxism. 818 96

Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks), periodontal signs (gingival recession and tooth mobility) and muscle-joint sensitivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO) for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately). After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders.
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PMID:Dental wear caused by association between bruxism and gastroesophageal reflux disease: a rehabilitation report. 1908 53

Bruxism is an oral parafunctional activity. The more common symptoms are tooth grinding and tooth clenching; however, many other symptoms can be related to bruxism. Dentists treat the results of this condition which may include tooth wear, tooth mobility, tooth fracture, hypertrophy of masticatory muscles, head or neck ache, or poor sleep patterns. The etiology and pathophysiology of this disorder are still unclear. Anterior stop point appliances have been shown to be beneficial in the management of the signs and symptoms associated with bruxism, including nocturnal headaches in certain patient populations. The object of this study was to determine if anterior bite stop appliances with a small discluding element would be helpful in managing the subject's nocturnal bruxism symptoms.
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PMID:Management of nocturnal bruxism with an anterior stop point appliance. 1924 42

The reported prevalence of symptoms related to bruxism varies in the general population because of different investigative methodologies, operational definitions, clinical criteria, and samples of population. Awareness of bruxism in the general population is 15% to 23%, however, this rate increases to 50% to 90% in clinical studies. The aim of this study was to investigate the prevalence of self-reported symptoms associated with bruxism in Istanbul, Turkey and to analyze the correlation between bruxism and factors such as age, gender, marital status, and occupation. Seven-hundred-ninety-five (795) adult subjects who resided in the city of Istanbul were interviewed by telephone about their age, gender, marital status, occupation, and description of the prevalence of bruxism awareness. The overall prevalence of clenching teeth was 45.7% and that of grinding teeth was 21.6%. Women responded positively to the questions more often than men. The data showed significant differences between males and females, regarding clenching teeth OR: 1.41 (95% CI: 1.05-1.87), difficulty opening OR: 2.64 (95% CI: 1.63-4.26), headache on awakening OR: 2.28 (95% CI: 1.58-3.27) joint sounds OR: 1.72 (95% CI: 1.24-2.38), sore on awakening OR: 2.97 (95% CI: 1.91-4.61), influence in daily activity (OR: 2.26 CI: 1.38-3.67). Tooth wear in the married group was higher than the single group. Age distribution showed significant differences related to grinding teeth, tooth wear and joint sounds. There were statistically significant differences between bruxism and job categories. As a conclusion, this study suggest an association between bruxism and stressful events such as marital status and job problems.
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PMID:Prevalence of bruxism awareness in Istanbul, Turkey. 2049 Dec 34

Sleep bruxism, a well-known burden for dentists, is commonly observed in pediatric populations. Dentists are responsible for the detection and prevention of the detrimental consequences on the stomatognathic system that may occur in some patients with sleep bruxism. However, sleep bruxism is much more than tooth wear, since it is frequently associated with orofacial pain, headaches, and other more severe sleep disorders, such as sleep-disordered breathing. Although the mechanisms underlying the possible interactions among sleep bruxism, headaches, and sleep-disordered breathing need further research, these conditions are often concomitant. A literature search was performed to identify relevant publications related to the topic, which have been integrated in this topical review. The aim of this article was to provide a brief overview on sleep bruxism, headaches, and sleep-disordered breathing in pediatric patients and to promote a multispecialist approach (including dentists, sleep specialist physicians, and psychologists) in the diagnosis and management of these frequently associated disorders.
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PMID:Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents. 2311 Feb 66

Severely worn out dentition needs to be given definite attention as it not only affects aesthetics but can also cause psychological distress to the affected individual. It can cause chewing difficulty, temporomandibular joint problems, headaches, pain and facial collapse. Before any attempt to restore severely worn dentition, aetiology of excessive tooth wear should be established. Severe wear can result from chemical cause, mechanical cause or a combination of various causes. Dental fluorosis can also result in severe wear of teeth. Teeth sometimes become extremely porous and friable with a mottled appearance ranging from yellow to brown-black. There occurs loss of tooth substance and anatomic dental deformities resulting in un-aesthetic dentition requiring full mouth rehabilitation. Here a similar case of full mouth rehabilitation of severely worn dentition due to dental fluorosis in a 27-year-old patient is presented. This case report conjointly presents the uncommon association of diabetes insipidus with dental fluorosis. Diabetes insipidus through its characteristic symptom of polydipsia can result in intake of more than permitted dose of fluoride thus causing dental fluorosis. In literature only few cases have been reported of dental fluorosis in association of diabetes insipidus. Full mouth rehabilitation of the patient was successfully accomplished through well-planned systematic approach to simultaneously fulfill aesthetic, occlusal and functional parameters.
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PMID:Full mouth rehabilitation in a medically compromised patient with fluorosis. 2517 54

The aim of this study was to explore the association between signs and symptoms of temporomandibular disorders (TMD) and orthodontic treatment need in orthodontically untreated children and adolescents. One thousand five hundred and ninety-seven subjects aged 11-19 years, without previous orthodontic history, from sixteen randomly selected public schools in Zagreb, Croatia, were examined. Malocclusion characteristics were assessed by using the criteria proposed by Bjork et al., the Dental Aesthetic Index, and the Aesthetic Component of Index of Orthodontic Treatment Need. Data on TMD signs/symptoms and parafunctional behaviour were obtained by means of questionnaire and clinical examination, respectively. Multiple logistic regression models were used for analysis. Twenty-two percent of children and young adolescents had one or more signs of TMD, ranging from 17% in age of 11 years up to 24% in age of 19. There was poor correlation between presence of TMD and orthodontic treatment need. Multiple logistic regression models showed that Class III, crowding and spacing were related to mandibular deflection on opening. Ectopic eruption was related to TMJ clicking, and severely tipped teeth with reduced mouth opening. Headaches presented a positive relationship with reverse overjet and severe rotations, and tooth wear with crowding, spacing and lateral openbite. Age, female gender and parafunctional habits were related to several TMD signs. Although logistic regression models were statistically significant (p < 0.05) malocclusions, parafunctional behaviours, age and gender accounted for less than 20% of the variability in TMD signs/symptoms. TMD signs and symptoms seemed to be poorly related to malocclusions or treatment needs.
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PMID:Temporomandibular disorders and orthodontic treatment need in orthodontically untreated children and adolescents. 2604 83

Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.
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PMID:Sleep bruxism: Current knowledge and contemporary management. 2765 52


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