Bruxism is a movement disorder characterized by grinding and clenching of teeth . Awake bruxism is found more in females as compared to males while sleep. the history to the current concepts in the diagnosis and treatment of bruxism. In simple terms, bruxism is a clenching and grinding of teeth when the individual. Sleep bruxism (SB) is a parafunctional oromotor habit that can http://www.

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Bruxism is parafungsional activity includes clenching and grinding motion on day or night during sleep. Signs bruksisme most easily observed is the presence of. PDF | After being extensively used in various forms, indications of occlusal splints are reduced, Keywords: Bite splint, bruxism, occlusal appliance, occlusal. surfaces of the dentition due to excessive mandibular movements such as bruxism or grinding be present. Management of TMJ disorders usually includes.

A protective factor: bruxism is associated with 1 or more positive health outcomes. It should be noted that the latter 2 possibilities are not mutually exclusive eg, OSA patients may have severe tooth wear due to protective sleep bruxism.

In addition, for clinical application of the above, a dichotomous system viz. Thus, it seems premature to consider implementing a simple dichotomous classification system for either sleep bruxism or awake bruxism. Moreover, whenever we recognise that the underlying behaviour and degree of risk is continuous that is more masticatory muscle activity has the potential to progressively increase the risk of a certain health outcome, dichotomisation becomes only a clinical convenience.

It may be preferable to acknowledge that classification may need to specify multiple degrees of behaviour characterised by increasing levels of risk. They may be requested to note in a diary at the end of each day if they recall having clenched their teeth that day. Specifically, multiple informants can be interrogated, viz. The patient is again asked to monitor their own behaviour, and to record if they have somehow noticed or have been told that they grind their teeth, keep their teeth together or brace their jaw whilst sleeping, preferably using a diary.

The bed partner can also be asked to keep a diary to record if they hear the patient grind their teeth at night. However, these signs can also be consequences of functional oromotor activity, such as swallowing. Bruxism and its effect on the natural teeth. The Journal of prosthetic dentistry, 53 5 , The social and psychologic factors of bruxism.

The journal of prosthetic dentistry, 65 3 , Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. Journal of orofacial pain, 27 1. Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep, 17 8 , Obstructive sleep apnea syndrome is related to the progression of chronic kidney disease.

International urology and nephrology, 44 2 , The impact of obstructive sleep apnea on chronic kidney disease.

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Current hypertension reports, 12 5 , Sleep bruxism: clinical aspects and characteristics in patients with and without chronic orofacial pain. Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents.

Journal of orofacial pain, 26 4.

A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep medicine, 12 7 , ADHD, bruxism and psychiatric disorders: does bruxism increase the chance of a comorbid psychiatric disorder in children with ADHD and their parents?. Sleep and Breathing, 12 4 , Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children. Oral diseases, 22 6 , Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to gender and ethnicity.

The open respiratory medicine journal, 8, Bruxism: a literature review. SSRTs serotonin reuptake inhibitors which exert an indirect influence on the dopaminergic system [ 14 ] may cause bruxism after long term use. Amphetamine [ 11 ] which increases the dopamine concentration by facilitating its release has been observed to increase bruxism. Nicotine stimulates central dopaminergic activities which might explain the finding that cigarette smokers report bruxism two times more than the non smokers [ 15 ].

Psychosocial Factors Number of studies is published in the literature regarding the role of psychosocial factors in the etiology of bruxism but none of these describe the conclusive nature because of the absence of large scale longitudinal trials.

Bruxism: A Literature Review

Bruxers differs from healthy individuals in the presence of depression, increased levels of hostility [ 16 ] and stress sensitivity [ 17 ]. Bruxing children are more anxious than non bruxers [ 18 ]. A multifactorial large scale population study to sleep bruxism revealed highly stressful life as a significant risk factor [ 19 ]. A study by Van Selms et al. All these studies show possible relationship between bruxism and various psychosocial factors is growing but not conclusive.

Peripheral Factors Several occlusal factors were suggested to be related to self reported bruxism in a study with children. Giffin [ 21 ] in his article has mentioned that for an effective management of bruxism, establishment of harmony between maximum intercuspation and centric relation is required.

But most of studies published in the literature on this subject now agrees that there is no or hardly any relationship between clinically established bruxism and occlusal factors in adults [ 17 , 22 ]. Manfredini et al. Hence its early assessment is very essential. Some of the methods to assess bruxism in the clinic are mentioned below: Questionnaires Questionnaires are generally used in both research and clinical situations.

This method can be applied to large population but the disadvantage with this method is that information obtained is sujective in nature. Is your jaw ever fatigue or sore on awakening in the morning? Are you teeth or gums ever sore on awakening in the morning? Do you ever experience temporal headache on awakening in the morning?

Are you ever aware of grinding your teeth during the day? Are you ever aware of clenching your teeth during the day?

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Several studies have demonstrated a positive relationship between tooth wear and bruxism [ 29 ] but others have not [ 30 ]. A number of systems for the classification and measurement of incisal and occlusal tooth wear have been introduced. One such system of classifications is an Individual personal Tooth-Wear Index which was given to rank persons with regard to incisal and occlusal wear and was developed to investigate the prevalence and severity of tooth wear [ 31 ].

First, the extent of incisal or occlusal wear for a single tooth was evaluated by the following four-point scale: 0: no wear or negligible wear of enamel; 1: obvious wear of enamel or wear through the enamel to the dentine in single spots; 2: wear of the dentine up to one-third of the crown height; 3: wear of the dentine up to more than one-third of the crown height; excessive wear of tooth restorative material or dental material in the crown and bridgework, more than one-third of the crown height.

Then, the individual personal tooth-wear index IA was calculated from the scores of incisal or occlusal wear for each tooth of that individual. This method makes it possible to calculate the degree of individual personal tooth wear without being influenced by the number of missing teeth. Major disadvantage with tooth wear is that it neither proves ongoing bruxism nor static tooth clenching.

Tooth wear is a cumulative record of both functional and parafunctional activities and various factors such as age, gender, diet and bruxism are associated with tooth wear. Erosion by acidic drink is considered to be major contributing factor to tooth wear [ 32 ].

All mechanisms of tooth wear rarely act alone and usually interacts with each other to cause wear.

So the evaluation of tooth wear to for predicting actual bruxism is controvercial and is difficult to estimate the degree of contribution of bruxism to tooth wear alone. Intraoral Appliance Bruxism activity can be evaluated using the intra-oral appliance and is classified into two groups: observation of wear facets of the intra-oral appliance [ 33 , 34 ].

They observed wear facets on full-arch acrylic resin splints, which reappeared in the same location with a similar pattern and direction, even after adjustment of the splints. Also, Korioth et al. Unfortunately, no confirmation of the reliability of these methods has been reported.

Bruxcore Plate The Bruxcore Bruxism-Monitoring Device BBMD is an intra-oral appliance that was introduced as a device for measuring sleep bruxism activity objectively [ 36 ] and the Bruxcore plate evaluates bruxism activity by counting the number of abraded microdots on its surface and by scoring the volumetric magnitude of abrasion.

The BBMD is a 0. The number of missing microdots is counted to assess the abraded area and the number of layers uncovered represents the depth parameter.

Both parameters are combined to obtain an index for the amount of bruxism activity. The major disadvantage with this method is that it is difficult to count the number of missing dots with good precision. Pieree and Gale [ 37 ] in their study did not find any significant co relation between the duration of bruxism analyzed with the EMG data and that with the bruxcore plate scores. In this respect, the bruxism activity assessed by Bruxcore plates may not be the same as that measured with a portable EMG device.

However, the relationship between wear and bruxism activity is still questionable [ 38 ]. Detection of Bite Force Takeuchi et al. It was confirmed that the duration of bruxism events during simulated bruxism, i. Even though the ISFD did not correctly capture force magnitudes during sustained clenching because of the characteristic of the piezoelectric film, i.

ISFD was not suitable for detecting the magnitude of force during steady-state clenching behaviour.

It is obvious, however, that the major problem of these methods is that subjects have to wear the intra-oral device and this may change the original bruxism activity.

Well-designed comparative studies with polysomnographic recordings, are required to evaluate the possible influences of the intra-oral device on the original bruxism activity.

Masticatory Muscle Electromyographic Recording Among the various methods for the assessment of bruxism, the EMG recording has been commonly used to measure actual sleep bruxism activity directly. The principal advantage is, that the occurrence of bruxism can be assessed without intra-oral devices, which may change natural bruxism activity.

Portable EMG Recording Device Starting in the s, sleep bruxism episodes were measured over an extended period in patients homes with the use of battery-operated EMG recording devices [ 40 ]. The portable EMG recording system has become easy for subjects to operate and can measure masticatory muscle activity more minutely, i.

Criteria for the detection of sleep bruxism with the portable EMG recording system have been suggested [ 41 ] but their validity in a large population has not yet been confirmed. The detection power of sleep bruxism is generally considered inferior to that in a sleep laboratory because other confounding oro-facial activities e.

Also, other sleep disorders cannot be ruled out or other physiological changes related to sleep bruxism e. The implement for recording the heart rate was recommended as one of the compensatory measures for improving the accuracy of sleep bruxism recognition. Also, a surface EMG electrode with a built-in buffer-amplifier and a cordless type of EMG measurement system was developed to improve the reliability of recordings [ 45 ].

The device, which is comprised of EMG electrodes, an amplifier, a central processing unit CPU with software, a display which presents the outcome in the morning, a light emitting diode and a lithium battery records the number of masseter muscle activities above a preset threshold. The special feature of this device is that the number of bruxism events can be objectively estimated by simply attaching it to the skin over the masseter muscle. Minakuchi and Clark [ 46 ] examined the sensitivity and specificity of the BiteStrip recording versus masseter EMG recordings during a polysomnogram in five suspected bruxers.

Overall, there was good specificity for all subjects but fair sensitivity for subjects that exhibit moderate to high levels of EMG determined bruxism.

International consensus on the assessment of bruxism: Report of a work in progress

The device might be a cost-effective tool for screening moderate- to high level bruxism subjects. More recently, a miniature self-contained EMG detector—analyser with a biofeedback function Grindcare was developed as a detector and biofeedback device for sleep bruxism [ 47 ]. It is comprised of EMG and stimulation electrodes, a microprocessor, a memory for data storage, a display for user interface, light-emitting diodes, a rechargeable battery, a plug-in USB connector for data connection to computer to a battery charger, and a strap for carrying the apparatus around the forehead.

It enables the online recording of EMG activity of the anterior temporalis muscle, online processing of EMG signals to detect tooth grinding and clenching and also biofeedback stimulation for reducing sleep bruxism activities. Although scientific confirmation is needed for a large population, it is considered as one of the potent devices for detecting and also for managing sleep bruxism.

The portable EMG recording system enables multiple-night recording in a natural environment for the subject with minimal expense. Finally, a miniature self-contained EMG detector—analyser seems to be a potentially useful device for detecting sleep bruxism. Polysomnography Polysomnographic sleep laboratory recordings for sleep bruxism generally include electroencephalogram, EMG, electrocardiogram and thermally sensitive resistor monitoring air flow signals along with simultaneous audio—video recordings.

Because the sleep laboratory setting offers a highly controlled recording environment, other sleep disorders e.

Physiological changes related to sleep bruxism e. Hence, a polysomnographic study allows for multidimensional analyses of sleep-related physiological behaviours and studies on sleep laboratory EMG-based assessments are reported to be very reliable. One major limitation is that a change in the environment for sleep may influence the actual behaviour of bruxism.A protective factor: bruxism is associated with 1 or more positive health outcomes. The condition covers a pathophysiologic continuum, and treatment need depends on the presence of clinically relevant consequences rather than the presence of bruxism itself.

Berbagai Teknik Penanganan Bruksisme

Are you ever aware of clenching your teeth during the day? Thus, for a more accurate assessment, EMG outcome measures like power area , peak amplitude and interval duration between activities could be included, 34 - 36 although the practical and valid use of such outcomes needs to be confirmed. Other issues concern the EMG outcome measures to be determined. Huynh et al. Then, the individual personal tooth-wear index IA was calculated from the scores of incisal or occlusal wear for each tooth of that individual.

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