8/12/2019 bruxism in dentistry
1/30
Journal club presentation
Presentation by guided by
Dr. Sai Kumar Dr. AnamChandrasekar
8/12/2019 bruxism in dentistry
2/30
J Indian Prosthodont Soc (July-Sept 2010)10(3):141148
BRUXISM: A LITERATUREREVIEW
8/12/2019 bruxism in dentistry
3/30
CONTENTS Introduction
Etiology
Diagnosis
Managementocclusal splintsbiofeedback
pharmacological
Conclusion
References
8/12/2019 bruxism in dentistry
4/30
INTRODUCTION The term parafunction was introduced by Drum.
Parafunctional activities are non functional
oromandibular or lingual activities that includesjaw clenching, bruxism, grinding, tooth tapping,
cheek biting, lip biting, object biting etc. that can
occur alone or in combination and are different
from functional activities like chewing, speaking
and swallowing.
8/12/2019 bruxism in dentistry
5/30
The term la bruxomanie was first introduced byMarie Pietkiewicz in 1907 .
GPT-8 defines bruxism as parafunctional grindingof teeth or an oral habit consisting of involuntary
rhythmic or spasmodic non functional gnashing,
grinding or clenching of teeth in other than
chewing movements of the mandible which may
lead to occlusal trauma.
8/12/2019 bruxism in dentistry
6/30
Classification: Awake Bruxism (AB) or Diurnal Bruxism (DB).
Sleep Bruxism (SB).
SB is an oromandibular behavior that is defined
as a stereotyped movement disorder occurringduring sleep and characterized by tooth grinding
and/or clenching.
Prevalance:
8/12/2019 bruxism in dentistry
7/30
ETIOLOGY1. Central or Pathophysiological Factors- arousal
response, It is hypothesized that the direct
and indirect pathways of the basal ganglion,
a group of five subcortical nuclei that are
involved in the coordination of movements is
disturbed in bruxer.
2. Psychosocial Factors
3. Peripheral Factors
8/12/2019 bruxism in dentistry
8/30
DIAGNOSIS1. Questionnaire for detecting bruxer-(symptoms)
Has anyone heard you grinding your teeth at
night?
Is your jaw ever fatigue or sore on awakening inthe morning?
Are you teeth or gums ever sore on awakening in
the morning?
Do you ever experience temporal headache onawakening in the morning?
Are you ever aware of grinding your teeth during
the day?
Are you ever aware of clenching your teeth during
8/12/2019 bruxism in dentistry
9/30
2. Clinical Findings/Evaluation-
Clinical Examination-Report of tooth grinding or
tapping sounds .
Presence of tooth wear seen within normal range of
jaw movements or at eccentric position.
Presence of masseter muscle hypertrophy onvoluntary contraction.
Complain of masticatory muscles discomfort, fatigue
or stiffness in the morning (occasionally, headache in
temporal muscle region).
Tooth or teeth hypersensitive to cold air or liquid.
Clicking or locking of temporomandibular joint.
Tongue on cheek indentation.
8/12/2019 bruxism in dentistry
10/30
3. Tooth Wear-
First, the extent of incisal or occlusal wear for asingle 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 materialor dental material in the crown
and bridgework, more than one-third of the crownhei ht.
8/12/2019 bruxism in dentistry
11/30
Then, the individual (personal) tooth-wear index(IA) was calculated from the scores of incisal or
occlusal wear for each tooth of that individual.
IA = 10 * G1 + 30 * G2 + 100 * G3/G0 + G1 + G2+ G3
8/12/2019 bruxism in dentistry
12/30
4. Bruxism activity can be evaluated using theintra-oral appliance and is classified into two
groups:
(i) observation of wear facets of the intra-oral
appliance(ii) measurement of bite force loaded on the intra-
oral appliance
8/12/2019 bruxism in dentistry
13/30
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 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.
Pieree and Gale in their study did not find any
significant co relation between the duration of
bruxism analyzed with the EMG data and thatwith the bruxcore plate scores.
8/12/2019 bruxism in dentistry
14/30
Detection of Bite Force-
Takeuchi et al. developed a recording device for
sleep bruxism, an intra-splint force detector(ISFD)
this transducer is best at detecting rapid changesin force, not static forces.
8/12/2019 bruxism in dentistry
15/30
Masticatory MuscleElectromyographic Recording The EMG recording has been commonly used to
measure actual sleep bruxism activity directly.
Portable EMG Recording Device-
Miniature Self-Contained EMG Detector
Analyser- Bitestrip and Grindcare.
Polysomnography
8/12/2019 bruxism in dentistry
16/30
0no sleep bruxism
(125 events)E - error
ELECTROCHEMICAL DISPLAYINDICATOR LIGHT
8/12/2019 bruxism in dentistry
17/30
8/12/2019 bruxism in dentistry
18/30
polysomnography
8/12/2019 bruxism in dentistry
19/30
MANAGEMENT OF BRUXISM Occlusal Therapy-
Occlusal Interventions
Occlusal Appliances
BiofeedbackBruxism During Wakefulness/Daytime
Sleep bruxism
Pharmacological Approach
8/12/2019 bruxism in dentistry
20/30
Occlusal appliance occlusal guard, bite guard, night guard or occlusal
appliance
These splints are made of hard acrylic resins,
worn in maxillary arch.
Hard splints are generally preferred over soft
splints for practical reasons (e.g. soft splints are
more difficult to adjust than hard ones), to preventinadvertent tooth movements, and because hard
splints are suggested to be more effective inreducing bruxism activity than soft splints.
8/12/2019 bruxism in dentistry
21/30
The following reasons justify the use of occlusal
splints-
1. To protect the teeth in bruxing patients.
2. To protect the cheek and/or tongue in patients
with oral parafunctions.
3.To stabilize unstable occlusion.
4. To promote jaw muscle relaxation in patients
with stress related pain symptoms like tension
headache and neck pain of muscular origin.
5. To test the effect of changes in occlusion on theTMJ and jaw muscle function before extensive
restorative treatment.
6. To eliminate the effect of occlusal interferences
8/12/2019 bruxism in dentistry
22/30
Types:
According to Okeson
1) Muscle relaxation appliance/ stabilization
appliance used to reduce muscle activity
2) Anterior repositioning appliances/ orthopedic
repositioning appliance
Other types:
Anterior bite plane
Pivoting appliance Soft/ resilient appliance
8/12/2019 bruxism in dentistry
23/30
According to Dawson:
1. Permissive splints/ muscle deprogrammer
2. Directive splints/ non-permissive splints
3. Pseudo permissive splints (e.g Soft splints,Hydrostatic splint)
8/12/2019 bruxism in dentistry
24/30
MAXILLARY OR MANDIBULARSPLINT? Most splints are maxillary- more stable
more retentive
less likely to break
increased stability because allmandibular contacts are
on flat surfaces.
mandibular splintmore esthectic and easier for
the patient to speak with it in place.
8/12/2019 bruxism in dentistry
25/30
Before any permanent therapy is begun, oneneeds to be aware that there are six generalfeatures common to all devices that may beresponsible for decreasing muscle activity andsymptoms.
1. Alteration of the occlusal condition
2. Alteration of the condylar position
3. Increase in the vertical dimension
4. Cognitive awareness
5. Placebo effect: 40% of the patients suffering from
certain TM disorders respond favorably to suchtreatment.
6. Increased peripheral input to the CNS: Anychange at the peripheral input level seems tohave an inhibitory effect on this CNS activity
8/12/2019 bruxism in dentistry
26/30
Biofeedback Biofeedback is based on the principle that
bruxers can unlearn their behaviour when a
stimulus makes them aware of their adverse jawmuscle activities (aversive conditioning).
Awake bruxism- Mittleman described an EMG
technique that provides the daytime clencher with
auditory feedback from his/her muscle activityletting him know the degree of muscle activity orrelaxation that is taking place.
8/12/2019 bruxism in dentistry
27/30
For the use of biofeedback in the management ofsleep bruxism, Cherasia and Parks published a
prescription.
Their technique used contingent arousal from
sleep with actual awakenings
Nissani used a taste stimulus to awaken the
patient. This stimulus was caused by the bruxism-
related rupture of capsules, filled with an aversive
substance (agreed upon with the patient) in the
dental appliance.
A sound blast was applied as the aversivestimulus.
8/12/2019 bruxism in dentistry
28/30
Pharmacological approach Drugs that have paralytic effect on the muscles
through an inhibition of acetylcholine release at the
neuromuscular junction (botulinum toxin)decreases
bruxism activity especially in severe cases with
comorbidities like coma, brain injury, amphetamineabuse, Huntingtons disease and autism.
Many of the studies showed that the catecolamine
precursor L-dopa exerted a modest attenuating
effect on sleep bruxism.
Antidepressant drugs.
8/12/2019 bruxism in dentistry
29/30
Conclusion
Bruxism is a sleep related, centrally mediateddisorder with the psychosocial factors having a
little role in its etiology.
There are no reliable methods for assessing it
clinically.
Many devices have been proven to be useful
clinically but in the absence of definitive evidence,
bruxism can be managed by occlusal appliances,
counselling, change in lifestyle andpharmacological interventions.
8/12/2019 bruxism in dentistry
30/30
References
1. Bruxism: A Literature Review- J Indian Prosthodont Soc(July-Sept 2010) 10(3):141148
2. TMJ Disorders and Occlusal Splint TherapyA ReviewInternational journal of dental clinics: 2 (2):22-29
3. Dental erosion and bruxism. A tooth wear analysis fromSouth East Queensland- Australian Dental Journa1998;43:(2):117-27
4. Principles for the management of bruxism-Journal ofOral Rehabilitation 2008 35; 509523
5. Bruxism :theory and practice- Daniel paesani
6. Functional occlusion from TMJ to Smile design- Dawson,333 and 379
7. Treatment of functional disturbances of masticatorysystem- Okesson, pg- 507