Bruxism

Symptoms Of Bruxism 

Individuals may be unaware of this habit, and signs and symptoms can vary, including:

Physical Symptoms:

• Facial pain

• Tense facial and jaw muscles

• Facial muscle pain

• Limitation of mouth opening

• Headache or earache

• Jaw dislocation or locking

• Popping or clicking in the temporomandibular joint (TMJ)

• Tongue and cheek indentations

• Damage to the inside of the cheek

• Tightness and stiffness of the shoulders

Oral Symptoms:

• Increased tooth sensitivity

• Fractured teeth

• Abraded (worn down) teeth

• Chipped or cracked teeth

• Wear facets (smooth areas on the biting surfaces of teeth from repeated rubbing)

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The prevalence of teeth grinding decreases with age, with approximately 8% of middle-aged adults and only 3% of older adults reported to experience it during sleep.

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Types of Bruxism

Bruxism exhibits a wide variety of classifications, with the common types being:

1. Sleep bruxism (SB) 

• Involves involuntary grinding or clenching of teeth during sleep.

• Characterized as rhythmic (phasic) or non-rhythmic (tonic).

• Potential contributing factors: stress, sleep disorders, dental issues.

2. Awake bruxism (AB)

• Characterized by grinding or clenching teeth while conscious.

• Occurs during heightened stress, anxiety, or concentration.

Causes Of Bruxism

While stress and anxiety are known to trigger bruxism, the exact cause may vary from person to person. However, several risk factors can contribute to bruxism which are discussed in the next segment.

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Risk Factors For Bruxism

Many risk factors can lead to bruxism. They include:

1. Malocclusion (Teeth misalignment)

Misalignment of the teeth (malocclusion) or improper bite can contribute to bruxism as the jaw seeks a comfortable resting position.

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2. Sleep disorders

• Sleep apnea

• Restless Leg Syndrome

• Sleep-related gastroesophageal reflux disease

• Sleep-related epilepsy

Note: Studies suggest that about 50% of adults with obstructive sleep apnea also experience sleep bruxism.

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3.  Age

• Bruxism is more common in children, with many outgrowing the habit as they get older.

4. Lifestyle factors

• Excessive alcohol consumption

• Caffeine

• Use of recreational drugs

• Smoking

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5. Genetics

• Sleep bruxism has a genetic component and can run in families, with close family members also experiencing the condition.

6. Medications

• Aripiprazole

• Atomoxetine

• Duloxetine

• Flecainide

• Ketotifen

• Methadone

• Venlafaxine

• Fluoxetine

• Paroxetine

7. Personality traits

• Aggressiveness

• Competitiveness

• Hyperactivity

8. Neurologic and psychiatric disorders

• Alzheimer's disease

• Huntington's disease

• Multiple system atrophy

• Traumatic brain injury

• Down syndrome

• Rett syndrome

• Cerebral palsy

• Attention-deficit/hyperactivity disorder (ADHD)

9. Other medical conditions

• Parkinson's disease

• Dementia

• Gastroesophageal reflux disorder (GERD)

• Epilepsy

Diagnosis Of Bruxism

Effectively diagnosing bruxism poses unique challenges for physicians, often relying on a combination of self-reports, oral history, and clinical examinations. 

To ensure accuracy, the process involves the following:

1. History

Physicians employ questionnaires and interviews to gather information about symptoms, habits, and potential triggers for teeth grinding or clenching. 

2. External observations

Input from parents (in the case of children) or partners can offer valuable insights into behaviors, especially during sleep.

3. Clinical examination

• Dentists and healthcare professionals conduct a thorough examination, assessing signs of bruxism such as tooth wear, jaw tenderness, and muscle pain. 

• Understanding the patient's dental history is crucial during this examination.

4. Instrumental measurements

• Electromyographic (EMG) recordings: EMG recordings are valuable for assessing muscle activity during both awake and sleep bruxism.
  
  

• Polysomnography: An overnight study monitoring various physiological parameters (like brain activity, eye movements, muscle activity, heart rate, oxygen levels etc.) during sleep is conclusive for diagnosing sleep bruxism. 
  
  

• Audio and video recordings: These supplementary recordings, especially during sleep, can provide additional information to support the diagnosis.

5. App-based assessments

Real-time information about awake muscle activity obtained through app-based assessments can contribute additional evidence for diagnosing awake bruxism.

6. Grading system (Lobbezoo et al.)

The grading system proposed by Lobbezoo et al. categorizes bruxism diagnosis into three levels:

• Possible: Based on self-report only.

• Probable: Combines self-report with clinical examination.

• Definite: Involves self-reporting, clinical inspection, and polysomnographic recording, ideally supported by audio and video recordings, particularly for sleep bruxism.

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Prevention Of Bruxism

Preventive measures for bruxism focus on reducing or managing the underlying causes and protecting the teeth and jaw. Here are some recommended strategies:

1. Keep stress at bay

• Nearly 70% of bruxism cases are caused by stress and anxiety. 

• Practice stress-reducing techniques such as meditation, yoga, or deep breathing exercises can help reduce stress and prevent bruxism

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2. See your dentist often

Regular dental checkups can help prevent bruxism by allowing your dentist to identify early signs of teeth grinding, such as tooth wear or jaw tension. 

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3. Be mindful

• Consciously relax your jaw if you realize you are clenching or grinding during the day. 

• Also, avoid habits like chewing on pens or pencils, as they can contribute to jaw tension.

4. Modify your lifestyle

• Limit or avoid caffeine and alcohol, especially in the evening.

• Additionally, avoid chewing gum, as it can contribute to increased jaw tension.

5. Establish a regular sleep routine

• Practice relaxation techniques before bedtime to promote a calm state of mind.

• Avoid using mobile phones or watching TV, instead take a warm bath, listen to soothing music, or read a book to keep yourself calm and relaxed. 

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6. Address underlying causes

Identify and address underlying causes such as sleep disorder, GERD, anxiety or stress, etc. 

Doctor To Visit

If you suspect you have bruxism it's crucial to consult a healthcare professional. Doctors who can help include:

• Dentist

• General Practitioner (GP)

• Sleep specialist

Dentist: Dentists are often the first healthcare professionals to identify and address bruxism. They can examine your teeth, assess any damage, and recommend preventive measures or treatments.

General practitioner (GP): If your symptoms are more generalized or if there are concerns about underlying health issues, consulting with a general practitioner can be beneficial.

Sleep specialist: If bruxism is significantly impacting your sleep, a sleep specialist may be consulted to explore potential sleep disorders or disturbances.

When To See a Doctor?

Seek medical attention if you experience persistent symptoms such as:

• Damaged teeth

• Discomfort in the jaw

• Sleep disturbances

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Treatment Of Bruxism

The treatment of bruxism aims to alleviate symptoms, prevent further damage to the teeth, and address underlying causes. The approach to treatment may involve a combination of the following strategies:

I. Oral devices 

1. Custom-fitted mouthguards and Splints

• These are commonly used to protect teeth from nighttime grinding, distributing forces to prevent wear and damage.
• Hard acrylic-resin stabilization splints are considered more effective than soft alternatives.

2. Mandibular Advancement Device (MAD):

• MADs, known for addressing chronic snoring and mild obstructive sleep apnea, position the lower jaw forward, helping keep the airway open and, in some cases, reducing teeth grinding. 
• They are recommended when bruxism coincides with sleep apnea.

II. Dental corrections

• In some cases, orthodontic treatments (such as braces or aligners), crowns or overlays, or dental adjustments may be recommended to restore damaged teeth and improve their resilience to grinding forces.

III. Contingent electrical stimulation (CES)

• It intends to decrease masticatory muscle activity (chewing) by applying low-level electrical stimulation during bruxism.

• Limited studies; further research is needed to elucidate long-term results.

IV. Medication

Certain medications are reserved for short periods and severe cases when other approaches are ineffective. Examples of drugs include:

• Antianxiety agents: Lorazepam

• Tranquilizers: Diazepam

• Sedatives: Zolpidem

• Muscle relaxants: Cyclobenzaprine

• Tricyclic antidepressants: Amitriptyline 

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V. Botulin toxin

• Botox injections into the masseter muscles of the jaw help weaken the muscles and prevent involuntary teeth grinding and jaw clenching. 

• This method is used in more extreme cases of bruxism since it is more effective than other methods like mouth guards.

Management of Bruxism in Children

1. Multidisciplinary approach

• It requires a comprehensive approach that integrates the expertise of healthcare professionals, parents' active involvement, and the child's cooperation. 

2. Behavioral interventions

• Stress reduction techniques, such as relaxation exercises and creating a calm bedtime routine, can help manage emotional triggers contributing to teeth grinding.

3. Physiotherapy methods

• It aims to address muscular aspects of bruxism, promoting relaxation and minimizing the physical manifestations of teeth grinding. Various techniques are employed, including:

• Kinesiotherapy: Involves therapeutic exercises to improve muscle function, flexibility, and coordination, targeting the muscles involved in jaw movement.
  
  

• Massage: Focuses on relaxing tense muscles in the jaw and neck area, reducing overall muscle tension associated with bruxism.
  
  

• Infrared Therapy: Utilizes infrared light to promote circulation, reduce inflammation, and alleviate muscle discomfort in the jaw.
  
  

• Low-Level Laser Therapy (LLLT): Involves the application of low-level lasers to stimulate tissue repair and reduce muscle tension.

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Home-care For Bruxism

Effectively managing sleep bruxism at home can alleviate discomfort in the teeth, jaw, and neck. Consider these tips:

1. Try Warm Compress

• Apply a warm compress to relax muscles and improve blood circulation in the jaw. 

• Consider warm salt water rinsing to relax tense muscles and reduce pain.

2. Add magnesium to your plate

• Include almonds, spinach, bananas, fish, and flaxseed in your diet to relax muscles and prevent grinding. 

• Along with this, you can also consider magnesium supplements in your daily routine.

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3. Drink turmeric milk

• Benefit from turmeric's anti-inflammatory properties and tryptophan in milk for relief in jaw muscles.

4. Consider herbal teas

• Choose non-caffeinated herbal or chamomile tea to naturally reduce stress and grinding symptoms.
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5. Beware of what you eat

• Avoid hard foods like nuts, popcorn, and tough candies to reduce irritation and discomfort from sleep bruxism. 

• Be cautious with sticky foods like peanut butter, chewing gums, and toffies as they can make chewing difficult and worsen bruxism symptoms.

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Complications Of Bruxism

Bruxism, the habitual grinding or clenching of teeth, can lead to several complications and adverse effects on oral health and overall well-being. Some common complications include:

1. Tooth damage: Persistent grinding can result in the wearing down of tooth enamel (outer layer of the tooth), leading to increased tooth sensitivity, fractures, and even tooth loss in severe cases.

2. Jaw Disorders (TMJ Disorders): Bruxism can contribute to jaw pain, difficulty in jaw movement, and clicking or popping sounds when opening or closing the mouth.

3. Headaches: Chronic bruxism is often associated with tension headaches, as the constant muscle tension and strain in the jaw can radiate pain to the head and neck.

4. Ear Pain and Tinnitus: Bruxism can lead to earaches or pain. Additionally, it may induce tinnitus, manifesting as ringing or buzzing sounds in the ears for some individuals.

5. Sleep Disturbances: The grinding noises produced during sleep can disturb a person's sleep or that of their sleep partner, leading to disrupted sleep patterns and fatigue.

6. Facial Muscle Pain: Grinding can cause facial pain, especially around the jaw and temporomandibular joint areas, leading to discomfort and reduced quality of life.

7. Gum Recession: Bruxism can contribute to gum recession, exposing the roots of the teeth and making them more susceptible to decay and sensitivity.

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Alternative Therapies For Bruxism

Complementary and alternative therapies for bruxism focus on holistic approaches to manage symptoms and address underlying causes. Always consult with healthcare professionals before trying alternative treatments. Some options include:

1. Acupuncture

• This traditional Chinese medicine technique involves inserting thin needles into specific points on the body. 

• Some individuals report reduced tension and stress, potentially contributing to bruxism relief.

2. Biofeedback

• This technique helps individuals become more aware of and control physiological processes. Sensors may be used to monitor muscle tension, and individuals are trained to recognize and consciously control these tensions to reduce grinding.

3. Hypnosis

• Hypnotherapy involves inducing a relaxed state and suggesting behavioral changes to the subconscious mind. 

• It may help individuals manage stress and anxiety, potentially reducing bruxism.

4. Relaxing techniques

• Practice stress-reducing techniques like meditation and yoga to address mental health issues associated with bruxism.

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5. Osteopathy or chiropractic care

• Some individuals seek the services of osteopaths or chiropractors to address musculoskeletal issues that may contribute to bruxism. 

• However, scientific evidence supporting their effectiveness for bruxism is limited.

Living With Bruxism

Living with bruxism can significantly impact various aspects of an individual's quality of life. Here are some ways in which bruxism may affect daily living:

1. Physical discomfort: This results from persistent pain and dental issues can significantly impede daily activities, affecting the overall quality of life.

Coping strategy:

• Seeking dental care and adopting preventive measures for long-term relief.

• Try pain management techniques, such as medication or physical therapy.

2. Sleep disturbance: Caused by bruxism-related disruptions can lead to sleep deprivation and fatigue, further exacerbating the impact on one's well-being and overall quality of life.

Coping strategies:

• Implementing relaxation techniques before bedtime to manage stress and bruxism.

• Using dental appliances, like night guards, to alleviate the impact of teeth grinding on sleep.

3. Emotional toll: Coping with chronic discomfort adds another layer of stress, contributing to a decline in mental and emotional well-being.

Coping strategies:

• Engaging in stress-reducing activities like meditation or exercise.

• Seeking support from friends, family, or mental health professionals to address emotional challenges.

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