Bruxism

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**Bruxism**
*Classifications and external resources*
DiseasesDB	29661
MedlinePlus	001413

Bruxism (derived from Greek βρυγμός, masculine noun - grinding teeth) is grinding of the teeth.

This is an oral para-functional activity observed in most people to some degree. Bruxism includes clenching and/or grinding of the teeth. Some have incorrectly characterized bruxism as a habit; however, bruxism is caused by the activation of reflex chewing activity. Chewing is a complex neuromuscular activity that is controlled by reflex nerve pathways with higher control by the brain. During sleep, the reflex part is active, while the brain control is inactive. The result is an abnormal chewing action known as bruxism. Some dentists believe it is due to a lack of symmetry in the teeth; others, that it reflects anxiety, digestive problems or a disturbed sleep pattern.[1], [2]

Bruxism causes chips in the teeth, wear of the biting surface, abfractions and cracks in the teeth. This type of dental damage is diagnosed as occlusal disease. Many dentists wrongly believe that occlusal disease is a natural part of aging and fail to recognize that tooth wear is preventable and is caused by bruxism.

Often, bruxism occurs during sleep; even during short naps. In a typical case, the canines and incisors are commonly moved against each other laterally, i.e. with a side to side action. This abrades tooth enamel, removing the sharp biting surfaces and flattening the edges of the teeth. Sometimes, there is a tendency to grind the molars together, which can be loud enough to wake a sleeping partner. Some will clench without significant side to side jaw movement. Bruxism is one of the most common sleep disorders: thirty to forty million Americans grind their teeth on a nightly basis. [3] Given enough time, dental damage will usually occur. Bruxism is the number one cause of occlusal disease and a significant cause of tooth loss.

Over time, bruxing shortens and blunts the teeth being ground, and may lead to pain in the joint of the jaw, the temporomandibular joint, or headache. Most people are not aware of their bruxism and only five to ten percent will develop symptoms such as jaw pain and headache. Teeth hollowed by previous decay (caries) may collapse; the pressure exerted by bruxism on the teeth is extraordinarily high.

A recently introduced device called the BiteStrip enables at-home overnight testing for Sleep Bruxism and might help diagnose bruxism before damage appears on the teeth. The device is a miniature electromyograph machine that senses jaw muscle activity while the patient sleeps. A dentist can establish the frequency of bruxing, which helps in choosing a treatment plan. Anyone having major occlusal rehabilitation should be aware that bruxism can and does ruin dental work.

The effects of the condition may be quite advanced before sufferers are aware they brux. Abraded teeth may be brought to the patient's attention during a routine dental examination. If enough enamel is abraded, the softer dentine will be exposed, and abrasion will accelerate. This opens the possibility of dental decay and tooth fracture, and in some people, gum recession. Early intervention by a dentist is advisable.

Some drugs are known to cause bruxism as a side-effect, e.g. MDMA and others of the amphetamine-based family.

[edit] Treatment of bruxism

Unfortunately, there is no accepted cure as yet; mainly because the causation for the condition is normal physiological reflex activity. Ongoing management of bruxism is based on prevention of the abrasion of tooth surfaces by the wearing of a full-width acrylic dental guard, created to the shape of the individual's upper teeth from a bite mould. This requires visits to a dentist for measuring and fitting. Alternatively, smaller guards can be bought from a store and moulded at home – although these are usually intended for sports and may be unsuitable for use when sleeping. The main goal of treatment is to prevent further tooth damage, and requires that the nightguard be worn as long as the person has teeth.

There is limited evidence that suggests taking certain combinations of vitamin supplementats may alleviate bruxism.[4]

One way of stopping the damage and severity of grinding and clenching is through the making of a repositioning splint. A repositioning splint looks like the traditional night guard but has certain functions built into it. This device not only protects your teeth when you do grind but in addition, it reduces your urge to grind.

Damaged teeth can be repaired by replacing the worn natural crown of the tooth with an artificial crown. Materials used to make crowns vary; some are less prone to breaking than others, and can last longer. Porcelain fused to metal crowns may be used in the anterior (front) of the mouth, and in the posterior (back) gold is the preferred material. All porcelain crowns are now becoming more and more common and work well for both anterior and posterior restorations. To protect the new crowns, and dental implants an occlusional guard may be fabricated to wear at night.