Bruxism is defined as a repetitive jaw muscle activity characterized by teeth clenching or grinding during sleep or wakefulness. It occurs in 14% of children and 8% of adults. Risk factors include stress, anxiety, personality type, and certain medications. It is thought to be related to disturbances in the central neurotransmitter system and may be associated with breathing or arousal disturbances during sleep. Bruxism is diagnosed through patient interviews about symptoms, clinical examinations of the jaw and teeth, and sleep studies that record jaw muscle activity. Treatment options include oral appliances and potentially Botox injections.

1. BRUXISM
Ade Wijaya, MD
August 2017

2. OUTLINE
• Definition
• Epidemiology
• Risk Factors
• Pathophysiology
• Diagnosis (interview, clinical examinations, sleep studies)
• Treatment
• Conclusion

3. DEFINITION
Bruxism is a repetitive jaw-muscle activity characterized by clenching or
grinding of the teeth and/or by bracing or thrusting of the mandible.
Bruxism has two distinct circadian manifestations: it can occur during sleep
(indicated as sleep bruxism) or during wakefulness (indicated as awake
bruxism).
Lobbezoo, F., Ahlberg, J., Glaros, A. G., Kato, T., Koyano, K., Lavigne, G. J., ... & Winocur, E. (2013). Bruxism defined and graded: an international consensus. Journal of oral rehabilitation, 40(1), 2-4.

4. EPIDEMIOLOGY
• Sleep Bruxism:
- 14 % in children
- 8 % in adults
- 3 % in elderly
• Awake Bruxism: 22-31 %
(Lavigne and Montplaisir, 1994; Laberge et al., 2000; Ohayon et al., 2001).

5. RISK FACTORS
• Workload
• Strong familial demand
• Persistent activation of fear circuity
• Anxiety
• Stress (higher level of dopamine and epinephrine in urine)
• A-type personality
• Drug-related: L-Dopa, haloperidol or other dopamine antipsychotic,
SSRI, cocaine, ecstasy
Handbook of Clinical Neurology, Vol. 99 (3rd series)
Sleep Disorders, Part 2
P. Montagna and S. Chokroverty, Editors
# 2011 Elsevier B.V. All rights reserved

6. PATHOPHYSIOLOGY
• Part of arousal response
• Disturbances in central neurotransmitter system
• Related to breathing disturbance ?
• Autonomic–cardiac excitability and respiration
• Rhytmic jaw activity
Macaluso GM, et al. Sleep bruxism is an disorder related to periodic arousals of sleep. J Dent Res.1998;77:565. doi: 10.1177/00220345980770040901.
Lobbezoo F, Lavinge GJ, Tanguay R, Montplaier JY. The effect of the catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Mov Disord. 1997;12:73. doi: 10.1002/mds.870120113.
Lobbezoo F, Soucy JP, Montplaster JY, Lavinge GJ. Striatal D2 receptor binding in sleep bruxism: a controlled study with iodine-123-iodobenzamide, single photon emission computed tomography. J Dent Res.1996;75:1804. doi:
10.1177/00220345960750101401.
Handbook of Clinical Neurology, Vol. 99 (3rd series)
Sleep Disorders, Part 2
P. Montagna and S. Chokroverty, Editors
# 2011 Elsevier B.V. All rights reserved

7. DIAGNOSIS
• Interview,
• Clinical examination, and
• Ambulatory or sleep laboratory recordings
Shetty, S., Pitti, V., Satish Babu, C. L., Surendra Kumar, G. P., & Deepthi, B. C. (2010). Bruxism: A Literature
Review. Journal of Indian Prosthodontic Society, 10(3), 141–148. http://doi.org/10.1007/s13191-011-0041-5

8. INTERVIEW
• Medications
• Pain in jaw muscles
• Temporomandibular dysfunction
• Diurnal sleepiness
• Fatique upon awakening
• Morning temporal headache
• Tooth fracture or tooth sensitivity
• Gastric reflux during sleep

9. CLINICAL EXAMINATION
• Head and neck muscles palpation
• Examination of oral mucosa
• Quality of salivation, masseter muscle hypertrophy
• Tooth wear

10. AMBULATORY OR SLEEP
LABORATORY RECORDINGS
Sound and/or video recordings

11. TREATMENT
Botulinum Toxin (?)

12. CONCLUSION
• Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding
of the teeth and/or by bracing or thrusting of the mandible.
• Bruxism has two distinct circadian manifestations: it can occur during sleep
(indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism).
• Sleep-related movement disorder
• More common in Children
• Related to physiological factor, sometimes medication-induced
• Pathophysiology: part of arousal response, neurotransmitter disturbance,
breathing-related (?), etc
• Diagnosed by interview, clinical examination, sleep studies (incl. EMG of masetter
muscle)
• Treatment: oral devices, experimental pharmacological treatments (botulinum
toxin ? )

13. THANK YOU