Bruxism is one of the most parafunctional habbits commonly seen in adults and children …current studies reveal that etiology is unknown but is multifactorial……. …….one of the major challenges of dentists is to diagnose bruxism restore the functional occlusion and oral hygiene back to normal stage….
Sleep bruxism originates in CNS and is associated with lightening of sleep or so called micro arousal……awake bruxism is seen in day time …….Phasic-corresponds to last three muscle contraction bursts of 0.25 to 2.0 seconds of duration separated by two inter-burst intervals.
Tonic-muscle contraction bursts that lasts for more than 2 seconds
Mixed-a combination of phasic and tonic episodes separated by a 30 sec interval.
Primary –not related to any medica conditions…..secondary- side effect of prescribed medications….
International classification of sleep disorders revised
mild as occurring less than nightly, with no damage to teeth or psychosocial impairment; moderate as occurring nightly, with mild impairment of psychosocial functioning; and severe as occurring nightly, and with damage to the teeth, tempormandibular disorders and other physical injuries, and severe psychosocial impairment.[13]
namely acute, which lasts for less than one week; subacute, which lasts for more than a week and less than one month; and chronic which lasts for over a month.[13]
Tooth wear is a term referring to different processes which either individually or in association lead to irreversible loss of tooth hard tissue.
When occlusal forces exceed 300 newtons in molar area results in wearing away of teeth structures….cuspal fracture and attrition are one of the most clinical signs of tooth wear seen in relation to bruxism….dentinal hypersensitivity to cold or hot foods…..
Studies by Shetty et al in 2010 has shown tooth wear in 78 % of subjects cuspal fracture in 12 % of subjects muscle and TMJ pain in 7 %of subjects and 3% due to drugs…..
Mainly characterised by…..
Traumatic forces can occur in normal periodontium with normal height of bone, normal periodontium with reduced ht of bone and marginal periodontitis with rduced ht of bone……In injury body attempts to repair the inury and restore the periodontium which occurs if occlusal forces are diminished if forces are chronic the periodontium will remodel to cushion this impact.in repair stage ,the periodontium tries to repair the damaged part by new CT cells and fibers ,bone and cementum and forced remain traumatic only if damage produced exceeds reparative capacity of tissues.In adaptive remodelling stage, here is a widening pdl which is funnel shaped in crest and angular defects in bone with no pocket formation,and thus the involved teeth becomes loose.
As long as inflammation is confined to gingiva the inflammatory forces is not affected by occlusal forces but when it extends to supporting periodontal tissues plaque induced inflammation enters the zone influenced by occlusion which Glickman has called as zone of co-destruction.
Bruxism is being classified as a form of chronic trauma fron occlusion which occurs in periodontium due to gradual changes in occlusion produced by tooth wear,drifting movement,extrusion combined with parafunctional habitKarolyi was the first person to associate bruxism with periodontal lesion….and was hypothesized excessive occlusal forces will cause irreparable periodontal breakdown……
Bbf buttressing bone formation
Normal muscular function may be interrupted or altered by bruxism ….when the physiologic mechanism of adaptation and tissur resisitance are overstreched it is possible to trigger a state of muscular pathophysiology involving muscular disorders. This s wen the pt will manifest the foll symptoms such as:
Internal derangement of TMJ has been defined as an abnormal relationship of articular disc relative to the mandibular condyle,fossa and articular eminence.-disc displacement with reduction and disc displacement without reduction
Occusal splints shud not alter the growth pattern….in cases of attrition stainless steel crowns can be used.
Clinical history to detect pre existing disease like migraine, sleep apnea syndrome, temporomandibular disorders, respiratory problems, need for tonsillectomy, daytime sleepiness and in these cases send the child to specialist competence
Questionnaire …..personal interview
Attrition…….cuspal fracture associated with extensive occlusal forces,,,,,,,fractured amalgam restorations………..implant fracture………
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. Sleep bruxism activity is assessed based on EMG activity in the masticatory muscles (masseter and/or temporalis). Because the sleep laboratory setting offers a highly controlled recording environment, other sleep disorders (e.g. sleep apnoea and insomnia) can be ruled out .Bite strip is A miniature self-contained EMG detector–analyser (BiteStrip) was developed as a screening test for moderate to high level bruxers [46]. 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.Grind care 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.
International classification of sleep disorders revised criteria
hypnosis…voluntary relaxation…..excercise
Counselling….habit awareness and hence voluntary control
Based on severity of tooth wear ….restorative materials are selected ………..either restorative materials such as amalgams and if pulpal involvement is there rct and crown is necessary………..
Whilw fabricating splint care shud be taken that
Anxiolytic-muscle relaxing effect and have a greater safety margin with regard to drug toxicity and have a long half life of 100 hrs.
Neuroleptics-make synaptic alterations in basal ganglia levels ,on prolonged intake leads to production of free radicals relaxes the muscle and reduces the pain.
Botulinum toxin type a is commonly used in treating bruxism cases.
Botulinum toxin is injected in 5 prominent points in masseter muscle below the imaginary line drawn from tragus to commissure of lips.10 units ……
On masseter muscle…..is usually a form of Chinese medicine in which microneedles are used which helps in relieving stress from nerves…
