Bruxism

Teeth grinding or clenching is medically known as bruxism. It is a common problem amongst busy Sydney people with tight schedules and stressful jobs; or even if you’re not busy with work, it can be triggered by emotionally demanding situations, eg. relationships or psychological wellbeing. Yet, the cause is actually unknown and has been linked with sleep-disordered breathing (snoring and/or obstructive sleep apnoea). Currently, there is no evidence to conclusively support the association or causality of sleep bruxism and obstructive sleep apnoea (OSA). However, there do appear to be clinical commonalities between sleep bruxism and OSA. It is yet to be demonstrated in the current scientific literature whether both entities are coincidental, causally related or linked to some sleep arousal activity. Repetitive arousal and sleep fragmentation after obstruction can often lead to increased sympathetic nervous system activation and tiredness due to poor quality sleep.

Like obstructive sleep apnoea, many people do not know they have bruxism and self-reporting lies at around 4% to 8% with poor reliability. It is important to note that the diagnosis of sleep bruxism should not be based on the observation of tooth grinding by the bed partner or dentist’s observation of teeth wearing, as both are unreliable methods of assessing sleep bruxism. Often the damage caused by bruxism over a long term period can be quite excessive to wear, flatten or break teeth or restorative work. It is reported that sustained and repetitious adverse loading of the muscles that can occur with sleep bruxism can cause TMD (see section on TMD).

The International Classification of Sleep Disorders-3 ICSD3 recognizes that bruxism has two distinctive circadian manifestations: sleep bruxism or awake bruxism. Sleep bruxism can be divided into primary/idiopathic bruxism which is without an identifiable cause, or secondary sleep bruxism which is often related to sociopsychosocial and/or medical conditions (sleep disorder, neurologic or psychiatric condition, or medication or recreational drugs). Sleep bruxism is a sleep disorder of repetitive masticatory muscle activity RMMA, much like periodic limb movement, while awake bruxism is most often seen as tooth clenching.

What does this mean to you, the patient?

If you think you have sleep bruxism or have been advised by a dentist or bed partner, then seek the appropriate treatment.  CALL NOW.

Some common clinical signs and symptoms of Bruxism (you may have more than one):

• Chipping of front and/or back teeth.
• Worn teeth, flattened cusps (the pointed part of the end of the tooth).
• Broken or fractured teeth.
• Limited opening of the jaw.
• Clicking or popping of the jaw joint.
• Generalised pain in most teeth, waking with an aching face or teeth.
• Chronic facial pain, often with a headache caused by constant muscular contraction.
• Tongue scalloping or cheek biting.

It is not unknown that patients have sustained vertical root fractures of teeth and dislodged implants due to ongoing and severe bruxism.

A (single arch) occlusal splint is often recommended to protect the teeth and in many cases provides an “orthotic” to redistribute the forces or change the muscular paradigm. In many cases, this provides a sense of relief but bruxism can be very hard to control and will continue despite the use of an occlusal splint. Occasionally, further diagnosis with a sleep study reveals issues related to the central nervous system and other related sleep disorders, eg. REM behaviour disorder. Bruxism can also be related to the use of SSRI (antidepressant medications) in some people.

There is evidence amongst research literature suggesting that single arch occlusal splints used to treat sleep bruxism can increase obstructive sleep apnoea (OSA). Patients who are candidates for night-guards or single arch splints provided with the intention of combatting bruxism should ideally be questioned about snoring and obstructive sleep apnoea prior to commencing treatment. (Nikolopoulou).

Practitioners (Dentists) must be aware that sleep bruxism may occur concomitantly with a variety of sleep disorders, of which there are more than 80, eg. insomnia, REM behaviour disorder and sleep-disordered breathing (obstructive and central sleep apnoea) and sleep epilepsy. In such cases, it may well be indicated the patient is prescribed a MAS, not single arch splint to protect the teeth. A Mandibular Advancement Splint (MAS) will treat both sleep-disordered breathing and bruxism, with the protection of the teeth.

Balasubranamiam R, Klasser GD, Cistulli PA, et al. The link between sleep bruxism, sleep-disordered breathing and temporomandibular disorders. An evidenced-based review. Journal of dental sleep medicine. 2014;1(1):39-50