Day bruxism and sleep bruxism
Day bruxism
- 20% of the population Lavigne 2008
- Repetitive clenching (not grinding)
- Risk factors – not fully understood, multifactorial
Normal clenching
- 20 minutes of the day Grad 1969
- Day bruxism = usually phychological factors and muscle pain
Sleep bruxism
- Rhythmic masticatory muscle activity = grinding of teeth
- Prevalence – children 18%, adults 8% Lavigne 2003
- Aetiology – alcohol, stress, caffeine, smoking, anxiety, acid reflux
How frequent are the episodes of grinding
- SB = 5/hours (non-SB 2/ hour)
- SB grinding
- 8 seconds per episode
- Total grinding = 8 minutes at night (not long) Lavigne 1996
- Force = 22.5 kgf, less than normal chewing force (normal chewing force = around 70kgf)
- SB
- OSA, Gastric reflux, dry mouth
- SB = short duration, low intensity
- SB grinding
Tooth wear
- Not reliable marking of on going bruxism
- Combination of attrition and erosion, overlapping aetiology
- Tooth wear occurs more rapidly in erosive environment
Saliva
- Small reduction in PH during sleep Farella 2016
- Intra oral PH varies significantly in the population
NO CUT OFF POINT FOR DAY BRUXISM
Orthodontics relevance
- Bruxism and muscle forces reduce during orthodontic treatment Goldreich 1994, Michelotti 1999, 2005
- RME reduces bruxism in children by 65% Bellerive 2015
- Splint occlusal therapy – Cochrane review shows insufficient evidence to support
- Twinblock improves sleep disorder breathing, but transient Idris 2018
Effects of wear on the dentition
- Upper and lower anterior retroclination
- Extrusion of upper and lower incisors
- Treatment involves – decompensation –
- Proclination of upper and lower incisors
- Intrusion of upper and lower incisors
- Avoid ceramic backets lower arch
- Reduce risk factors – alcohol, caffeine, smoking, diet, stress
- Restorations should be minimally invasive: Lommans
- Exercises
- Posturing the mandible 2mm = reduction in muscle force 40-50% Michelotti 1997
- Treatment involves – decompensation –
Orthodontic patients who have day bruxism
- Greater effect of occlusal interference and develop jaw discomfort/ headaches RED FLAG FOR ORTHODONTIC TREATMENT Michelotti 2012
- Types of orthodontic devices increase discomfort (anecdotal): Extra oral forces, Removable appliances, Mandibular advancement appliances, Clear aligners.
- First onset of TMD can be successfully managed at home Michalotti 2005
Conclusion
- Bruxism less severe during orthodontic treatment
- Orthodontic appliances may retain acid
Orthodontics can be used to help manage heavily worn dentition
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