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Importance Of Occlusion And Physiological Significance Of Sleep Bruxism Shouichi Miyawaki. Episode 59. IOC 2020

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Farooq Ahmed

Relationship between occlusion and digestive tract

  • Mastication supresses initial gastric emptying Takada 2012
  • Malocclusion reduces masticatory function, reduces gastric emptying rate, as it takes longer to eat Koike 2018
  • Gastroesophageal reflux (GERD) in class 3 malocclusion was greater than normal subjects, and reduce bite force Togawa 1991
  • GERD caused by transient lower esophageal sphincter relaxation
    • GERD can lead to heartburn and cancer
    • Common in elderly population
    • Erosive wear to the teeth

 

Sleep Bruxism SB

  • Results in tooth wear
    • 40% of non-bruxists also have signs of tooth wear
  • Abfraction lesions
  • Broken prosthesis
  • Gingival recession
  • Headaches 65% of bruxists
  • Bruxism is associated with TMD Systematic review Jimenez-Silva 2017
  • Bruxism increase risk of TMD by 4-8 times due to anterior disk displacement Huang 2003
  • Hypoertrophy of masseter muscle

 

Risk of SB

  • Associated factors of SB
    • OSA
    • Micro arousal 90%
    • Phycological stress

 

Causes of sleep bruxism

  • Was considered to be malocclusion – peripheral theory discredited – Greene 1982, Rugh 1985
  • Sensing by the periodontal membrane = modify muscle activity Lavigne 2000
    • = CNS cause of bruxism
    • But unclear mechanism so considered multifactorial model
  • SB greater swallowing Miyawaki 2003
    • Increase in swallowing = increase in GER Miyawaki 2004

 

Theory of GER and SB and malocclusion

  • GER = microarousal = bruxism = increase swallowing = worsen GER
    • 73% of GERD patients had SB Mengatto 2013
    • SB strong association with GERD (OR 4.3), systematic review Castroflorio 2017
  • Theory = malocclusion – GERD
  • Bruxism is a mechanism of the body to protect itself from GER – by increasing saliva and swallowing. Miyawaki
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