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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