Bruxism: Grinding, Gnashing or Clenching the Teeth During the Sleep - Essay Example

Bruxism While often confused with TMJ disorders, the condition known as bruxism or teeth grinding canactually be considered a disorder all its own. The characteristics of this disorder include an unconscious tendency of children and adults to grind their teeth together, gnash their teeth or clench their teeth whenever they feel anxious or tense (Mayo Clinic, 2005). This behavior can take place during the day, but it more usually happens at night when one is sleeping. The degree to which this behavior takes place can be relatively mild, with few, if any effects beyond normal or it can be very severe, leading to serious dental complications, jaw disorders and headaches. In one study, it was found that the level of pressure exerted on the teeth, gums and joints of the mouth during bruxism episodes is as high as three times the forces experienced during normal chewing (Castaneda, 1992: 46). It is not known exactly what causes bruxism, but the condition does seem to be strongly linked to incidents of stress. In the case of those individuals who experience bruxism primarily when they’re asleep, this sleep disorder may not be diagnosed until well after complications arise, making it essential that the signs and symptoms of bruxism be recognized and directly addressed as a means of reducing the level of damage. The causes of bruxism remain unknown. Stress is one important recognized factor in the development of the disorder, but other considerations may also play a part. In very young children, the disorder has a tendency to work itself out as they grow older, thus having little to no effect upon their permanent teeth. “In one study, for example, 126 children between the ages of 6 and 9 years were diagnosed with bruxism. Five years later, upon re-examination, only 17 children retained the bruxing habit. Thus, juvenile bruxism is probably a ‘self-limiting condition which does not progress to adult bruxism and which appears to be unrelated to TMJ symptoms’” (Nissani, 2000b citing Kieser & Groeneveld, 1998). While some drugs may help reduce the symptoms of bruxism, others may actually induce them. According to Dr. Moti Nissani (2000b), several anti-depressants and antipsychotic medications have been shown to have some links with the disorder as have the habits of smoking and drinking alcoholic beverages. Studies have also been conducted to investigate the possibility that bruxism may be caused by specific mineral or nutritional deficits in the individual’s system. Supplements that seemed to have the greatest effect on reducing symptoms included magnesium, calcium and pantothenic acid (Vitamin B5). “Until such claims are confirmed, narrowed down, or refuted in a large scale, double-blind study, the best strategy may involve taking the following on a daily basis: magnesium (approximately 100 mg), calcium (150 mg), and pantothenic acid (50 mg), combined with at least the following: vitamins A (1,000 IU), C (300 mg), E (60 mg), and iodine (0.1 mg=100 mcg)” (Nissani, 2000b). In addition to being a reaction to stress, bruxism may also be an indicator symptom for other problems. Although it is believed about 8 percent of the US population experience bruxism as a sleep disorder, but it seems a disproportionate number of these are Caucasian men. In these cases, it appears that bruxism is an indicator symptom of sleep apnea, another form of sleep disorder in which the individual’s airways become obstructed for a brief amount of time. “The relationship between obstructive sleep apnea and sleep bruxism is usually related to an arousal response … Men typically have more severe sleep apnea, and perhaps may have more arousal responses, which may explain the higher prevalence of teeth grinding in men” (American College of Chest Physicians, 2009). However, it is difficult to determine whether the bruxism is caused by the apnea or by the efforts the individual takes to combat sleepiness during the day as a result of the apnea. Many individuals consume coffee or smoke as a means of attempting to stay awake, but these substances can contribute to bruxism events at night. This can contribute to further loss of sleep both for the individual and for their life partner, which can lead to depression and poor health, further contributing to an increasingly devolving pattern. Thus, bruxism, left untreated, can contribute to a number of issues that can’t fully be overcome without also treating the initial teeth grinding issues. “Bruxism can be both a daytime syndrome as well as a nighttime syndrome, but it is bruxism during sleep, including short naps, that causes the majority of health issues … Studies do suggest that when sleep bruxism is related to OSA (obstructive sleep apnea), certain therapies, including continuous positive airway pressure, may eliminate bruxism during sleep” (American College of Chest Physicians, 2009). In learning to recognize the condition, it is important to note one of the primary symptoms of extreme bruxers is significantly worn down tooth enamel. “Instead of a white enamel cover, one often sees the more yellowish and softer dentin. The back teeth of some chronic bruxers often lose their cusps and natural contours, appearing instead flat, as if they had been worked over with a file or sandpaper” (Nissani, 2000a). This wearing down of the enamel has the obvious consequences of leaving teeth more vulnerable to cavity-causing bacteria requiring greater need for bridges, crowns, root canals, implants, partial dentures and sometimes even full dentures. “In one study, more than 75 percent of observed implant fractures occurred in patients with signs and histories of chronic bruxism. Hence, in cases of untreatable severe bruxism, the use of implants is strongly counterindicated” (Rangert et al, 1995). There are several other visible symptoms of bruxism as well. These include changes in appearance over time, as the teeth become shorter, bringing the chin and the nose closer together, and the overdevelopment of facial muscles, especially those most concerned with chewing. Not as visible are the damages to the joints of the jaw, leading to highly developed TMJ and other conditions. Several treatment options have been proposed to help those with bruxism stop the habit, but few have been proven effective or even advisable. One of the most common approaches is the use of a splint, otherwise known as nightguards, biteguards, occlusal splints, biteplates, removable appliances and interocclusal orthopedic appliances (Pierce et al, 1995). While this treatment has shown some positive results in the few weeks after initial prescription, long term negative effects tend to outweigh the benefits, which decrease over time. One negative effect of this treatment option is the fact that symptoms are not eliminated, rather the device provides a cushion effect to the teeth, evidenced by the fact that the splint device wears down over time in exactly those portions of the mouth where the bruxist tends to grind. Another negative effect of the device is its tendency to trap bacteria beneath its surface, against the already damaged surface of the teeth and accelerating decay. Finally, the use of splints can cause long-term lasting damage to the patient’s bite, leading eventually to an open bite in which the patient remains unable to bring their front teeth together. Although it is often recommended as an immediate stopping action to the present damage, more effective and less harmful treatments must be discovered. Another method of preventing bruxism is the use of sleep feedback. By attaching sensors to the facial muscles most involved in teeth clenching, the sleeper can be awakened by a sound any time their muscles register a predetermined level of tenseness. This works in much the same way that sleep apnea functions on a less conscious level in that the sleeper is awakened when they are doing something wrong. Problems with this treatment option include the patient’s tendency to overcome the wake-up call of the alarm as well as the difficulty all the equipment causes the patient in obtaining the necessary sleep. Like the splints, this treatment tends to lose its effectiveness over time and has the added negative effects of being expensive, intrusive and unpleasant, therefore less likely to be used (Nissani, 2000b). It also tends to add to the stress the patient is feeling at the same time that the patient is getting less sleep than necessary. Thus, the most effective means of addressing bruxism to date remains the practice of stress reducing techniques and eliminating caffeine and other stimulating chemicals from the patient’s diet. There are some pharmaceutical drugs may also help reduce the effects of bruxism. While bruxism is not considered life-threatening in any way, there are some significant health issues that must be addressed in treating a patient with this disorder. In addition to the damage inflicted upon the teeth, the bruxism patient has a higher risk of developing other TMJ disorders and other issues they may or may not associate with their nighttime teeth grinding. For example, morning headaches or sleepiness could be caused not only by the constant pressure exerted but also by the difficulty of gaining a good night’s sleep as the dream state becomes interrupted with activity. While the damage being done can be observed in the form of flattened teeth and a reduction in enamel, the cause of this disorder remains relatively unclear. Several factors may combine to cause the condition, specific drugs may trigger the behavior or deficits in certain nutrients may play a role. This uncertainty makes it difficult to find effective treatment options. A variety of approaches have been tried, ranging from those treatments that target the end-symptom in the form of splints or other devices designed to prevent the patient from being able to grind his/her teeth to those approaches that attempt to target the source, such as drug therapy, stress therapy and mineral supplementation. References American College of Chest Physicians. (November 5, 2009). “Teeth Grinding Linked to Sleep Apnea: Bruxism Prevalent in Caucasians with Sleep Disorders.” Science Daily. Castaneda, R. (1992). “Occlusion.” Temporomandibular Disorders. A.S. Kaplan & L.A. Assael (Eds.). Philadelphia: Saunders, pp. 40-49. Mayo Clinic Staff. (May 19, 2005). “Bruxism/Teeth Grinding.” Sleep. Mayo Clinic Online. February 9, 2010 Nissani, Moti. (2000a). “Symptoms, Signs and Consequences of Bruxism.” Wayne State University. February 9, 2010 Nissani, Moti. (2000b). “When the Splint Fails: Nontraditional Approaches to the Treatment of Bruxism.” Wayne State University. February 9, 2010 Pierce, C.J.; Weyant, R.J.; Block, H.M. & Nemir, D.C. (1995). “Dental Splint Prescription Patterns: A Survey.” Journal of the American Dental Association. Vol. 126, pp. 248-254. Rangert, B., et al. (1995). “Bending Overload and Implant Fracture: A Retrospective Clinical Analysis.” International Journal of Maxillofacial Implants. Vol. 10, pp. 326-334. Read More