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Saturday, August 23, 2025

Bruxism,Teeth grinding


Teeth grinding or jaw clenching

Introduction

Bruxism is a repetitive jaw-muscle activity characterized by clenching, grinding, or gnashing of teeth. It affects both adults and children, with prevalence estimates of 8–15% in adults and up to 30% in children (often resolving spontaneously).

Bruxism is classified into:

  • Awake bruxism: Conscious or semi-conscious clenching, usually related to stress or concentration.

  • Sleep bruxism: Involuntary teeth grinding during sleep, considered a sleep-related movement disorder.

While mild cases may not need treatment, persistent bruxism can cause tooth damage, jaw pain, headaches, and TMJ dysfunction.

Pathophysiology

The exact cause is multifactorial and not fully understood. Proposed mechanisms:

  • Neurological: Hyperactivity of motor pathways regulating chewing muscles.

  • Sleep disturbances: Association with arousals during non-REM sleep.

  • Psychological: Stress, anxiety, personality traits.

  • Medications: Certain antidepressants (SSRIs), stimulants.

  • Dental occlusion: Malocclusion plays a minor role.

Causes and Risk Factors

1. Psychological

  • Stress, anxiety, anger, frustration.

  • Hyperactive personality.

2. Sleep Disorders

  • Sleep apnea, snoring.

  • Periodic limb movement disorder.

3. Medications & Substances

  • SSRIs: Fluoxetine, Sertraline.

  • Stimulants: Amphetamines, methylphenidate.

  • Antipsychotics.

  • Recreational drugs (MDMA, cocaine).

  • Excess caffeine, alcohol, nicotine.

4. Neurological Conditions

  • Parkinson’s disease.

  • Huntington’s disease.

  • Epilepsy.

5. Age & Family History

  • Children: common, often outgrown.

  • Family tendency observed.

Clinical Features

  • Dental: Tooth wear, enamel cracks, tooth sensitivity, broken fillings.

  • Musculoskeletal: Jaw pain, tightness, hypertrophy of masseter muscles.

  • TMJ: Clicking, locking, restricted movement.

  • Headaches: Morning headaches, temple pain.

  • Sleep disturbance: Partner may hear grinding.

  • Complications: Tooth loss, severe TMJ disorders, myofascial pain.

Diagnostic Approach

1. History

  • Ask patient or bed partner about grinding sounds.

  • Daytime habits, stress, caffeine/alcohol intake.

  • Associated symptoms: jaw pain, headaches.

  • Medication history.

2. Examination

  • Worn tooth surfaces.

  • Cracked enamel, broken restorations.

  • Tongue indentations, cheek biting.

  • Enlarged masseter muscles.

  • TMJ tenderness or reduced range.

3. Investigations

  • Polysomnography (sleep study): Gold standard for sleep bruxism, records EMG activity.

  • Dental impressions/X-rays: To assess tooth wear.

  • Psychological assessment: Stress, anxiety, depression screening.

Management and Treatment

There is no single cure, but multiple approaches help control symptoms, protect teeth, and address underlying causes.

A. Non-Pharmacological Treatment

1. Behavioral Interventions

  • Stress management (counseling, cognitive behavioral therapy).

  • Relaxation techniques (deep breathing, meditation, yoga).

  • Habit reversal training: awareness + relaxation of jaw during day.

2. Dental Approaches

  • Occlusal splints (night guards): Custom-fitted plastic appliances worn at night to protect teeth.

  • Mouth guards: Over-the-counter, less effective but cheaper.

  • Occlusal adjustment: Rarely indicated, limited benefit.

3. Physical Therapy

  • Jaw stretching and massage.

  • Heat packs to relax muscles.

  • Physiotherapy for TMJ function.

4. Lifestyle Modification

  • Limit caffeine, alcohol, smoking.

  • Good sleep hygiene.

  • Avoid chewing gum or hard foods.

B. Pharmacological Treatment

No drug is universally effective; medications are used in selected patients.

1. Muscle Relaxants

  • Diazepam 2–5 mg orally at bedtime for short-term use (risk of dependence).

  • Tizanidine 2–4 mg orally at bedtime.

2. Botulinum Toxin (Botox) Injections

  • Injection into masseter and temporalis muscles.

  • Reduces grinding intensity and jaw pain for 3–6 months.

3. Antidepressant Adjustment

  • If bruxism is SSRI-induced, switching to another antidepressant (e.g., from Fluoxetine to Bupropion) may help.

4. Pain Control

  • Paracetamol 500–1000 mg orally every 6–8 h.

  • Ibuprofen 400 mg orally every 8 h for short-term use.

5. Experimental / Refractory Cases

  • Clonazepam 0.5–1 mg at bedtime has shown benefit in sleep bruxism.

  • Gabapentin 300 mg at night, titrated as needed, may reduce muscle activity.

C. Treatment of Underlying Conditions

  • Sleep apnea: CPAP therapy reduces bruxism episodes.

  • Anxiety/depression: SSRIs/SNRIs may worsen bruxism; alternative therapy + CBT useful.

  • Parkinson’s disease: Optimize dopaminergic therapy.

Complications

  • Severe dental wear, tooth fractures, tooth loss.

  • TMJ disorders, jaw dislocation.

  • Facial muscle hypertrophy.

  • Chronic headaches.

  • Sleep disruption for patient/partner.

Prognosis

  • Children: Often outgrow bruxism by adolescence.

  • Adults: Can persist for years but manageable with splints and stress reduction.

  • Severe untreated bruxism → permanent dental and joint damage.

Patient Education

  • Bruxism is common and manageable.

  • Most important: protect teeth with night guards.

  • Reduce stress, caffeine, smoking, alcohol.

  • Inform dentist of symptoms for early intervention.

  • Seek medical care if persistent headaches, jaw locking, or severe tooth damage.



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