Bruxism: Etiology, diagnosis and Management

Volume 2 Issue 11 November, 2012

Consultation Liaison Psychiatry Focus: Dentistry

Bruxism has been a much discoursed and debated over topic for dentists, psychiatrist and neurologist likewise. Even today, after decades of research, bruxism still remains a subject in need of more concrete representation. It is a tedious task to study and document facts relating to bruxism because most patients are unaware that they brux unless the problem has reached a point of serious consequences. But it is considered as common, affecting 8% of population, in children it is more common affecting 14%‐20%.of them.

Bruxism is a diurnal or nocturnal para‐functional activity that includes grinding, gnashing, or clenching of the teeth. Sleep bruxism has been classified under parasomnia. It takes place in the absence of subjective consciousness. Various theories regarding the etiology of bruxism have been reported and they fall into the following categories: dental occlusion related, psychological and originating within the central nervous system. Certain medical conditions can also trigger bruxism like digestive ailments, allergic reactions and sleep disorders People whose lifestyle includes use of tobacco and amphetamine like stimulants are at a higher risk. The dentist is usually the one to diagnose bruxism when the patient presents for a routine dental check‐up. Patients may present with a variety of symptoms like headache, mobile teeth, insomnia, stress and depression. The presence of tooth wear, gingival recession, fractures of posterior teeth cusps and dental restorations are indicative of bruxism. Abnormal muscle activity can be monitored by electromyography and at home bite‐strips

The first line of treatment is to address the possible causes also includes lifestyle and behavior modifications. The patient can be referred to psychiatrist for opinion, where he can be evaluated, appropriate therapy can be considered and or medications. Placing a resin or an occlusal splint intra‐orally after occlusion adjustments is the most predictable and effective method to prevent tooth wear and bruxism. It is custom fabricated by the dentist and should be worn, monitored and replaced on a timely basis. Some patients with severe bruxism require complete oral rehabilitation with porcelain, ceramic or fibre re‐inforced polymer crowns and fixed prosthesis followed by post‐operative occlusal splints. A recent innovation is the professionally administered Botulinum Toxin injections which reduces the nocturnal bruxing events by decreasing muscle activity. Failure to diagnose and treat bruxism in its early stages might lead to increase in the severity of the problem eventually resulting in myofacial pain dysfunction syndrome (MPDS) and temporomandibular joint disorder (TMD). So, it is a need of the hour for an interdisciplinary approach in combating bruxism which would benefit the patient in avoiding its distressing sequelae.

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