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| [[File:Topviewtooth.jpg|right|thumb|View from above of an anterior (front) tooth showing severe tooth wear which has exposed the dentin layer (normally covered by enamel). The pulp chamber is visible through the overlying dentin. Tertiary dentin will have been laid down by the pulp in response to the loss of tooth substance. Multiple fracture lines are also visible.]]
| | == Bruxism == |
| [[File:Gray382.png|thumbnail|right|The left temporalis muscle]]
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| [[File:Gray383.png|thumbnail|right|The left medial pterygoid muscle, and the left lateral pterygoid muscle above it, shown on the medial surface of the mandbilar ramus, which has been partially removed along with a section of the zygomatic arch]]
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| [[File:Gray378 (masseter highlight).png|thumb|right|The left masseter muscle (red highlight), shown partially covered by superficial muscles]]
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| == Introduction ==
| | [[File:Topviewtooth.jpg|right|thumb|View from above of an anterior (front) tooth showing severe [[Tooth wear|tooth wear]] exposing the [[Dentin|dentin]] layer. The [[Dental pulp|pulp chamber]] is visible.]] |
| Bruxism is excessive teeth grinding or jaw clenching, an oral parafunctional activity that is unrelated to normal functions such as eating or talking<!--<ref name="bruxism1">[1]</ref> --> Bruxism is a common behavior, with prevalence rates ranging from 8% to 31% in the general population<!--<ref name="bruxism2">[2]</ref> --> It can lead to several symptoms, including hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations (e.g., crowns and fillings)<!--<ref name="bruxism3">[3]</ref> --> In some cases, symptoms may be minimal, and patients may not be aware of their condition.
| | [[File:Gray382.png|thumbnail|right|The left [[Temporalis muscle|temporalis muscle]]]] |
| | [[File:Gray383.png|thumbnail|right|The left [[Medial pterygoid muscle|medial pterygoid muscle]] and [[Lateral pterygoid muscle|lateral pterygoid muscle]]]] |
| | [[File:Gray378 (masseter highlight).png|thumb|right|The left [[Masseter muscle|masseter muscle]] in red]] |
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| Bruxism can be categorized into two main types: nocturnal bruxism, which occurs during sleep, and awake bruxism, which occurs during wakefulness<!--<ref name="bruxism4">[4]</ref> --> Dental damage may be similar for both types; however, sleep bruxism symptoms are often worse upon waking and improve throughout the day, while awake bruxism symptoms may not be present upon waking and worsen as the day progresses<!--<ref name="bruxism5">[5]</ref> --> The causes of bruxism are not completely understood and likely involve multiple factors<!--<ref name="bruxism4"/><!--<ref name="bruxism5"/>-->. Awake bruxism is more common in females, while sleep bruxism affects males and females in equal proportions<!--<ref name="bruxism5"/>-->. Although several treatments are in use, there is limited evidence for the robust efficacy of any particular treatment<!--<ref name="bruxism6">[6]</ref> --> | | '''Bruxism''' is the excessive grinding of the [[teeth]] or clenching of the [[jaw]], often an unconscious habit. It is classified as a [[parafunctional habit]], meaning it serves no functional purpose such as eating or speaking. Bruxism can occur while awake (awake bruxism) or during sleep (sleep bruxism). |
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| == Signs and symptoms == | | == Types of Bruxism == |
| | Bruxism is typically divided into two categories: |
| | * '''[[Sleep bruxism]]''' – occurs during [[sleep]] and is considered a [[sleep-related movement disorder]]. |
| | * '''Awake bruxism''' – occurs during [[wakefulness]], often in response to stress or anxiety. |
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| Most people who experience bruxism are unaware of the problem, either because there are no symptoms or because the symptoms are not understood to be associated with clenching and grinding<!--<ref name="bruxism7">[7]</ref> --> Sleep bruxism symptoms are usually most intense immediately after waking and slowly abate, while awake bruxism symptoms may not be present upon waking and worsen throughout the day<!--<ref name="bruxism7"/>-->. Bruxism may cause a variety of signs and symptoms, including:
| | == Causes == |
| | The exact causes of bruxism are not fully understood, but several contributing factors may include: |
| | * [[Stress]], [[anxiety]], and emotional disturbances |
| | * [[Malocclusion]] (misalignment of the teeth) |
| | * [[Sleep disorders]] such as [[sleep apnea]] |
| | * Certain [[Medications|medications]] (e.g., some antidepressants) |
| | * [[Neurodevelopmental disorders]] (e.g., [[ADHD]]) |
| | * Substance use (e.g., caffeine, alcohol, tobacco, recreational drugs) |
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| Excessive tooth wear, particularly attrition, which flattens the occlusal (biting) surface, and possibly other types of tooth wear such as abfraction, where notches form around the neck of the teeth at the gumline<!--<ref name="bruxism8">[8]</ref><!--<ref name="bruxism9">[9]</ref> --> | | == Signs and Symptoms == |
| Tooth fractures and repeated failure of dental restorations (fillings, crowns, etc.)<!--<ref name="bruxism3"/><!--<ref name="bruxism10">[10]</ref> --> | | Common signs and symptoms of bruxism include: |
| Hypersensitive teeth (e.g., dental pain when drinking a cold liquid) caused by wearing away the thickness of insulating layers of dentin and enamel around the dental pulp<!--<ref name="bruxism10"/>-->.
| | * Excessive [[tooth wear]], especially attrition on the occlusal (biting) surfaces |
| Inflammation of the periodontal ligament of teeth, which may make them sore to bite on and possibly cause a degree of loosening<!--<ref name="bruxism10"/>-->.
| | * [[Tooth sensitivity]] due to worn enamel and exposed [[dentin]] |
| A grinding or tapping noise during sleep, sometimes detected by a partner or parent. This noise can be surprisingly loud and unpleasant, and can wake a sleeping partner. Noises are rarely associated with awake bruxism<!--<ref name="bruxism10"/>-->.
| | * [[Headaches]], particularly in the [[temporal region]] |
| Other parafunctional activities that may occur together with bruxism, such as cheek biting (which may manifest as morsicatio buccarum and/or linea alba)<!--<ref name
| | * Pain or tenderness in the [[Temporomandibular joint|TMJ]] and [[Muscles of mastication]] |
| alba7"/><!--<ref name="bruxism8"/>, and/or lip biting<!--<ref name="bruxism10"/>-->.
| | * [[Tooth fracture]]s or damage to [[dental restorations]] |
| | * [[Trismus]] (limited mouth opening) |
| | * Audible grinding or clenching sounds during sleep (reported by a partner) |
| | * [[Scalloped tongue]] or [[linea alba]] on the inner cheeks due to cheek biting |
| | * Enlargement (hypertrophy) of the [[masseter muscle]] |
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| A burning sensation on the tongue (glossodynia)<!--<ref name="bruxism10"/>, possibly related to a coexistent "tongue thrusting" parafunctional activity.
| | == Tooth Wear and Damage == |
| Indentations of the teeth in the tongue ("crenated tongue" or "scalloped tongue")<!--<ref name="bruxism8"/>-->.
| | [[Tooth wear]] from bruxism often appears as: |
| Hypertrophy of the muscles of mastication (increase in the size of the muscles that move the jaw), particularly the masseter muscle<!--<ref name="bruxism10"/><!--<ref name="bruxism7"/><!--<ref name="bruxism11">[11]</ref> -->
| | * [[Attrition]] – enamel loss from tooth-to-tooth contact |
| Tenderness, pain, or fatigue of the muscles of mastication<!--<ref name="bruxism10"/>, which may worsen during chewing or other jaw movements<!--<ref name="bruxism7"/>-->.
| | * [[Abfraction]] – wedge-shaped defects at the gumline |
| Trismus (restricted mouth opening)<!--<ref name="bruxism10"/>-->.
| | * Cracks and [[tooth fractures]] |
| Pain or tenderness of the temporomandibular joints<!--<ref name="bruxism10"/>, which may manifest as preauricular pain (in front of the ear) or pain referred to the ear (otalgia)<!--<ref name="bruxism12">[12]</ref> -->
| | * Compromised [[dental crowns]], [[fillings]], and [[veneers]] |
| Clicking of the temporomandibular joints<!--<ref name="bruxism5"/>-->.
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| Headaches, particularly pain in the temples<!--<ref name="bruxism5"/>, caused by muscle pain associated with the temporalis muscle.
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| Bruxism is often detected due to the effects of the process, such as tooth wear and pain, rather than the process itself. The large forces generated during bruxism can have detrimental effects on the components of the masticatory system, including the teeth, the periodontium, and the articulation of the mandible with the skull (the temporomandibular joints)<!--<ref name="bruxism1"/>-->. The muscles of mastication that move the jaw can also be affected, as they are utilized over and above their normal function<!--<ref name="bruxism1"/>-->.
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| == Tooth wear == | | == Diagnosis == |
| | Bruxism is diagnosed based on: |
| | * Clinical examination of tooth wear and jaw muscle tension |
| | * Patient-reported symptoms such as jaw pain or morning headaches |
| | * Observation by a partner (especially for sleep bruxism) |
| | * Use of [[polysomnography]] in complex or uncertain cases |
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| Many publications list tooth wear as a consequence of bruxism, but some report a lack of a positive relationship between tooth wear and bruxism<!--<ref name="bruxism5"/>-->. Tooth wear caused by tooth-to-tooth contact is termed attrition. This is the most common type of tooth wear in bruxism and affects the occlusal surface (the biting surface) of the teeth. The exact location and pattern of attrition depend on how the bruxism occurs, e.g., when the canines and incisors of the opposing arches are moved against each other laterally, by the action of the medial pterygoid muscles, this can lead to the wearing down of the incisal edges of the teeth<!--<ref name="bruxism1"/>-->.
| | == Complications == |
| | | Untreated bruxism can lead to: |
| To grind the front teeth, most people need to posture their mandible forward, unless there is an existing edge-to-edge, class III incisal relationship. People with bruxism may also grind their posterior teeth (back teeth), which wears down the cusps of the occlusal surface. Once tooth wear progresses through the enamel layer, the exposed dentin layer is softer and more vulnerable to wear and tooth decay. If enough of the tooth is worn away or decayed, the tooth will effectively be weakened and may fracture under the increased forces that occur in bruxism<!--<ref name="bruxism1"/>-->.
| | * Damage to teeth and dental restorations |
| | | * [[Temporomandibular joint dysfunction]] |
| == Other effects == | | * [[Periodontal disease]] aggravation |
| | | * [[Myofascial pain syndrome]] |
| In addition to tooth wear, bruxism can lead to other dental issues, such as tooth mobility and damage to dental restorations<!--<ref name="bruxism1"/>-->. Abfraction is another type of tooth wear that is postulated to occur with bruxism, although some still argue whether this type of tooth wear is a reality<!--<ref name="bruxism9"/>-->. Abfraction cavities are said to occur usually on the facial aspect of teeth, in the cervical region as V-shaped defects caused by flexing of the tooth under occlusal forces. It is argued that similar lesions can be caused by long-term forceful toothbrushing. However, the fact that the cavities are V-shaped does not suggest that the damage is caused by toothbrush abrasion, and that some abfraction cavities occur below the level of the gumline, i.e., in an area shielded from toothbrush abrasion, supports the validity of this mechanism of tooth wear<!--<ref name="bruxism1"/>-->.
| | * Sleep disturbances |
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| It is generally accepted that increased occlusal forces are able to increase the rate of progression of pre-existing periodontal disease (gum disease), however, the mainstay treatment is plaque control rather than elaborate occlusal adjustments<!--<ref name="bruxism14"/>-->. It is also generally accepted that periodontal disease is a far more common cause of tooth mobility and pathological tooth migration than any influence of bruxism, although bruxism may much less commonly be involved in both<!--<ref name="bruxism1"/>-->.
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| == Pain ==
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| Most people with bruxism will experience no pain<!--<ref name="bruxism4"/>-->. The presence or degree of pain does not necessarily correlate with the severity of grinding or clenching<!--<ref name="bruxism4"/>-->. The pain in the muscles of mastication caused by bruxism can be likened to muscle pain after exercise<!--<ref name="bruxism4"/>-->. The pain may be felt over the angle of the jaw (masseter) or in the temple (temporalis), and may be described as a headache or an aching jaw. Most (but not all) bruxism includes clenching force provided by the masseter and temporalis muscle groups; but some bruxers clench and grind front teeth only, which involves minimal action of the masseter and temporalis muscles<!--<ref name="bruxism1"/>-->.
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| The temporomandibular joints themselves may also become painful, which is usually felt just in front of the ear or inside the ear itself. Clicking of the jaw joint may also develop. The forces exerted on the teeth are more than the periodontal ligament is biologically designed to handle, and so inflammation may result. A tooth may become sore to bite on, and further, tooth wear may reduce the insulating width of enamel and dentin that protects the pulp of the tooth and result in hypersensitivity, e.g., to cold stimuli<!--<ref name="bruxism1"/>-->.
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| The relationship between bruxism and temporomandibular joint dysfunction (TMD, or temporomandibular pain dysfunction syndrome) is debated. Many suggest that sleep bruxism can be a causative or contributory factor to pain symptoms in TMD<!--<ref name="bruxism3"/><!--<ref name="bruxism5"/><!--<ref name="bruxism7"/><!--<ref name="bruxism15"/>-->. Indeed, the symptoms of TMD overlap with those of bruxism<!--<ref name="bruxism16"/>-->. Others suggest that there is no strong association between TMD and bruxism<!--<ref name="bruxism4"/>-->. A systematic review investigating the possible relationship concluded that when self-reported bruxism is used to diagnose bruxism, there is a positive association with TMD pain, and when stricter diagnostic criteria for bruxism are used, the association with TMD symptoms is much lower<!--<ref name="bruxism17"/>-->. In severe, chronic cases, bruxism can lead to myofascial pain and arthritis of the temporomandibular joints<!--<ref name="citation_needed">[medical citation needed]</ref> -->
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| == Treatment == | | == Treatment == |
| | While there is no single cure, treatments focus on symptom management and preventing further damage. |
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| Several treatments are in use for bruxism, although there is little evidence of robust efficacy for any particular treatment<!--<ref name="bruxism6"/>-->. The main goal of treatment is to manage symptoms, reduce damage to teeth and dental restorations, and improve sleep quality. Treatment options include:
| | === Dental Interventions === |
| | | * '''[[Occlusal splints]]''' (night guards): Custom devices that protect teeth from grinding forces. |
| === Dental treatments === | | * '''Occlusal adjustment''': Selective reshaping of tooth surfaces to balance the bite (used cautiously). |
| | | * '''Restorative dentistry''': Repairing damaged teeth with crowns or other restorations. |
| '''Occlusal splints:''' These are custom-made, removable devices that fit over the teeth and help protect them from damage caused by grinding or clenching<!--<ref name="bruxism1"/>-->. They may also help reduce muscle strain and temporomandibular joint pain. The splints can be made from hard or soft materials and are generally worn at night. | |
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| '''Occlusal adjustment:''' In some cases, selective reshaping of the biting surfaces of the teeth (also known as occlusal equilibration) may be necessary to achieve a more harmonious bite<!--<ref name="bruxism1"/>-->. However, this treatment is considered controversial and should be used cautiously, as the benefits are not well-established. | |
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| === Behavior modification ===
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| '''Stress management:''' Since stress and anxiety can contribute to bruxism, various stress-reduction techniques may help alleviate the condition<!--<ref name="bruxism4"/>-->. These can include relaxation techniques, meditation, or counseling.
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| '''Sleep hygiene:''' Improving sleep habits, such as maintaining a consistent sleep schedule, creating a comfortable and quiet sleep environment, and avoiding stimulating activities before bedtime, may help reduce bruxism<!--<ref name="bruxism1"/>-->. | |
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| '''Habit awareness:''' Becoming more aware of the habit and using strategies to break it, such as placing a reminder on the bathroom mirror or setting an alarm on a smartphone, can help reduce daytime clenching and grinding<!--<ref name="bruxism1"/>-->. | | === Behavioral Therapy === |
| | * '''[[Stress management]]''' techniques such as [[biofeedback]], [[cognitive behavioral therapy]] (CBT), [[meditation]], and [[relaxation therapy]] |
| | * '''[[Sleep hygiene]]''' improvements to reduce nighttime grinding |
| | * '''Awareness training''' to reduce daytime clenching |
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| === Medications === | | === Medications === |
| | * '''[[Muscle relaxants]]''' before bedtime (short-term use) |
| | * '''[[Anxiolytics]]''' (for stress-related bruxism) |
| | * '''Adjustment of antidepressants''' if they contribute to bruxism |
| | * '''[[Botulinum toxin]] (Botox)''' injections in severe cases to reduce muscle activity |
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| Although there is no specific medication for bruxism, certain medications may help manage symptoms or address underlying causes<!--<ref name="bruxism1"/>:
| | == Prognosis == |
| | | The prognosis varies. Many individuals experience improvement with stress management and dental protection. In children, sleep bruxism often resolves without treatment. |
| '''Muscle relaxants:''' Short-term use of muscle relaxants before bedtime may help reduce muscle tension and decrease grinding and clenching.
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| '''Anxiolytics:''' Anti-anxiety medications, such as benzodiazepines, may help alleviate bruxism if anxiety is a contributing factor. However, these medications can have side effects and may not be suitable for long-term use.
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| '''Antidepressants:''' In some cases, adjusting the dose or changing the type of antidepressant medication may help reduce bruxism if it is a side effect of the medication<!--<ref name="bruxism1"/>-->.
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| '''Botulinum toxin:''' Injections of botulinum toxin (Botox) into the masseter and temporalis muscles have been used to reduce muscle activity and alleviate bruxism symptoms in some cases<!--<ref name="bruxism18"/>-->. However, more research is needed to determine the safety and efficacy of this treatment.
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| == Conclusion == | |
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| Bruxism is a common condition that can cause tooth wear, pain, and sleep disturbances. Although the exact causes of bruxism are not fully understood, it is thought to involve a combination of genetic, psychological, and environmental factors. Treatment options include dental interventions, behavior modification, and medications, but there is no one-size-fits-all solution. It is important for individuals who suspect they have bruxism to consult with a dental professional to discuss their symptoms and develop a personalized treatment plan to manage the condition effectively.
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| == See also == | | == See also == |
| | | * [[Temporomandibular joint dysfunction]] |
| | * [[Tooth wear]] |
| | * [[Sleep disorders]] |
| | * [[Occlusal trauma]] |
| * [[Dentistry]] | | * [[Dentistry]] |
| * [[Temporomandibular joint dysfunction]] | | * [[Muscles of mastication]] |
| * [[Sleep hygiene]]
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| [[Category:Health]]
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| [[Category:Dentistry]]
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| {{stub}}
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| {{SleepSeries2}} | | {{SleepSeries2}} |
| {{Mental and behavioral disorders|selected = physical}} | | {{Mental and behavioral disorders|selected = physical}} |
| | [[Category:Dentistry]] |
| [[Category:Sleep disorders]] | | [[Category:Sleep disorders]] |
| [[Category:Pathology of temporomandibular joints, muscles of mastication and associated structures]] | | [[Category:Orofacial pain]] |
| | [[Category:Temporomandibular joint disorders]] |
| | [[Category:Parafunctional habits]] |
| | [[Category:Tooth disorders]] |
| | [[Category:Pathology of temporomandibular joint]] |
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