Sleep Bruxism A to Z PDF

Sleep Medicine “SLEEP BRUXISM A to Z” Definition or Sleep Bruxism “gnashing of teeth” It matters who you ask o First definition not for dentists o Requires Polysomnogram o Defined bruxism in conjunction w other sleep disorders not as a stand-alone o A repetitive jaw-muscle activity characterized by...

Sleep Medicine “SLEEP BRUXISM A to Z” Definition or Sleep Bruxism “gnashing of teeth” It matters who you ask o First definition not for dentists o Requires Polysomnogram o Defined bruxism in conjunction w other sleep disorders not as a stand-alone o A repetitive jaw-muscle activity characterized by clenching, grinding of teeth, and bracing/thrusting of mandible o 2 circadian manifestations: § Sleep bruxism § Awake bruxism o Sleep bruxism is a masticatory muscle activity that can be rhythmic/phasic (grinding), or non-rhythmic/tonic (clenching) § Diagnosed w audio/video polysomnogram § No difference btwn sexes, decreases w age § Can occur in all sleep stages, most common in minutes leading to REM § 80% of episodes seen in a cyclic pattern Etiology of SB No single etiology Multiple influences Autonomic nervous system, brain arousals (when changing sleep stages, when we struggle to breath/apnea) Damage Done to the Dentition, Dental Restorations and Implants by SB Occlusal trauma o Erosion from acid pitting o Abfraction o Bruxing creates sharp edges Tooth wear o Attrition o Abrasion o Erosion Tooth cracks and fractures Damage to implants When does sleep bruxism lead to mechanical damage? 4 factors: o Inaccurate diagnosis based only on pt self reporting/clinical signs is NOT accurate § Definite diagnosis requires proper testing (audio, video, polysomnogram to eval muscle movement) o Variability of symptoms over time o All bruxers are different o Difficulty identifying failure factors § Materials can but usually don’t spontaneously fracture and breakoff § Tends to happen to long-standing restorations w recent load § Spontaneous break during physiologic function seen more often Bruxism can cause teeth to loosen but NO ATTACHMENT LOSS unless pt has perio involvement Physiologic Mechanisms Associated with SB RMMA à “rhythmic masticatory muscle activity” o Caused by nighttime arousals o Age dependent o Linked to apnea, hypopnea more freq in non-rem Phasic Tonic Mixed Microarousals Causes of Sleep Bruxism Primary/ idiopathic bruxism has no comorbidities Secondary is assc with a comorbid dz SB as a Comorbid condition of other Sleep Disorders is SECONDARY SB o SB and OSA § May help by subconsciously protruding mandible, helping airway patency § Front teeth will be worn § Tx of OSA may decrease microarousal freq, reduce bruxing o SB and Insomnia § Insomnia à Must happen 3x a week for 3mo § Bruxers have harder time initiating sleep, staying asleep, more daytime sleepiness o SB and RBD (REM behavioral disorder) § Parasomnia of abnormal paramotor behaviors during REM § Can be assc w neurodegenerative issues like dementia, parkinsons — Common preceding element for these neuro dzs (90%) § There should be no bruxing during REM o SB and Sleep-Related Gerd § Gerd may be assc w OSA as well — Neg pressure can pull acid from stomach into esophagus and mouth when closed-airway breathing § Barrett’s esophagus from Gerd can lead to esophageal cancer Standard of care for comorbid sleep bruxism is interprofessional, NOT monodisciplinary Psychosocial Factors in Sleep (and Awake) Bruxism Awake bruxism = overuse behavior, muscles are used for a Physical, emotional, social, spiritual health issues functionless motion o Key words to listen for: § Family problems Ex. Gum chewing § Depression § Anxiety § Substance abuse No curative therapy for § Sexual abuse sleep bruxism exists § Violence Psychosocial Factors related to SB o Etiology of bruxism is mainly regulated centrally through neural and psychologic factors (rather than occlusion) o Comorbid factors: § Hypnogogic hallucinations § Sleep talking § REM behavior disorders § Depression, anxiety disorders § Etc o More stress hormones Psychosocial Factors related to WOP (Waking Oral Parafunction) o Different from night bruxing o Characterized by repetitive and sustained activities that serve no goal o Includes: § Tooth contact behaviors (clenching/grinding) § Bracing/thrusting of mandible w no tooth contact § Excursive positioning of mandible § Gum chewing § Object biting § Tongue pushing on teeth o Considered to have damaging effects on teeth, TMJ, jaws w repetitive trauma to masticatory muscles due to overuse o Increased WOP assc w psychologic status and stress § Like waking tooth clenching à anxiety, depression § Inc risk of substance use/abuse o Bruxism is strong indicator of WOP o Anxiety and TMD pain have direct correlation (TMD reduction can reduce anxiety) § Anxiety, TMD, and WOP all go hand-in-hand Genetic Factors in SB o Can be inherited Clinical Approaches to Diagnosis of SB Probable vs Definite Diagnosis o Probable = mix of pts self report, clinical exam (not very accurate) o Definite = comes with polysomnogram w audio, video (gold standard) Questionnaires o Self-reports o Under and overestimation is common by pt Clinical Examinations o Based on tooth wear, restoration failure, mobility, pain/muscles fatigue and hypertrophy, etc o Tooth wear most common § Irreversible cumulative consequence Intraoral Devices and Recording Systems o Intraoral devices § Based on observation of wear facets, occlusal force o Recording systems § Polysomnogram § Portable Polysomnogram § Portable limited-channel device using four to seven channels (limited interp) § Portable limited-channel device using one or two channels (limited interp) Behavioral, Dental, Pharmacologic Management of SB (NO RECORDING PAST HERE) Behavioral treatment Dental Interventions Pharmacologic Therapy Alternate approaches to Managing SB Closing thoughts and recommendations