Bruxism

Fred F. Ferri, M.D.

Basic Information

Definition

Forcible clenching or grinding of the teeth during sleep or wakefulness, often leading to damage of the teeth.

ICD-10CM CODES
G47.63	Sleep related bruxism
F45.8	Other somatoform disorders

Epidemiology & Demographics

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Occurs in 15% of children and 75% of adults
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Familial cases have occasionally been described.
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Bruxism often presents between age 10 and 20 yr but may persist throughout life.
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Nocturnal bruxism is noted most often during stages I and II NREM sleep and REM sleep.

Physical Findings & Clinical Presentation

Complaints of grinding of teeth from a sleep partner or members of the family are common. In many cases the masticatory system will adapt to the phenomenon, but in severe cases nearly every part of the masticatory system may be damaged. Excessive wearing of dentition is the most common physical finding (Fig. E1). Tender or hypoatrophied masticatory muscles may also be observed.

FIG.E1

Example of sleep-related grinding damage. A, Frontal view. B, Occlusal view on the lower jaw.

From Kryger M, Roth T, Dement WC: *Principles and practice of sleep medicine*, ed 6, Philadelphia, 2017, Elsevier.

Etiology

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Cause is controversial. Fig. E2 illustrates the cascade of physiologic events in the genesis of sleep bruxism and rhythmic masticatory muscle activity and course of action for management.

FIG.E2

Cascade of physiologic events in genesis of sleep bruxism and rhythmic masticatory muscle activity (left) and courses of action for management (right).

From Lavigne G, et al.: Sleep bruxism. In Kryger MH, Roth T, Dement WC, [eds]: Principles and practice of sleep medicine, ed 5, Philadelphia, 2011, Elsevier, pp. 1128–1139.
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Possible causes include occlusal discrepancies, anatomy of the bony structures of the orofacial region, part of the sleep arousal response, disturbances of the central dopaminergic system, smoking, alcohol, drugs, stress, and personality.

Diagnosis

Differential Diagnosis

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Dental compression syndrome
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Temporomandibular joint disorders
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Chronic orofacial pain disorders
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Oral motor disorders
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Malocclusion

Workup

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History should have an emphasis on sleep habits, including excessive snoring, pain in the temporal mandibular region, interview with close family members, health habits, personality quirks.
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Physical examination of the teeth and masticatory muscles is mandatory.
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Sleep studies in selected cases may be helpful.

Laboratory Tests

None indicated unless a systemic disease is suspected (e.g., infection, autoimmune disorder)

Imaging Studies

X-ray studies of teeth and temporomandibular joints

Treatment

Nonpharmacologic Therapy

Biofeedback, psychological counseling, and elimination of harmful health habits have been used with limited success.

General Rx

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Oral splints (Fig. E3); night guard to protect teeth may be useful

FIG.E3

A, Example of a hard occlusal stabilization appliance, indicated for the management of sleep bruxism and commonly used to assess the presence and progression of the condition based on wear patterns on the occlusal surface. B, In situ on the upper jaw.

From Kryger M, Roth T, Dement WC: Principles and practice of sleep medicine, ed 6, Philadelphia, 2017, Elsevier.
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Correction of malocclusion
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Pain management (e.g., gabapentin, ibuprofen)
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Medication to relieve anxiety and improve sleep (e.g., benzodiazepine or trazodone at bedtime)
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Local injections of botulinum toxin into masseter muscles to prevent dental and temporomandibular joint complications

Disposition

Referral to dentist mandatory if damage to teeth evident

Pearls & Considerations

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Like any poorly understood disease, treatment is often unsatisfactory and subject to quackery.
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Both diurnal and nocturnal bruxism may be associated with various movement and degenerative disorders (e.g., Huntington disease, oromandibular dystonia) and are quite common in children with cerebral palsy and mental retardation.

Ferri – Bruxism