Sandbox:remotework

Bruxism

Bruxism is defined as repeated involuntary grinding and clenching of teeth which can occur either diurnal or nocturnally.

Historical Perspective

• In 1907 Marie Pielkiewics coined a french term 'La Bruxomanie" for bruxism. (https://pubmed.ncbi.nlm.nih.gov/21886404/)
• In 1931, Frohman first coined the term english term bruxism.

Classification

Bruxism can be classified into awake bruxism and sleep bruxism based on the physiological sleep status of the individual.

Awake Bruxism/Diurnal Bruxism	Sleep Bruxism/Nocturnal Bruxism
Day Time /Awake	Sleep
Semi-Voluntary	Sterotyped
Clenching predominant	Teeth grinding

Definitions
American Academy of Orofacial Pain (2008)	Diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth. I
The Academy of Prosthodontics (2005)	1. The parafunctional grinding of teeth. 2. An oral habit consisting of involuntary rhythmic or spasmodic non-functional gnashing, grinding or clenching of teeth, in other than chewing movements of the mandible, which may lead to occlusal trauma – called also tooth grinding, occlusal neurosis
The International Classification of Sleep Disorders (2005)	Sleep-related bruxism is an oral activity characterized by grinding or clenching of the teeth during sleep, usually associated with sleep arousals.

Causes

Etiology of bruxism can be categorized into three groups psychosocial factors, peripheral factors and pathophysiological factors.

Etiology of Bruxism
Psychological	Common psychological factors responsible for bruxism include Stress induced bruxism Depression associated bruxism Anxiety related bruxism
Peripheral	Caffine intake Smoking Alcohol consumption
Pathological	Problem with arousal mechanism during sleep Imbalance in the dopamine release in the basal ganglion

Treatment

Medical Therapy

• Removal of any offending agent responsible for bruxism is primary step in the management.
• Wait-and-see approach is recommended in cases with medical induced bruxism, as spontaneous remission is ensured with the cessation of the offending agent.
• Pharmacotherapy mainly concentrated to alleviate symptoms
• Buspirone and Gabapentin are the two recommended medications to manage bruxism
  • Preferred regimen 1 : Buspirone 15 to 20 mg/day PO q12.
  • Preferred regimen 2: Gabapentin 100 to 300 mg PO q24

Surgery

Surgery is the main stay of treatment in the management of bruxism