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==Pathophysiology==
==Pathophysiology==


== Differential Diagnosis ==
==Differential Diagnosis==
Other – A range of  can sometimes be confused with bruxism, including facial myoclonus, chewing-like movements, swallowing, sleep talking, expiratory groaning (catathrenia), other parasomnias, and rarely, nocturnal seizures [62,65-71].
<br />
 
Description of the movements and sounds by a bed partner or parent is often sufficient to distinguish these alternative diagnoses from bruxism, as the tooth grinding noises associated with sleep-related bruxism are remarkably loud and distinct, whereas tooth grinding noises are not a feature of the other orofacial movements. (See "Approach to abnormal movements and behaviors during sleep".)
 
Ictal bruxism has been reported rarely in association with temporal lobe seizures [71,72]. In such cases, additional clues that tooth grinding is not simple sleep-related bruxism are typically present, including other more classical symptoms of temporal lobe seizures (eg, rising epigastric sensation, déjà vu, altered awareness), and occurrence of events during both day and night. (See "Localization-related (focal) epilepsy: Causes and clinical features".)
 
●Other causes of tooth wear – The differential diagnosis of tooth wear is broad, and it can be difficult if not impossible for a dental clinician to distinguish bruxism-related tooth wear from other causes of tooth wear by examination alone. Distinguishing active versus chronic or static tooth wear is also difficult.
 
Patients should be asked about risk factors for other causes of tooth wear, including chemical erosion related to dietary factors (eg, soft drinks), gastroesophageal reflux, bulimia nervosa, or xerostomia; abrasion (wear caused by chewing abrasive substances); normal age-related tooth wear; and wakeful bruxism.
 
●Other causes of jaw pain and fatigue – Although the presence of morning pain or fatigue in the jaw muscles, teeth, and temples is part of the diagnostic criteria for sleep-related bruxism [1], these symptoms alone are not sufficient for diagnosis. In fact, some evidence suggests that patients with frequent sleep-related bruxism may be less prone to present with complaints of jaw muscle pain and fatigue compared with individuals without sleep-related bruxism. (See 'Symptoms and signs' above.)
 
Alternative causes of jaw muscle pain and fatigue, including temporomandibular disorders, can usually be differentiated from sleep-related bruxism based upon the absence of self-reported tooth grinding noises, absence of tooth wear, and negative findings on polysomnography. The clinical features and diagnosis of temporomandibular joint disorders are reviewed in detail separately. (See "Temporomandibular disorders in adults".)
{| class="wikitable"
{| class="wikitable"
|+
|+
! colspan="3" |
! colspan="3" |
|-
|-
| rowspan="2" |'''Orofacial movements'''  
| rowspan="2" |'''Orofacial movements'''
|Bruxism
|Bruxism
|Loud noticeable teeth grinding noise during sleep
|Loud noticeable teeth grinding noise during sleep
|-
|-
|Pathological orofacial movements  
|Pathological orofacial movements  


* Facial myoclonus
*Facial myoclonus
* Chewing-like movements
*Chewing-like movements
* Swallowing  
*Swallowing
* Sleep talking
*Sleep talking
* Expiratory groaning
*Expiratory groaning
|
|
|-
|-

Revision as of 02:15, 20 January 2021

Bruxism

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

Historical Perspective

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

Pathophysiology

Differential Diagnosis


Orofacial movements Bruxism Loud noticeable teeth grinding noise during sleep
Pathological orofacial movements
  • Facial myoclonus
  • Chewing-like movements
  • Swallowing
  • Sleep talking
  • Expiratory groaning
Tooth wear
Jaw pain and fatigue

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

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