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  • Updated 08.02.2022
  • Released 07.20.1994
  • Expires For CME 08.02.2025

Sleep bruxism

Introduction

Overview

Sleep bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth or bracing or thrusting of the mandible. Sleep medicine defines bruxism as a sleep-related movement disorder characterized by repetitive movements and transient arousals during sleep. In dentistry, the current international consensus definition establishes that sleep bruxism is a behavior. A sequential shift in brain cortical and autonomic activities precedes sleep bruxism, suggesting that the central and autonomic nervous systems, rather than the peripheral system, play a dominant role in sleep bruxism onset. Polysomnography and electromyography are used to diagnose definite bruxism associated with the clinical signs of the stomatognathic system and the patient's self-report. Sleep bruxism can have consequences, such as tooth wear, fractures of restorations, temporomandibular disorders, headaches, and orofacial pain. Among associated factors that can be cited are psychological factors (eg, stress, personality traits, and anxiety), sleep-related breathing disorders, temporomandibular disorders, genetic factors, encephalopathies, and the use of medications and addictive substances. Treatment is palliative and multidisciplinary, including oral appliances, behavioral therapies, and medications.

Key points

• Sleep bruxism is a behavior mainly regulated by the central nervous center and associated with rhythmic activity of the masticatory muscles.

• Polysomnography and EMG are used to diagnose definite sleep bruxism associated with the clinical signs of the stomatognathic system and the patient's self-report.

• Sleep bruxism is often reported by bed partners due to teeth noises; self-report has a substantial false-negative rate.

• Snoring, sleeptalking, and nightmares are factors associated with sleep bruxism.

• Treatment is palliative and multidisciplinary and involves oral appliances, behavioral therapies, and medications.

Historical note and terminology

The allusion to grinding and clenching of teeth comes from ancient times, where they are mentioned in the Bible in gospels such as Luke 13:28, Matthew 13:41-2, Matthew 8:12, Matthew 13:50, Matthew 22:13, and Matthew 24:51. In 1938, Miller introduced the term bruxism for bruxomania or repetitive teeth grinding (66). One of the first recorded notations of this phenomenon was from Black, who commented that abrasion of the teeth tends to remove the cusps quite rapidly (13). In 1941, Bodecker described a patient whose bruxism had destroyed the clinical crowns of all the lower anterior teeth (14).

In 2013, an international expert consensus examined several definitions of bruxism from sleep medicine and dental organizations and defined bruxism as a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth or bracing or thrusting of the mandible. Bracing means forcefully maintaining a mandibular position, and thrusting means moving the jaw forward or laterally. These activities do not necessarily require tooth contact. According to its circadian phenotype, bruxism is classified as sleep bruxism or awake bruxism (51).

In the international consensus, experts defined bruxism as a behavior (52). According to the grading system, bruxism has three classifications: possible, probable, and definite. Possible sleep/awake bruxism is based on a positive self-report. Probable sleep/awake bruxism is based on a positive clinical inspection, with or without a positive self-report. Definite sleep/awake bruxism is based on a positive instrumental assessment, with or without a positive self-report or a positive clinical inspection. Sleep and awake bruxism appear to be distinct behaviors with different underlying causes and require a different management approach (52).

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