What is Bruxism?
Bruxism is an oral motor condition that has raised interest in dental, sleep, and neurological research[1]; it is a repetitive masticatory muscle activity that is characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible[2]. Normally, the jaws rest harmoniously facilitating actions like talking, chewing, and swallowing. However, some individuals exert excessive pressure on their teeth without conscious control, leading to potential long-lasting harm.
What is the difference between normal clenching and bruxism?
During clenching, the teeth remain in constant contact with each other without any motion or movement. In contrast, bruxism is characterized by the repetitive and continuous movement of the jaw in a lateral motion with the teeth tightly clenched.
What are the types of bruxism?
Wakeful or diurnal bruxism refers to the occurrence of bruxism while awake, whereas nocturnal bruxism occurs during sleep. Awake bruxism is usually seen as a jaw-clenching habit that appears in response to stress and anxiety, while sleep bruxism represents a sleep-related rhythmic masticatory activity generally associated with arousal[3]. The act of teeth grinding during the night generally leads to greater damage compared to grinding during the day, primarily due to the unconscious nature of the behavior as the individual has no control over that action. Sometimes individuals may be completely unaware that they are experiencing bruxism until someone brings it to their attention. Both awake and sleep bruxism are sub-classified into either primary, not related to any other medical condition, or secondary, associated with neurological disorders or considered an adverse effect of drugs[4].
What are the symptoms of bruxism?
- Hypersensitive teeth to heat and cold, due to the wear of protective enamel.
- Headache and facial pain due to the temporalis muscle contraction.
- Flattened, abraded, and worn tooth surfaces leaving the dentine layer exposed.
- Chipping or fracture of teeth and dental restorations.
- Soreness and pain in the temporomandibular joint, accompanied by clicking and popping sounds upon the opening or closing of mouth. If left untreated, this may lead to limited mouth opening.
- Stiffness of the neck and shoulders sometimes accompanied by an earache.
- Implants failure.
How can bruxism be treated?
The main goal of treatment is to identify the root causes of bruxism, alter the behaviors that lead to it, and rectify the damage caused by bruxism. At the present moment, there is no treatment that effectively and permanently eliminates the bruxing habit[5]. However, possible treatments for bruxism are:
1. Intraoral devices: Occlusal splints commonly known as night guards are custom-made appliances covering the occlusal surface of all teeth, they have been considered the first line of management for preventing dental grinding noise and tooth wear in case of sleep bruxism[6]. Splints are reversible interventions[7]; they are classified into hard splints and soft splints. Hard splints are preferred over soft splints because soft splints are difficult to adjust and hard splints are effective in reducing the bruxism activity[8].
2. Psychotherapy: Psychoanalysis, hypnosis, meditation, sleep, hygiene measures with relaxation techniques and self-monitoring have been considered for the treatment of bruxism. The treatment of sleep bruxism usually begins with counseling the patient with respect to sleep hygiene. It includes instructing the bruxer to stop smoking and drinking coffee or alcohol at night, to limit physical or mental activity before going to bed, and to ensure good bedroom conditions like quiet and dark[9]. Psychological therapies do not present contraindications or sequential effects; these psychological complications can decrease anxiety and muscular hyperactivity characteristic of bruxomania episodes[10].
3. Physical therapy: Treatment with physical therapy consists of performing exercises of the masticatory muscles and they should be performed without exerting excessive intensity since this can generate micro trauma to the muscle fibers[11].
4. Medication: Pharmacological treatments include various drugs such as benzodiazepines, anticonvulsants, beta-blockers, dopamine agents, antidepressants, muscular relaxants, and others, patients with severe bruxism have been administered local injections of botulinum toxin[12]. Although their use must be restricted to no recurrent situations, such as the start of treatment or periods of exacerbation due to a rise in emotional tension, and always as part of a comprehensive, interdisciplinary approach[13]. In addition, Botox injections over a period of 20 weeks showed a decrease in bruxism activity[14].
5. The patient’s cooperation in observation of the habit during wakefulness and the patient’s engagement in the self-management of the habit through self-relaxation measures are very important elements for helping to reduce the frequency and intensity of masticatory muscle activity during wakefulness, which favors muscle relaxation and the reduction of bruxing episodes during sleep[15].
Can individuals with bruxism undergo orthodontic treatment with clear aligners?
Despite not being specifically designed for bruxism treatment, aligners can still play a crucial role in preventing teeth grinding. Firstly, clear aligners act as a protective barrier, similar to a night guard, preventing the teeth from grinding against each other. Unlike traditional night guards, clear aligners are thin and do not cause discomfort, even during prolonged wear. Additionally, by aligning the teeth properly, the occurrence of grinding or clenching is reduced. This proper alignment allows the jaw to close more comfortably minimizing stress on the teeth and jaw muscles. Lastly, clear aligners can potentially serve as a habit breaker, as the patient is constantly reminded to stop whenever they feel something new in their mouth. It is worth noting that in extreme cases, severe tooth grinders may damage their aligners due to constant grinding, although this is a rare occurrence.
[1] Guaita and Högl, “Current Treatments of Bruxism.”
[2] Lobbezoo et al., “International Consensus on the Assessment of Bruxism.”
[3] Guaita and Högl, “Current Treatments of Bruxism.”
[4] Guaita and Högl.
[5] De La Hoz-Aizpurua et al., “Sleep Bruxism. Conceptual Review and Update.”
[6] Kanathila et al., “Diagnosis and Treatment of Bruxism: Concepts from Past to Present.”
[7] Macedo et al., “Occlusal Splints for Treating Sleep Bruxism (Tooth Grinding).”
[8] Kanathila et al., “Diagnosis and Treatment of Bruxism: Concepts from Past to Present.”
[9] Kanathila et al.
[10] Luis Gabriel et al., “Bruxism Management.”
[11] Luis Gabriel et al.
[12] Macedo et al., “Occlusal Splints for Treating Sleep Bruxism (Tooth Grinding).”
[13] De La Hoz-Aizpurua et al., “Sleep Bruxism. Conceptual Review and Update.”
[14] Kanathila et al., “Diagnosis and Treatment of Bruxism: Concepts from Past to Present.”
[15] De La Hoz-Aizpurua et al., “Sleep Bruxism. Conceptual Review and Update.”