Habitual grinding of teeth for other than the purpose of chewing is referred to as bruxism. It is a very common condition that has two variations – day time bruxism and nighttime (nocturnal) bruxism. Day time bruxism refers to the conscious grinding of teeth during the day. It can be associated with other habits such as chewing nails, pencils or lips. The nocturnal type occurs subconsciously at night when a person is asleep. Over time, bruxism can cause erosion of the teeth, increase the chance of cavities and even lead to problems with the temporomandibular joint (TMJ).
The severity of symptoms depends upon the frequency and intensity of grinding. The patient exhibits typical grinding sounds during sleep. The grinding is at its peak when a person shifts from deep to light sleep.
Bruxism affects the tooth structure as well as the muscles of mastication. The cusps of molar and canine teeth become flat due to wearing down. The grinding surfaces of the teeth show soccer shaped depression referred to as occlusal facets. Tooth restorations can fracture due to abnormal forces during grinding.
The teeth under trauma faces periodontal problems such as gingivitis, periodontitis and bone loss. The teeth involved eventually become mobile. Soft tissue ulcers may also be present. Due to constant clenching, the muscles involved in mastication get affected. The muscles may become enlarged and tender. The muscles are usually painful during early morning.
Temporomandibular joint problems are often seen in cases of bruxism. A clicking sound may be heard on opening the jaws and there may also be a deviation of the lower jaw. Tenderness over the joint is common. Headaches are also commonly associated with bruxism usually from TMJ problems or spasm of muscles of mastication.
Bruxism usually begins at the mixed dentition period (6 to 13years of age) and may persist into adulthood.
Day time bruxism occurs in individuals with central nervous system problems, such as children with cerebral palsy and mental retardation. The causes of nocturnal bruxism vary from dental or skeletal anomalies to deep rooted psychological issues.The dental causes include irregular teeth and improper dental restorations.
Erupting permanent teeth or third molars usually initiate bruxism. Psychological problems causing bruxism are anxiety and psychological stress. The condition is prominent in people with stressful jobs, who have a history of anxiety and in sports persons. Magnesium deficiency and allergies are also associated with bruxism.
Correction of dental problems is the first step in treating bruxism. Faulty restorations are corrected and coronoplasty is carried out on worn out tooth surfaces. Orthodontic treatment is implemented. Mouth guards and Vulcanite splints are used to avoid grinding during night time.
The muscle pain is treated using anti-inflammatory medication and sometimes muscle relaxants may be needed as well. In severe cases of muscle pain and spasm, local anesthetics or electro galvanic methods of muscle relaxation are used respectively. Botox is also used to reduce the muscle spasm and enlargement (hypertrophy) associated with long term bruxism.
Anti-anxiety drugs and sedatives may be used for patients with bruxism associated with psychological stress. Counseling and other forms of psychotherapy are advised for stress management. Low doses of tricyclic antidepressants are usually prescribed on a long term basis.