Table 18.1 Nomenclature of bone tumors
Bruxism
BASIC INFORMATION
DEFINITION
Bruxism is an involuntary, forceful grinding of teeth during sleep that affects 12-22% of the population. The patient is usually unaware of the problem. The typical age of onset is 18-20 years, and spontaneous remission usually occurs by age 40. Sex distribution appears to be equal. In many cases, the diagnosis is made during dental examination, damage is minor, and no treatment is indicated. In more severe cases, treatment with a rubber tooth guard is necessary to prevent disfiguring tooth injury. Stress management or, in some cases, biofeedback can be useful when bruxism is a manifestation of psychological stress. There are anecdotal reports of benefit using benzodiazepines.
EPIDEMIOLOGY & DEMOGRAPHICS
Occurs in 12% of children and 95% of adults
PHYSICAL FINDINGS & CLINICAL PRESENTATION
Complaints of grinding of teeth from sleep partner or members of the family. In many cases, the masticatory system will adapt to the phenomenon, but in severe cases nearly every part of the masticatory system may be damaged. Excessive wearing of dentition is the most common physical finding. Tender or hypoatrophied masticatory muscles may also be observed.
ETIOLOGY
Cause is quite controversial. Possible causes in the literature include occlusal discrepancies, anatomy of the bony structures of the orofacial region, part of the sleep arousal response, disturbances of the central dopaminergic system, smoking, alcohol, drugs, stress, and personality.
DIFFERENTIAL DIAGNOSIS
• Dental compression syndrome
• Temporomandibular joint disorders
• Chronic orofacial pain disorders
• Oral motor disorders
• Malocclusion
WORKUP
History should have an emphasis on sleep habits, including excessive snoring, pain in the temporal mandibular region, interview with close family members, health habits, personality quirks. Physical examination of the teeth and masticatory muscles is mandatory. Sleep studies in selected cases may be helpful.
LABORATORY TESTS
None indicated unless a systemic disease suspected (e.g., infection, autoimmune)
IMAGING STUDIES
X-ray studies of teeth and temporomandibular joints
TREATMENT
NONPHARMACOLOGIC THERAPY
Biofeedback, psychological counseling, elimination of harmful health habits have been used.
ACUTE GENERAL Rx
None
CHRONIC Rx
Oral splints, correction of malocclusion, pain management (e.g., gabapentin, ibuprofen), medication to relieve anxiety and improve sleep. A nightguard to protect teeth may be useful.
DISPOSITION
Referral to dentist mandatory if damage to teeth evident.
History should have an emphasis on sleep habits, including excessive snoring, pain in the temporal mandibular region, interview with close family members, health habits, personality quirks. Physical examination of the teeth and masticatory muscles is mandatory. Sleep studies in selected cases may be helpful.
LABORATORY TESTS
None indicated unless a systemic disease suspected (e.g., infection, autoimmune)
IMAGING STUDIES
X-ray studies of teeth and temporomandibular joints
TREATMENT
NONPHARMACOLOGIC THERAPY
Biofeedback, psychological counseling, elimination of harmful health habits have been used.
ACUTE GENERAL Rx
None
CHRONIC Rx
Oral splints, correction of malocclusion, pain management (e.g., gabapentin, ibuprofen), medication to relieve anxiety and improve sleep. A nightguard to protect teeth may be useful.
DISPOSITION
Referral to dentist mandatory if damage to teeth evident.
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