W5 - Bruxism / Night Guard - Booth Flashcards
Defintiion of bruxism
Repetitive muscles activity characteristic by clenching or grinding of teeth and /or bracing or thrusting of the mandible
Classifications of Bruxism
Primary bruxism - either awake bruxism (AB) or sleep bruxism (SB)
AB - concentrated or stress related activity
SB - sleep movement disorders. More likely to have other sleep disorders such as snoring and pauses in breathing (apnoea)
Secondary bruxism - associated with medical conditions and learning difficulties or side effects of medications / drugs
Principle concerns with patients seeking treatment (4)
Poor aesthetics
Sensitivity
Functional problems (TMD, fractured teeth, eating discomfort)
Pain - tension type headaches
Diagnosis of bruxism
Most accurate method - polysomnography
May be episodic with short bursts of masseteric activity
<2 seconds (phasic or grinding) or >2s of tonic (clenching) or a combination of both
What phase of sleep does bruxism occur?
Light sleep - REM
- questions around sleep patterns are informative
Symptoms and signs of bruxism (8)
- teeth grinding or clenching
- flattened fractured chipped of loos
- worn enamel or dentine exposure
- tired or tight MMoM
- Jaw, neck or facial pain
- Pain mimicking ear ache
- Dull head-aches over temporal area
- Poor sleep patterns
Causes of bruxism
AB - emotions, coping strategy, or habit
SB - Sleep apnoea, non-working side interferences, restricted excursive mocements
Stress
Age - common in young children
Personality type - aggressive, competitive or hyperactive
Medications - antidepressants , caffeine, alc
Familal
Other - GORD, Parkinson’s, ADHD,
How should bruxism be treated
Restorations for dental manifestations
Since it is a medical problem, should also be referred to someone who can help moderate stress (therapy)
General management strategies of bruxism (dental, medical, alternatives)
Dental - soft or hard occlusal coverage appliances
Medical - muscle relaxants
Cognitive behavioural therapy
Low voltage biofeedback appliance (Grindcare)
Refer for sleep management
Yoga, meditation or exercise
Indication for soft splints + problem
- Used as an emergency appliance due to compressibility but may increase chewing or bruxism in severe cases
- Has poor wear characteristics
What is bilaminar appliance used for
Reduce effects of bruxism while also protecting anterior composites
What is a bilaminar appliance
Composed of two separate layers bonded together with soft inner coverage with hard exterior
- Allows absorption of occlusal forces whilst having a resistant exterior
- Constructed with full occlusal and lingual coverage with limited buccal extension to allow ease of wear and fitting
- Often better tolerated in the mandible
What is the disadvantage of bilaminar appliances
Must be recalled every month for checkups
Bites can make grooves into plastic which can ultimately shift teeth overtime
- Excessive wear on posterior surfaces of appliances may lead to changed in VDO and further compromises to occlusion
Four most common treatments for TMD
- Counselling
- Drug therapy
- Physiotherapy
- Splint therapy
Best outcomes come from a combination of the above
4 Types of splints
- Soft vacuum formed splint usually for lower arch use
- Localised occlusal interference splint
- Anterior repositioning splint
- Stabilisation splint
Features of soft bite guard
- Most commonly prescribed
- Fast, easy to make, cheap
- no records needed, single lower impression
- Should only really be used for emergencies or acute cases
- May make situation worse in 10% of cases - Avoid in bruxism pts -> may make it worse
Features of localised occlusal interference splint
- Indicated in bruxists with and without TMJ
- “Habit breaker”
- Useful for pts who clench in centric occlusion but not excursive lateral movements
- Worn day and night
- U/L models required
- Ball clasps are positioned on mesial marginal ridge of premolars or mx canine cingulum
Features of anterior repositioning splint
- Used in patients with clicking jaw (disc displacement)
- Full coverage splint which guides md forward and downward (temporary therapeutic protruded position)
- Allows for disc repositioning
- To be worn all the time for up to 3 months then gradual withdrawal (but beware of jaw locking)
- Accurate occlusal records required
Features of the stabilisation splint
what is it used for
(aim)
- Used for patients with pain dysfunction syndrome (facial arthromyalgia)
- Facial arthromyalgia caused by discrepancy between centric occlusion and centric relation
- May be used to determine centric relation for complex restorative tx
- Aim of splint is to stabilise md against mx to produce balanced, stable centric occlusion and ideal occlusion in both static and dynamic function
- Hard splints, made from acrylic with full coverage of either mx or md (although md is preferred by pt)
Describe the ideal occlusion described by Ash and Ramfjord
- Teeth are in contact in centric relation (end point of the terminal hinge axis)
- Centric occlusion is very slightly in front of centric relation but in the same sagittal and horizontal planes
- There should be unrestricted glide from centric relation to centric occlusion
- There should be smooth gliding eccentric movements
- There should be no non-working side interference during lateral and protrusive movements
What is the aim of the splint
Provide patient with static occlusion where the maximum number of teeth make contact at the same time and with the same force between the opposing teeth and the splint
Surface of splint should present shallow and smooth guidance against the opposing anteriors providing an immediate and lasting disclusion of posterior teeth
How is the splint fabricated
Upper and lower models in centric jaw registration, should then be mounted with face-bow record
Acrylic is fitted and occlusion adjusted to eliminate any interferences until a stable mandibular position is obtained
What records need to be taken prior to splint therapy
Pre-treatment records as occlusion may change during therapy (may have resto or legal implications)
Centric relation and centric occlusion records
When should the stabilisation splint be worn?
Night
- little evidence to support that daytime wear alone improves success rate
What happens when wear facets are worn into splints?
May lead to tooth movement
how long are soft bite guards used for?
Worn at night for up to 6 weeks
What is required on occlusal records for anterior repositioning splint?
Need accurate occlusal records with precise indentation on occlusal surface to locate maxillary teeth preventing tooth movements
Why is it favouable to have teeth in CR when wearing splint?
Most stable and reproducible, exerting the least stress on musculature
Why does an occlusal appliance require regular visits?
Occlusion may wear and teeth can shift
