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 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)
