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Prof Booth > Week 5- Bruxism and Splints > Flashcards

Week 5- Bruxism and Splints Flashcards

1
Q

Why is bruxism more common nowadays?

A

Living longer and stresses

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2
Q

What is bruxism?

A

Repetitive muscle activity characterised by clenching or grinding of teeth and/or bracing or thrusting of the mandible

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3
Q

What are the types of bruxism?

A

Primary bruxism: Awake & sleep bruxism

Secondary bruxism

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4
Q

What is awake bruxism?

A

Concentrated or stress related activity or parafunction

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5
Q

What is sleep bruxism?

A

Sleep movement disorders. More likely to have other sleep disorders such as snoring and pauses in breathing (sleep apnea)

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6
Q

What is secondary bruxism?

A

Associated with medical conditions including cerebral palsy and learning difficulties or side effects of medications or illicit drug use.

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7
Q

What is pathological tooth surface loss?

A

Attrition, abrasion and erosion with a possible contribution from each.

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8
Q

What are the principle concerns with patient presenting with pathological tooth surface loss?

A
  • Poor aesthetics
  • Sensitivity
  • Functional problems (TMD, fractured teeth, eating discomfort)
  • Pain (tension headaches)
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9
Q

How is bruxism diagnosed?

A

Polysomnography is the most accurate
May be episodic with short bursts of masseteric activity

  • <2 secs (phasic or grinding)
  • >2 secs tonic (clenching)
  • Combination of both.
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10
Q

What are signs and symptoms of bruxism (11)?

A
  • Teeth grinding or clenching
  • Flattened, fractured, chipped or loose teeth
  • Worn tooth enamel
  • Tired or tight muscles of mastication
  • Trismus
  • Jaw, neck or facial pain
  • Pain mimicking ear-ache
  • Dull headaches (temporal area)
  • Chewing inside of cheek
  • Poor sleep patterns
  • Parafunctional activity due to loss of teeth & subsequent disordered occlusion
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11
Q

What are causes of bruxism (8)?

A
  • AB: anxiety, stress, frustration, concentration may be coping strategy
  • SB: sleep related chewing activity associated with arousal during sleep.
  • Stress
  • Age: common in young children but usually disappears in adulthood
  • Personality type: aggressive, hyperactive
  • Medications
  • Family members
  • Medical disorders: Parkinson’s disease, dementia, GORD, epilepsy. sleep apnea, ADHD
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12
Q

What are general management strategies for bruxers?

A

Dental manifestations can be managed with restos, but bruxism is mainly a medical problem so treatment should be directed at moderating stress

  • Dental- soft or hard occlusal coverage appliances
  • Medical- pharmacological (muscle relaxants)
  • Cognitive behavioral therapy
  • Low voltage biofeedback appliance
  • Refer for sleep management
  • Yoga, meditation, exercise
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13
Q

What are soft splints used for? What are they made out of?

A

Used as emergency appliance in acute cases due to compressibility (made of 2mm thick polyvinyl)

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14
Q

What are bilaminar appliances used for?

A

Helps reduce effects of bruxism and tooth wear, thus, protecting restos (particularly anterior composites)

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15
Q

What are the advantages of bilaminar appliance?

A

Allows some absorption of occlusal forces during bruxism and has more resistant exterior compared to entirely soft occlusal splints

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16
Q

What happens when wear facets are worn into splints?

A

Can lead to tooth movement

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17
Q

Are occlusal splints recommended for sleep bruxism?

A

No sufficient evidence to state occlusal splints are effective for treating SB. However, there is some benefit wrt tooth wear.

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18
Q

What are the 4 most commonly employed treatments in specialist TMD?

A
  • Counselling
  • Drug therapy
  • Physiotherapy
  • Splint therapy
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19
Q

What are the 4 main types of splint applicable to the general dentist?

A
  • Soft vacuum formed splint usually for lower arch
  • Localised occlusal interference splint
  • Anterior repositioning splint
  • Stabilisation splint
20
Q

What is a localised occlusal interference splint used for?

A
  • Known as interceptor splint
  • Used to break bruxist habit in pt with or without TMD
  • Useful in pts who brux/clench in centric occlusion but not in extreme excursive movements.
  • Worn day or night
21
Q

Who is an anterior repositioning splint used in?

A

Splint of choice for those with displacement of disc with reduction (clicking)

22
Q

Who is a stabilisation splint indicated for?

A

Pt with symptoms of pain dysfunction syndrome (aka facial arthromyalgia) where occlusal discrepancy between CO and CR or occlusal interferences are factors.

May be used to determine CR for complex restorative cases.

23
Q

What is ideal occlusion?

A
  • Teeth in contact in CR
  • CO slightly in front of CR but in same sagittal and horizontal plane
  • Unrestricted glide from CR to CO
  • Smooth gliding eccentric movements
  • No working side interference during lateral and protrusive movements.
24
Q

How are splints fabricated?

A
  1. Accurate md and mx models with centric jaw relation, mounted with face-bow record
  2. Splint made from hard heat cured acrylic which needs to be adjusted to allow for desired smooth, unhindered movements until no interferences and stable md position is obtained.
25
Q

What is the occurrence rate of bruxism?

A

5-48%

26
Q

How are bilaminar appliances designed and what are they composed of?

A

2 separate layers bonded together with soft inner coverage with hard exterior. There is full occlusal and lingual coverage with limited buccal extension to allow ease of wear and fitting.

27
Q

How often should bilaminar appliances be worn?

A

Should be worn during periods of bruxism either during the day or night but long periods of wear are not advised.

28
Q

What are disadvantages of bilaminar appliances?

A

Excessive wear on posterior surfaces of appliance may lead to changes in vertical dimension and further compromises to occlusion

29
Q

What are the 3 types of occlusal appliances?

A
  • Soft splint: easy to fabricate, cheap, may exacerbate bruxing habit, emergency appliance
  • Hard splint: time consuming, used for TMD management
  • Bilaminar splint/night guard: protection of anterior bonded restos & prevention of tooth wear, easy to fabricate
30
Q

What is required in TMD pts before commencing tx?

A
  • Pre-tx records as occlusion may change during therapy
  • Record made in centric relation and centric occlusion
  • Note anterior guidance and working/non-working interferences posteriorly
31
Q

Are soft bite guards and bilaminar appliances better tolerated in md or mx?

A

Better tolerated in lower

32
Q

What are disadvantages of soft bite guards?

A
  • Poor wear characteristics
  • Can make situation worse in 10% of cases- avoid in bruxism as may increase activity
  • Difficult to adjust
33
Q

What are advantages of soft bite guards?

A
  • Most commonly prescribed
  • Quick and easy
  • No records needed, no occlusion
34
Q

How long are soft bite guards used for?

A

Worn at night for up to 6 weeks

35
Q

Describe the features of a localised occlusal interference splint

A
  • Upper and lower model required
  • Appliance made to fit palate with ball clasps positioned on mesial marginal ridges of premolars or cingulum of mx canine.
  • Occlusion on ball claps so prevents teeth meeting in centric.
36
Q

What is this appliance?

A

Localised occlusal interference splint

37
Q

What is this appliance?

A

Soft bite guard

38
Q

What are the functions of an anterior repositioning splint?

A
  • Full coverage splint made for lower jaw guiding md forwards and downwards into protruded position.
  • Made to maintain md in temporary therapeutic protruded position eliminating click and allowing disc repositioning
39
Q

What is required on occlusal records for anterior repositioning splint?

A

Need accurate occlusal records with precise indentations on occlusal surface to locate maxillary teeth preventing tooth movement.

40
Q

How long should anterior repositioning splints be worn?

A

All the time for up to 3 months, then gradual withdrawal. Beware of jaw locking.

41
Q

What is this appliance?

A

Anterior repositioning splint

42
Q

What are design features of stabilisation splint?

A
  • Designed with stable balanced CO and ideal occlusion in both static and dynamic function
  • Made from hard acrylic with full coverage (either md or mx)
43
Q

What is this appliance?

A

Stabilisation splint

44
Q

What is the aim of the splint?

A
  • Provide pt with static occlusion where max number of teeth make contact at same time with same force between opposing teeth and surface of splint (ideally in CR)
45
Q

Why is it favourable to have teeth in CR when wearing splint?

A

Most stable and reproducible, exerting the least stress on musculature

46
Q

Why does an occlusal appliance require regular visits?

A

Occlusion may wear and teeth can move

47
Q

Should stabilisation splint be worn at night or day time?

A

Night

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