Bruxism (tooth grinding)
Assessment
Bruxism is nonfunctional jaw movement that includes clenching, grinding, clicking, and gnashing of the teeth, most commonly occurring during sleep. Prevalence in adults is 8%. Roughly 3% of patients do not resolve completely.
Bruxism is classified into primary (idiopathic) or secondary (iatrogenic). Some of the common secondary causes seen in clinical practice include Down's syndrome, Parkinson's disease, depression and anxiety disorders.
Diagnosis
Obtain a history from patient of tooth grinding or tapping. Look for abnormal tooth wear or jaw muscle discomfort on examination. Symptoms related to bruxism include pain or abnormal sounds of the TMJ, craniofacial pain, morning headaches, and difficulties with mouth movements, more specifically difficulty closing the mouth.
Management
Dental treatment with a mandibular advancement device (NIGHT GUARD) decreases bruxing episodes, but discomfort while wearing the device limits compliance.
Pharmacotherapy with clonidine or clonazepam may provide a short-term decrease in bruxing episodes, but evidence on reduced pain and improved sleep is lacking. Clonidine (Catapresan) 0.3 mg given at bedtime decreases episodes of sleep bruxism, but with significant side effects including hypotension and loss of rapid eye movement sleep. Clonazepam (Apetryl, Amotril, Clopam) 1 mg at bedtime has also been shown to decrease sleep-related bruxism. Studies looking at L-dopa, amitriptyline, bromocriptine, propranolol, and tryptophan have shown no benefit for the treatment of bruxism.
References
- Carra MC, Macaluso GM, Rompré PH, Huynh N, Parrino L, Terzano MG, Lavigne GJ. Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep. Sleep. 2010 Dec;33(12):1711-6.
- Huynh NT, Rompré PH, Montplaisir JY, Manzini C, Okura K, Lavigne GJ. Comparison of various treatments for sleep bruxism using determinants of number needed to treat and effect size. Int J Prosthodont. 2006 Sep-Oct;19(5):435-41.
- Ciancaglini R, Gherlone EF, Radaelli G. The relationship of bruxism with craniofacial pain and symptoms from the masticatory system in the adult population. J Oral Rehabil. 2001 Sep;28(9):842-8.
