Bruxism is a disease of civilisation that affects an ever greater number of people around the world.
Have you noticed that lately you reach for painkillers more often, because in the morning after waking up your head, the muscles of your face and neck begin to hurt? Do you feel dizzy? Do you feel that your body is tense and, despite an adequate amount of sleep, you feel tired? Does a tooth or several teeth begin to hurt even though you care perfectly for your oral hygiene and are a very aware patient?
Unfortunately, dentists all over the world are observing a growing number of patients who have symptoms of bruxism. The cause of this phenomenon is our lifestyle, which is ever faster and, consequently, more stressful. That is precisely why bruxism is a disease linked to the development of civilisation, and a big step towards avoiding its unpleasant complications is the mere raising of patients' awareness.
What is bruxism?
Earlier, authors described bruxism as an occlusal parafunction, i.e. the non-physiological activity of clenching and grinding the teeth. Nowadays bruxism is increasingly spoken of as a sleep parafunction, i.e. a parasomnia.
What exactly is the cause of bruxism and what is it linked to?
Mainly the everyday lifestyle – stress, anxiety, haste, drinking large amounts of coffee, alcohol, taking drugs. In addition, problems related to sleep: snoring, sleep apnoea syndrome. Sometimes it is linked to medications being taken, for example SSRI antidepressants (selective serotonin reuptake inhibitors), antipsychotic drugs (haloperidol) or barbiturates.
What are the symptoms of bruxism?
The main symptoms of bruxism are pain of the face, neck, nape, shoulders, head, the temporomandibular joint and the ears. With a longer duration of the undiagnosed and untreated disease, hypertrophy of the masseter muscles is observed – from which the characteristic "square" shape of the face and of the temporal muscles results – as well as an increase in the tension of the shoulder-girdle muscles, especially the sternocleidomastoid muscle. It happens that the patient has a limited range of mouth opening.
Visible in the mouth are: cracks in the enamel, wedge-shaped defects (non-carious depressions with sharp edges at the border of the crown and root of the tooth resulting from a lack of enamel, in which yellow or brown dentine is visible), a pathological shortening of the height of the crowns through many years of tooth-on-tooth abrasion, a lowering of the occlusal height and changes on the mucosa: maceration of the epithelium and a thickening on the mucosa.
What are the complications of bruxism?
The complications of bruxism occur mainly on the part of the temporomandibular joint. This is pressure tenderness in the area of the joint, pathological acoustic symptoms such as clicks and jumping, and disturbances in the mobility of the heads of the mandible. Besides this, a lowering of the quality of life through troublesome painful ailments, chronic muscle tension and a less aesthetic appearance of the teeth, whose crowns are worn and short, which makes the smile look older.
How is bruxism treated?
A very important step is making the patient aware that they are wearing down and clenching their teeth – so-called self-control, i.e. observing oneself during the day when one "holds the teeth clenched". These can be stressful situations, e.g. sitting an important exam, an argument, problems at work, longer moments of concentration during intensive study, and even driving a car. Sometimes patients wake up at night with "clenched teeth". When the patient notices when this happens and in what situations, they should consciously relax the muscle tension, and an empty space then forms between the teeth and they are not clenched. In addition, manual therapy is very important – a massage of the masseter and temporal muscles and special exercises that have a relaxing effect on them. Nowadays a range of such exercises can be found on the internet, and when they are not enough one should go to a physiotherapist dealing with the rehabilitation of temporomandibular disorders. It should be remembered that the main cause of bruxism is stress, which is why a detailed interview indicating where it comes from is very important, as is trying to avoid it and to release internal tensions through relaxation and sport.
When the patient is already aware, the treatment is complemented by a splint, whose task is to protect the teeth from further abrasion and to improve the work of the temporomandibular joint and the muscles through their relaxation. It should be remembered that this is an ad-hoc solution that does not eliminate the cause of the problem. In some cases a special therapeutic splint adapted to the patient's condition should be made.
As a supplementary treatment, injections of botulinum toxin into the area of the masseter muscles can be performed. It blocks the flow of nerve impulses to the muscle cells. Thanks to this they are weakened and relaxed. At each procedure the doctor selects the appropriate dose of the drug and examines and finds the trigger points, i.e. the points of greatest muscle tension. The procedure is short and uncomplicated. After the procedure a slight redness of the skin persists, which quickly disappears. The effects can be observed as early as after 3 to 7 days and last about 6 months, which is why the procedure has to be repeated periodically. An additional effect is a softening of the facial features in the area of the mandibular angle.
Studies
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International consensus on the assessment of bruxism: Report of a work in progress
Lobbezoo F., Ahlberg J., Raphael K. G., Wetselaar P., Glaros A. G., Kato T., Santiago V., Winocur E. i wsp. (2018) · Journal of Oral Rehabilitation · international expert consensus
Bruxism is defined as masticatory muscle activity during sleep or wakefulness, not automatically as a disease. Assessment should combine history, clinical examination and, in selected situations, instrumental measurement.
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Efficacy and Safety of Botulinum Toxin in the Management of Temporomandibular Symptoms Associated with Sleep Bruxism: A Systematic Review
Buzatu R., Luca M. M., Castiglione L., Sinescu C. (2024) · Dentistry Journal · systematic review
Botulinum toxin can briefly reduce contraction force and some pain symptoms in a proportion of adults with bruxism. The findings do not justify treating it as a first-choice treatment or as therapy that removes the cause.
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Botulinum Toxin Therapy for Managing Sleep Bruxism: A Randomized and Placebo-Controlled Trial
Shim Y. J., Lee H. J., Park K. J., Kim H. T., Hong I. H., Kim S. T. (2020) · Toxins · randomised placebo-controlled trial
After botulinum toxin injection the intensity of masseter activity fell, but the number of bruxism episodes did not change clearly. That points to a symptomatic effect rather than to suppression of the mechanism itself.