Tooth grinding, bruxism and occlusal para function are involuntary oral habits whose cause is essentially a mystery.

December 28th, 2010 | Posted in Professionals, Bruxism

Presentation:

Wear of the enamel of the teeth showing as shiny polished areas on the tooth surface in its minimal form to repeat fractures of the teeth, chipping of the incisor tips, vertical stress lines on the teeth, “abfraction” at the gum margins of teeth e.g. depressions of the thin enamel dentine areas of teeth previously thought to be caused by excess tooth brushing. The teeth may reduce in overall size so that typically the incisors will be shortened  giving rise to a generalised flattening of the teeth with loss if incisor tips, cusp tips height of teeth and tooth loss. Sophia Loren was an excellent example of this.  Repeated fracture of restorations may also occur.

Sleeping partners or family members may be aware of the noise at night.

Those with learning difficulties especially Downs Syndrome and Cerebral Palsy often suffer from bruxism.

Symptoms:

Patients may complain of tooth sensitivity especially at the necks of the teeth.  Very commonly seen on the bicuspid and molar teeth in the upper arch.

There is loss of tooth length /height and evidence of chipping of the enamel

Patients may complain of headaches, migrinous headaches and tension headaches.

The muscle of mastication may also be uncomfortable or over developed causing the patient’s face to appear broadened especially at the angle of the lower jaws.

Causation:

Largely unknown. May be induced by stress or occlusal imbalance, jaw displacements. Occlusal interferences e.g. a high restoration. There may be a genetic / familial predisposition. Secondary to mental status.

Aggravating factors:

Generalised stress,  occlusal imbalance, jaw displacements, occlusal interferences e.g. a high restoration.  Some dietary  factors may trigger the onset or weaken the enamel hastening tooth loss. Red meats, Cafeen, and dietary  stimulants. The acids contained in drinks and fruit may soften the enamel. Use of abrasive tooth paste and abrasive tooth brushes may hasten the process.

Management:

The first step is recognition & patient awareness.

To limit any aggravating factors e.g. reduction in red meat and caffeen in the diet, limit the intake of acid drinks and control the amount and frequency of these. To manage stress in life e.g. Yoga, palates, meditation , acupuncture, hypnotherapy.

To treat dental  factors e.g. reduce high restorations, get the bite balanced, have the malocclusion and especially the jaw displacement rectified.

Dental Solutions:

The above life style and local measures sadly often fail to break a learned subconscious habit especially when the damage is being done at night.

Dentists prescribe plastic bite guards or gum shields or more sophisticated Michigen splints. All of these devices aim to change the biting habits and act as a separator between opposing teeth. As with any plastic dental appliance, the plastic or thermo plastics degrade, absorb water & micro oral organisms, they become unsightly are difficult to clean and parts wear. Unfortunately with the wearing of the plastics, the teeth will migrate and over erupt only to be subjected to yet more grinding. These plastic devices must therefore be considered a temporary solution to bruxism.

The role of Somnowell in managing Bruxism and occlusal para function behaviour:

Somnowell offers a long term dental solution. The appliance is worn at night and the two opposing metal frameworks serve as a barrier between the opposing jaws so that the bruxist grinds metal against metal rather than enamel to enamel. In most case the Somnowell will not halt the habit though in some case the habit may be broken by the introduction of the somnowell.

The weight of the grinding habit is distributed over the surface of the dentition by the Sonmowell appliance.

 Where the MAA Somnowell is used for bruxism and para function habit management, the somnowell physically prevents the individual from moving the jaw posteriorly and limits the excursive movements of the jaws at night which may retrain and re programme the patient  leading to a  breaking of the habit ( this has yet to be scientifically proven and is currently a clinical observation). The Somnowell MAA holds the heads of the mandibular condyles in a forward position in the jaw socket and may in this way alter the proprio receptive mechanisms responsible for the bruxism habit.