Sleep bruxism: an overview
Sleep bruxism: an overview
  • Takafumi Kato
  • 승인 2013.11.06 13:37
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2013 대한턱관절교합학회 종합학술대회 초록

▲ Takafumi Kato, DDS, PhD
Sleep bruxism (SB) has been recognized as a clinically relevant problem in dentistry since the consequences of having SB are related to tooth wear, dental restoration fractures, headache, jaw muscle pain, and temporomandibular joint problems. SB is a sleep-related movement disorder, characterized by an involuntary tooth grinding and clenching.

This condition should be differentiated from bruxism occurring during awake (e.g., awake bruxism). The prevalence of SB is 5 to 10 % of the adult population. Several risk factors have been reported for SB: psychosocial factors (eg, anxiety), life habits (eg, smoking), drugs (eg, dopamine-related), heritability and diseases (eg, sleep disorders). However, no single factor has been determined as a cause of SB.

Current knowledge on the pathophysiology of SB has been improved. SB patients exhibit rhythmic masticatory muscle activity (RMMA) with or without tooth grinding during sleep. RMMA episodes occur three times more frequently with higher intensity in SB patients compared to normals. Most RMMA episodes occur in light non-REM
sleep during the ascending phase of the sleep cycle.

The genesis of RMMA is associated with arousal fluctuations during sleep. For example, RMMA occurs within a physiolobical sequence from transient autonomic and cortical activation to jaw, pharyngeal and respiratory motor activation. Thus, tooth grinding (or contacts) is a secondary consequence after arousal-related central nervous system activity.

Clinically, SB can be diagnosed based on a self-report of tooth grinding, morning jaw muscle discomfort, tooth wear, and masseter muscle hypertrophy. Concomitant risk factors should be carefully interviewed. Moreover, it is also important to recognize a co-morbidity with other sleep disorders such obstructive sleep apnea syndrome and
REM sleep behavior disorders: some of which can be screened upon clinical interview and oral examination at chairside. If polysomnographic recording is available, SB and concomitant sleep disorders can be specifically diagnosed in sleep laboratory.

Management strategies of SB are mostly aimed at reducing the associated orofacial symptoms (eg, pain) and at preventing damage to teeth and dental restorations. Occlusal splints are usually used by dentists but the effects on SB activity could be unpredictable or short-term if any effects.

Some pharmacological agents are effective at reducing SB, and cognitive/behavioral strategies could be helpful, although their safety and reliability have not been tested. If SB patients have concomitant sleep disorders, dentists may need collaboration with sleep physicians in the management of SB.


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