Bruxism (habit of grinding or clenching the teeth) is a parafunctional habit (meaning that it is not part of the normal function), quite frequent and that goes unnoticed most of the times.
There are 2 types of Bruxism:
Nocturnal: the most harmful, the person grinds his teeth at night not having any awareness or control over the situation. As a result , there are many more contacts between teeth and with much greater pressure than during normal chewing, which will wear out much more tooth structure than the chewing itself.
Daytime: clenching your teeth. In this case, the consequences are less serious since it is semi-conscious and the person ends up realizing what is happening and can unclench the teeth.
Prevalence
It affects a very large number of people and there is no agreement in terms of the percentage of the population that suffers from this situation. It is thought to be around or above 15% .
Causes
Stress. It is the main cause, being a way of releasing tension, so present nowadays. It is not at all a universal way of reacting to stress, two people subjected to the same degree of stress, one may have bruxism and the other not. Bruxism is not always present and may only appear at times of greater stress.
There may be potentiating factors such as, for example, changes in the occlusion of the teeth.
Signs and symptoms
Being a non-conscious habit, in most cases, those affected do not know that they suffer from Bruxism and often this is only diagnosed when signs and symptoms appear, which can be:
- Muscle pain or tension in the masticatory muscles, neck or shoulders (more pronounced in the morning)
- Headaches
- Pain in Temporo-Mandibular Joints
- Dental Wear
Consequences:
- Enamel and Dentin wear.
- Vertical dimension loss: Usually the first teeth involved are the front teeth that start to get thinner at the incisal edge (there is an increase in transparency). When the protection of the front teeth is lost, the process progresses to the back teeth with loss of the occlusal anatomy of the tooth (the teeth gradually become flattened).
- Cervical abrasions or erosions of the teeth (near the gums) . They can affect one or more teeth. They are often mistakenly attributed to brushing your teeth too hard ( the process is due to the grinding of teeth, which causes them to flex too much, which generates loss of the cervical enamel of the tooth, once the Enamel is lost and Dentin is exposed ( much less resistant), the brushing can accelerate the loss of tooth structure).
- Fractures of fillings or of the tooth itself
What to do?
After the Diagnosis, we can and should act according to the stage of evolution of this condition:
Eliminate or reduce causal factors:
- Decrease Stress. This point is obvious but sometimes very difficult to achieve.
- Identify and eliminate possible premature contact points between the teeth through an Occlusal Analysis and Adjustment (sometimes there are specific points on the teeth that come into contact before all the others, premature contacts, which must be identified and eliminated as they act as trigger zones for the habit of grinding ).
- Wisdom teeth: sometimes they are the source of premature contacts in which case they may have to be extracted.
- Replace lost tooth structure: This step can range from procedures as simple as direct composite fillings to as complex and extensive as full mouth rehabilitations, depending on the degree of structure lost. The objective is both aesthetic (correcting transparencies, restoring the size of the teeth, etc.) and functional (the teeth, losing their size and anatomy, lose masticatory effectiveness).
Protect the teeth and restorations:
Night-guard or acrylic interocclusal splint. The use of the Night-guard is mandatory since Bruxism is unconscious and in most cases it will continue . Sleeping with an acrilic oclusal splint prevents the teeth from touching each other. When the person grinds, instead of wearing down the tooth, it wears the softer acrylic.
Let’s go through some interesting cases that I rehabilitated of patients with Bruxism.
Cases
Diogo- This is a particularly severe case, both due to the degree of wear and tear and the age of the patient. There was a combination of 2 factors: The 1st was mechanical wear from teeth grinding, the 2nd chemical wear from acid erosion from excessive consumption of a popular soft drink. See case here!
Filomena- In this case the loss of structure was predominantly at the cervical level of the teeth and not so much on the occlusal surfaces. See case here!
José – Case in which the incisors were worn out and with loss of vertical dimension that still did not involve the back teeth. We only worked on these teeth and performed cervical fillings on some posterior teeth. See case here!
Francisco- In this case all the teeth were involved with loss of vertical dimension and profound cervical wear. See case here!
