Bruxism is a clenching or creaking that occurs while sleeping or awake. It is a parafunctional habit. There is 80% probability of being seen in the community. Bruxism occurs not only in adults but also in children. It is a multifactorial disease. Excessive use of substances such as amphetamines, cigarettes and alcohol causes bruxism. Temporomandibular joint disorders and bruxism are more common in substance-addicted individuals than normal individuals. Smokers are two times more likely than non-smokers. It is known that personality traits increase stress levels of patients with bruxism.
What causes bruxism?
Bruxism causes bilateral and simultaneous contraction that covers the chin. Muscles become stronger in individuals with bruxism for a long time. This causes pain. Although bruxism periods are at short intervals, they cause serious problems in the chewing system. Bruxism causes hypertrophy in the chewing muscles, tooth restoration and implant fractures, pain in the chewing system, headache, periodontal disease, tooth wear and tenderness. Occlusal plaques and Botox are commonly recommended in the treatment of bruxism.
Treatment of bruxism
1-Occlusal ziplites; occlusal ziplites improve the patient’s occlusal condition, increase the reduced vertical size, improve mandibular condyle position, and reduce patient awareness and placebo effects and muscle hyperactivity. Occlusal splints not only change the occlusal relationship but also improve the relations of temporomandibular joint components. In case of bruxism, occlusal splints are used as a result of abrasion, breakage, reduction of mobility and pain in the teeth, prevention of TMJ pain, traumatic arthritis and local deformation of tissues, prevention of spasm and pain and uncoordinated chewing muscles.
2-Cognitive and behavioral treatment method; relaxation used in the treatment of sleep bruxism includes Biofeedback training programs and hypnosis. The use of Biofeedback has been found to be effective in reducing chewing muscle activity, but its effect is relieved after treatment.
3-Patient education; the patient is informed about the function such as clenching or grinding. Mobilizes these patients about their habits they are not aware of before. Explaining the problem to the patient relives the patient. Clenching exercises have been shown to reduce nighttime parafunctional activities. This technique continues with the patients clenching their teeth for 5 seconds and then relaxing. This exercise is repeated 6 times a day, 10 times per session. Its purpose is to suppress the parafunctional activity program in the brain. If the patient has pain during clenching, this exercise should not be applied. Many people with chewing system dysfunction or orofacial pain are unaware of the possible relationship between these problems and emotional stress. Therefore, patients with muscle hyperactivity should be informed about the relationship between emotional stress and disease
4-Medication; There is no pharmacological treatment related to sleep bruxism. Various medications are recommended but they are not fully effective. Pharmacological treatment is only suitable for short-term use. Some of these drugs are used to prevent chin and facial pain. The benzodiazepine group and muscle relaxant drugs acting on the central nervous system are known to reduce muscle activity associated with bruxism but long-term use is not recommended because they cause daytime sleepiness. Another recommended group of drugs for sleep bruxism is tricyclic antidepressants. However, 25 mg of antidepressants in 1 to4 weeks of treatment did not have any effect on sleep bruxism.
5-Botox treatment; Botilinum toxin (BoNT, BTX), is a protein produced by the bacteria called Clostridium Botilinum. BTX basically prevents the release of acetylcholine in the presynaptic junction and prevents the formation of contractions in the muscle. Axon terminals, formed after 3-6 months after BTX, cause regression of the effect on the muscles. It should be considered that BTX is temporary and needs to be repeated continuously.
In which cases Botox is not applied?
- If there is infection in the area to be treated.
- Patients with allergens with hypersensitivity to BTX
- Pregnant and puerperant patients
- Systematic muscle patients
- Patients using aminoglycoside antibiotics, tubocurarine type myorelaxants and neuromuscular transmission drugs
- In blood diseases in anticoagulant therapy
- Botox is not applied in the presence of inflammatory skin diseases.
In which cases dental Botox is applied?
Botox can be used for dental purposes in bruxism hypertrophy and dystonia. Before massetere BTX injections, the teeth are compressed and the anterior and posterior boundaries of the muscle are determined. Injection is made to the anterior, middle and posterior points about 1 cm above the basal mandible. Before the 8 mm injection, the teeth are tightened and the muscle is activated and the anterior line is determined.
The most preferred method of treating bruxism is occlusal splints. Botulinum toxin also results in treatment of TMJ patients.
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