Teeth Grinding, Clenching (Bruxism)
Bruxism is the clenching and/or grinding of the teeth that occurs while asleep and awake. It is a parafunctional habit. Its incidence in the community is reported to be 80% on average. It is seen not only in adults but also in children. Its etiology is not fully known. It is a multifactorial disease. There are studies showing that excessive use of substances such as amphetamines, cigarettes and alcohol causes teeth clenching and grinding. It has been determined that temporomandibular joint disorders and bruxism are more common in substance addicted individuals compared to normal individuals. Smokers are twice as likely to show signs of bruxism as nonsmokers. It is stated that personality traits increase stress levels in patients with bruxism.
What causes bruxism?
Bruxism causes bilateral and simultaneous contractions in the muscles that close the jaw. Muscles become stronger in individuals with a long-term history of bruxism. This also causes pain. While an average of 2-12 kg of force is applied in the posterior region, depending on the type of food, during chewing in healthy individuals, this value can increase 10 times and reach an average of 22-26 kg during bruxist movements while sleeping. Although periods of teeth grinding are at short intervals, they can cause serious problems in the chewing system. As a result of bruxism, problems such as hypertrophy of chewing muscles, fractures/failures in dental restorations and implants, pain in the chewing system, headache, periodontal disease, abnormal wear of teeth, sensitivity and mobility cause temporomandibular disorders to occur and accelerate. Over the years, many treatment methods including prosthetic treatments have been tried to stop bruxism, occlusal plaques and botox treatment are commonly applied.
Treatment;
1.Occlusal splints; Occlusal splints reduce muscle hyperactivity and symptoms with patient awareness and placebo effects by improving the patient's occlusal status, increasing the decreased vertical dimension, and correcting the position of the mandibular condyle. Occlusal splints not only change the occlusal relationship, but also improve the relationships of the temporomandibular joint components (condyle-fossa relationship). In bruxism cases, occlusal splints are used to reduce wear, fracture, mobility and pain in the teeth, to prevent TMJ pain, traumatic arthritis and local deformation of tissues, to prevent pain and incoordination and spasm in the chewing muscles.
2.Cognitive and behavioral treatment methods; Psychobehavioral methods used in the treatment of sleep bruxism; relaxation, “biofeedback” training programs and hypnosis. The use of biofeedback has been found to be effective in reducing masticatory muscle activity, but its effect does not persist after treatment.
3.Patient education; The patient is informed that monetary functions such as clenching or grinding are not performed. This activates the patients about their habits that they were not aware of before. The patient is relieved by explaining the problem. It has been reported that clenching exercises reduce parafunctional activities at night. This technique continues with the patients clenching their teeth for 5 seconds and then loosening them. This exercise is repeated 6 times a day, 10 times in each session. Its purpose is to inhibit the parafunctional activity program in the brain. If the patient has pain during clenching, this exercise should not be performed. The first step of emotional stress treatment is to make the patient aware of his condition. Many people with masticatory 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 the disease.
4.Medication; There is no effective pharmacological treatment for sleep bruxism. Although various drugs have been suggested, their efficacy has not been fully demonstrated. Pharmacological therapy is only suitable for short-term use, long-term use is not recommended. While some of these drugs are widely used to prevent maxillofacial pain, they are rarely used. It is known that benzodiazepine group (diazepam valium) and muscle relaxant (methocarbamol) drugs acting on the central nervous system reduce muscle activity associated with bruxism; However, long-term use is not recommended as they cause daytime sleepiness. Another group of drugs recommended for the treatment of sleep bruxism is tricyclic (amitriptyline) antidepressants. However, small doses of amitriptyline (25 mg) during 1 to 4 weeks of treatment were found to have no effect on sleep bruxism.
5.Botox treatment in the treatment of bruxism; Botulinum toxin (BoNT, BTX) is a protein produced by the bacterium Clostridium Botulinum. BTX basically inhibits the release of acetylcholine at the presynaptic junction, preventing muscle contraction. Axon terminals formed at the end of 3-6 months after BTX administration cause regression of the effect on the muscles. The temporary nature of BTX applications and the necessity of repeating should be considered in treatment planning. In terms of dentistry, masticatory muscle (m. masseter, m.temporalis, m.pterygoideus medialis and lateralis) hypertrophies and hyperactivity, bruxism, maxillofacial dystonias, TMJ dislocations due to dystonias, muscle spasms, tics, salivary glands Mal functions, hypersalivation, Frey Syndrome), myofascial pain and other pain control and inactivation of m.geniohyoideus after orthognathic surgery are the main areas of use of BTX.
In which cases Botox cannot be applied?
In which cases is dental botox applied?
Botox has an indication for dental use in bruxism, hypertrophy and dystonia. Before Massetere BTX injections, the patient's teeth are clamped to determine the anterior and posterior borders of the muscle. Injections are made to the anterior, middle, posterior points on a horizontal line approximately 1 cm above the basal mandible, and to the points 1 cm above the midpoint. Injection is made at a depth of 8 mm. Before the temporal muscle injection, the teeth are compressed and the muscle is activated and its anterior line is determined.
As a result;
Occlusal splints are the most preferred method in the treatment of bruxism, which is known as clenching and grinding of the teeth during the day and/or night. With botulinum toxin, satisfactory results are obtained in the treatment of TMJ disorders.
