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      Sleep bruxism: Current knowledge and contemporary management

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          Abstract

          Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

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          Most cited references63

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          Bruxism is mainly regulated centrally, not peripherally.

          Bruxism is a controversial phenomenon. Both its definition and the diagnostic procedure contribute to the fact that the literature about the aetiology of this disorder is difficult to interpret. There is, however, consensus about the multifactorial nature of the aetiology. Besides peripheral (morphological) factors, central (pathophysiological and psychological) factors can be distinguished. In the past, morphological factors, like occlusal discrepancies and the anatomy of the bony structures of the orofacial region, have been considered the main causative factors for bruxism. Nowadays, these factors play only a small role, if any. Recent focus is more on the pathophysiological factors. For example, bruxism has been suggested to be part of a sleep arousal response. In addition, bruxism appears to be modulated by various neurotransmitters in the central nervous system. More specifically, disturbances in the central dopaminergic system have been linked to bruxism. Further, factors like smoking, alcohol, drugs, diseases and trauma may be involved in the bruxism aetiology. Psychological factors like stress and personality are frequently mentioned in relation to bruxism as well. However, research to these factors comes to equivocal results and needs further attention. Taken all evidence together, bruxism appears to be mainly regulated centrally, not peripherally.
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            Oral appliances for snoring and obstructive sleep apnea: a review.

            We conducted an evidence-based review of literature regarding use of oral appliances (OAs) in the treatment of snoring and obstructive sleep apnea syndrome (OSA) from 1995 until the present. Our structured search revealed 141 articles for systematic scrutiny, of which 87 were suitable for inclusion in the evidence base, including 15 Level I to II randomized controlled trials and 5 of these trials with placebo-controlled treatment. The efficacy of OAs was established for controlling OSA in some but not all patients with success (defined as no more than 10 apneas or hypopneas per hour of sleep) achieved in an average of 52% of treated patients. Effects on sleepiness and quality of life were also demonstrated, but improvements in other neurocognitive outcomes were not consistent. The mechanism of OA therapy is related to opening of the upper airway as demonstrated by imaging and physiologic monitoring. Treatment adherence is variable with patients reporting using the appliance a median of 77% of nights at 1 year. Minor adverse effects were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use, but the long-term dental significance of this is uncertain. In comparison to continuous positive airway pressure (CPAP), OAs are less efficacious in reducing the apnea hypopnea index (AHI), but OAs appear to be used more (at least by self report), and in many studies were preferred over CPAP when the treatments were compared. OAs have also been compared favorably to surgical modification of the upper airway (uvulopalatopharyngoplasty, UPPP). Comparisons between OAs of different designs have produced variable findings. The literature of OA therapy for OSA now provides better evidence for the efficacy of this treatment modality and considerable guidance regarding the frequency of adverse effects and the indications for use in comparison to CPAP and UPPP.
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              Quantitative study of bite force during sleep associated bruxism.

              Nocturnal bite force during sleep associated bruxism was measured in 10 subjects. Hard acrylic dental appliances were fabricated for the upper and lower dentitions of each subject. Miniature strain-gauge transducers were mounted to the upper dental appliance at the right and left first molar regions. In addition, thin metal plates that contact the strain-gauge transducers were attached to the lower dental appliance. After a 1-week familiarization with the appliances, nocturnal bite force was measured for three nights at the home of each subject. From the 30 recordings, 499 bruxism events that met the definition criteria were selected. The above described system was also used to measure the maximum voluntary bite forces during the daytime. The mean amplitude of detected bruxism events was 22.5 kgf (s.d. 13.0 kgf) and the mean duration was 7.1 s (s.d. 5.3 s). The highest amplitude of nocturnal bite force in individual subjects was 42.3 kgf (15.6-81.2 kgf). Maximum voluntary bite force during the daytime was 79.0 kgf (51.8-99.7 kgf) and the mean ratio of nocturnal/daytime maximum bite force was 53.1% (17.3-111.6%). These data indicate that nocturnal bite force during bruxism can exceed the amplitude of maximum voluntary bite force during the daytime.
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                Author and article information

                Journal
                J Conserv Dent
                J Conserv Dent
                JCD
                Journal of Conservative Dentistry : JCD
                Medknow Publications & Media Pvt Ltd (India )
                0972-0707
                0974-5203
                Sep-Oct 2016
                : 19
                : 5
                : 383-389
                Affiliations
                [1 ]Department of Dentistry, Sleep Disorders Multi-disciplinary Care Clinic, Ng Teng Fong General Hospital, Jurong Health Services, Singapore
                [2 ]Faculty of Dentistry, National University of Singapore, Singapore
                [3 ]School of Science and Technology, SIM University, Singapore
                [4 ]Department of Medicine, Sleep Disorders Multi-disciplinary Care Clinic, Ng Teng Fong General Hospital, Jurong Health Services, Singapore
                Author notes
                Address for correspondence: Prof. Adrian U. J. Yap, Department of Dentistry, Ng Teng Fong General Hospital, Jurong Health Services, 1 Jurong East Street 21, 609606, Singapore. E-mail: tmdsleepden@ 123456gmail.com
                Article
                JCD-19-383
                10.4103/0972-0707.190007
                5026093
                27656052
                b64a692c-1567-400b-b64b-5f621d41d469
                Copyright: © Journal of Conservative Dentistry

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 17 May 2016
                : 15 July 2016
                : 04 August 2016
                Categories
                Invited Review

                Dentistry
                consequences,diagnosis,etiology,management,sleep bruxism
                Dentistry
                consequences, diagnosis, etiology, management, sleep bruxism

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