Week 5- Bruxism and Splints Flashcards
Why is bruxism more common nowadays?
Living longer and stresses
What is bruxism?
Repetitive muscle activity characterised by clenching or grinding of teeth and/or bracing or thrusting of the mandible
What are the types of bruxism?
Primary bruxism: Awake & sleep bruxism
Secondary bruxism
What is awake bruxism?
Concentrated or stress related activity or parafunction
What is sleep bruxism?
Sleep movement disorders. More likely to have other sleep disorders such as snoring and pauses in breathing (sleep apnea)
What is secondary bruxism?
Associated with medical conditions including cerebral palsy and learning difficulties or side effects of medications or illicit drug use.
What is pathological tooth surface loss?
Attrition, abrasion and erosion with a possible contribution from each.
What are the principle concerns with patient presenting with pathological tooth surface loss?
- Poor aesthetics
- Sensitivity
- Functional problems (TMD, fractured teeth, eating discomfort)
- Pain (tension headaches)
How is bruxism diagnosed?
Polysomnography is the most accurate
May be episodic with short bursts of masseteric activity
- <2 secs (phasic or grinding)
- >2 secs tonic (clenching)
- Combination of both.
What are signs and symptoms of bruxism (11)?
- Teeth grinding or clenching
- Flattened, fractured, chipped or loose teeth
- Worn tooth enamel
- Tired or tight muscles of mastication
- Trismus
- Jaw, neck or facial pain
- Pain mimicking ear-ache
- Dull headaches (temporal area)
- Chewing inside of cheek
- Poor sleep patterns
- Parafunctional activity due to loss of teeth & subsequent disordered occlusion
What are causes of bruxism (8)?
- AB: anxiety, stress, frustration, concentration may be coping strategy
- SB: sleep related chewing activity associated with arousal during sleep.
- Stress
- Age: common in young children but usually disappears in adulthood
- Personality type: aggressive, hyperactive
- Medications
- Family members
- Medical disorders: Parkinson’s disease, dementia, GORD, epilepsy. sleep apnea, ADHD
What are general management strategies for bruxers?
Dental manifestations can be managed with restos, but bruxism is mainly a medical problem so treatment should be directed at moderating stress
- Dental- soft or hard occlusal coverage appliances
- Medical- pharmacological (muscle relaxants)
- Cognitive behavioral therapy
- Low voltage biofeedback appliance
- Refer for sleep management
- Yoga, meditation, exercise
What are soft splints used for? What are they made out of?
Used as emergency appliance in acute cases due to compressibility (made of 2mm thick polyvinyl)
What are bilaminar appliances used for?
Helps reduce effects of bruxism and tooth wear, thus, protecting restos (particularly anterior composites)
What are the advantages of bilaminar appliance?
Allows some absorption of occlusal forces during bruxism and has more resistant exterior compared to entirely soft occlusal splints
What happens when wear facets are worn into splints?
Can lead to tooth movement
Are occlusal splints recommended for sleep bruxism?
No sufficient evidence to state occlusal splints are effective for treating SB. However, there is some benefit wrt tooth wear.
What are the 4 most commonly employed treatments in specialist TMD?
- Counselling
- Drug therapy
- Physiotherapy
- Splint therapy
What are the 4 main types of splint applicable to the general dentist?
- Soft vacuum formed splint usually for lower arch
- Localised occlusal interference splint
- Anterior repositioning splint
- Stabilisation splint
What is a localised occlusal interference splint used for?
- Known as interceptor splint
- Used to break bruxist habit in pt with or without TMD
- Useful in pts who brux/clench in centric occlusion but not in extreme excursive movements.
- Worn day or night
Who is an anterior repositioning splint used in?
Splint of choice for those with displacement of disc with reduction (clicking)
Who is a stabilisation splint indicated for?
Pt with symptoms of pain dysfunction syndrome (aka facial arthromyalgia) where occlusal discrepancy between CO and CR or occlusal interferences are factors.
May be used to determine CR for complex restorative cases.
What is ideal occlusion?
- Teeth in contact in CR
- CO slightly in front of CR but in same sagittal and horizontal plane
- Unrestricted glide from CR to CO
- Smooth gliding eccentric movements
- No working side interference during lateral and protrusive movements.
How are splints fabricated?
- Accurate md and mx models with centric jaw relation, mounted with face-bow record
- Splint made from hard heat cured acrylic which needs to be adjusted to allow for desired smooth, unhindered movements until no interferences and stable md position is obtained.
