Chapter 55 - Sleep bruxism

Abstract

Sleep bruxism is a sleep-related movement disorder with repetitive jaw muscle contraction. It is occasionally associated with tooth-grinding noises. Patients may experience jaw muscle and joint pain, headaches, and sensitivity to teeth due to forceful jaw muscle contractions. It is important to distinguish clenching while awake from sleep bruxism during sleep, because of different etiology and pathophysiology. In the absence of any medical or sleep disorders, use of medication or recreational drugs, sleep bruxism is classified as primary. Age seems to be an important variable, as the condition is reported in 14% in children, compared with 3% in older people. Furthermore, the prevalence of sleep bruxism–tooth grinding stands at 8% in adults. The pathophysiology of sleep bruxism remains unclear, but may be associated with: some neurological and psychiatric disorders; influence of sensory factors on motor control; interaction with neurotransmitters; and some mechanisms related to sleep arousal. A diagnosis of sleep bruxism is reached following patient interview, clinical examination, and sleep recordings. The most appropriate strategy to manage patients with sleep bruxism is to reassess the main motive for the consultation, such as tooth-grinding noises or morning pain. A dental device, adapted to either the maxillary or the mandibular arches, is the recognized procedure used to prevent the grinding sounds in absence of sleep apnea. If sleep-disordered breathing is suspected, the mandibular advancement appliance may be used. In mild cases, the first line of approach might be short-term use of a muscle relaxant.