Abstract
Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks), periodontal signs (gingival recession and tooth mobility) and muscle-joint sensitivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO) for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately). After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders.
Highlights
Tooth wear can be defined as a non-carious gradual loss of tooth structure caused by many factors, such as toothto-tooth friction; foreign abrasive substances; endogenous chemical factors, like the acid gastric juice present in patients suffering from bulimia or gastroesophageal reflux disease; and exogenous chemical factors from low pH substances, like citrus fruits[9]
The aim of this study is to report a case describing and discussing the treatment of a patient who presented bruxism associated with gastroesophageal reflux disease (GERD), usual acid food intake and smoking habit, generating severe tooth wear
To meet all these requirements, the following criteria must be followed: the patient can function from centric relation to occlusion without occlusal interferences (Figure 6A); the temporomandibular joint (TMJ) is loaded without tenderness; there are posterior centric stops between the maxillary and mandibular arches before contact of anterior teeth; anterior coupling allows for disocclusion of posterior teeth (Figure 6B, 6C and 6D); teeth are positioned in balance with the tongue and facial muscles[16]
Summary
Tooth wear can be defined as a non-carious gradual loss of tooth structure caused by many factors, such as toothto-tooth friction; foreign abrasive substances (i.e., toothbrushing and dentifrice); endogenous chemical factors, like the acid gastric juice present in patients suffering from bulimia or gastroesophageal reflux disease; and exogenous chemical factors from low pH substances, like citrus fruits[9]. Bruxism causes attrition and can be understood as a common parafunctional activity that includes tooth grinding or clenching The exogenous sources of corrosion have been related to any food substance with a critical pH value of less than 5.5, which is known to become a corroding agent and demineralize teeth[9] This may occur as a result of consuming and/or mulling highly acidic foods and beverages, such as mangoes, lemons and other citrus fruits, drinking carbonated soft drinks and sucking sour candies[9]. Attrition-corrosion is the loss of tooth substance due to the action of a corroding agent in areas in which tooth-totooth wear occurs[9]. This process may lead to a loss of vertical dimension, especially in patients with GERD or gastric regurgitation. The aim of this study is to report a case describing and discussing the treatment of a patient who presented bruxism associated with GERD, usual acid food intake and smoking habit, generating severe tooth wear
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