Involuntary Jaw Movements Research Articles

Avaliação da associação entre cronotipo, qualidade do sono e autorrelato de bruxismo do sono entre estudantes universitários de Odontologia

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

Cerebral palsy

Cerebral palsy is one of the most severely handicapping conditions affecting irregular gait childhood. This condition manifests itself as a number of neuromuscular dysfunctions and involves muscle weakness, stiffness, paralysis, poor balance irregular gait, and uncoordinated or involuntary movement. These children may have higher risk of caries due to their inability to maintain good oral hygiene, intake of soft and cariogenic food, increased prevalence of enamel hypoplasic defects on the teeth. Periodontal diseases occur with great frequency, as they are unable to brush and floss adequately, they may also be on phenytoin to control seizure activity which is a cause of some degree of gingival hyperplasia. Malocclusion occurs twice, bruxism is commonly seen in athetoid type, and due to the nature of disorder, these children are more susceptible to trauma, especially of the maxillary anteriors. They have excessive drooling and difficulty in swallowing. Spastic children present with spastic tongue thrust, Class II DIV 2 malocclusion with unilateral crossbite. Athetoid patients presents with mouth breathing and anterior open bite. Many patients prefer to be treated in the wheel chair, which may be tipped back into the dentist's lap, head should be stabilized throughout the procedure, use physical restraints for control of failing extremities, mouth props, and finger splints can be used for control of involuntary jaw movements, avoid abrupt movements, lights and noises to minimize startle reflex reactions. Local anesthetic can be used with care, rubber dam can be used to protect the working area from hyper active tongue movements, and gauge shield should be used during extraction to avoid aspiration. Premedication can be used to reduce hypertonicity, involuntary movement, and anxiety; general anesthesia can be used as a last resort. This article discusses about etiology, clinical features along with management of children with cerebral palsy.

Oromandibular dystonia—functional and clinical characteristics: a report on 21 cases

The objectives of this study were to describe subtypes, characteristics, and orofacial function of patients with oromandibular dystonia and report results of special dental importance. Symptoms, signs, and function were evaluated by questionnaires, video, and clinical and physiological examinations in 21 patients with primary and secondary dystonia (13 focal, 7 segmental, 1 multifocal). A mixture of 2 or more subtypes of jaw movements was most common (43%), and the dystonic electromyographic activity was frequent in the anterior digastric (62%) and temporal and lateral pterygoid (48%) muscles. The impact from the oromandibular dystonia was marked. The prevalence of problems with mastication and swallowing was high, as well as with hyposalivation, dental attrition, and other dental problems. Patients with oromandibular dystonia may present to dentists with involuntary jaw movements and other severe functional problems. Care must be adapted to the neurological disorder and may be complicated by the condition itself.

Low-Dose Aripiprazole in the Treatment of SSRI-Induced Bruxism

Low-Dose Aripiprazole in the Treatment of SSRI-Induced Bruxism

Clinical characteristics of lateral pterygoid myospasm: a retrospective study of 18 patients

The available scientific literature on masticatory myospasm-induced oromandibular dystonia is limited. The objective of this study was to determine the clinical characteristics of lateral pterygoid myosapsm in a series of 18 patients. Clinical and electromyographic (EMG) data of 36 patients diagnosed with masticatory muscle myospasm were reviewed, and data from 18 patients with needle EMG-confirmed lateral pterygoid myospasm were extracted for retrospective study. The study population included 6 men and 12 women with a mean age of 53.2 ± 15.3 years. Patients' chief complaints, severity and frequency of myospasm, clinical observations, video recordings, and surface/needle EMG recordings were analyzed. Despite the variety of manifestations, 3 characteristic signs and symptoms of lateral pterygoid myospasm were observed. These were: 1) jaw function disabilities; 2) difficulty in jaw closing after wide opening; and 3) involuntary jaw movements. A differential diagnosis of lateral pterygoid myospasm should be included when oromandibular dystonia is accompanied by the fore mentioned.

Oromandibular dystonia after dental treatments: a report of two cases

Oromandibular dystonia (OMD) is a rare focal form of dystonia caused by prolonged muscles spasms in the mouth, face, and jaw. OMD can develop after dental treatment, as poorly aligned dentures or multiple tooth extraction may cause an impairment of proprioception in the oral cavity, leading to the subsequent development of dystonia. These repetitive involuntary jaw movements may interfere with chewing, swallowing, and speaking. We report here two cases of OMD after dental procedures.

Motor control of jaw movements: An fMRI study of parafunctional clench and grind behavior

Jaw-clenching and tooth-grinding associated with bruxism can contribute to abnormal tooth wear and pain in the masticatory system. Clench and tooth-grinding jaw-movement tasks were evaluated in a block-design fMRI study comparing a dental-control (DC) group with a tooth-grinding (TG) group. Group classification was made prior to imaging based upon self-reported parafunctional clench and grind behavior and clinical evidence of abnormal tooth wear. Group differences in brain activation patterns were found for each task compared to the resting baseline. The DC group showed a more widely distributed pattern; more extensive activity in the supplementary motor area (SMA) proper that extended into the pre-SMA; and, for clench, activity in the left inferior parietal lobule (IPL). The DC group activated more than the TG subjects the left IPL for clench, and pre-SMA for grind. Neither task elicited more activity in the TG than DC subjects. Our group findings suggest that jaw-movement tasks executed by the TG group elicited (1) more efficient brain activation pattern consistent with other studies that found less extensive activity with executing “over-learned” tasks; (2) “underactive” SMA activity that underlies reduced motor planning; (3) decreased inferior parietal activity that is associated with lesser motor-attentional demands. Thus orofacial parafunctional habits may influence brain circuits recruited for jaw movements, providing a possible basis for understanding involuntary jaw movements in bruxism and oral movement disorders in general.

Tardive Dystonia Associated With Ziprasidone

Back to table of contents Previous article Next article Letter to the EditorFull AccessTardive Dystonia Associated With ZiprasidoneSPIRIDON PAPAPETROPOULOS, M.D., Ph.D., STEVE WHEELER, M.D., and CARLOS SINGER, M.D., SPIRIDON PAPAPETROPOULOSSearch for more papers by this author, M.D., Ph.D., STEVE WHEELERSearch for more papers by this author, M.D., and CARLOS SINGERSearch for more papers by this author, M.D., Miami, Fla.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ajp.162.11.2191AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Although the new atypical neuroleptics have held the promise of fewer extrapyramidal signs, there have been several reports of tardive movement disorders associated with their use. Ziprasidone-associated tardive dyskinesia has been rarely described (1). However, to our knowledge, there have been no reports of tardive dystonia caused by ziprasidone.Ms. A, a 56-year-old woman, was seen with a chief complaint of involuntary jaw movements. She had a 35-year history of migraines for which she had received a number of treatments (triptans, beta-blockers and calcium channel blockers, antiepileptics, antidepressants, and clonazepam) with limited success. Her first trial with an atypical neuroleptic was 2.5 years before her presentation, when she was administered ziprasidone (80 mg/day). Ms. A experienced a moderate decrease in the frequency and severity of her migraine attacks. Eleven months later, she started noticing mild involuntary movements of her tongue, and ziprasidone was gradually discontinued. Within 2 weeks, involuntary movements involving jaw opening were superimposed on the involuntary movements of her tongue. Gradually, her symptoms intensified, causing eating difficulties accompanied by weight loss (5–6 kg). She also experienced occasional tongue and oral mucosa injuries. Her past medical history was remarkable only for a hysterectomy performed for an ovarian cyst.A neurological examination revealed frequent, sustained jaw opening, with occasional tongue protrusions and rare dystonic furrowing of her eyebrows. No other abnormalities were noted; brain magnetic resonance imaging was normal. Ms. A had already received botulinum toxin type A injections without success and declined repeat injections.Tardive dystonia is a late-onset complication of treatment with dopamine-blocking agents consisting of persistent dystonic movements of focal onset involving mainly the craniocervical region. It usually appears while receiving a stable dose, but it may manifest while tapering the dose or even 1–3 weeks after discontinuation (as in our case) (2). In many patients, tardive dystonia is combined with the classic tardive oral-buccal-lingual dyskinesias (3). Tardive dystonia is very resistant to treatment and can occur in patients with psychiatric as well as other conditions (in our case, migraine headaches) (2). Although very rare, tardive dystonia has been reported with the use of other atypical neuroleptics, including clozapine, risperidone, and olanzapine (4).We found no reports of tardive dystonia occurring with ziprasidone on PubMed. Although our patient’s clinical diagnosis was unequivocally tardive dystonia, with its time course consistent with ziprasidone monotherapy as the precipitant, the remote possibility of dystonia due to other causes (i.e., idiopathic, psychogenic) may be considered. Clinicians should keep in mind that there is no “absolutely safe” atypical neuroleptic since there is always a potential for the appearance of extrapyramidal signs.

Involuntary Jaw Movements in Elderly Patients

To the Editor.— In a recent issue ofThe Journal, Daniel M. Laskin, DDS, responded to a question regarding involuntary jaw movements in elderly patients. Although he lists three conditions that should be considered in elderly patients who manifest continuous involuntary jaw movements, there is one very important condition that he neglected to comment on: namely, tardive dyskinesia, which is quite common in elderly patients who have been receiving long-term antipsychotic drug therapy. Once the condition is established, it may be irreversible (largely depending on its duration), although numerous drugs (eg, deanol and valproate sodium) have been advocated as being efficacious in reversing this extremely disturbing syndrome. Of equal importance however, is the fact that using drugs such as benztropine (Cogentin) mesylate, trihexyphenidyl hydrochloride (Artane), and similar anticholinergic drugs are contraindicated in the treatment of tardive dyskinesia, since these medications worsen the symptoms. Similarly, agents that increase CNS dopamine levels

Involuntary Jaw Movements in Elderly Patients

To Editor.— We believe reply by Dr Laskin in QUESTIONS AND ANSWERS section (236:2447, 1976) regarding cause and treatment of involuntary chewing-like movements in geriatric patients contains errors and misconceptions. Dr Laskin implies that most common cause for condition is parkinsonism. While patients with Parkinson disease occasionally have involuntary movements of face and mouth other than rhythmic tremor, is uncommon. It is true that during epidemic of von Economo encephalitis, afflicted patients commonly experienced such involuntary movements during active stages of disease. It is also true that levodopa therapy frequently produces oral dyskinesias in patients being treated for Parkinson disease. Dr Laskin then goes on to say that the next most common condition is orofacial dyskinesia, and that this extrapyramidal disorder usually is a sequela of encephalitis. We do not agree that is case. In fact, if one

Involuntary Jaw Movements in Elderly Patients

To Editor.— Dr Laskin makes two points that merit further comment. First, he notes that abnormal jaw movements may be caused by factors unrelated to ingestion of major tranquilizers. This fact seems to be frequently forgotten in controversy over tardive dyskinesia in clinical psychiatry. Registered with our aftercare program is a woman who has been receiving major tranquilizers for many years. She demonstrates oral-buccal-lingual movements said to be typical of tardive dyskinesia. An admission note from another hospital in 1951 describes identical abnormal movements. Major tranquilizers were introduced into her drug regimen in 1954. Major tranquilizers cannot be implicated in every instance of a psychiatric patient who experiences abnormal jaw movements. Secondly, author states that in cases of drug-induced movement disorders, the problem can be eliminated by discontinuing therapy with drug. Drug discontinuation in face of apparent tardive dyskinesia is a complex issue with

Involuntary jaw movements in elderly patients

Involuntary jaw movements in elderly patients