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Bruxism Management: a Comprehensive Review Luis Gabriel Ladino1* , Melissa Vargas2 , Johana Rodriguez2 and Efrain López1

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Bruxism Management: a Comprehensive Review Luis Gabriel Ladino1* , Melissa Vargas2 , Johana Rodriguez2 and Efrain López1 ISSN: 2378-3656 Ladino et al. Clin Med Rev Case Rep 2020, 7:316 DOI: 10.23937/2378-3656/1410316 Volume 7 | Issue 8 Clinical Medical Reviews Open Access and Case Reports REVIEW ARTICLE Bruxism Management: A Comprehensive Review Luis Gabriel Ladino1* , Melissa Vargas2 , Johana Rodriguez2 and Efrain López1 1Associate Professor, Postgraduate Program in Prosthodontics, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia Check for updates 2Resident, Postgraduate Program in Prosthodontics, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia *Corresponding author: LuisGabriel Ladino, Associate professor Postgraduate program in Prosthodontics, Institución Universitaria Colegios de Colombia UNICOC. Autopista Norte Km 20. Bogotá, Colombia, Tel: +573057979215, E-mail: [email protected] Introduction ed with its presence, which may or may not be etiolog- ical; However, in adult patients, possible causal factors According to the international consensus of experts have been reported such as: occlusal forces, emotional for the diagnosis and treatment of bruxism, carried out causes or those generated by the central nervous sys- by Lobbezoo, et al. [1], Bruxism is defined as a masti- tem [4]; psychological problems such as stress and anx- catory muscle activity that can occur while the person iety at all ages; In addition, SB in children is associated is asleep or awake. After several debates that emerged with respiratory problems, physiological dental wear, after the first consensus held in 2013, in which they caries, malocclusions and use of pacifiers. defined bruxism as “an excessive activity of the chew- ing muscles, characterized by clenching or grinding the About the frequency, according to the study by Ro- teeth and/or by the recurrent excessive effort made by drigues, et al. [5] the prevalence of bruxism in children the of the jaw [2]; the need to redefine bruxism was ranges from 3.5% to 46%, while the study by Manfre- seen, emphasizing the “masticatory muscular activity” dini, et al. [6] shows that the prevalence of bruxism in of the patient and the activity according to the moment adults ranges from 8% to 31.4%; without reporting dif- in which it is performed: sleep bruxism (SB) or awake ferences between gender or age in the SB, and a slight bruxism (AB); highlighting the need to separate the predominance of the AB in women [3]. In an umbrel- terms, since bruxism is generated in two moments and la review, Melo, et al. [7] reported the prevalence of therefore different signs, symptoms and characteristics bruxism in adults and children according to the type of will appear. Additionally, it must be in mind that brux- bruxism diagnosed; concluding that in adults AB occurs ism is not considered a disorder but rather a behavior from 22% to 30%, and SB occurs between 10% to 13%, because its effects do not necessarily produce damage evidencing a decrease at older age and in children or as a disorder would. adolescents the SB in a range from 3% to 49% [6,7]. The physiological predisposing factors of bruxism Treatment for bruxism is suggested to be multidisci- cannot be individualized, since this is the result of a com- plinary, for both children and adults. Dental treatment bination of causes which produce a pathogenic, repeti- includes some intraoral devices, which aim to protect tive, and often unconscious action. Whenever bruxism teeth and restorations from possible wear and tear that is discussed in adults or children, the presence of dental may be generated as a result of parafunctional activity contacts should be verified and established [1-3]; Ad- [8]; Treatment with physical therapy consists of per- ditionally, establishing a specific etiology for bruxism is forming exercises of the masticatory muscles and they impossible, since there are causes and factors associat- should be performed without exerting excessive inten- Citation: Ladino LG, Vargas M, Rodriguez J, López E (2020) Bruxism Management: A Comprehensive Review. Clin Med Rev Case Rep 7:316. doi.org/10.23937/2378-3656/1410316 Accepted: August 29, 2020: Published: August 31, 2020 Copyright: © 2020 Ladino LG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Ladino et al. Clin Med Rev Case Rep 2020, 7:316 • Page 1 of 6 • DOI: 10.23937/2378-3656/1410316 ISSN: 2378-3656 sity, since this can generate microtrauma to the muscle and AB in adults or youth, aggravating the situation the fibers [9]. Likewise, other options include management multiple methods that can be used to evaluate them [7]. with cognitive-behavioral therapies including psycho- In a first consensus carried out in 2013, they defined analysis, autosuggestion, hypnosis, progressive relax- bruxism as an “excessive activity of the masticatory ation, meditation, self-control, and sleep hygiene [10]. musculature, characterized by clenching or grinding the As alternative Biofeedback is a behavioral technique, teeth and/or by excessive and recurrent effort made consisting of the use of biological signals themselves to by the jaw” [2]; but the concept obtained according to achieve a change in physiological functioning [11]. Re- the consensus in 2018, is a “masticatory muscle activity garding pharmacological treatment, medications such that occurs during sleep and/or wakefulness”; which is as benzodiazepines, anticonvulsants, beta-blockers, and conditioned by a series of variables that interact with its antidepressants may be indicated; It is recommended presence; according to the moment in which the man- that this type of therapy should only be performed in dibular movement is performed, we can start from a case other more conservative treatments have not classification: SB and AB; In addition to the moment in been effective [12]. On the other hand, the application which the patient carries out the bruxomaniac activity, of botulinum toxin has been used for the management we must be sure of the evolution time of this “behav- of bruxism, this is defined as a neurotoxin that is pro- ior”, since it is so called, if the abnormal function time is duced by a gram-positive bacterium called Clostridium less than a month and there are no pathological clinical botulinum. Botulinum toxin type A (BTZ-A) is a biologi- consequences, therefore, it is only considered a habit or cal variable of these exotoxins that temporarily inhibits disorder, if there is dental wear; evident clinical sign of skeletal muscle at the time it restricts the production of contact of the teeth in parafunction by the patient, in acetylcholine and inactivates calcium channels in nerve the same way considering the presence of bruxism as a endings [13]. risk or protective factor 1[ ]. Psychological therapies are recommended as initial Oral pathognomonic signs to clinical diagnose of treatment for bruxism in children, since they will not bruxism involve invasive treatments, they do not interfere with the growth and development of the maxillary structures According to the American Academy of Sleep Medi- and they do not present contraindications or sequential cine (AASM), the evaluation of bruxism is based on re- effects; these psychological complications can decrease ports of teeth grinding and sounds during sleep, how- anxiety and muscular hyperactivity characteristic of ever, it is very complex because there is no consensus bruxomania episodes [14]. The purpose of this article is to measure tooth wear due to parafunction, although to generate clinical recommendations as a complement not all episodes of this rhythmic activity of the chewing to the comprehensive treatment of patients, for deci- muscles are accompanied by the grinding or clenching sion-making about the therapies indicated in SB and AB. of the teeth [15]. Results and Discussion The clinical examination of the oral cavity allows identifying the characteristic signs of teeth grinding, 41 studies were selected to generate recommenda- among which are: tions according to the best available scientific evidence; • Hypertrophy of the masseter and/or temporal mus- the risk of bias was evaluated according to each study cles. as follows: systematic reviews according to the method reported in each document, for observational studies it • Changes in facial symmetry. was evaluated using the Newcastle - Ottawa Scale tool • Indentation of the tongue. and for randomized clinical studies the Jadad scale was used; in addition, the quality of evidence and the degree • Dental wear. of recommendation were also evaluated according to • Fissured or cracked tooth syndrome. GRADE. • Gingival recession [15,16]. Bruxism classification Tooth wear is the most reported evidence for both Various terms have been proposed for the classifica- SB and AB, it is associated with other factors that can tion of bruxism over the years, starting from the factors exacerbate injuries such as age, occlusal disharmony, that may influence its presence, and the different etiolo- consumption of carbonated drinks, consumption of gies, for this reason, the great discrepancy in classifying medications, gastric reflux, and eating disorders. It was it; according to its etiology they classify it into primary shown that although dental wear is a pathognomonic bruxism and secondary bruxism; according to the move- sign of bruxism, its presence should not be taken as an ment carried out by the jaw muscles, they classify it
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