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For Peer Review Journal of Oral Rehabilitation Sleep bruxism and vigil bruxism: Should we consider a new therapeutic approach? Journal: Journal of Oral Rehabilitation Manuscript ID: Draft ManuscriptFor Type: Review Peer Review Date Submitted by the Author: n/a Complete List of Authors: Ferrer-Gallegos, Joaquín; Servicio Andaluz de Salud, Dentistry Gómez-Moreno, Gerardo; University of Granada, School of Dentistry Patient: adult, paediatric Condition: bruxism Co-morbidity: stress, smoking, depression / mood disorder Content method: prosthodontics, restorative dentistry, therapeutics Study method: literature review N/A Page 1 of 40 Journal of Oral Rehabilitation 1 2 3 Sleep bruxism and vigil bruxism: Should we consider a new 4 5 6 therapeutic approach? 7 8 9 10 11 J. FERRER-GALLEGOS *, G. GÓMEZ-MORENO 12 13 14 15 *Dentist, Loja/Montefrío Health Center (Granada, Spain), managed by the Andalusian 16 17 18 Public Health System.For Peer Review 19 20 †Full Professor Department of Special Care in Dentistry, Pharmacological Research in 21 22 Dentistry, Director of Master in Periodontology and Implant Dentistry, Faculty of 23 24 Dentistry, University of Granada, Granada, Spain. 25 26 27 28 29 30 31 32 33 Running Title: Sleep bruxism and vigil bruxism 34 35 36 37 38 39 40 41 Correspondence: 42 43 Joaquín Ferrer Gallegos. C/ Pedro Antonio de Alarcón 41-1d,18004 Granada (Spain) 44 Tel.: +34 958520496, Fax: +34 958520496 45 E-mail: [email protected] 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 N/A1 Journal of Oral Rehabilitation Page 2 of 40 1 2 3 SUMMARY 4 5 Sleep bruxism (SB) and vigil bruxism (VB) are pathologies that remain among a group of 6 7 diseases put aside “for further research.” Much is known of their consequences and 8 9 10 treatment but little of their etiology. Perhaps this is because these disorders have unusually 11 12 limiting effects on daily life, but never place the sufferer’s life in danger. Maybe if their 13 14 etiology was known approaches to treating SB and VB might be more effective and long- 15 16 lasting. Today, it is clear that they are two separate pathologies, with different muscular 17 18 activity and differentFor etiologies, Peer although Reviewboth may co-exist in a single individual. 19 20 21 Approaches to therapies for treating their consequences are undergoing a change. To date 22 23 the use of daytime occlusal splints has been recommended for both SB and VB. The splints 24 25 are uncomfortable and patients often fail to use them regularly; for this reason, it would 26 27 appear logical to improve their design, a project that represents an important line of 28 29 30 research. Occlusal considerations (dental contact) are losing relevance in approaches to 31 32 both pathologies. In fact, occlusal splints represent interference in the whole 33 34 stomatognathic system and yet remain the first choice for treating the consequences of 35 36 bruxism. Meanwhile, it has been observed that drastic changes in occlusal vertical 37 38 dimension prevent bruxist episodes (orthodontic treatment). 39 40 41 42 43 44 KEYWORDS: sleep bruxism, vigil bruxism, management, oral rehabilitation. 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 N/A2 Page 3 of 40 Journal of Oral Rehabilitation 1 2 3 Introduction 4 5 Bruxism is defined as a diurnal or nocturnal parafunctional activity including tooth 6 7 clenching, bracing, gnashing, and grinding of the teeth that may be diurnal, known as vigil 8 9 10 bruxism (VB), nocturnal sleep bruxism (SB), or mixed (1-2). SB and VB consist of a 11 12 rhythmic muscular activity, which is considered phasic when muscular contractions have 13 14 intervals of 0.2 - 5 seconds, tonic if the contractions are of more than two seconds. In some 15 16 cases the SB and VB may combine tonic and phasic contractions. The most frequent form 17 18 of SB is phasic,For while VB isPeer commonly tonic. Review It can be considered a parafunctional habit 19 20 21 (non-functional, with no purpose) or an orally self-destructive habit (1-4). SB and VB can 22 23 also be classified as centric consisting of clenching the teeth without side-to-side 24 25 movements, or excentric consisting of grinding the teeth by moving the jawbone (5, 6). 26 27 VB is considered to be a ‘tic’ related to stress in daily life, while SB is induced by 28 29 30 the central nervous system (CNS) associated with mechanisms of sleep lightening or with 31 32 micro-awakenings (7). In this way, they are separate pathologies with different etiologies. 33 34 Diagnosis must determine between the two and whether the SB/VB is slight, moderate or 35 36 severe, whether it consists of tooth grinding or teeth clenching. SB and VB present a 37 38 challenge to any dental treatment, no matter how simple. 39 40 41 The patient must be made aware of the problem, understand the complications 42 43 arising from the pathologies, which may prevent treatment from achieving the expected 44 45 outcomes both in terms of the duration of treatment and the aesthetic results (6). There are 46 47 several questionnaires designed to identify SB and VB (7, 8). 48 49 50 51 52 Infantile SB and VB 53 54 SB and VB can sometimes appear at a young age and require treatment whenever one of 55 56 the following symptoms occurs: dental attrition, dental fractures, muscular hypertrophy, 57 58 59 60 N/A3 Journal of Oral Rehabilitation Page 4 of 40 1 2 3 breakage of dental prostheses, premature loss of teeth, headache, or TMJ pain. Currently, 4 5 the consumption of fizzy drinks is claimed to be the most significant factor in dental wear, 6 7 causing much erosion among youngsters. Children with SB and VB also have a greater 8 9 10 tendency to suffer high levels of anxiety, and SB and VB often occur in children with 11 12 anxious personalities; hyperactivity and attention deficit disorder are also risk factors. No 13 14 causal relation has been identified between infantile SB/VB and TMJ disorders. 15 16 Parafunctional habits (nail biting and thumb sucking) have been associated with VB. But 17 18 children with respiratoryFor problems Peer show a Reviewgreater tendency towards SB, which can be 19 20 21 alleviated by sleeping without a pillow to improve air flow in the airway; this also 22 23 alleviates the SB. 24 25 Children with SB and VB should not chew gum; daytime naps are recommended, 26 27 no television before going to bed, and parents should read their child a story before they go 28 29 30 to sleep (8-10). The occurrence of SB/VB at a young age predisposes the individual to 31 32 suffering SB/VB in adulthood (11). A child with a pattern of dental wear is a challenge but 33 34 at the same time an opportunity to prevent risks to permanent teeth. Sometimes a change of 35 36 lifestyle (diet: avoiding fizzy drinks, stimulants, soft diet, television, whatsapp) can correct 37 38 the bruxist habit (12). For children with SB/VB, the most important service that dental 39 40 41 professionals can provide in the clinic is early diagnosis and the prompt implementation of 42 43 preventative measures. However, it should be remembered that SB and VB are not the only 44 45 causes of dental wear (13). The first teeth to be affected by bruxist tooth grinding in 46 47 children are the canines (canine guidance) and result in lateralization of group function 48 49 50 (loss of canine guidance). In the adult population, this wear is physiological and leads to 51 52 group function, whether SB and VB are present or not (14-15). 53 54 55 56 57 58 59 60 N/A4 Page 5 of 40 Journal of Oral Rehabilitation 1 2 3 Etiology 4 5 The etiology of SB is uncertain and there is no consensus as to its treatment. It has a high 6 7 prevalence in the general population and affects general health. Treating SB is not the 8 9 10 same as treating its consequences (16). No agreement has been reached among the 11 12 scientific community as to the exact definition or diagnosis of SB and VB. More 13 14 information has been generated on SB as its study is more reliable and suited to scientific 15 16 methodology (by means of polysomnography, for example). A better understanding of its 17 18 etiology might Forserve to determine Peer the most Review appropriate form of treatment (17). Most 19 20 21 authors suggest that the origin of SB is pathophysiological and unrelated to 22 23 temporomandibular joint (TMJ) anatomy, and even less so to dental occlusion (18). 24 25 For treating SB and VB, the drilling of selected teeth is neither indicated nor 26 27 justifiable. More recent scientific research, involving premature contact with artificial 28 29 30 crowns, with occlusal fillings, or other means, have made it clear that these occlusal 31 32 interferences reduce the bruxist habit. Artificial occlusal interferences reduce SB and VB 33 34 but natural occlusal interferences are a consequence of SB and VB rather than its cause. 35 36 The same scenario occurs regarding maxillary, mandibular and TMJ anatomy/architecture 37 38 – not one scientific study has been able to relate SB and VB to these anatomical structures 39 40 41 (19). 42 43 44 45 Clinical signs of SB and VB 46 47 Clinical signs of SB and VB are as follows: non-specific dental wear, dental fractures or 48 49 50 fractured restorations; temporal/masseter hypertrophy; widening periodontal ligament 51 52 space (x-ray); dental mobility without periodontal disease or dental pulp necrosis; 53 54 ulceration in patients with removable prostheses; enlarged cheek line or lingual 55 56 indentations (although there is some controversy regarding the latter); bruxofacets on night 57 58 59 60 N/A5 Journal of Oral Rehabilitation Page 6 of 40 1 2 3 guards that follow a set pattern.
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