How Do I Manage Bruxism Pain?

Bruxism is a phenomenon in which the jaw performs a certain rhythmic movement or shows a greater tendency to exercise while the teeth are under a certain intensity of occlusal force in an unconscious state. Bruxism is a common and frequently-occurring disease in the stomatology department. It is characterized by intermittent isotonic contraction of the jaw muscles, accompanied by regular chewing-like movements. It can occur in any age group, and is more common in children and young people. . Can be divided into three types, one is the molar type, often molars after falling asleep at night, also known as night molars. The second is the clenching type, which often unconsciously clenches the teeth during the day when the concentration is concentrated, but there is no phenomenon of grinding the upper and lower teeth. The third is a mixed type, which has both the phenomenon of night molars and clenched teeth during the day.

Basic Information

nickname: Bruxism
English name: bruxism
Visiting department: Stomatology
Multiple groups: More common for children and young people

Common locations: tooth
Common causes: Intestinal parasitic diseases, gastrointestinal diseases, oral diseases, psycho-psychological factors, incoordination of occlusion, etc.
Common symptoms: Grinding or thumping of teeth during sleep, sometimes accompanied by sound
Contagious: no

Causes of bruxism

Tooth occlusion factor

Inconsistent occlusal relationships are considered to be a major factor in bruxism, including misalignment, missing teeth, missing or excessive teeth, unilateral chewing, etc. Median or lateral occlusal contact is the most common initiation factor for bruxism. During the period of tooth replacement, most children are not coordinated due to the occlusal relationship, and the upper and lower teeth do not fit well. Therefore, patients often have a subconscious mind. They want to make most of the teeth in close contact. The idea becomes spasm and contraction of the chewing muscles, which can cause nighttime molars.

2. Neurological factors

Studies suggest that bruxism is a manifestation of sleep disorders, and its appearance is related to mild wakefulness in sleep. Studies on the central nervous system and neurochemistry have shown that bruxism is related to abnormal changes in dopamine and norepinephrine, mediators of central nervous system information transmission.

3. Psychological factors

Mental stress is one of the causes of bruxism. Emotional tension, excessive fatigue, stressful thinking, or children's too much excitement or excessive tension during the day often result in inability to fall asleep at night, that is, although most of the cerebral cortex is inhibited after falling asleep. State, but there is still a part of the state of excitement, resulting in contraction of the masticatory muscles and molars. Bruxism patients often have characteristics such as anxiety and psychological immaturity, and the higher the degree of anxiety, the higher the frequency of bruxism.

4. Systemic factors

Intestinal parasite infection, gastrointestinal dysfunction, endocrine imbalance, allergic disorders, vitamin D deficiency rickets, hyperuricemia, hyperthyroidism, bladder stress, etc. can all cause bruxism. When children accumulate food and indigestion, the toxins secreted by bacteria in the gastrointestinal tract are absorbed and stimulate the cerebral cortex, causing the excitement or inhibition of the process to become unbalanced, causing night molars.

5. Genetic factors

Studies have shown that bruxism in childhood often persists and genetic factors cannot be ignored.

Bruxism clinical manifestations

Nocturnal teeth are mainly manifested as grinding or throbbing of teeth during sleep, sometimes accompanied by sound. Daytime molars are mainly manifested as involuntary clenching of teeth during concentration, but there is no grinding of upper and lower teeth.

Long-term grinding will cause abnormal tooth wear. Serious wear and tear can cause allergies to hot and cold sourness, tooth soreness, tooth looseness, periodontal tissue damage, broken tooth tip, and pulpitis. Nocturnal molars can produce a huge occlusal force, which places an excessive load on the temporomandibular joint, leading to temporomandibular joint disorder syndrome.

Because of excessive force, bruxism patients often show chewing muscle fatigue, tenderness, dysfunction, and muscle tension pain. Clinically, it is common for patients to have pain in the masseter muscles, external pterygoid muscles, and digastric muscles, sometimes with masseter muscle hypertrophy, and even muscle pain in the neck and back. Some people have autonomic nervous system symptoms and headaches in the morning.

Bruxism diagnosis

It is not difficult to make a diagnosis based on typical clinical manifestations and oral examinations. At the same time, the possible causes of bruxism should be judged in order to treat the cause. You can refer to the following standards:

1. Patients have typical actions of grinding or clenching teeth during sleep.

2. Stubborn bruxism can be seen, and the conjunctival and adjacent surfaces are severely worn.

3. Periodontal, alveolar bone, gingival atrophy, tooth loosening, displacement and other changes.

4. Masticatory muscle fatigue, weak bite.

5. Associated with temporomandibular joint dysfunction.

6. After getting up, the patient has symptoms of head and neck pain.

7. More common in children and adolescent male patients.

Bruxism treatment

There are many ways to treat bruxism. In clinical, the main purpose is to reduce the damage caused by molars to the occlusal surface of the teeth and reduce the symptoms of muscular joints. The principle is to block the cause and reduce damage.

1. Psychological and Behavioral Therapy

(1) Psychotherapy There are indeed psychological and psychological factors that make the jaw muscles over-tensioned. Eliminate tension, relieve unnecessary concerns, and arrange work reasonably. Oral diazepam if necessary (depending).

(2) Reduce brain excitement. Resting and relaxing before bedtime, doing proper gymnastics, avoiding excitatory foods and smoking, and improving the sleeping environment will help reduce the brain's excitement. The psychological effects of self-awareness and self-control of patients are mobilized to reduce the occurrence of teeth. Little effect.

(3) Muscle relaxation therapy Excessive tension in the jaw muscles is one of the causes of bruxism. Relieving excessive muscle tension during treatment is a necessary means to control bruxism. Commonly used methods are: application of muscle relaxation instrument; physical therapy, physiological function training of chewing muscles; massage; audiovisual cues and other methods. Little effect.

2. Biofeedback therapy

(1) Wake stimulation during sleep Through biofeedback, patients are awakened by electrical signals such as sound when molars occur and temporarily stop molars. Some scholars performed temporary afferent electrical stimulation on the lips, and the results were effective in controlling bruxism. However, this method interferes with the sleep of patients and cohabitants, and the effect is not long-term.

(2) Taste biofeedback Some scholars put a disgusting taste but safe liquid into the capsule and put it in a comfortable position between the patient's upper and lower mandibles. When the patient molars, the The liquid will squeeze out to reach the mouth, and the strong stimulus caused by the bad taste will work through the biological feedback mechanism, which will stop the molar action.

3. Treatment of dental occlusion

(1) Adjusting the occlusal relationship of the teeth By adjusting the grinding of a small amount of dental tissue, removing the occlusal interference, and establishing the occlusal balance relationship, in order to achieve the physiological balance between the jaw, chewing muscle, and temporomandibular joint, and eliminate bruxism. For patients with occlusal deformities, first perform orthodontics or repair. Correct unilateral chewing, pencil biting, chewing gum and other bad habits.

(2) Use of the occlusal plate Make a dental pad, wear it on your teeth before going to bed at night, and remove it in the morning to relieve muscle tension. At present, it is most easily accepted by physicians and patients. The effect of preventing tooth wear is obvious but it cannot treat bruxism.

4. Drug treatment

(1) The main focus of botulinum toxin is to try to adjust dental and maxillofacial dyskinesia and muscle dystonia. Topical application of botulinum toxin (BTX) is effective in treating dyskinesias. BTX was injected into the bilateral chewing muscles of perennial molar patients. As a result, most patients started to stop tooth grinding within 4 weeks after injection, but some patients also had difficulty swallowing.

(2) Central nervous system drugs The use of L-dopa to regulate the central nervous system can significantly reduce the number of molars of molars, but it is easy to cause nausea, vomiting, insomnia, arrhythmias, and psychotic episodes. It should only be considered if other treatments have not been effective for bruxism.

(3) Other drug treatments Target intestinal parasitic infections, gastrointestinal dysfunction, endocrine imbalances, allergies, vitamin D deficiency, children's food accumulation, indigestion and other diseases to provide targeted drug treatment to remove possible causes of molars.

Bruxism prevention

Children 8 to 12 years old can be left untreated and pay attention to rest. Parents usually pay attention to regulating the children's diet and life:

1. Relieve stress, relax and adjust your mindset. Avoid excessive excitement during the day, watch less irritating TV shows before bedtime, and try to relax yourself, especially before falling asleep. Can do some gymnastics, hot water bath, listen to light music and so on.

2. Avoid excitatory foods and smoking (such as drinks or foods containing caffeine. Like coffee, chocolate, cola, etc.), improve the sleeping environment.

3. Pay attention to calcium supplement in daily diet, eat more foods rich in vitamins. Deworm regularly.

4. Applying heat to the upper and lower jaw can relax and engage the muscles, and also reduce the chance of headaches.

5. Maintain correct posture. Bent hump can also lead to molars.

6. Be sure to brush your teeth before going to bed.

7. Keep your mouth in a healthy resting state during the day, that is, keep your teeth relaxed.