Have you ever woken up with a headache, aching jaw, or that disconcerting sensation that you hardly slept at all? If so, you might be grappling with a condition known as “Sleep Bruxism.” In today’s fast-paced and stressful world, this parafunctional issue affects countless individuals. In this article, Dr Chelsea Cahi delves into what Sleep Bruxism is, its symptoms, and potential ways to manage it effectively.
Understanding Sleep Bruxism
Oral parafunction refers to any oral activity that doesn’t serve a functional or physiological purpose. One of the most common parafunctional habits is Bruxism, which often involves clenching and grinding of the teeth. This behaviour can exert excessive stress on the temporomandibular joint (TMJ) and is strongly linked to the development of temporomandibular disorders and joint degeneration.
What is Sleep Bruxism?
Sleep Bruxism (SB) is gaining attention due to its significant prevalence in the general population. According to the International Classification of Sleep Disorders (ICSD), SB is characterized by clenching or grinding of the teeth during sleep. It ranks as the third most frequent parasomnia, reflecting abnormal nervous system behaviour during sleep, among adults. Factors such as neurological and psychiatric conditions, sleep disorders, and medication use can influence its occurrence.
Microarousal, a sudden bodily movement from deeper to lighter sleep stages, is often linked to SB. This triggers activity in the central nervous system, leading to facial muscle activation and contraction, resulting in clenching and grinding. These episodes can happen multiple times each hour, lasting only a few seconds. Although patients tend to return to deeper sleep stages afterwards, these interruptions can hinder overall sleep quality.
Recognising the Symptoms
Due to the frequent sleep disruptions, 70-80% of individuals with SB may experience various symptoms, including:
- Excessive daytime sleepiness
- Fatigue and nonrestorative sleep
- Nightmares
- Profuse sweating and mood changes
- Muscle pain and tenderness
These interruptions can compromise essential sleep functions, like hormone regulation and bodily function control. Poor sleep quality or insomnia can lead to heightened anxiety, perpetuating a cycle of disrupted sleep patterns and increased oral parafunction.
Impact on Temporomandibular Health
Sleep bruxism might contribute to the degradation of the temporomandibular joint. Interestingly, while some sleep disorders are more prevalent in men, females exhibit a higher incidence of temporomandibular disorders related to bruxism.
Approaches to Treatment
Addressing occlusal-related disorders can be challenging for both patients and doctors due to the variable nature of symptoms. While no definitive treatment for sleep bruxism currently exists, behaviour modification-based therapies like habit awareness, habit reversal therapy, relaxation techniques, and biofeedback therapy can target awake bruxism.
To mitigate the negative effects of bruxism, several strategies have been proposed. Among these, the use of interocclusal appliances, such as occlusal splints or night guards, stands out. These appliances can be helpful in managing sleep bruxism, although they might not provide a definitive cure.
Other treatment options encompass:
- Trigger point injections
- Vapocoolant spray and stretch
- Transcutaneous electrical nerve stimulation
- Biofeedback
- Posture correction
- Medication (like tricyclic antidepressants, muscle relaxants, and anti-inflammatories)
- Cortisone injections into the TM Joint to alleviate pain and enhance disc mobility
- Surgical intervention in severe joint compromise cases
Botulinum Toxin has also shown promise in relieving bruxism symptoms. Early reports highlight its successful use in treating severe bruxism with injections to the temporalis and masseter muscles in a brain-injured patient.
Injection Site of Botulinum neurotoxin into left Masseter Muscle
In Conclusion
Bruxism, a common parafunctional habit, has a complex origin. It can occur during both sleep and wakefulness, with sleep bruxism potentially leading to tooth wear, occlusal trauma, sleep disturbances, and headaches. Accurate diagnosis is pivotal for effective treatment. Various options are available, which, once bruxism is managed, can potentially improve sleep quality and overall well-being.
References
- Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint; Glaucia Marques Dias et al, J Craniofac Surg 2015;26: 2347–2350
- Botox Therapy in Dentistry: A Review; Aftab Azam et al, Journal of International Oral Health 2015; 7(Suppl 2):103-105
- Bruxism: A Literature Review; S Varalakshmi Reddy et al, Journal of International Oral Health 2014; 6(6):105-109
- Botox: Broadening the Horizon of Dentistry; Pranav Nayyar et al, DOI: 10.7860/JCDR/2014/11624.5341
- Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls; K. G. Raphael et al, Journal of Oral Rehabilitation 2015 42; 751–758
(BDS WITS)
Dr Chelsea Cahi works at the Cahi Dental Practice, she graduated from the University of the Witwatersrand with her BDS (Bachelor of Dental Science) in 2014, where she was the proud recipient of the Deans Golden Key Award for academic excellence. In 2015, Chelsea completed her year of community service in Soweto for impoverished communities. She has a special interest in the management of TMJ and Orofacial pain related to clenching and teeth grinding. She also focuses on children’s dentistry (including theatre work under general anaesthetic) and non-surgical facial aesthetics.