Bruxism – a silent enemy

The impact of bruxism

Awake bruxism (AB) and sleep bruxism (SB) are distinguished as two different entities – SB is considered a sleep-related movement disorder, while AB is thought to be influenced largely by psychosocial factors such as anxiety, stress and personality characteristics. These psychosocial determinants haven’t been linked quite as clearly to SB.[ii] [iii] The prevalence of bruxism suggests that many clinicians often see the tell-tale signs in their day-to-day work. Patients might complain of orofacial pain, headaches, tooth sensitivity, ear aches and may also present with severely worn/broken teeth. [iv] [v] In more severe cases, bruxism may be one of the causes of temporomandibular disorders (TMD).[vi] Aside from worn down teeth, bruxism can also accelerate aging in the lower face,[vii] due to the parafunctional habit and muscle hyperkinesis in patients with the condition. As such, patients who have sustained significant damage to their teeth as a result of grinding will likely suffer from poor self-esteem, and potentially other social consequences. The functional and mental ramifications of bruxism and tooth wear have been compared to that of edentulism.[viii] Due to the nature of the condition, it can be considered a silent enemy to a patient’s oral cavity, as most individuals are unaware they are routinely grinding their teeth or clenching their jaw.

Restoring aesthetics, restoring confidence

In light of this, restoring aesthetics and function in bruxism patients is of the utmost importance. As you know, treatment options are guided by the severity of the condition – patients may require a multidisciplinary approach to care, which might include periodontal and endodontic surgeries, for instance.[ix] Subsequent wear being sustained is also of concern, and patients may very well undergo treatment to minimise the future impact of bruxism. This might include wearing a mouthguard at night, receiving botulinum toxin (Botox^™) injections, undergoing physical therapy for muscle relaxation or even taking medication for stress, if that is believed to be the cause of the issue.^vi Oral rehabilitation for bruxers is not straightforward and will depend upon various factors, such as the patient’s style of bruxing, periodontal health, medical comorbidities and other conditions that could complicate rehabilitation.^x It is unsurprising to note that fractures are one of the commonly-reported failures pertaining to the rehabilitation of bruxism-related tooth wear.^ix Various restorative options are viable when rehabilitating worn teeth when the risks of fracture are minimised, such as through implementing an occlusal splint device and regular check-ups post-treatment.^ix

In severe cases, dental crowns may be indicated; materials such as gold and porcelain-fused-to-metal (PFM) have been noted for their durability and efficacy when restoring worn dentition in bruxers,[x] in addition to zirconia.[xi] In situations where such an invasive option is not required, minimally invasive methods can be implemented. Advanced clinical techniques have allowed professionals to conserve more of the natural soft and hard tissues, while still providing satisfactory outcomes, with direct or conservative indirect restorations[xii]like veneers and onlays/inlays.[xiii] The utilisation of minimally invasive adhesive techniques have also been noted as an effective, conservative option for the rehabilitation of worn teeth. In comparison with conventional restorations, adhesive protocols grant clinicians the flexibility to repair or replace the restoration should breakages/fractures occur.[xiv]

Quality materials for optimal outcomes

It goes without saying that, regardless of the procedure pathway you choose, the materials selected are integral to the success and longevity of the treatment. Scotchbond Universal Plus from 3M Oral Care provides outstanding adhesion and is universally suitable for direct and indirect restorations.* Clinicians are provided with gold standard adhesion to all dental and restorative substrates, utilising a one-bottle system without the need for a separate primer or silane.** There is minimal post-op sensitivity for enhanced patient comfort and the flip-top vial provides convenience for professionals, allowing for one handed, clean dispensing. For an excellent performance, choose the Scotchbond Universal Plus from 3M Oral Care.

Bruxism is a complex condition that can evade detection for years and often requires a multidisciplinary approach to rehabilitate. Every stage of rehabilitation is vital to ensure patients can enjoy a functioning and aesthetic dentition for life. With careful planning and the utilisation of quality materials, clinicians can help to alleviate the common symptoms of this condition.

For more information, call 08705 360 036 or visit www.3M.co.uk/Dental

3M, Scotchbond is a trademark of the 3M Company.

* 3M Internal data

[i] www.bruxism.org.uk. (n.d.). What Is Bruxism? [online] Available at: http://www.bruxism.org.uk/what-is-bruxism.php.

[ii] Soto-Goñi, X.A., Alen, F., Buiza-González, L., Marcolino-Cruz, D., Sánchez-Sánchez, T., Ardizone-García, I., Aneiros-López, F. and Jiménez-Ortega, L. (2020). Adaptive Stress Coping in Awake Bruxism. Frontiers in Neurology, [online] 11. Available at: https://www.frontiersin.org/articles/10.3389/fneur.2020.564431/full [Accessed 31 Oct. 2022].

[iii] Tavares, L.M.F., da Silva Parente Macedo, L.C., Duarte, C.M.R., de Goffredo Filho, G.S. and de Souza Tesch, R. (2016). Cross-sectional study of anxiety symptoms and self-report of awake and sleep bruxism in female TMD patients. CRANIO®, [online] 34(6), pp.378–381. Available at: https://www.tandfonline.com/doi/abs/10.1080/08869634.2016.1163806 [Accessed 31 Oct. 2022].

[iv] Hassan, K.A. and Khier, S.E. (2020). Awake Bruxism Intensified During COVID-19 Pandemic by Cumulative Stress – An Overview. Journal of Clinical Research. doi:DOI: 10.33309/2639-8281.030103.

[v] NHS (2017). Teeth grinding (bruxism). [online] nhs.uk. Available at: https://www.nhs.uk/conditions/teeth-grinding/ [Accessed 31 Oct. 2022].

[vi] CALDAS, W., CONTI, A.C. de C.F., JANSON, G. and Paulo César Rodrigues, C. (2016b). Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice. Journal of Applied Oral Science, [online] 24(4), pp.411–419. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990372/ [Accessed 2 Nov. 2022].

[vii] Aguilera, S.B., Brown, L. and Perico, V.A. (2017). Aesthetic Treatment of Bruxism. The Journal of Clinical and Aesthetic Dermatology, [online] 10(5), pp.49–55. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479477/ [Accessed 31 Oct. 2022].

[viii] Papagianni, C.E., van der Meulen, M.J., Naeije, M. and Lobbezoo, F. (2012). Oral health-related quality of life in patients with tooth wear. Journal of Oral Rehabilitation, [online] 40(3), pp.185–190. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/joor.12025 [Accessed 31 Oct. 2022].

[ix] Mengatto, C.M., Coelho-de-Souza, F.H. and de Souza Jnr., O.B. (2016). Sleep bruxism: challenges and restorative solutions. Clinical, Cosmetic and Investigational Dentistry, [online] p.71. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853149/[Accessed 31 Oct. 2022].

[x] Lee, J.-H., Kim, S.-H., Han, J.-S., Yeo, I.-S.L. and Yoon, H.-I. (2019). Contemporary full-mouth rehabilitation using a digital smile design in combination with conventional and computer-aided design/manufacturing restorative materials in a patient with bruxism. Medicine, [online] 98(48), p.e18164. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890298/ [Accessed 2 Nov. 2022].

[xi] Levartovsky, S., Pilo, R., Shadur, A., Matalon, S. and Winocur, E. (2019). Complete rehabilitation of patients with bruxism by veneered and non-veneered zirconia restorations with an increased vertical dimension of occlusion: an observational case-series study. Journal of Prosthodontic Research, [online] 63(4), pp.440–446. Available at: https://www.jstage.jst.go.jp/article/jpr/63/4/63_440/_article/-char/ja/ [Accessed 2 Nov. 2022].

[xii] Moreira, A., Freitas, F., Marques, D. and Caramês, J. (2019). Aesthetic Rehabilitation of a Patient with Bruxism Using Ceramic Veneers and Overlays Combined with Four-Point Monolithic Zirconia Crowns for Occlusal Stabilization: A 4-Year Follow-Up. Case Reports in Dentistry, [online] 2019, pp.1–7. Available at: https://www.hindawi.com/journals/crid/2019/1640563/ [Accessed 1 Nov. 2022].

[xiii] Thayer, Mark.L.T. and Ali, R. (2022). The dental demolition derby: bruxism and its impact – part 3: repair and reconstruction. British Dental Journal, 232(11), pp.775–782.

[xiv] Mak, A. and Chio, A. (2019). Minimally invasive rehabilitation of the worn dentition: a case report utilising adhesive additive techniques and digital technologies. Australian Dental Journal, [online] 64(S1), pp.S46–S58. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/adj.12697 [Accessed 2 Nov. 2022].