Journal of Dental Rehabilitation and Applied Science (구강회복응용과학지)

Korean Academy of Stomatognathic Function and Occlusion (대한턱관절교합학회)
권호 표지

The Diagnosis and Treatment of Bruxism

이갈이의 진단 및 치료

  • Jeong-Seung, Kwon (Department of Orofacial pain and Oral medicine, College of dentistry, Yonsei University) ;
  • Jung, Da-Woon (Department of Orofacial pain and Oral medicine, College of dentistry, Yonsei University) ;
  • Kim, Seong-Taek (Department of Orofacial pain and Oral medicine, College of dentistry, Yonsei University)
  • 권정승 (연세대학교 구강내과학교실) ;
  • 정다운 (연세대학교 구강내과학교실) ;
  • 김성택 (연세대학교 구강내과학교실)
  • Received : 2012.01.23
  • Accepted : 2012.03.25
  • Published : 2012.03.30
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Abstract

Bruxism is extensively defined as a diurnal or nocturnal parafunctional habit of tooth clenching or grinding. The etiology of bruxism may be categorized as central factors or peripheral factors and according to previous research results, central factors are assumed to be the main cause. Bruxism may cause tooth attrition, cervical abfraction, masseter hypertrophy, masseter or temporalis muscle pain, temporomandibular joint arthralgia, trismus, tooth or restoration fracture, pulpitis, trauma from occlusion and clenching in particularly may cause linea alba, buccal mucosa or tongue ridging. An oral appliance, electromyogram or polysomnogram is used as a tool for diagnosis and the American Sleep Disorders Association has proposed a clinical criteria. However the exact etiology of bruxism is yet controversial and the selection of treatment should be done with caution. When the rate of bruxism is moderate or greater and is accompanied with clinical symptoms and signs, treatment such as control of dangerous factors, use of an oral appliance, botulinum toxin injection, pharmacologic therapy and biofeedback therapy may be considered. So far, oral appliance treatment is known to be the most rational choice for bruxism treatment. For patients in need of esthetic correction of hypertrophic masseters, as well as bruxism treatment, botulinum toxin injection may be a choice.

이갈이는 이를 갈거나 악무는 것을 포함하는 부기능적인 행위를 말하며 광범위하게는 주간 및 야간에 나타나는 것을 모두 포함한다. 이갈이의 원인으로는 기본적으로 말초성 요인과 중추성 요인으로 나누어 살펴볼 수 있는데 현재까지의 연구 결과를 종합하여 볼 때 중추성 요인이 주로 작용하는 것으로 알려져 있다. 이러한 이갈이는 교모, 치경부 미세파절, 교근 비대, 교근 및 측두근의 통증, 턱관절의 통증 및 움직임의 제한, 치아 및 수복물 파절, 치수염, 외상성 교합 등을 유발 할 수 있고 특히 이악물기의 경우 협점막 압흔이나 협점막 백선 또는, 혀의 측면에 압흔 등을 유발한다. 이갈이의 정확한 진단을 위해 구강내 장치, 근전도, 수면다원검사 등을 이용하며 미국수면장애학회의 경우 이갈이의 임상 진단 기준을 제시하고 있다. 그러나 아직까지 이갈이의 명확한 원인이 밝혀져 있지 않기 때문에 치료법의 선택은 신중하여야 한다. 이갈이가 중등도 이상이고 임상 증상이나 징후를 유발하는 경우에 이갈이를 관리하기 위한 방법으로는 위험 요인의 조절, 구강내 장치, 보툴리눔 독소 주사, 약물 치료, 바이오피드백 등이 있으며 구강내 장치 요법이 현재로서 가장 합리적인 방법이다. 이갈이 치료와 교근비대에 대한 심미적인 개선을 같이 원하는 환자에서는 보툴리눔 독소 주사 요법이 이용될 수 있다.

Keywords

References

  1. Okeson JP. Orofacial pain : guidelines for assessment, diagnosis, and management: Quintessence; 1996.
  2. Paesani DA. Bruxism : theory and practice2010.
  3. Rao SM, Glaros AG. Electromyographic correlates of experimentally induced stress in diurnal bruxists and normals. Journal of dental research. 1979;58(9):1872-8. https://doi.org/10.1177/00220345790580090501
  4. Kato T, Rompr P, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: an oromotor activity secondary to micro-arousal. Journal of dental research. 2001;80(10):1940-4. https://doi.org/10.1177/00220345010800101501
  5. Macaluso GM, Guerra P, Di Giovanni G, Boselli M, Parrino L, Terzano MG. Sleep bruxism is a disorder related to periodic arousals during sleep. Journal of dental research. 1998;77(4):565-73. https://doi.org/10.1177/00220345980770040901
  6. Reding GR, Rubright WC, Zimmerman SO. Incidence of bruxism. Journal of dental research. 1966;45(4):1198-204. https://doi.org/10.1177/00220345660450042701
  7. Seligman DA, Pullinger AG, Solberg WK. The prevalence of dental attrition and its association with factors of age, gender, occlusion, and TMJ symptomatology. Journal of dental research. 1988;67(10):1323-33. https://doi.org/10.1177/00220345880670101601
  8. Egermark Eriksson I, Carlsson GE, Ingervall B. Prevalence of mandibular dysfunction and orofacial parafunction in 7-, 11- and 15-year-old Swedish children. European journal of orthodontics. 1981;3(3):163-72. https://doi.org/10.1093/ejo/3.3.163
  9. Kieser JA, Groeneveld HT. Relationship between juvenile bruxing and craniomandibular dysfunction. Journal of oral rehabilitation. 1998;25(9):662-5. https://doi.org/10.1046/j.1365-2842.1998.00304.x
  10. Carlsson GE, Egermark I, Magnusson T. Predictors of bruxism, other oral parafunctions, and tooth wear over a 20-year follow-up period. Journal of orofacial pain. 2003;17(1):50-7.
  11. Marbach JJ, Raphael KG, Dohrenwend BP, Lennon MC. The validity of tooth grinding measures: etiology of pain dysfunction syndrome revisited. The Journal of the American Dental Association. 1990;120(3):327-33. https://doi.org/10.14219/jada.archive.1990.0051
  12. Ingervall B, Mohlin B, Thilander B. Prevalence of symptoms of functional disturbances of the masticatory system in Swedish men. Journal of oral rehabilitation. 1980;7(3):185-97. https://doi.org/10.1111/j.1365-2842.1980.tb00435.x
  13. Swanljung O, Rantanen T. Functional disorders of the masticatory system in southwest Finland. Community dentistry and oral epidemiology. 1979;7(3):177-82. https://doi.org/10.1111/j.1600-0528.1979.tb01211.x
  14. Attanasio R. An overview of bruxism and its management. Dental clinics of North America. 1997;41(2):229-41.
  15. Bader G, Lavigne G. Sleep bruxism; an overview of an oromandibular sleep movement disorder. REVIEW ARTICLE. Sleep medicine reviews. 2000;4(1):27-43. https://doi.org/10.1053/smrv.1999.0070
  16. Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. Journal of oral rehabilitation. 2001;28(12):1085-91. https://doi.org/10.1046/j.1365-2842.2001.00839.x
  17. Molin C, Levi L. A psycho-odontological investigation of patients with bruxism. Acta odontologica scandinavica. 1966;24(3):373-91. https://doi.org/10.3109/00016356609028227
  18. Ramfjord S. Bruxism, a clinical and electromyographic study. J Am Dent Assoc. 1961;62:21-44. https://doi.org/10.14219/jada.archive.1961.0002
  19. Rugh JD, Barghi N, Drago CJ. Experimental occlusal discrepancies and nocturnal bruxism. The Journal of prosthetic dentistry. 1984;51(4):548-53. https://doi.org/10.1016/0022-3913(84)90312-3
  20. Kardachi BJ, Bailey JO, Ash MM. A comparison of biofeedback and occlusal adjustment on bruxism. Journal of periodontology. 1978;49(7):367-72. https://doi.org/10.1902/jop.1978.49.7.367
  21. Giffin KM. Mandibular adaptive reposturing: the etiology of a common and multifaceted autodestructive syndrome. General dentistry. 2003;51(1): 62-7; quiz 8.
  22. Manfredini D, Landi N, Tognini F, Montagnani G, Bosco M. Occlusal features are not a reliable predictor of bruxism. Minerva Stomatologica. 2004;53(5):231-9.
  23. Demir A, Uysal T, Guray E, Basciftci FA. The relationship between bruxism and occlusal factors among seven- to 19-year-old Turkish children. The Angle orthodontist. 2004;74(5):672-6.
  24. Clark GT, Adler RC. A critical evaluation of occlusal therapy: occlusal adjustment procedures. The Journal of the American Dental Association. 1985;110(5):743-50. https://doi.org/10.14219/jada.archive.1985.0430
  25. Miller VJ, Yoeli Z, Barnea E, Zeltser C. The effect of parafunction on condylar asymmetry in patients with temporomandibular disorders. Journal of oral rehabilitation. 1998;25(9):721-4. https://doi.org/10.1046/j.1365-2842.1998.00303.x
  26. Young DV, Rinchuse DJ, Pierce CJ, Zullo T. The craniofacial morphology of bruxers versus nonbruxers. The Angle orthodontist. 1999;69(1):14-8.
  27. Lobbezoo F, Rompr PH, Soucy JP, Iafrancesco C, Turkewicz J, Montplaisir JY, et al. Lack of associations between occlusal and cephalometric measures, side imbalance in striatal D2 receptor binding, and sleep-related oromotor activities. Journal of orofacial pain. 2001;15(1):64-71.
  28. Rugh JD, Solberg WK. Electromyographic studies of bruxist behavior before and during treatment. The Journal - California Dental Association. 1975;3(9):56-9.
  29. Solberg WK, Clark GT, Rugh JD. Nocturnal elec1tromyographic evaluation of bruxism patients undergoing short term splint therapy. Journal of oral rehabilitation. 1975;2(3):215-23. https://doi.org/10.1111/j.1365-2842.1975.tb00915.x
  30. van Selms MK, Lobbezoo F, Wicks DJ, Hamburger HL, Naeije M. Craniomandibular pain, oral parafunctions, and psychological stress in a longitudinal case study. Journal of oral rehabilitation. 2004;31(8):738-45. https://doi.org/10.1111/j.1365-2842.2004.01313.x
  31. Pierce CJ, Chrisman K, Bennett ME, Close JM. Stress, anticipatory stress, and psychologic measures related to sleep bruxism. Journal of orofacial pain. 1995;9(1):51-6.
  32. Watanabe T, Ichikawa K, Clark GT. Bruxism levels and daily behaviors: 3 weeks of measurement and correlation. Journal of orofacial pain. 2003;17(1):65-73.
  33. Olkinuora M. Psychosocial aspects in a series of bruxists compared with a group of non-bruxists. Proceedings of the Finnish Dental Society. 1972;68(4):200-8.
  34. Kampe T, Edman G, Bader G, Tagdae T, Karlsson S. Personality traits in a group of subjects with long-standing bruxing behaviour. Journal of oral rehabilitation. 1997;24(8):588-93. https://doi.org/10.1046/j.1365-2842.1997.00541.x
  35. Molina OF, dos-Santos J. Hostility in TMD/bruxism patients and controls: a clinical comparison study and preliminary results. Cranio. 2002;20(4):282-8. https://doi.org/10.1080/08869634.2002.11746220
  36. Manfredini D, Landi N, Romagnoli M, Bosco M. Psychic and occlusal factors in bruxers. Australian Dental Journal. 2004;49(2):84-9. https://doi.org/10.1111/j.1834-7819.2004.tb00055.x
  37. Macaluso GM, Guerra P, Di Giovanni G, Boselli M, Parrino L, Terzano MG. Sleep bruxism is a disorder related to periodic arousals during sleep. Journal of dental research. 1998;77(4):565-73. https://doi.org/10.1177/00220345980770040901
  38. Kato T, Rompr P, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: an oromotor activity secondary to micro-arousal. Journal of dental research. 2001;80(10):1940-4. https://doi.org/10.1177/00220345010800101501
  39. Kato T, Montplaisir JY, Guitard F, Sessle BJ, Lund JP, Lavigne GJ. Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. Journal of dental research. 2003;82(4):284-8. https://doi.org/10.1177/154405910308200408
  40. Kato T, Lavigne GJ. Sleep Bruxism: A Sleep-Related Movement Disorder. Sleep Medicine Clinics. 2010;5(1):9-35. https://doi.org/10.1016/j.jsmc.2009.09.003
  41. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest. 2001;119(1):53-61. https://doi.org/10.1378/chest.119.1.53
  42. Sjholm TT, Lowe AA, Miyamoto K, Fleetham JA, Ryan CF. Sleep bruxism in patients with sleep-disordered breathing. Archives of oral biology. 2000;45(10):889-96. https://doi.org/10.1016/S0003-9969(00)00044-3
  43. Lobbezoo F, Soucy JP, Montplaisir JY, Lavigne GJ. Striatal D2 receptor binding in sleep bruxism: a controlled study with iodine-123-iodobenzamide and single-photon-emission computed tomography. Journal of dental research. 1996;75(10):1804-10. https://doi.org/10.1177/00220345960750101401
  44. Lobbezoo F, Lavigne GJ, Tanguay R, Montplaisir JY. The effect of catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Movement disorders. 1997;12(1):73-8. https://doi.org/10.1002/mds.870120113
  45. Van der Zaag J, Lobbezoo F, Van der Avoort PG, Wicks DJ, Hamburger HL, Naeije M. Effects of pergolide on severe sleep bruxism in a patient experiencing oral implant failure. Journal of oral rehabilitation. 2007;34(5):317-22. https://doi.org/10.1111/j.1365-2842.2006.01651.x
  46. Magee KR. Bruxisma related to levodopa therapy. JAMA (Chicago, Ill). 1970;214(1):147-.
  47. Micheli F, Fernandez Pardal M, Gatto M, Asconap J, Giannaula R, Parera IC. Bruxism secondary to chronic antidopaminergic drug exposure. Clinical neuropharmacology. 1993;16(4):315-23. https://doi.org/10.1097/00002826-199308000-00003
  48. Lobbezoo F, van Denderen RJ, Verheij JG, Naeije M. Reports of SSRI-associated bruxism in the family physician's office. Journal of orofacial pain. 2001;15(4):340-6.
  49. See SJ, Tan EK. Severe amphethamine-induced bruxism: treatment with botulinum toxin. Acta neurologica Scandinavica. 2003;107(2):161-3.
  50. Malki GA, Zawawi KH, Melis M, Hughes CV. Prevalence of bruxism in children receiving treatment for attention deficit hyperactivity disorder: a pilot study. The journal of clinical pediatric dentistry. 2004;29(1):63-7.
  51. Milosevic A, Agrawal N, Redfearn P, Mair L. The occurrence of toothwear in users of Ecstasy (3,4-methylenedioxymethamphetamine). Community dentistry and oral epidemiology. 1999;27(4):283-7.
  52. Lavigne GL, Lobbezoo F, Rompr PH, Nielsen TA, Montplaisir J. Cigarette smoking as a risk factor or an exacerbating factor for restless legs syndrome and sleep bruxism. Sleep. 1997;20(4):290-3.
  53. Hublin C, Kaprio J, Partinen M, Koskenvuo M. Sleep bruxism based on self-report in a nationwide twin cohort. Journal of sleep research. 1998;7(1):61-7. https://doi.org/10.1046/j.1365-2869.1998.00091.x
  54. Michalowicz BS, Pihlstrom BL, Hodges JS, Bouchard TJ. No heritability of temporomandibular joint signs and symptoms. Journal of dental research. 2000;79(8):1573-8. https://doi.org/10.1177/00220345000790080801
  55. Okeson JP. management of temporomandibular disorders and occlusion. 6 ed: Mosby; 2007.
  56. Reding GR, Zepelin H, Robinson JE, Zimmerman SO, Smith VH. Nocturnal teeth-grinding: all-night psychophysiologic studies. Journal of dental research. 1968;47(5):786-97. https://doi.org/10.1177/00220345680470052001
  57. Kydd WL, Daly C. Duration of nocturnal tooth contacts during bruxing. The Journal of prosthetic dentistry. 1985;53(5):717-21. https://doi.org/10.1016/0022-3913(85)90031-9
  58. Okeson JP, Phillips BA, Berry DT, Cook Y, Paesani D, Galante J. Nocturnal bruxing events in healthy geriatric subjects. Journal of oral rehabilitation. 1990;17(5):411-8. https://doi.org/10.1111/j.1365-2842.1990.tb01412.x
  59. Trenouth MJ. The relationship between bruxism and temporomandibular joint dysfunction as shown by computer analysis of nocturnal tooth contact patterns. Journal of oral rehabilitation. 1979;6(1):81-7. https://doi.org/10.1111/j.1365-2842.1979.tb00408.x
  60. Christensen LV, Mohamed SE. Contractile activity of the masseter muscle in experimental clenching and grinding of the teeth in man. Journal of oral rehabilitation. 1984;11(2):191-9. https://doi.org/10.1111/j.1365-2842.1984.tb00568.x
  61. Clarke NG, Townsend GC, Carey SE. Bruxing patterns in man during sleep. Journal of oral rehabilitation. 1984;11(2):123-7. https://doi.org/10.1111/j.1365-2842.1984.tb00561.x
  62. Lavigne GJ, Rompre PH, Montplaisir JY. Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study. Journal of dental research. 1996;75(1):546-52. https://doi.org/10.1177/00220345960750010601
  63. Lavigne GJ, Guitard F, Rompr PH, Montplaisir JY. Variability in sleep bruxism activity over time. Journal of sleep research. 2001;10(3):237-44. https://doi.org/10.1046/j.1365-2869.2001.00261.x
  64. Chung SC, Kim YK, Kim HS. Prevalence and patterns of nocturnal bruxofacets on stabilization splints in temporomandibular disorder patients. Cranio. 2000;18(2):92-7. https://doi.org/10.1080/08869634.2000.11746119
  65. Holmgren K, Sheikholeslam A, Riise C. Effect of a full-arch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. The Journal of prosthetic dentistry. 1993;69(3):293-7. https://doi.org/10.1016/0022-3913(93)90109-2
  66. Harada T, Ichiki R, Tsukiyama Y, Koyano K. The effect of oral splint devices on sleep bruxism: a 6-week observation with an ambulatory electromyographic recording device. Journal of oral rehabilitation. 2006;33(7):482-8. https://doi.org/10.1111/j.1365-2842.2005.01576.x
  67. Ivanhoe CB, Lai JM, Francisco GE. Bruxism after brain injury: successful treatment with botulinum toxin-A. Archives of physical medicine and rehabilitation. 1997;78(11):1272-3. https://doi.org/10.1016/S0003-9993(97)90343-9
  68. Tan EK, Jankovic J. Treating severe bruxism with botulinum toxin. The Journal of the American Dental Association. 2000;131(2):211-6. https://doi.org/10.14219/jada.archive.2000.0149
  69. Pidcock FS, Wise JM, Christensen JR. Treatment of severe post-traumatic bruxism with botulinum toxin-A: case report. Journal of oral and maxillofacial surgery. 2002;60(1):115-7. https://doi.org/10.1053/joms.2002.29127
  70. Clark GT. The management of oromandibular motor disorders and facial spasms with injections of botulinum toxin. Physical medicine and rehabilitation clinics of North America. 2003;14(4):727-48. https://doi.org/10.1016/S1047-9651(03)00044-5
  71. Lee SJ, McCall WD, Kim YK, Chung SC, Chung JW. Effect of botulinum toxin injection on nocturnal bruxism: a randomized controlled trial. American journal of physical medicine & rehabilitation. 2010;89(1):16-23. https://doi.org/10.1097/PHM.0b013e3181bc0c78
  72. Saletu A, Parapatics S, Saletu B, Anderer P, Prause W, Putz H, et al. On the pharmacotherapy of sleep bruxism: placebo-controlled polysomnographic and psychometric studies with clonazepam. Neuropsychobiology. 2005;51(4):214-25. https://doi.org/10.1159/000085917
  73. Huynh N, Lavigne GJ, Lanfranchi PA, Montplaisir JY, de Champlain J. The effect of 2 sympatholytic medications--propranolol and clonidine--on sleep bruxism: experimental randomized controlled studies. Sleep. 2006;29(3):307-16. https://doi.org/10.1093/sleep/29.3.307
  74. Rosales VP, Ikeda K, Hizaki K, Naruo T, Nozoe S, Ito G. Emotional stress and brux-like activity of the masseter muscle in rats. European journal of orthodontics. 2002;24(1):107-17. https://doi.org/10.1093/ejo/24.1.107
  75. Raigrodski AJ, Christensen LV, Mohamed SE, Gardiner DM. The effect of four-week administration of amitriptyline on sleep bruxism. A double-blind crossover clinical study. Cranio. 2001;19(1):21-5. https://doi.org/10.1080/08869634.2001.11746147
  76. Lobbezoo F, van der Zaag J, van Selms MK, Hamburger HL, Naeije M. Principles for the management of bruxism. Journal of oral rehabilitation. 2008;35(7):509-23. https://doi.org/10.1111/j.1365-2842.2008.01853.x