Saturday, September 30, 2023

Bruxism is no longer what it used to be (and could even prove to be an ally)

We republished this article from Laura Jimenez Ortegaprofessor in the Department of Psychobiology and Methodology in Behavioral Sciences at the Complutense University of Madrid; Eva Willaert Jimenez-Pajareroassociate professor of Prosthetics and Craniomandibular Dysfunction at the University of Barcelona and Maria Garcia GonzalezProfessor of Dentistry at the European University, published in The Conversation on May 18, 2023.

According to him Council of Dentists of Spainhe bruxism It is the dental diagnosis that has increased the most since the pandemic, almost quadrupling: its incidence among the population has gone from 6% to 23%.

Whether we are affected or not, we all know what this behavior basically entails –clenching or grinding the teeth–, but in recent years the concept has changed and is now classified into two distinct entities: sleep bruxism and wakefulness bruxism. And they can be approached as two independent phenomena, although sometimes they appear together.

While the first arises involuntarily while we sleep, the second manifests itself when we are awake. In the latter case, the person may be aware of the behavior and therefore stop it.

two different phenomena

Currently, sleep bruxism it defines as “a rhythmic or non-rhythmic masticatory musculature activity that is not a movement or sleep disorder in healthy individuals”. And that of wakefulness as “an activity of the masticatory muscles during wakefulness characterized by sustained or repetitive dental contact or by tension or thrust of the jaw”. Nor is it a movement disorder in healthy individuals.

In other words, what we popularly think of as clenching/grinding our teeth when we sleep (either night or day) would be called sleep bruxism, while jaw clenching, dental contact, or clenching when awake would be waking bruxism. .

Although the two definitions seem to refer to very similar behaviors, their etiology, function, and way of approaching them are different.

In some clinical settings, both modalities can be considered a risk factor or a sign of an underlying disease. For example, headaches (headaches and migraines) or temporomandibular disorders, which affect the jaw joint and the muscles that control its movement. And there is always the possibility that they carry negative consequences: can produce tooth wear and fractures, as well as muscle or joint pain.

What if it was beneficial?

In any case, current research implies another important modification in the conception of bruxism: not considered a pathology, but a simple motor activity. That is to say, does not have to be harmful in and of itself.

First of all, a study of 2020 concluded that waking bruxism could constitute a mechanism of escape from stress. And secondly, the one that occurs while we sleep seems to be related to gastric reflux and obstructive sleep apnea (respiratory pauses during night rest). Some authors propose that it could exert a protective paper against the effects of both disorders.

The psychological factor

Regarding the etiology or origin of this behavior, it is still not completely clear, but they have been identified risk factor’s such as alcohol, nicotine, recreational drugs, caffeine, some drugs, anxiety or stress. Emotional stress seems to play an important role, especially in waking bruxism. In fact, it is considered the main trigger.

In this line, a recent study conducted by researchers from the Faculty of Dentistry of the Complutense University of Madrid has compared samples from participants before, during, and after the COVID-19 pandemic. According to her conclusions, sleep and wakefulness bruxism could be influenced by different states of anxiety: while the first would be related to the passive stress -associated with worry or defenselessness-, the vigilance seems to be linked to a greater extent to the immediate daytime activity.

This same team found in a previous work that the bruxists who watched stressful negative videos and with scenes of pain had greater muscle tension than the non-bruxists. This relationship supports the link between the most immediate and daily stress with vigilant bruxism.

prevention techniques

Therefore, and although vigilant bruxism can be an escape mechanism from stress, it can be prevented by learning to spot the habit – in order to reduce muscle tension – and then lowering stress levels through relaxation and coping techniques.

Perhaps for all this, one of the most effective treatments is the so-called biofeedback. It consists of patients learning to identify and reduce muscle tension by adopting a mandibular rest posture thanks to the use of a electromyographdevice that measures the electrical activity of the muscles.

Many people are unaware that so that the jaw is relaxed and at rest there should be no dental contact, as can be deduced from the definition described above. The mere fact of being aware of it and trying to correct it reduces the incidence of bruxism.

Recently, mobile applications have been developed to achieve these two objectives. However, they are usually not sufficiently optimized and are tedious.

Perhaps the easiest way to detect that we clench our teeth is to put post-it notes in visible places (computer screen, mirror, etc.) that remind us of it. And since stress is present in a chronic way in our life, habitually carry out relaxation techniques and control of that tension, those that are less difficult for us to do.

The Conversation


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