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What is a bruxism ?

We can propose a simple and synthetic definition, by evoking, with regard to bruxism, involuntary and unconscious contractions of the masticatory muscles outside the physiological function, including the clenching and grinding of the teeth with dental contacts, day or night, and a possibility of association between all these forms.
Clenching (continuous motor activity) consists of simple jaw clenching, without noise and without jaw movement, while grinding (rhythmic motor activity) is noisy and occurs mostly at night, moving the jaw back and forth.

How do you know if you have bruxism?

We learn that we are suffering from bruxism most often by jaw pain felt in the morning (due to having clenched our teeth at night) or by the complaints of our spouse who wants us to stop clenching our teeth at night.

When & how does tooth clenching occur: the different forms
To each his bruxism, to each his solution
There are daytime bruxism and nighttime bruxism, with a possible association between these two forms: mixed type bruxism.

Our solutions to bruxism – Dr. Claire Castets – Cabinet Dentaire
Daytime bruxism is less frequent and less destructive than nighttime bruxism, because the subject can control himself and can decide to stop clenching his teeth.
Nocturnal bruxism is a sleep disorder related to stress and anxiety experienced during the day. It occurs at night, usually during stage 2 of light sleep. It may be associated with ventilatory sleep arrhythmias, including obstructive sleep apnea syndrome.
Primary idiopathic Vs. secondary iatrogenic
A further distinction is made between:

Primary idiopathic bruxism, with no identified medical or dental cause, which may be associated with the exacerbation of psychosocial factors.
Secondary bruxism of iatrogenic origin related to neurological or psychiatric pathologies, sleep disorders or the use of medication.

Diagnosis at the dental office
Before finding a solution to bruxism, it is necessary to validate that you are unconsciously clenching your teeth. The dentist makes the diagnosis and notes premature wear, cracks, fissures, and even fractures of the teeth at a more advanced stage. The forces generated during bruxism are excessive for dental, prosthetic and implant components, making their future uncertain. Bruxism must be diagnosed at an early stage because it can cause significant damage to the various systems of the manducatory apparatus (teeth, periodontium, muscular and osteoarticular systems) and reveal a psychological condition that must be treated.

The symptoms
Temporomandibular dysfunction
Bruxism is often associated with a dysfunction of the joint and the jaw muscles. Pain in the temporomandibular joints is, in most cases, present. This is known as manducatory apparatus dysfunction (MAD).

Masseter and temporal hypertrophy
Hypertrophy of the masseter and temporal muscles causes an increase in the transverse diameter of the face with a trapezoidal appearance. This leads to an excess of power of the elevator muscles, which causes an excess of pressure on the temporomandibular joints, which explains fatigue and some of the pain. Painful spasms, which can go as far as trismus, appear and some patients have to massage their masseters and temporal muscles before they can open their mouths.

Neck pain and headaches
Bruxism and/or ADAM can be accompanied by neck pain and headaches. Diffuse, persistent, unexplained and “wandering” pains can also occur, especially in women who are anxious and stressed. These muscular pains predominate in the neck, lumbar region, mid-back and also in the limbs. The pains are sometimes so diffuse that the patient complains of having “pain everywhere”. They occur against a background of abnormal fatigue and sleep disorders. It is often associated with headaches and stomach aches due to irritable bowel.

This chronic pain condition, which affects young or middle-aged women in more than 80% of cases, is called fibromyalgia.

The person being inclined not to stop clenching her teeth, at night and/or during the day, the jaw pain is very frequent and often early. The clinical examination is normal, but, on palpation, characteristic pain points are located, which correspond to muscular and tendinous attacks. Fibromyalgia remains a diagnosis by exclusion, and can only be confirmed after all diseases responsible for chronic pain have been eliminated and if the blood tests are normal. Persistent pain and fatigue affect morale and can lead to depressive disorders. In turn, this reactive depression will aggravate the pain sensation and the muscle contractures. This is why it is essential to find a solution to bruxism as soon as possible, to find a way to stop clenching your teeth at night and/or during the day.

The risks of not stopping clenching your teeth at night and/or during the day
Dental wear: risk N°1
If nothing is done, the teeth continue to wear down, appearing as if they have been ground down and showing characteristic facets, as if they had been sanded. In the long run, teeth will wear away and may even fracture, especially ceramic crowns and bridges, which are harder than natural teeth. The disappearance of enamel and dentin can expose the living part of the tooth, the pulp, to external aggressions. Dental wear is the major sign associated with bruxism. It disturbs the intermaxillary relations and can lead to an advancement of the mandible.

A severe form called “brycosis” can go as far as almost total abrasion of the teeth. At this advanced stage, the wear is unsightly and painful. The solution to bruxism is then a complex and expensive treatment, because it is necessary to rebuild the teeth and to treat the psychological disorders. It is the responsibility of the dental surgeon to consider the psychological aspect, since all bruxism can be the primary stage of a brycosis.

Are you afraid of being a bruxer? Consult your dental surgeon!
The objective of the interview is to identify those patients who may be suffering from stress, anxiety or depression. It should be oriented to evaluate the patient’s lifestyle: professional overwork and high level of stress, habits of taking stimulants especially in the evening (alcohol, coffee and drugs), association with certain medications (neuroleptics). These situations can be aggravated by external events such as death, divorce, dismissal. The use of a computer, driving a car, reading a book are all examples where bruxism occurs without the patient being aware of it. Dental contacts are made during chewing, swallowing or during an important effort, a strong emotion, such as anger or determination, which lead to clenching the teeth and jaws: these pressures, by their brief and occasional nature, are considered normal. On the other hand, the persistence and repetition of these phenomena give bruxism its pathological character. Indeed, the manducatory apparatus was not designed to support permanent constraints, so it is urgent to find a way to stop clenching the teeth, at night and/or during the day.


Bruxism: what solution?

To stop clenching your teeth, at night and/or during the day, the treatment consists, after the confirmation of the bruxism by the dental surgeon, in becoming aware that you are clenching your teeth and in trying to prevent it during the day (self-control). The interview will thus play a primordial therapeutic role. It must be followed by a thorough clinical examination. This awareness that one is clenching one’s teeth is an essential prerequisite to the anti-bruxism treatment and has a major influence on its prognosis. The patient is an essential actor in the management of his bruxism, the solution is in his hands.

The orthodontic mouthpiece
If this self-control is not enough to stop clenching the teeth, especially at night, prevention will require a resin mouthpiece (which can be worn during the day: stress at work, driving…). Since bruxism has a central origin, the mechanisms of which are still poorly understood, there does not seem to be a really effective solution to bruxism to date, but rather palliative solutions to stop clenching the teeth at night and/or during the day.

Are you looking for a solution to bruxism in Toulouse or its region?
Dr. Claire Castets, a dental surgeon experienced in jaw clenching problems, welcomes you to her hi-tech and cosy dental office in Plaisance du Touch.