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Bruxism

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Description: Bruxism is a condition characterized by the involuntary grinding or clenching of teeth, often occurring during sleep.
Type: Bruxism is a condition characterized by the excessive grinding of the teeth and/or clenching of the jaw. The genetic transmission of bruxism is not entirely clear, but it is believed to have a multifactorial inheritance pattern, meaning it may be influenced by multiple genes combined with environmental factors.
Signs And Symptoms: Most people who brux are unaware of the problem, either because there are no symptoms, or because the symptoms are not understood to be associated with a clenching and grinding problem. The symptoms of sleep bruxism are usually most intense immediately after waking, and then slowly abate, and the symptoms of a grinding habit which occurs mainly while awake tend to worsen through the day, and may not be present on waking. Bruxism may cause a variety of signs and symptoms, including:

A grinding or tapping noise during sleep, sometimes detected by a partner or a parent. This noise can be surprisingly loud and unpleasant, and can wake a sleeping partner. Noises are rarely associated with awake bruxism.
Other parafunctional activity which may occur together with bruxism: cheek biting (which may manifest as morsicatio buccarum and/or linea alba), and/or lip biting.
A burning sensation on the tongue (see: glossodynia), possibly related to a coexistent "tongue thrusting" parafunctional activity.
Indentations of the teeth in the tongue ("crenated tongue" or "scalloped tongue").
Hypertrophy of the muscles of mastication (increase in the size of the muscles that move the jaw), particularly the masseter muscle.
Tenderness, pain or fatigue of the muscles of mastication, which may get worse during chewing or other jaw movement.
Trismus (restricted mouth opening).
Pain or tenderness of the temporomandibular joints, which may manifest as preauricular pain (in front of the ear), or pain referred to the ear (otalgia).
Clicking of the temporomandibular joints.
Headaches, particularly pain in the temples, caused by muscle pain associated with the temporalis muscle.
Excessive tooth wear, particularly attrition, which flattens the occlusal (biting) surface, but also possibly other types of tooth wear such as abfraction, where notches form around the neck of the teeth at the gumline.
Tooth fractures, and repeated failure of dental restorations (fillings, crowns, etc.).
Hypersensitive teeth, (e.g. dental pain when drinking a cold liquid) caused by wearing away of the thickness of insulating layers of dentin and enamel around the dental pulp.
Inflammation of the periodontal ligament of teeth, which may make them sore to bite on, and possibly also a degree of loosening of the teeth.Bruxism is usually detected because of the effects of the process (most commonly tooth wear and pain), rather than the process itself. The large forces that can be generated during bruxism can have detrimental effects on the components of masticatory system, namely the teeth, the periodontium and the articulation of the mandible with the skull (the temporomandibular joints). The muscles of mastication that act to move the jaw can also be affected since they are being utilized over and above of normal function.
Prognosis: Prognosis for bruxism:

The prognosis for bruxism varies depending on the underlying cause and the effectiveness of treatment. If bruxism is successfully managed with dental interventions, stress reduction techniques, and behavior modifications, most people experience significant relief from symptoms and prevent further dental damage. Untreated bruxism can lead to more serious complications, such as chronic jaw pain, temporomandibular joint disorders (TMJ), and significant dental wear or damage. Regular follow-up with healthcare providers can help ensure a positive outcome.
Onset: The onset of bruxism can occur at any age, but it is often noticed in childhood or young adulthood. The exact cause of onset can vary and may be linked to factors such as stress, anxiety, malocclusion (misalignment of teeth), or other underlying conditions. It's a condition where individuals grind or clench their teeth, often unconsciously.
Prevalence: Bruxism, or teeth grinding, affects approximately 8-31% of the general population at some point in their lives. The prevalence varies widely due to differences in study methodologies and population groups. It can occur in both children and adults, with a slightly higher incidence in children.
Epidemiology: There is a wide variation in reported epidemiologic data for bruxism, and this is largely due to differences in the definition, diagnosis and research methodologies of these studies. E.g. several studies use self-reported bruxism as a measure of bruxism, and since many people with bruxism are not aware of their habit, self-reported tooth grinding and clenching habits may be a poor measure of the true prevalence.The ICSD-R states that 85–90% of the general population grind their teeth to a degree at some point during their life, although only 5% will develop a clinical condition. Some studies have reported that awake bruxism affects females more commonly than males, while in sleep bruxism, males and females are affected equally.Children are reported to brux as commonly as adults. It is possible for sleep bruxism to occur as early as the first year of life – after the first teeth (deciduous incisors) erupt into the mouth, and the overall prevalence in children is about 14–20%. The ICSD-R states that sleep bruxism may occur in over 50% of normal infants. Often sleep bruxism develops during adolescence, and the prevalence in 18- to 29-year-olds is about 13%. The overall prevalence in adults is reported to be 8%, and people over the age of 60 are less likely to be affected, with the prevalence dropping to about 3% in this group.A 2013 systematic review of the epidemiologic reports of bruxism concluded a prevalence of about 22.1–31% for awake bruxism, 9.7–15.9% for sleep bruxism, and an overall prevalence of about 8–31.4% of bruxism generally. The review also concluded that overall, bruxism affects males and females equally, and affects elderly people less commonly.
Intractability: Bruxism, the condition characterized by the grinding or clenching of teeth, is generally not considered intractable. Management and treatment options, such as behavioral therapies, dental interventions (like mouthguards or splints), and medical treatments (such as muscle relaxants or Botox injections), can effectively alleviate symptoms for many individuals. However, underlying causes, including stress or sleep disorders, may require addressing to provide long-term relief.
Disease Severity: Bruxism, commonly known as teeth grinding or clenching, varies in severity. Severity can range from mild to severe based on frequency, intensity, and impact on dental and overall health. Mild cases may involve occasional grinding with minimal impact, while severe cases can result in consistent grinding that causes significant dental damage, jaw pain, and other complications. Regular dental check-ups are crucial for assessing the severity and implementing appropriate treatments.
Healthcare Professionals: Disease Ontology ID - DOID:2846
Pathophysiology: Pathophysiology of bruxism involves excessive grinding or clenching of teeth that can occur during sleep (sleep bruxism) or when awake (awake bruxism). It is influenced by multiple factors, including psychological stress, anxiety, and certain medications. Neurological factors may involve central nervous system dysfunction or heightened arousal states. Muscle hyperactivity in the jaw muscles (masticatory muscles) is a key component, often leading to symptoms like jaw pain, tooth wear, and temporomandibular joint disorders. Sleep bruxism is classified as a sleep-related movement disorder, suggesting that neurological and sleep-related regulatory mechanisms play a significant role.
Carrier Status: Bruxism does not have a "carrier status" as it is not a genetic condition transmitted in the same way as some hereditary diseases. Bruxism is characterized by the excessive grinding of teeth or clenching of the jaw, often occurring during sleep or in response to stress or anxiety. Factors such as stress, sleep disorders, abnormal bite, and certain medications can contribute to bruxism. While there may be a genetic predisposition in some individuals, it is not classified in terms of carrier status.
Mechanism: Bruxism is a condition characterized by the grinding or clenching of teeth, typically occurring either during sleep (sleep bruxism) or while awake (awake bruxism).

### Mechanism:
1. **Neurological Factors**: Dysregulation in the central nervous system, particularly involving neurotransmitters like dopamine and serotonin, may play a role in bruxism by causing increased orofacial muscle activity.

2. **Sleep-related Factors**: For sleep bruxism, unusual brain activity during sleep stages, especially during transitions between non-REM and REM sleep, has been observed. This may trigger the mandibular muscle movements leading to grinding.

3. **Psychological Factors**: Stress, anxiety, and emotional stability can significantly impact the onset and continuation of bruxism. Awake bruxism is often stress-related, whereas sleep bruxism can be associated with disturbances in sleep and psychological strain.

### Molecular Mechanisms:
1. **Neurotransmitter Imbalance**: Altered levels of neurotransmitters like dopamine can affect motor control and muscle activity. Dysregulation of dopaminergic pathways has been implicated in bruxism.

2. **Cortical Arousal**: Increase in cortical activity or "micro-arousals" during sleep are associated with the occurrence of sleep bruxism. These periods of arousal may trigger bursts of muscle activity in the jaw.

3. **Genetic Factors**: Certain genetic polymorphisms have been linked to increased susceptibility to bruxism. These genetic variations can affect neurotransmitter metabolism and receptor function, impacting muscle activity.

4. **Inflammatory Mediators**: Elevated levels of certain cytokines and inflammatory markers have been implicated, suggesting that systemic inflammation may also influence bruxism.

Understanding these mechanisms helps in formulating comprehensive treatment strategies, involving both psychological management and pharmacological interventions targeting neurotransmitter pathways.
Treatment: Bruxism, or teeth grinding/clenching, can be managed through various treatments including:

1. **Behavioral Interventions:**
- Stress management techniques such as meditation, yoga, or therapy.
- Training to recognize and change behaviors causing bruxism.

2. **Dental Approaches:**
- Use of mouthguards or splints to prevent tooth damage.
- Corrective dental treatments if misalignment is a factor.

3. **Medications:**
- Muscle relaxants to reduce jaw tension.
- Botox injections in severe cases to weaken jaw muscles.

4. **Lifestyle Changes:**
- Reducing caffeine and alcohol intake.
- Avoiding chewing gum and hard foods.

5. **Biofeedback:**
- Using devices to monitor and change jaw muscle activity.

Consultation with a healthcare provider or dentist is recommended for a tailored treatment plan.
Compassionate Use Treatment: Bruxism, commonly known as teeth grinding, can sometimes require treatments beyond standard approaches. Here are some compassionate use, off-label, or experimental treatments for bruxism:

1. **Botulinum Toxin (Botox) Injections**: This off-label treatment involves injecting Botox into the jaw muscles to reduce muscle activity and alleviate teeth grinding.

2. **Medications**:
- **Clonazepam**: An anti-anxiety medication sometimes used off-label to relax muscles and reduce bruxism.
- **Gabapentin**: Initially developed to treat epilepsy, this medication is occasionally used off-label for neuropathic pain and might help reduce bruxism symptoms.
- **Antidepressants**: Certain antidepressants like SSRIs may have off-label use in managing bruxism, especially if anxiety or depression is a contributing factor.

3. **Deep Brain Stimulation (DBS)**: This experimental treatment involves implanting electrodes in specific brain areas to modulate neural activity. It is highly invasive and typically considered only in extreme cases.

Compassionate use treatments are usually considered on a case-by-case basis, especially when traditional therapies fail, and the patient’s condition severely impacts quality of life. Always consult with a healthcare professional to evaluate the appropriateness of these options for individualized cases.
Lifestyle Recommendations: Lifestyle recommendations for managing bruxism include:

1. **Stress Management**: Engage in stress-reducing activities such as yoga, meditation, or deep breathing exercises.
2. **Good Sleep Hygiene**: Maintain a consistent sleep schedule and create a relaxing bedtime routine.
3. **Avoid Stimulants**: Reduce intake of caffeine and alcohol, especially before bedtime.
4. **Mindfulness and Relaxation**: Practice mindfulness techniques to increase awareness of clenching and grinding.
5. **Exercise**: Regular physical activity can help reduce stress and improve sleep quality.
6. **Avoid Chewing Non-Food Items**: Avoid habits like chewing on pens or pencils, which can exacerbate bruxism.

If symptoms persist, it is advisable to consult with a healthcare professional for further evaluation and management.
Medication: Certain stimulant drugs, including both prescribed and recreational drugs, are thought by some to cause the development of bruxism. However, others argue that there is insufficient evidence to draw such a conclusion. Examples may include dopamine agonists, dopamine antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors, alcohol, cocaine, and amphetamines (including those taken for medical reasons). In some reported cases where bruxism is thought to have been initiated by selective serotonin reuptake inhibitors, decreasing the dose resolved the side effect. Other sources state that reports of selective serotonin reuptake inhibitors causing bruxism are rare, or only occur with long-term use.Specific examples include levodopa (when used in the long term, as in Parkinson's disease), fluoxetine, metoclopramide, lithium, cocaine, venlafaxine, citalopram, fluvoxamine, methylenedioxyamphetamine (MDA), methylphenidate (used in attention deficit hyperactive disorder), and gamma-hydroxybutyric acid (GHB) and similar gamma-aminobutyric acid-inducing analogues such as phenibut. Bruxism can also be exacerbated by excessive consumption of caffeine, as in coffee, tea or chocolate. Bruxism has also been reported to occur commonly comorbid with drug addiction. Methylenedioxymethamphetamine (MDMA, ecstasy) has been reported to be associated with bruxism, which occurs immediately after taking the drug and for several days afterwards. Tooth wear in people who take ecstasy is also frequently much more severe than in people with bruxism not associated with ecstasy.Many different medications have been used to treat bruxism, including benzodiazepines, anticonvulsants, beta blockers, dopamine agents, antidepressants, muscle relaxants, and others. However, there is little, if any, evidence for their respective and comparative efficacies with each other and when compared to a placebo. A multiyear systematic review to investigate the evidence for drug treatments in sleep bruxism published in 2014 (Pharmacotherapy for Sleep Bruxism. Macedo, et al.) found "insufficient evidence on the effectiveness of pharmacotherapy for the treatment of sleep bruxism."Specific drugs that have been studied in sleep bruxism are clonazepam, levodopa, amitriptyline, bromocriptine, pergolide, clonidine, propranolol, and l-tryptophan, with some showing no effect and others appear to have promising initial results; however, it has been suggested that further safety testing is required before any evidence-based clinical recommendations can be made. When bruxism is related to the use of selective serotonin reuptake inhibitors in depression, adding buspirone has been reported to resolve the side effect. Tricyclic antidepressants have also been suggested to be preferable to selective serotonin reuptake inhibitors in people with bruxism, and may help with the pain.
Repurposable Drugs: Repurposable drugs for bruxism may include:

1. **Botulinum Toxin (Botox):** Originally used for muscle spasticity and cosmetic purposes, Botox injections can help relax the jaw muscles involved in bruxism.

2. **Clonazepam:** Primarily an anti-seizure and anti-anxiety medication, clonazepam has been used off-label to reduce the muscle activity associated with bruxism.

3. **Gabapentin:** Originally developed for neuropathic pain and seizures, gabapentin has shown some efficacy in treating bruxism due to its muscle relaxant properties.

4. **Amitriptyline:** A tricyclic antidepressant that can be used off-label for its muscle relaxant and pain-relief properties, potentially helping with nocturnal bruxism.

Each of these drugs has a primary indication for other conditions but may be considered off-label for the management of bruxism. Consult with a healthcare professional before starting any treatment.
Metabolites: Bruxism is a condition characterized by the excessive grinding of teeth and clenching of the jaw. This condition does not have specific metabolites that are used for its diagnosis or monitoring. Bruxism is typically diagnosed through clinical examination and patient history.
Nutraceuticals: Nutraceuticals, which are food-derived products believed to have health benefits, are being explored for their potential role in managing bruxism. Commonly researched nutraceuticals for this condition include:

1. **Magnesium**: Thought to promote muscle relaxation and reduce stress, potentially alleviating symptoms of bruxism.
2. **Vitamin B complex**: May help in reducing stress and improving nerve function, which could be beneficial for those experiencing bruxism due to stress or anxiety.
3. **Melatonin**: Known for its role in regulating sleep, it may help improve sleep patterns and reduce nighttime teeth grinding.

Research is still ongoing, and the effectiveness of these nutraceuticals can vary from person to person. Always consult a healthcare provider before starting any new supplement regimen.
Peptides: In the context of bruxism, peptides and nanotechnology (nanomedicine) are areas of emerging research. Peptides are short chains of amino acids that can influence muscle activity and pain, potentially offering therapeutic benefits for conditions like bruxism. Nanotechnology could be leveraged to develop advanced drug delivery systems, allowing precise targeting and controlled release of medication to relieve symptoms. However, these applications are largely experimental and not yet widely adopted in clinical practice for managing bruxism.