Clinical | Published:

Sleep bruxism: an overview for clinicians

BDJ volume 225, pages 497501 (28 September 2018) | Download Citation

Abstract

Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support. Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors. It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow. A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity. Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism. Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects. Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism.

Key points

  • Provides understanding of the pathophysiology and contemporary concepts of sleep bruxism.

  • Provides understanding of diagnosis of sleep bruxism.

  • Provides awareness of treatment strategies for sleep bruxism.

  • Provides awareness of links between sleep bruxism and other sleep-related conditions.

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References

  1. 1.

    , , et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40: 2–4.

  2. 2.

    . Bruxism Theory and Practice. Chicago: Quintessence Publishing Co. Inc., 2010.

  3. 3.

    , , et al. Are bruxism and the bite causally related? J Oral Rehabil 2012; 39: 489–501.

  4. 4.

    , , et al. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain 2013; 27: 14–20.

  5. 5.

    , , et al. Sleep Bruxism: Diagnostic Considerations. pp. 1427–1434. In Kryger M, Roth T, Dement W (editors) Principles and Practice of Sleep Medicine. Philadelphia: Elsevier, 2017.

  6. 6.

    , , . Clinical Periodontology and Implant Dentistry. Oxford UK: Blackwell Munksgaard, 2008.

  7. 7.

    , , et al. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil 2008; 35: 476–494.

  8. 8.

    , . Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 1994; 17: 739–743.

  9. 9.

    , , et al. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain2013; 27: 99–110.

  10. 10.

    , , et al. Rhythmic masticatory muscle activity during sleep in humans. J Dent Res 2001; 80: 443–448.

  11. 11.

    , . Use of the Grindcare(R) device in the management of nocturnal bruxism: a pilot study. Br Dent J 2013; 215: 10.1038/sj.bdj.2013.653.

  12. 12.

    , . Sleep bruxism; an overview of an oromandibular sleep movement disorder. Sleep Med Rev 2000; 4: 27–43.

  13. 13.

    , , . Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine. Dent Clin North Am 2012; 56: 387–413.

  14. 14.

    , , . Risk factors for sleep bruxism in the general population. Chest 2001; 119: 53–61.

  15. 15.

    , , et al. Association between nocturnal bruxism and gastroesophageal reflux. Sleep 2003; 26: 888–892.

  16. 16.

    . Seven signs and symptoms of occlusal disease: the key to an early diagnosis. Dentistry Today, 2009. Available at (accessed June 2017).

  17. 17.

    The American Academy of Sleep Medicine. International classification of sleep disorders. Second edition. Westchester: American Academy of Sleep Medicine, 2005.

  18. 18.

    , , et al. Nocturnal bruxing events in subjects with sleep-disorderd breathing and control subjects. J Craniomandib Disord 1991; 5: 258–264.

  19. 19.

    , , et al. Association between sleep bruxism, swallowing-related laryngeal movement, and sleep positions. Sleep 2003; 26: 461–465.

  20. 20.

    , , . Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents. J Orofac Pain 2012; 26: 267–276.

  21. 21.

    , , et al. Validation of the BiteStrip screener for sleep bruxism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: e32–e39.

  22. 22.

    , , . Body movement during sleep in subjects with long-standing bruxing behavior. Int J Prosthodont 2000; 13: 327–333.

  23. 23.

    , , . Sleep bruxism: validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 1996; 75: 546–552.

  24. 24.

    , . Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure. Sleep Med 2002; 3: 513–515.

  25. 25.

    , , et al. A significant increase in breathing amplitude precedes sleep bruxism. Chest 2008; 134: 332–337.

  26. 26.

    , , et al. Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion. Sleep Breath 2015; 19: 1459–1465.

  27. 27.

    , , et al. Temporal association between sleep apnea-hypopnea and sleep bruxism events. J Sleep Res 2013; 10.1111/jsr.12099.

  28. 28.

    , . The pattern of swallowing during sleep. Electroencephalogr Clin Neurophysiol 1975; 38: 427–432.

  29. 29.

    , , et al. Correlation between self-reported and clinically based diagnoses of bruxism in temporomandibular disorders patients. J Oral Rehab 2013; 40: 803–809.

  30. 30.

    Medicine AAoS. International Classification of Sleep Disorders: diagnostic and coding manual. Second edition. Westchester, Illinois, USA: American Academy of Sleep Medicine, 2005.

  31. 31.

    , , et al. Self-reported oral parafunctions and pain intensity in temporomandibular disorder patients. J Orofac Pain 2006; 20: 31–35.

  32. 32.

    , , . Treatment approaches to bruxism. Am Fam Physician 1994; 49: 1617–1622.

  33. 33.

    , , et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009; 32: 779–790.

  34. 34.

    , , et al. Sleep bruxism and myofascial temporomandibular disorders: a laboratory-based polysomnographic investigation. J Am Dent Assoc 2012; 143: 1223–1231.

  35. 35.

    , , et al. Principles for the management of bruxism. J Oral Rehab 2008; 35: 509–523.

  36. 36.

    , , et al. Does tooth wear status predict ongoing sleep bruxism in 30yearold Japanese subjects? Int J Prosthodont 2004; 17: 39–44.

  37. 37.

    , . Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e26–e50.

  38. 38.

    , , et al. Assessment of bruxism in the clinic. J Oral Rehab 2008; 35: 495–508.

  39. 39.

    , , et al. Management of sleep bruxism in adults: a qualitative systematic literature review. J Oral Rehab 2015; 42: 862–874.

  40. 40.

    , . The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache – where do we stand? A qualitative systematic review of the literature. BMC Oral Health 2008; 8: 22.

  41. 41.

    , , et al. Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. J Dent Res 2004; 83: 398–403.

  42. 42.

    , , et al. Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism. J Orofac Pain 2005; 19: 151–158.

  43. 43.

    , , . A Clinical Guide to Temporomandibular Disorders. Second Edition. London: BDJ Books, 2003.

  44. 44.

    , , et al. Behavioural changes and occlusal splints are effective in the management of masticatory myofascial pain: a short-term evaluation. J Oral Rehab 2012; 39: 754–760.

  45. 45.

    , . Dental appliances with inadequate occlusal coverage: a case report. Br Dent J 2011; 210: 109–110.

  46. 46.

    , , et al. Overthecounter (OTC) bruxism splints available on the Internet. Br Dent J 2014; 216: E24. 10.1038/sj.bdj.2014.452.

  47. 47.

    , , . Dentistry's role in the diagnosis and co-management of patients with sleep apnoea/hypopnoea syndrome. Br Dent J 2000; 189: 76–80.

  48. 48.

    , , et al. Effects of occlusal stabilization splints on obstructive sleep apnea: a randomized controlled trial. J Orofac Pain 2013; 27: 199–205.

  49. 49.

    , , et al. Aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: a pilot study. Int J Prosthodont 2004; 17: 447–453.

  50. 50.

    , , . Principles and Practice of Sleep Medicine. Fourth edition. Philadelphia: Elsevier Saunders, 2005.

  51. 51.

    , , et al. Do sleep hygiene measures and progressive muscle relaxation influence sleep bruxism? Report of a randomised controlled trial. J Oral Rehab 2015; 42: 259–265.

  52. 52.

    , , et al. Drugs and bruxism: a critical review. J Orofac Pain 2003; 17: 99–111.

  53. 53.

    , , et al. Pharmacotherapy for sleep bruxism. Cochrane Database Syst Rev 2014; 10: CD005578.

  54. 54.

    , , et al. Efficacy of botulinum toxins on bruxism: an evidence-based review. Int Dent J 2012; 62: 1–5.

  55. 55.

    , , . Botulinum toxin in masticatory muscles of the adult rat induces bone loss at the condyle and alveolar regions of the mandible associated with a bone proliferation at a muscle enthesis. Bone 2015; 77: 75–82.

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Author information

Affiliations

  1. University of Leeds, Department of Restorative Dentistry, Leeds Dental Institute, Leeds, LS2 9LU

    • H. Beddis
  2. University Dental Hospital of Manchester, Oral Medicine, Higher Cambridge street, Manchester, M15 6FH

    • M. Pemberton
  3. TMD Clinic Manchester University Dental School, Manchester, M15 6FH

    • Stephen Davies

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Corresponding author

Correspondence to H. Beddis.

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DOI

https://doi.org/10.1038/sj.bdj.2018.757