Bruxism Management: A Comprehensive Review

Abstract

According to the international consensus of experts for the diagnosis and treatment of bruxism, carried out by Lobbezoo, et al. , Bruxism is defined as a masticatory muscle activity that can occur while the person is asleep or awake. After several debates that emerged after the first consensus held in 2013, in which they defined bruxism as "an excessive activity of the chewing muscles, characterized by clenching or grinding the teeth and/or by the recurrent excessive effort made by the of the jaw ; the need to redefine bruxism was seen, emphasizing the "masticatory muscular activity" of the patient and the activity according to the moment in which it is performed: sleep bruxism (SB) or awake bruxism (AB); highlighting the need to separate the terms, since bruxism is generated in two moments and therefore different signs, symptoms and characteristics will appear. Additionally, it must be in mind that bruxism is not considered a disorder but rather a behavior because its effects do not necessarily produce damage as a disorder would. The physiological predisposing factors of bruxism cannot be individualized, since this is the result of a combination of causes which produce a pathogenic, repetitive, and often unconscious action. Whenever bruxism is discussed in adults or children, the presence of dental contacts should be verified and established ; Additionally, establishing a specific etiology for bruxism is impossible, since there are causes and factors associated with its presence, which may or may not be etiological; However, in adult patients, possible causal factors have been reported such as: occlusal forces, emotional causes or those generated by the central nervous system ; psychological problems such as stress and anxiety at all ages; In addition, SB in children is associated with respiratory problems, physiological dental wear, caries, malocclusions and use of pacifiers. About the frequency, according to the study by Rodrigues, et al. the prevalence of bruxism in children ranges from 3.5% to 46%, while the study by Manfredini, et al. shows that the prevalence of bruxism in adults ranges from 8% to 31.4%; without reporting differences between gender or age in the SB, and a slight predominance of the AB in women . In an umbrella review, Melo, et al. reported the prevalence of bruxism in adults and children according to the type of bruxism diagnosed; concluding that in adults AB occurs from 22% to 30%, and SB occurs between 10% to 13%, evidencing a decrease at older age and in children or adolescents the SB in a range from 3% to 49% . Treatment for bruxism is suggested to be multidisciplinary, for both children and adults. Dental treatment includes some intraoral devices, which aim to protect teeth and restorations from possible wear and tear that may be generated as a result of parafunctional activity ; Treatment with physical therapy consists of performing exercises of the masticatory muscles and they should be performed without exerting excessive intensity, since this can generate microtrauma to the muscle fibers . Likewise, other options include management with cognitive-behavioral therapies including psychoanalysis, autosuggestion, hypnosis, progressive relaxation, meditation, self-control, and sleep hygiene . As alternative Biofeedback is a behavioral technique, consisting of the use of biological signals themselves to achieve a change in physiological functioning . Regarding pharmacological treatment, medications such as benzodiazepines, anticonvulsants, beta-blockers, and antidepressants may be indicated; It is recommended that this type of therapy should only be performed in case other more conservative treatments have not been effective . On the other hand, the application of botulinum toxin has been used for the management of bruxism, this is defined as a neurotoxin that is produced by a gram-positive bacterium called Clostridium botulinum. Botulinum toxin type A (BTZ-A) is a biological variable of these exotoxins that temporarily inhibits skeletal muscle at the time it restricts the production of acetylcholine and inactivates calcium channels in nerve endings . Psychological therapies are recommended as initial treatment for bruxism in children, since they will not involve invasive treatments, they do not interfere with the growth and development of the maxillary structures and they do not present contraindications or sequential effects; these psychological complications can decrease anxiety and muscular hyperactivity characteristic of bruxomania episodes . The purpose of this article is to generate clinical recommendations as a complement to the comprehensive treatment of patients, for decision-making about the therapies indicated in SB and AB.