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Le bruxisme, ou quand votre sommeil grince !

Bruxism, or when your sleep grinds!

What can be done against bruxism?

Have you ever heard of bruxism? This term, if it is not very clear, can however prove to be a grinding subject, literally, and even noisy in some cases. Bruxism is a functional disorder that does not go unnoticed, as it can cause quite significant and disabling physical consequences, even if it occurs unconsciously.

But then, what do we really know about bruxism, this strange phenomenon which, although not a sleep disorder strictly speaking, can be heard, even without our knowledge, both at night and during the day? What can be the causes of bruxism, and what can be done to treat it? To (almost) know everything about bruxism, this way!

What is bruxism?

Bruxism… The word itself doesn't give us much indication about what it refers to, unless you were an attentive student in Greek class! Indeed, the word bruxism comes from the Greek "brugmos" which means "teeth grinding." Once this little clarification is made, everything becomes much clearer, doesn't it?

Bruxism is indeed a functional disorder causing teeth grinding, which can be accompanied or replaced by clenching of the teeth. The bruxomaniac (term designating a person suffering from bruxism) grinds and/or clenches their teeth involuntarily. This is called a masticatory parafunction, that is, an activity of clenching and dental friction that has no functional purpose.

This parafunction, like parasomnias (sleep apnea, night terrors…), occurs arbitrarily and unconsciously. Bruxism, even if it is not considered a sleep disorder in its own right, mainly manifests during sleep. This is called nocturnal bruxism. As we will see later, links can be considered between this phenomenon and certain sleep disorders (notably sleep apnea), which would make bruxism a sleep-related motor disorder. However, another form of this functional disorder can occur during the day, then called diurnal bruxism. The latter is more "conscious" since it occurs when the individual is awake, and is therefore easier to diagnose.

Whether it is nocturnal or diurnal, bruxism can take 2 different forms:

  • dynamic (or eccentric) bruxism: rubbing of the lower teeth on the upper teeth producing a more or less loud grinding
  • static (or centered) bruxism: more or less pronounced clenching of the jaw

Furthermore, it should be known that bruxism, regardless of its type or form, is considered a temporomandibular dysfunction ("DTM"). Knowing this, you are now ready to shine in society!

Finally, as a little anecdote, it is thought that originally, or at an evolutionary level, this parafunction served to help baby teeth fall out. Now you know, a small amount of teeth grinding could help children lose their baby teeth more quickly so they don't have to wait too long for the little mouse! That's what we could call "the magic of evolution."

Bruxism in a few figures

Bruxism may be more widespread than one might suppose. On this subject, several studies agree on the same prevalence. Indeed, a study conducted in 20131 based notably on questionnaires estimates that bruxism affects between 5.5 and 7.4% of the population. This figure is broadly confirmed by a 2016 cross-sectional survey2 published on the very reputable site « Sleep Research Society », the latter evaluating the prevalence of bruxism in the adult population at 8.6%.

Children are also affected by bruxism, even in a greater proportion than adults. This may seem logical if we consider the previously mentioned developmental factor. Thus, the estimated prevalence of bruxism in children (between 4 and 17 years old) is between 15%3 and 26%4 according to the studies referred to.

Bruxism would therefore affect children more than adults, but what about gender parity on the subject? According to a 2015 study5, parity does exist for this functional disorder since sleep bruxism (nocturnal bruxism) affects men and women equally. However, daytime bruxism would concern women more than men. We might find an explanation for this fact by analyzing the factors related to bruxism a little later, noting that nocturnal bruxism and daytime bruxism would not have the same causes! We will come back to this.

If nocturnal bruxism is mostly of the eccentric type (lateral grinding of the upper teeth on the lower ones), daytime bruxism is mainly centered (continuous jaw clenching of a parafunctional type). The « la Fondation Sommeil6 » and several studies have found that sleep bruxism is much more widespread than daytime bruxism, accounting for 80% of cases.

The numbers show us that bruxism occurs at all ages, both night and day, and in different ways. How can such a phenomenon be explained, and what are its origins? That is the « grinçante » question!

What are the causes of bruxism?

Let me be clear, as with many sleep disorders or parasomnias, the exact causes of bruxism are not yet well known. However, a majority of specialists agree that the origins of this phenomenon are multifactorial7, but mainly central (related to the central nervous system) and psycho-affective (stress, anxiety). Moreover, psychological, local, genetic, or pharmacological mechanisms can also explain this functional disorder. To clarify, here are the main causes of bruxism8:

  • psycho-affective influence: stress, anxiety, hyperactivity
  • local factors: facial trauma, dental malocclusions, temporomandibular disorders (TMD), inflammations...
  • lifestyle: alcohol and tobacco consumption, poor diet
  • hormonal mechanisms: endocrine disorder
  • pharmacological factors: use of narcotics (ecstasy, cocaine, methamphetamines), use of certain medications (antidepressants, SSRIs...)
  • central nervous system lesions: Alzheimer's disease, epilepsy, Parkinson's disease...
  • psychiatric disorders ("bruxomania" for psychiatrists): depression, neuroses, schizophrenia, bulimia, anorexia...

Furthermore, certain predisposing factors exist. As we mentioned earlier, if children are particularly affected, some studies have revealed the existence of a genetic predisposition to bruxism. Indeed, 37%9 people suffering from bruxism would have a close relative (1st degree) who suffered from the same disorder during their life.

Moreover, it seems that bruxism mostly affects women10, notably due to its "emotional component" (are men not sensitive enough... to daytime bruxism?) Indeed, the pathophysiologies of daytime and nighttime bruxism are not the same! To summarize, it can be considered that:

  • daytime bruxism would be an "emotional" parafunction, a kind of daily tic, related to stress, anxiety, and psychosocial factors, so it is irregular and depends on emotional fluctuations
  • sleep bruxism would have a "central" origin (CNS), it would be linked to a psycho-affective influence (micro-awakenings during the REM sleep phase)

"As you can see, the causes of bruxism are not so simple to identify and categorize. Nevertheless, if you still have some space in your memory and in case you want to (even more) shine in society, know that a certain \"Thégosis\" theory exists. What is it? It is actually a theory invented by Every11, which proposes that bruxism is a habit \"inherited from animals, with a biological meaning\" and which consists of \"keeping sharp and piercing teeth for carnivores\" and \"maintaining tone in the jaw\". This internal animal tension (anger, aggression) or external (facing a threat or danger) could thus be assimilated to human stress! Would bruxism thus reveal our bestial side?"

"How does bruxism manifest itself?"

"bruxomaniacs very often present the same symptoms, although the consequences of bruxism can vary depending on the intensity and frequency of the disorder. Here are the main symptoms of bruxism12:"

  • "premature wear of dental enamel and/or dentin"
  • "dental hypersensitivity"
  • "pain in the cheeks, ears, temples, and jaw (especially upon waking)"
  • "dysfunction of the masticatory system: closed mouth lock, open mouth lock, clicking when opening the mouth"
  • "periodontal recession (tooth loosening)"
  • "implant failure (wear and/or prosthesis fracture)"
  • "muscle or spinal pain"

"To complement the characteristics of bruxism, we can also rely on the work of the AASM (\"American Academy of Sleep Medicine\") as well as that of several scientists, who have officially defined bruxism in a publication13 called \"International consensus on the assessment of bruxism\" (\"International consensus on the assessment of bruxism\"). According to this consensus, a single isolated symptom is not sufficient to characterize bruxism, hence the following classification14 of the different characteristic stages (Lobbezoo 2013):"

  • "stage 1" : "presence of regular and audible teeth grinding during sleep"
  • stage 2 : "presence of regular and audible teeth grinding during sleep with dental wear facets"
  • stage 2 : "presence of a regular and audible teeth grinding during sleep with dental wear facets, as well as transient jaw pain upon waking, muscle fatigue or difficulty opening the mouth"

How can bruxism be diagnosed?

The "international consensus on bruxism assessment" can serve as a basis for diagnosing bruxism, even if it defines the symptoms more. However, it is the ASDA ("American Sleep Disorders Association") that, in 1990, classified the clinical signs allowing identification of nocturnal bruxism15:

  • auditory perception of grinding or teeth clenching
  • early dental wear
  • discomfort, fatigue or muscle pain, as well as a clenched jaw upon waking
  • hypertrophy of the masseter muscles during vigorous voluntary clenching

It should be noted that the scientific validity of these criteria has not yet been established. Therefore, beyond these "standard" criteria (even if not scientifically proven), one can also use polysomnography to verify a diagnosis of sleep bruxism. This examination, in addition to the clinical examination, remains the most reliable to detect this functional disorder.

Moreover, comorbidities between bruxism and other pathologies are now established:

  • headaches, tinnitus
  • sleep apnea, sleep disorders ("OSA"): 3 to 5%16 of people suffering from bruxism also suffer from sleep apnea
  • gastroesophageal reflux

Premature tooth wear being one of the main symptoms aiding diagnosis (along with the "testimony" of collateral victims of the noise emitted by teeth grinding), it is essential to carry out a differential diagnosis to eliminate other possible causes of this damaged state of the teeth.

Given the large number of studies and the different criteria established to characterize and diagnose bruxism, it is clear that this subject is not easy to grasp. There is no formal or scientifically validated diagnosis, but just a set of strongly suspected and relatively standardized criteria (clinical examination of the teeth, polysomnography). One can also add, more marginally, specific recording devices17, EMG ("electromyography"), panoramic X-rays, or intraoral devices.

Finally, to conclude this paragraph and clarify this (grinding) diagnosis a bit, here is a summary of the bruxism diagnosis from the famous "international consensus" established by Lobbezoo in 2013:

  • "possible" if determined according to anamnesis and questionnaire
  • "probable" if clinical examination and study models are added
  • "definitive" if the examination is completed by polysomnography or electromyography

How to treat bruxism?

Bruxism, like many parasomnias and other sleep disorders, does not have a fundamental treatment. However, one can resort to an adapted symptomatic treatment, depending on the specific characteristics of individuals facing this functional or parafunctional disorder. Here are the main existing treatments:

  • occlusal splint: protects the teeth and absorbs jaw force
  • botulinum toxin injection: reduces the strength of the most powerful masticatory muscles to limit the impact of bruxism
  • NTI-TSS
  • CBT ("Cognitive Behavioral Therapy"): can limit the impact of awake bruxism due to its psychological action
  • hypnosis: relatively effective according to some studies18
  • Biofeedback19: behavioral change through electronic detection and stimulus
  • relaxation : stress and anxiety being two of the main supposed causes of bruxism, why not try a relaxation technique, or even test an object specially designed to relax such as Hoomband or Dodow, these being simple and effective!

It is not the sleep disorder that gets the most attention, it is not the loudest, even though it can make us grind our teeth, but nevertheless, bruxism, whether nocturnal or diurnal, is anything but trivial. Like some of its “cousins” parasomnias or sleep disorders, the causes of this functional disorder are not clearly established. However, standardized criteria still allow it to be identified and its impact on health to be limited which, given its potential health consequences (premature tooth wear, various facial or muscular pains, non-restorative sleep), is already not so bad!

To complement and illustrate this article on bruxism, here is a short video posted by the channel « Osmose » that helps to better put this strange phenomenon into perspective!

Sources: [1] Polysomnographic study of the prevalence of sleep bruxism in a population sample, M. Maluly, M. L. Andersen et al, « Journal of dental research », July 2013 [2] and [9] Sleep Bruxism-Tooth Grinding Prevalence, Characteristics and Familial Aggregation: A Large Cross-Sectional Survey and Polysomnographic Validation, Samar Khoury, PhD, Maria Clotilde Carra, DMD, PhD et al, « Sleep Research Society », November 2016 [3] Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population, Maria Clotilde Carra , Nelly Huynh et al, « European journal of oral sciences », October 2011 [4] The Prevalence of Bruxism and Correlated Factors in Children Referred to Dental Schools of Tehran, Based on Parent's Report, Bahman Seraj, DDs, Ms, Mehdi Shahrabi, DDs, Ms et al, « Iranian journal of pediatrics », June 2010 [5] Bruxism: Conceptual discussion and review1 Bruxism:, R. V. Murali, Priyadarshni Rangarajan et al, « Journal of pharmacy and bioallied sciences », April 2015 [6] Bruxism, site « Fondation Sommeil », 2020 [7] Sleep bruxism: fundamental and clinical aspects, B. Chapotat, O. Robin et al, site « Researchgate », January 1999 [8] Sleep bruxism neurobiology, F. Aloe, site « Sleep Science », 2009 [10] Current Treatments of Bruxism, Marc Guaita, DMD, PhD and Birgit Högl, MD et al, « Current treatment options in neurology », 2016 [11] Sleep bruxism: fundamental and clinical aspects, B. Chapotat, O. Robin et al, site « sommeil.Université Lyon1 », 2020 [12] Bruxism Management, Sona J. Lal, Kurt K. Weber, « Stats Pearls », February 2020 [13] International consensus on the assessment of bruxism: Report of a work in progress, F. Lobbezoo, J. Ahlberg et al, « Journal of oral rehabilitation », June 2018 [14] Bruxism defined and graded: an international consensus, F Lobbezoo 1, J Ahlberg et al, « Journal of oral rehabilitation », January 2013 [15] and [17] Validity of the diagnosis of sleep bruxism, E. D’Incau, J.A. Micoulaud Franchi et al, « Revue d’odonto-stomatologie », October 2017 [16] Relationship between sleep bruxism and sleep respiratory events in patients with obstructive sleep apnea syndrome, Hisashi Hosoya , Hideki Kitaura et al, « Sleep and Breathing », December 2014 [18] Sleep bruxism treatment, F. Aloe, site « Sleep Science », 2009 [19] Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol, Sasa Ilovar, Danaja Zolger et al, « Systematic reviews », May 2014

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