Bruxism (Teeth grinding) Treatments

Bruxism is an oral parafunctional activity that commonly occurs in most people at some point in their lives. The two main characteristics of this condition are grinding of the teeth and clenching of the jaw. These actions usually occur during a person’s sleeping hours, but occasionally they occur during the day.

Bruxism is one of the most common known sleep disorders.Chewing is a neuromuscular activity controlled by a subconscious process, but more highly controlled by the brain. During sleep, the subconscious process may become active, while the higher control is inactive (asleep), resulting in bruxism. The most common symptoms are earaches, headaches, depression, eating disorders, anxiety, and chronic stress.

A BiteStrip is a device available through our office used to diagnose bruxism at home.The device itself is a small electromyography, which can sense and monitor activity in the jaw muscles during sleep.The frequency and severity of the condition can then be assessed and a plan of treatment can be determined.

Why should I seek treatment for Bruxism?

• Gum recession. Bruxism is a leading cause of gum recession and tooth loss. Grinding can damage the soft tissue directly and lead to loose teeth and deep pockets where bacteria are able to colonize and decay the supporting bone.
• Facial pain. Grinding can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and in severe cases, incapacitating headaches.
• Occlusal trauma. The abnormal wear patterns on the occlusal (chewing) surfaces of the teeth can lead to fractures, which, if left untreated, may require restorative treatment at a later time.
• Arthritis. In the most severe cases, bruxism can eventually lead to painful arthritis in the temporomandibular (TMJ) joints that allow the jaw to open and close smoothly.

Treatment Options

Though there is no known cure for bruxism, there are a variety of devices and services available through our office to help treat bruxism:

• Mouthguards. An acrylic mouthguard can be designed from teeth impressions to minimize the abrasive grinding action during normal sleep.Mouthguards must be worn on a long-term basis to help prevent tooth damage.
• NTI-tss device: This device only covers the front teeth and must be fitted at our office. The idea behind the NTI-tss is to prevent grinding the rear molars by limiting the contraction of the temporalis muscle in the jaw.
• Botox: Botox can be injected into the muscles responsible for bruxing by disabling them enough to prevent grinding, but not enough to disrupt normal functions like speaking and chewing.

Once bruxing is under control, we can perform a variety of dental procedures to restore the pleasant aesthetic appearance to your smile such as crown application, gum grafts, and crown lengthening.

Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.

There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures usually performed under light IV sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.