Treatment of bruxism
Signs of bruxism( grinding and clenching teeth):
- Wear of teeth: flat areas on teeth( facets) and cup shaped defects on the biting surfaces of teeth, teeth are appearing progressively shorter
- Defects on the neck parts of the teeth( so called abfractions, V-shaped defects)
- Receding gums on the cheek and lip surface and on the tongue surface of the teet
- Tenderness of the sides of the the face
- Headaches
- Exaggerated muscles on the side of the face
- Pain in the TMJ
- Clicks, popping sound, noise in the TMJ when opening or closing mouth.
Dr. Kabak & Dr. Yurchuk are paying a lot of attention to the signs of bruxism to prevent negative effects on the dental and general health.
Treatment approaching for bruxism and TMJ disorder:
- education
- self- regulation(relaxation, meditation, better sleep habits, and others)
- splints/guards
- medications
- adjustment of the biting surfaces of the teeth
- orthodontic treatment
- injections of botox into the chewing muscles
- physiotherapy ( laser, wave diametry, heat application, acupuncture and other)
Interesting facts about bite splints or night guards:
- normally functioning teeth would lose 1 mm of the hard structure in 100 years!
- average force generated by normal chewing - 162 pounds per square inch
- forces generated when grinding and clenching - 800 and more( up to 400 kg) pounds per inch
How can night guards or other bite splints help?
- Decrease of the muscle tone
- Reduction of the load on the jaw
- Better positioning of the jaw
- Normalization of the vertical dimensions of the lower third of the face( before the beginning of placing crowns and other restorations in order to restore original position of the lower jaw that changed as a result of the excessive teeth wear)
- Protection of teeth of progressing wear caused by grinding and clenching
Types of the appliances by the function:
1. Traditional thermoplastic NG is an example of Michigan splint( flat plane, gnathologic appliance for stabilization of the jaw, teeth protection and muscle relaxation)
- full coverage splint on one of the arches - lower or upper)
- most common appliance
- has least adverse effects.
2. Anterior bite plane:
- Cover the roof and 6-8 frontal teeth
- Adverse effect - possible eruption of the back teeth that are disconnected by the appliance
- Decreasing the muscle tone and bruising activity.
3. Mini anterior bite plane( Lucia jig):
- include just 2-4 of your frontal teeth.
- can give you fast relieve in case of the headaches and muscle, TMJ pain
- can be done chairside, at your diagnostic or emergency appointment
- not meant to be a long standing guard, so you may need another kind of appliance after pain is gone
- adverse effects if used long-term –foreshortening of frontal teeth and eruption of back teeth
4. Anterior repositioning appliance
- Has a frontal guiding ramp( a special plastic elevation on your splint that is guiding your frontal teeth slightly forward when you are closing your mouth)
- Used when your TMJ disc is trapped, impinged, cannot return onto normal position
- When used too long can change your bite, so it is used just when you are in pain.
5. Posterior Bite plane appliance:
- Used to restore your vertical dimensions as preparation step before restoring multiple teeth affected by the wear.
- Made if hard acrylic material
- this splint will cover your back teeth on both sides, right and left parts will be connected with a bar.
- These splints are done for your lower jaw
- Cannot be used to long because it might cause overeruption of your frontal teeth
6. Pivot appliances:
- Decreasing TMJ symptoms
- Disconnecting a single pair of the back teeth on both sides of your jaw to provide reduction of pressure inside of the jaw( anload surface of the bone receiving pressure).
- Used to treat jaw problems
- Made of hard acrylics
- Cannot be used for long time
7. Hydrostatic appliances
8. Soft splints - great for mild grinding and clenching
Other classification of night guards and splints:
1. Permissive splints( muscle deprogrammers)
2. Directive splints( non- permissive)
3. Pseudo-permissive( soft splints, hydrostatic splints)
Types by the material used for the guards/splints:
- Hard - rigid appliances covering top part of the teeth
- Soft - soft pliable and covering top part of teeth
- Combination of both - hard outer layer and soft layer inside
Hard occlusal splints show better management of increased tone of muscles, better ability to adjust bite and durability.