Sleep Bruxism

Abstract

Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It is divided into sleep and awake bruxism (AB) as they are separate entities in terms of pathophysiology; however, they may overlap in some individuals. AB typically occurs in the form of clenching (high or very low force) and bracing or thrusting of the mandible. Much of the management of AB is based on habit reversal and stress management. The etiology of sleep bruxism (SB) seems to be multifactorial. There are a number of pathophysiological theories for SB including sleep arousal-related mechanisms, autonomic sympathetic cardiac activation, sleep-related respiratory physiology, familial-genetic predisposition, and various psychosocial exogenous factors or neurological concomitant conditions (secondary SB). Diagnosis of SB is primarily based on history and clinical findings; although ambulatory and polysomnography recordings may be utilized in some cases. Management for SB, after a differential diagnosis and assessment of the role of comorbidities, principally involves the use of an oral appliance to protect teeth from attrition; however, behavioral and pharmacological treatment options may be beneficial. It is prudent that clinicians understand that a simple cause and effect model rarely explains bruxism in an individual; hence, future studies to identify individual phenotypes and vulnerability based on a precision medicine model are desirable, with the ultimate aim of effective management.