Sleep Bruxism (SB) is a condition that occurs in a few people during sleep and is characterized by repetitive clenching and grinding of teeth. This can be highly destructive to oral tissues such as teeth and restorations, and in severe cases may lead to temporomandibular joint disorders (TMD) or head and neck pain.
Symptoms and Diagnosis
Common signs of bruxism include loud, nocturnal tooth grinding or clenching, teeth chattering during sleep, recurrent or persistent pain and morning headaches. Patients may also report difficulty breathing and snoring while asleep. Other indications include tooth wear, jaw pain and fatigue as well as clicking or grating sounds in the temporomandibular joints (TMJs) when chewing or speaking.
Risk Factors
Patients with sleep-related bruxism have an increased likelihood for dental fractures, TMJ/TMD, and headaches. In some instances, bruxism may also be connected to obstructive sleep apnea or other neurologic or psychiatric disorders.
Genetics
Polymorphisms in HTR2A rs2770304 and COMT rs4680 may increase the likelihood of sleep-related bruxism. These single nucleotide polymorphisms are inherited in an autosomal dominant pattern and affect a key gene responsible for producing mRNA for COMT; higher levels of mRNA at these SNPs seem to be linked with greater risks [5,6,8], though whether genetic factors influence either intensity or frequency [5-6-8].
Psychological and Behavioral Syndromes
Sleep bruxism may be triggered by micro-arousals from sleep, such as those caused by obstructive sleep apnea. These brief awakenings are normal occurrences during slumber but usually go undetected by the individual.
Other medical conditions, drugs, and mental disorders can cause bruxism as well. Certain medications like antidepressants and stimulants may increase the likelihood of bruxism in certain individuals. Furthermore, mental health disorders like anxiety, depression or posttraumatic stress disorder may increase one’s likelihood for bruxism as well.
Medications and Treatments for Sleep Bruxism
Certain prescription medications can reduce the intensity of sleep-related bruxism. Benzodiazepines such as clonazepam or diazepam are often prescribed to treat this disorder; they should be taken prior to going to bed in order to promote relaxation and reduce intensity of episodes associated with bruxism.
Physiotherapy and Oral Splinting
For patients suffering from sleep-related bruxism, an oral splint can help protect teeth from damage and reduce pain. This splint is made of acrylic material and covers the teeth so they do not come into contact.
Oral splints can be beneficial for moderate to severe sleep-related bruxism, but may not be suitable for everyone. They may cause discomfort while being worn and should not be used by those with limited mobility such as elderly or severely disabled individuals.
Botulinum Toxin A Injections
Studies have indicated that injections of botulinum toxin type A into the temporalis and masseter muscles administered by a movement disorders specialist can significantly reduce sleep-related bruxism. Unfortunately, there are limited data regarding their long-term effectiveness and safety.
Other therapies for sleep-related bruxism may include relaxation therapy, physiotherapy and over-the-counter or prescription anti-seizure medications.
While these sleep-related bruxism treatments may help those suffering from refractory symptoms, a bruxism expert is necessary to determine the most suitable course of action. If you have sleep disorder symptoms, you should consider a sleep study test and sleep apnea therapy with a CPAP machine based on professional advice of your doctor.
