Sleep Bruxism

Dentists and patients have been told for years ‘why’ they grind their teeth at night.  I’ve heard from occlusion specialists that sleep bruxism has to be because of imperfections in the bite, from myofacial pain specialists that it’s because of dis-coordination of the function due to inflammation in the muscles, from behavioral specialists it’s because of stress, and from neurologists claiming it is from brain dysfunction. Nutritionists, massage therapists, acupuncturists, psychiatrists, and kinesiologists all claim to have the answers.  There seem to be as many theories for ‘why’ as there are theorists and just as many solutions.

Research in this area often leads to confusion but the deepest research yields a firm understanding that there is no firm understanding of sleep bruxism.  The best resource I have found,  ‘Bruxism – Theory and Practice’ edited by Daniel Paesani (Quintessence, 2010) concludes many of its 25 chapters and 524 pages by noting that ‘more research is needed’ or ‘multiple explanations are likely’ for what it presents.

What does the practitioner do with this body of data?  I think we should treat our patients according to the best research we have available all the while sharing that we don’t know everything we wish we knew.  Those patients who claim that ‘stress’ is causing their sleep bruxism and those who are sure that it’s “because everyone in their family does it” could both be right.  There’s no reason for you to assert any other theory (and try to be ‘right’) because you can’t say with any more certainty than they can.

Treat the symptoms in the least invasive way possible.  Keep in mind that many of your sleep bruxism patients may be suffering with sleep disordered breathing and before you make that ‘nightguard’ – whatever design that means to you – be sure to screen for the medical condition.  You may just help the patient discover that there is more to what she/he is feeling than just sensitive teeth.

Steve Carstensen DDS

Steve Carstensen DDS

Steve Carstensen, Diplomate, American Board of Dental Sleep Medicine and Diplomate, American Sleep and Breathing Academy, is in private practice of dental sleep medicine in Bellevue, Washington, and is Editor-in-Chief of Dental Sleep Practice Magazine. He is most interested in helping dentists and other health professionals work together to improve community health through better sleep breathing. DSP Magazine’s vision is ‘Supporting Dentists through Practical Sleep Apnea Education.” Always interested in hearing what works in practice, it is the sharing of accumulated wisdom of experienced colleagues that can give the dedicated dentist hope of incorporating sleep medicine into everyday patient care. Steve also serves as Sleep Education Director of Pankey Institute and Spear Education. He can be found teaching offices, study clubs, and groups of dental professionals at conferences internationally, and is a proud member of the education teams at Nierman Practice Management and SomnoMed, Inc.

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