According to The Bruxism Association, around eight to 10 per cent of the UK population experience bruxism. The condition, which can result in tooth wear and breakage as well as jaw disorders such as temporomandibular disorder (TMD), is characterised by grinding the teeth and clenching the jaw. Because bruxism can damage the teeth, it’s important that dental professionals recognise the signs of tooth wear caused by parafunction and design customised treatment plans to address the concern effectively. As such, factors such as unique grinding/clenching patterns and rhythms should be considered, as well as management techniques and effective restorative materials where appropriate.
What are the causes?
To gain a full understanding of the unique challenges bruxism presents, it’s important to grasp the potential causes of the condition. Firstly, it might be classified as awake or sleep bruxism. Awake bruxism is generally characterised by clenching the jaw involuntarily, while sleep bruxism involves automatically and rhythmically grinding and clenching while asleep.[i] Further to this, bruxism may have a number of underlying causes. These include associations with medications like antidepressants or recreational drugs, Parkinson’s disease, depression, and anxiety. Additionally, sleep bruxism may be triggered by other sleep disorders, such as obstructive sleep apnoea, which cause disrupted sleep patterns.
Stress and anxiety are thought to be key causes of bruxism, with research suggesting that around 70 per cent of sleep bruxism cases are related to these triggers. A survey conducted by the Mental Health Foundation in March 2023 found that 73 per cent of participants felt anxious in the previous two weeks, with 20 per cent revealing that they felt anxious most or all of the time. As such, it’s important that clinicians consider their patients’ overall wellbeing, and the ways that stress and anxiety might be impacting their oral health. In doing so, this may allow dental professionals to more effectively manage their condition, and provide appropriate care.
What to consider when restoring worn teeth
As mentioned, bruxism causes attrition, often leading to tooth damage – with tooth wear and pain as common side effects. However, due to the nature of the condition, restoring damage caused by bruxism presents a number of challenges. The nature of the bruxing activity should first be identified and might include lateral grinding, anterior grinding, or simple clenching. By identifying the type of bruxism and whether its effects are localised or widespread, clinicians can more easily plan the reconstruction needed. This is because, when the unique situation is understood, restorations sympathetic to the behaviours can be created, as opposed to those which create conflict.
Additionally, the extent of the tooth wear should be considered to inform the restoration options available to the patient. If there is sufficient tooth structure, then direct or indirect adhesive restorations may be appropriate. However, if tooth wear is more severe, removable overdentures may be more suitable, depending on the patient’s unique situation.
Appropriate materials for restorative treatment
Should a patient be a suitable candidate for an indirect adhesive restoration, it’s then important to consider which material might be most suitable. It must offer shock-absorbing effects, especially if the patient continues to sometimes clench their teeth following treatment, as this will help to extend the longevity of the restoration, and reduce the risk of early failure. Composite materials with this feature are a great choice for providing conservative treatment which is minimally invasive and preserve remaining natural healthy enamel.
One such example is Brilliant Crios from Coltene. Recommended for use when treating bruxism patients, due to its shock absorbing properties, Brilliant Crios is a reinforced composite block, which combines all of the advantages of an innovative submicron hybrid composite material with a CAD/CAM fabrication process. This enables clinicians to deliver reliable, aesthetic, and fast restorations with shock absorbing effects. Plus, because it’s available in two sizes, three translucencies, and 15 shades, Brilliant Crios offers a broad range of options for day-to-day use.
In order to provide bruxism patients with the care they need, its vital that dental professionals first gain a good understanding of the condition, its many forms, and the factors which may be causing it. Stress-related bruxism is very common, and stress affects patients of all ages. It’s therefore important to consider patients’ overall health, look out for the early signs of tooth wear, and offer preventive advice or restorative treatment where appropriate. For restorative treatment to be most effective, assessing patients’ bruxing patterns can be very helpful to design a long-lasting, resilient restoration which will improve their smile aesthetics, oral health, and, ultimately, quality of life.
References are available on request.