Sleep Bruxism and Temporomandibular Disorders
TMDs have a multifactorial etiology: besides others, psychosocial and genetic aspects, habits, trauma, and bruxism have been proposed to cause and/or perpetuate TMD. This chapter will explore how investigators have attempted to diagnose and quantify bruxi
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Sleep Bruxism and Temporomandibular Disorders Marc Schmitter
Abstract
TMDs have a multifactorial etiology: besides others, psychosocial and genetic aspects, habits, trauma, and bruxism have been proposed to cause and/or perpetuate TMD. This chapter will explore how investigators have attempted to diagnose and quantify bruxism and determine its relationship to temporomandibular disorders.
Temporomandibular disorder (TMD) is a collective term for a heterogeneous group of disorders of the temporomandibular joint (TMJ) and related muscles [1]. In the orofacial region, TMD is the most common cause of non-dental and noninfectious pain [2]. The most common complaint of patients with TMD is myofascial pain (MP) of the masticatory muscles [3]. MP in the orofacial area often occurs in conjunction with widespread pain throughout the body [4]. TMDs have a multifactorial etiology: psychosocial and genetic predispositions, habits, trauma and bruxism, and others have been proposed to cause and/or perpetuate TMD. This chapter will explore how investigators have attempted to diagnose and quantify bruxism and determine its relationship to temporomandibular joint disorders. Bruxism is defined as “a repetitive jaw muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible” [5]. Bruxism has two circadian manifestations: it can occur during sleep (sleep bruxism) or during wakefulness (awake bruxism). According to a recent consensus paper, bruxism can be classified as “possible” (self-report), “probable” (self-report plus clinical examination), or “definite” (self-report plus clinical examination, plus polysomnographic recording) [5]. M. Schmitter (*) Department of Prosthodontics, University of Wurzburg, Wurzburg, Germany e-mail: [email protected] © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99912-8_1
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M. Schmitter
The relation between TMD and bruxism can be assessed using either clinical studies or experimental studies (including finite element analysis, FEA) as described below. However, given the current evidence, the relationship between bruxism and TMD seems to be still controversial at first glance. There are two major reasons for this dilemma: first, the complexity of the etiology of both bruxism and TMD and second the diagnostic uncertainty of both disorders [6].
1.1
TMD Diagnostics
When diagnosing TMD, it is mandatory to distinguish between myogenic and arthrogenic findings: myogenic and arthrogenic TMD might be caused and/or perpetuated by different causes. Thus, without this differentiation, it might be difficult to identify risk factors, including bruxism. However, most TMD patients suffer from myogenic pain—arthrogenic pain is much less common. The clinical examination is the first step when assessing TMD-related problems. Muscle-related TMD can be diagnosed reliably when using standardized clinical examination protocols, e.g., the RDC/TMD (
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