Bruxism Causes and Treatments
Confirming that seizure manifestations are strictly connected to fluctuations of arousal (Shouse et al., 1989), these findings also suggest a direct relationship between CAP and motor events. In addition to epileptic manifestations, CAP can trigger other motor activities from physiological body movements to nocturnal myoclonus (Parrino et al., 1996), sleep bruxism (Macaluso et al., 1998), night terrors, and sleepwalking (Zucconi et al., 1995). The definition of clear-cut boundaries between physiological and pathological movement patterns is in progress (Zucconi et al., 1997), while promising results are supplied by the genetic investigation of patients with exclusive nocturnal seizures (Scheffer et al., 1995 Oldani et al., 1998). It is known that the number and distribution of nocturnal movements is a personal characteristic of the sleeper, who is endowed with a given pool of opportunities for the accomplishment of motor episodes
Among infants who have sleep recordings for other reasons, rhythmic movement disorder is a common incidental finding. Other causes in infants of rhythmic muscle activity during polysomnography include bruxism and sucking on a pacifier. The cause of the rhythmic movements is uncertain a soothing effect
A 67-year-old dextral man was referred because of violent behavior during sleep He had slept uneventfully through adolescence in a small room with three brothers. But on his wedding night, his wife was scared with surprise over his sleep talking, groaning, tooth grinding, and minor body movements. This persisted without consequence for 41 years until one night, 4 years before referral, when he experienced the first 'physically moving dream' several hours after sleep onset he found himself out of bed attempting to carry out a dream. This episode signaled the onset of an increasingly frequent and progressively severe sleep disorder he would punch and kick his wife, fall out of bed, stagger about the room, crash into objects, and injure himself his wife began to sleep in another room 2 years before referral. They remain happily married, believing that these nocturnal behaviors are out of his control and discordant with his waking personality.
The other parasomnias are disorders in which the phenomena of interest are not closely associated with a particular stage of sleep. Of the other parasomnias, features of three may suggest the possibility of epilepsy sleep bruxism, sleep enuresis, and nocturnal dissociative disorder. In the psychogenic nocturnal dissociative disorder, conscious awareness becomes dissociated from behavior, and patients perform complex activities for which they are amnestic. Patients are often young women with psychiatric conditions, and the episodes are sometimes accompanied by self-mutilating behavior and injuries.
Sleep bruxism, which refers to grinding or clenching of the teeth during sleep, is characterized by rhythmic, chewing movements, or prolonged contractions of the jaw muscles, sometimes accompanied by clicking or grating sounds. Patients may present for evaluation because of daytime symptoms, because of the sounds disturbing bed partners, because of tooth damage, or because of the possibility that the rhythmic activity is caused by epilepsy. The severity of bruxism typically fluctuates from night to night and is highly variable across individuals. Significant tooth wear, muscular pain, or temporomandibular changes occur in 5-10 of population, with minor tooth wear in 10-20 (Glaros, 1981 Rugh and Harlan, 1988a Hartmann, 1994). In one study, jaw discomfort was noted in 6 of 18 bruxers and none of 18 control subjects (Lavigne et al., 1996). Tooth damage is a function of the forcefulness, frequency, direction, and duration of bruxing. The lateral grinding forces of sleep bruxism often lead...
Emotional stress is the most commonly reported precipitant of bruxism (Rugh and Harlan, 1988b). Medications including amphetamines (Ashcrost et al., 1965) and levodopa (L-dopa) (Magee, 1970) may precipitate this disorder long-term phenothiazine use (Kamen, 1975) and alcohol (Hartmann, 1979) have also been related to bruxism. Bruxism may have a genetic predisposition. Although bruxism has been postulated to be a centrally mediated sleep disorder on the basis of these observations, the specific mechanisms underlying this disorder are poorly understood.
The parasomnias refer to clinical disorders consisting of undesirable physical phenomena that occur predominantly during sleep (DCSC, 1990). They have been classified based on the stage of sleep from which they originate. They include both normal and abnormal phenomena. Included in the category of NREM parasomnias are hypnic jerks and hypnic imagery, considered to be normal, in addition to confusional arousals, sleep terrors (pavor nocturnus), and sleepwalking (somnambulism), referred to as disorders of arousal. These all originate from deep NREM sleep, stages 3 and 4. They are all common in childhood and decrease in frequency as age increases. These individuals tend to have a family history of similar disorders. REM parasomnias include nightmares and REM behavior disorder (RBD). A third group consists of disorders that may occur during any or all sleep stages and includes bruxism, enuresis, rhythmic movement disorder (including head-banging), sleep talking (somniloquy), and...
Because only 20 of bruxist episodes are accompanied by noise, the majority of bruxists are unaware of their bruxing. Wear patterns on the teeth, tooth mobility, and fracture cusps suggest bruxing activity. Other individuals come to medical attention because of muscle or joint pain, fatigue, stiffness on waking, or headaches. The rhythmic myogenic artifact resulting from bruxism appearing on a polysomnogram has a characteristic appearance (Fig. 12.2). FIGURE 12.2 Chewing movements produced by bruxism cause rhythmic activity with superimposed myogenic artifact in the EEG channels, bearing a superficial resemblance to generalized spike-wave discharges. (From Malow B. A., and Aldrich, M. S. (2000). Neurological Monitoring Techniques, In Principles and Practice of Sleep Medicine, 3rd ed., M. H. Kryger, T. Roth, and W. C. Dement, eds., Philadelphia W.B. Saunders, reproduced with permission.) FIGURE 12.2 Chewing movements produced by bruxism cause rhythmic activity with superimposed myogenic...
The parasomnias, including sleep walking, night terrors, restless legs, nocturnal myoclonus, bruxism, paroxysmal nocturnal dystonia and REM sleep disorder, can be more difficult to differentiate from seizures 62,63 whereas disorders with hypersomnolence rarely present diagnostic problems. Sleep disorders are common, particularly in the elderly. Bruxism, or tooth grinding, can be a very striking nocturnal phenomenon. It is a benign disorder that requires no specific therapy.
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