Clinical Features

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 to greater damage than the more vertical forces of diurnal bruxism. Tooth wear, most commonly on the incisal edges of the anterior teeth and on the cusps of the posterior teeth, is the most striking finding on physical examination. Severe sleep bruxism may also damage supporting structures (Seligman et al., 1988).

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