Bruksizm – periodically arising episodes of involuntary reduction of chewing muscles which are followed by tightening of jaws and gnashing by teeth. Except the main symptom - a scratch teeth, the bruksizm can result in pathological erasability and a giperesteziya of teeth, formation of wedge-shaped defects, pathology of a parodont and VNChS, chewing muscle pains, a headache etc. Bruksizm comes to light on the basis of complaints of the patient and his relatives, characteristic changes of teeth, a polisomnografichesky research, an electromyography. In treatment of a bruksizm the psychotherapy, massage, physical therapy, a botulinoterapiya, carrying protective mouthpieces is applied.
Bruksizm – the paroksizmalny gnash teeth arising owing to a spasm of chewing muscles, a stiskivaniye of jaws and their heavy traffic relatively each other. In the period of a dairy bite (from the teething moment to 7 years) the bruksizm occurs approximately at a half of children; prevalence of a problem among adults makes 5-10%. At children and adults speak about a bruksizm in case the scratch and a gnash teeth arises during sleep; if these manifestations happen in the afternoon, such state is regarded as a bruksiomaniye. Bruksizm and bruksiomaniye belong to parafunctions of chewing muscles (oral parafunctions).
As the complex of various reasons and their combination can be the cornerstone of development of a bruksizm, this problem is studied not only within stomatology, but also psychology, neurology, otolaryngology, gastroenterology. Let's consider the main etiologichesky prerequisites of a bruksizm.
According to the psychological theory, the bruksizm is reflection of emotional trouble, the stresses, overloads, frequent affective states, an overstrain causing involuntary muscular contractions and a gnash teeth. Bruksizm sometimes call "a disease of the businessmen" testing constant psychoemotional overloads, however short-term episodes of a bruksizm in a dream can arise also at the people having a positive emotional spirit.
The Nevrogenny theory of a bruksizm considers a problem from the point of view of violation of activity of the central and peripheral systems leading to neurologic and motive frustration. It is noticed that the bruksizm is quite often combined with sleep disorders (a sleep-walking, snore, nightmares, in a dream), a tremor, enuresis, epilepsy. Besides, such states as a trizm and a bruksizm can develop owing to the tonic tension of chewing muscles at damage of motor neurons of a trigeminal nerve.
The dental theory is based that emergence of a bruksizm is promoted by various deviations in a structure and functioning of zubochelyustny system: the wrong bite, anomalies of teeth (an edentia, accessory teeth), badly picked up dentures or breket-systems, low-quality dental care, arthrosis and arthritis of VNChS, etc.
From the point of view of the osteopathic theory, the bruksizm is interpreted as attempt of neuromuscular system to eliminate blocking of cranial seams and to restore the broken kraniosakralny rhythm. These phenomena at children can arise owing to the complicated course of childbirth and patrimonial injuries, anomalies of teeth, the wrong bite etc.; at adults – at incorrectly executed prosthetics of teeth, osteochondrosis of cervical department of a backbone, etc.
The other theories of a bruksizm which are not finding wide recognition and reliable scientific confirmations connect will cut off teeth with violation of nasal breath (adenoides, a curvature of a nasal partition, frequent rhinitises), a gastroezofagealny reflux disease, helminthoses (askaridozy, enterobiozy, etc.), improper feeding, abuse of chewing gum and so forth.
The persons having Parkinson's disease and horey Gentington are inclined to a gnash teeth. Bruksizm at children can arise during the periods of eruption and change of teeth. Can act as cofactors of a bruksizm recently postponed craniocereberal trauma, abuse of alcohol, nicotine, caffeine, hypnotic drugs, antidepressants.
Bruksizm episodes, as a rule, last about 10 seconds, however in a night can repeatedly repeat, being followed by a sound of a gnash or a poshchelkivaniye teeth. Usually these symptoms are noticed by relatives of patients (parents, spouses) as during sleep the person does not control the state and does not waken from a scratch of teeth. Gnash attacks teeth often are followed by change of breath, arterial pressure and pulse.
Next morning patients often note a front mialgiya, a toothache, pains in jaws, headaches, day drowsiness, dizziness. At a long current of a bruksizm pathological erasability of teeth, a giperesteziya of teeth, wedge-shaped defects, chips and cracks of enamel, changes of crowns of teeth can develop. As a consequence of traumatizing okolozubny fabrics at a bruksizm serves the inflammation in periodontal fabrics (periodontitis), shaking and loss of teeth. Excessive uncontrollable load of teeth can become the reason of chips of restorations and seals, ceramics chips on artificial crowns, breakages of dentures.
Musculoarticulate dysfunction of VNChS can serve as the remote consequences of a bruksizm and a bruksiomaniya: hypertrophy of chewing muscles, restriction of the movement of jaws, temporal and mandibular joint, shoulder joints, neck pains. The constant travmatization of a mucous oral cavity at some patients with a bruksizm leads to emergence of a gingivit, flat red depriving, fibromas of an oral cavity, scalloped (gear) language, grazes under removable artificial limbs.
Diagnostics of a bruksizm
The fact of a bruksizm is usually established on the basis of subjective complaints of the patient and his relatives, and also the indirect signs revealed by the stomatologist at survey of an oral cavity. As method of objective diagnostics of a bruksizm serves use so-called Brooks of cheker – the special mouthpieces made on the basis of a mold and model of a jaw of the patient and allowing to define existence of okklyuzionny obstacles. After night carrying the kappa is transferred for the analysis to clinic; Brooks of a cheker allows the stomatologist to define studying what teeth test an overload.
Pathological activity of chewing muscles can be registered in the course of carrying out an electromyography or a polisomnografiya. Much more complex challenge is represented by identification of the reasons of a bruksizm at the patient that quite often demands attraction of a number of adjacent experts: neurologists, psychologists, otolaryngologists, osteostalemates, gastroenterologists.
Treatment of a bruksizm
Ways of therapy of a bruksizm depend on its reasons and degree. The bruksizm usually does not demand special treatment from children of early age and comes independently by 6-7 years. At adult patients the maximum effect of treatment of a bruksizm is reached at an integrated approach with use of psychotherapeutic, medicamentous, physiotherapeutic and dental techniques.
At the bruksizm caused by psychogenic factors come to the forefront cognitive and behavioural psychotherapy: biological feedback, methods of a relaxation and self-checking, trainings and so forth. Medicamentous therapy of a bruksizm is directed to reduction of convulsive activity of chewing muscles in a dream and can include purpose of light sedative and sleeping medicines, medicines of magnesium, calcium, vitamins of group B, botulinum toxin injections, etc. In certain cases at a bruksizm osteopathic treatment, sessions of manual therapy and massage, statement of warm damp compresses on area of a jaw can be shown.
Dental treatment of a bruksizm is carried out with participation of various experts: therapist, stomatologaortoped, orthodontist, parodontolog. It assumes production and use of special protective mouthpieces from soft plastic or rubber, according to indications - a selective prishlifovyvaniye of teeth, correction of a bite by means of orthodontic treatment, replacement of the absent teeth with artificial limbs or dental implants.
It is necessary to start correction of esthetic defects of teeth (restoration of wedge-shaped defects, statement of seals, installation of vinir, statement of crowns, treatment of periodontitis etc.) only after elimination of the reasons and phenomena of a bruksizm.
Forecast and prevention of a bruksizm
Attempts to cope independently with a bruksizm, as a rule, are ineffectual and quite often lead to deplorable consequences. When understanding existence of this problem it is necessary to address to for professional consultation the stomatologist. Performing complex diagnostics and the choice of an adequate method of treatment allows to get rid forever of this persuasive pathological habit, to warn or eliminate bruksizm consequences.
Prevention of a bruksizm assumes normalization of a psychoemotional state, disposal of addictions, training in methods of self-relaxation and self-massage. As an important link of the prevention of a bruksizm serves timely elimination of diseases of teeth and nervous system.