in increased loads to the teeth and facial pains inchildren.
TMJ disturbances and pain are in many cases the
following signs and symptoms may be seenindividually or in different combinations and may be
different times: tooth mobility,
occlusal wear, muscular
Volume 28 (2) April 2010
fatigue, headaches, grind or tapping soundsand soft tissue trauma. These signs and symptoms
bruxism depend on:
bruxing, (2) theintensity with which the patient is bruxing,
the patient which may be associated with theduration
Bruxism can result in tooth mobility. Highermobility values in the morning are observed whichcould be from bruxing activities during the sleepingperiod.
has been suggested that bruxism might be anessential factor for the spread
gingivitis into thedeeper periodontal structures and alveolar bone
can beobserved as signs
bruxism. Bruxism can lead toincreased tooth sensitivity from excessive abrasion
the enamel. The enamel prisms are fractured fromhigh muscle forces generated during sleep and laterground down by the
movements. This issupported by the fact that people in industrializedcountries are living on a rather soft diet and thusabrasion
tooth structure is from bruxism in mostcases.In a study
year old children, it was foundthat attrition in the permanent dentition increasedsignificantly with age in all regions except in the
region on comparison between
yearsold children. In the oldest age group 14% had dentinvisible on at least one incisor. This 14% attrition inolderage groups included cuspid teeth.'
primary teeth is thin, and onoccasion wear facets can be extensive even withnormal wear. In some children most
enamel anddentin is worn
by bruxism. Fortunately suchattrition stimulates the odontoblasts to produceadditional dentin which protects the pulp. Sometimesthe pulp may be exposed which results in a dentalabscess." However, facets on the cuspid
mean that wear is still taking place as the cuspids
is possible for example, that the facets
caused by grinding while the tooth becameadjusted to the occlusal plane and that bruxism laterceased.'
all the oral structures stressed through bruxisticforces, pain can most easily be elicited in themusculature. The most common symptom
bruxismis, therefore, tenderness
muscles,especially to palpation. Muscular tiredness uponawakening can also be a complaint. In addition to painin the muscles, hypertrophy
the masseter musclehas also been described uni-or bilaterally. Fatigue
neck is also observed."In bruxism, isometric exercise
muscles can generate intense muscle forces resultingresult
bruxism. Along with the pain in the
itself, the associated muscles can also be painful. Thepain is usually dull and mostly unilateral. Crepitationand
mandibular movements and
deviations can oftenbe observed.'In her study, Egermark-Eriksson" found TMJdisturbance occurred more frequently in girls thanboys and more in
years old than the younger agegroups. Muscle tenderness also increased with age.She also reported a positive correlation betweensubjective symptoms and muscular tenderness.
Egermark-Eriksson" found a correlation betweenheadaches and dental wear and observed thatheadaches increased with age, and in older children itis more common in girls. The headaches are often
the muscular contraction type, which suggests thatpain in the muscles is the underlying cause.
Grinding or tapping sounds
bruxism are usually
by parents or asibling. Except for children who have organic braindiseases, it is not common for children to brux withthe same amount
audible intensity during the timethat they are awake.Soft tissue
Small ulcerations or ridging on the buccal mucosaopposite the molar teeth on one or both sides
theoral cavity has been observed in
bruxismisstillcontroversial. Manyauthors claim a multifactorial cause
etiologic factors can be distinguished.
(e.g., dental occlusion and anatomy
the orofacialskeleton) are thought to be involved in the etiology
bruxism. Local factors within the stomatognathicsystem malocclusions, faulty restorations, calculusand periodontitis and especially traumatic-occlusalrelationships and functionally incorrect occlusionsare mentioned as being responsible for bruxism.'Occlusal
contacts, which act as "triggers" that elicit bruxismare the most important local etiological factors.Three types
oeclusal anomalies significantlycorrelated with occlusal interferences: incisorcrossbite, postnormal occlusion and buccal crossbiteof the posterior teeth. Crossbites are found more inyounger age group and in those with sueking habits.
children are also found to have musculartenderness more often." Lindqvist considered thecuspid teeth as an etiological factor in bruxism. Sheshowed that children who had cuspid teeth inocclusion showed significantly more frequentextreme lateral contact facets, which could be fromthecuspidspreventingnormal movement