Most patients, when experiencing chronic headaches, will turn to their medical doctors for relief. For this reason, it is important that physicians are knowledgeable about sleep-related bruxism. There are no medications that have been FDA cleared to treat this condition. A recent study found that atrial hypertension was related to sleep-related bruxism. Another study found that sleep-related bruxism patients had elevated renalase concentration, a precursor to the development of hypertension that increased proportionately with the rate of sleep-related bruxism (bruxism index). Sleep-related bruxism results in the sympathetic stimulation of the trigeminal cardiac reflex, resulting in tachycardia, tachypnea, hypertension, and increased gastric motility (GERD). These are all related to the hyper-stimulation of the TCR. It is the opposite effect of other regions of stimulation that generate a parasympathetic response.
The two most commonly reported symptoms of sleep-related bruxism are tooth sensitivity and headaches in the temple region. Unfortunately, this overlaps many other conditions. There are quite a few other signs and symptoms relating to sleep-related bruxism that help differentiate it from other conditions.
Sleep-related bruxism is quite common, affecting 10-12% of the adult population. From over 30 years in clinical dentistry, I am convinced it occurs at a higher rate than this. It is not taught in dental schools although dentists are the primary care providers. Many dentists use single arch, upper or lower bruxism appliances to prevent damage to the teeth, muscles, and TMJ however, it does little to treat the underlying cause. These appliances frequently break or wear excessively under the extreme forces of sleep-related bruxism. Many patients become dependent on these splints and start wearing them in the daytime as well. Removal results in immediate and severe pain, often in the TMJ region.
There are medications that can initiate the condition or worsen existing sleep-related bruxism. SSRI and SSNRI medications have been shown to worsen sleep-related bruxism as these medications are serotonin sparing. With the HTR2a polymorphism seen in patients suffering from this condition, they are sensitive to serotonin, and increasing availability resulting from these medications results in increased suppression of protective jaw reflexes. This results in the damaging forces seen in EMG recordings and sequela of symptoms observed.
Yet, some patients are very symptomatic while others are not. This can be very challenging to manage clinically. It can be primary and secondary. The symptoms may not appear until after a head or neck trauma such as a car accident. The neck and shoulder muscles are accessory chewing muscles, stabilizing the skull when chewing. It is not uncommon to see pathology develop in these muscles with long-standing or severe untreated or poorly treated sleep-related bruxism.
Testing for Sleep-Related Bruxism Clinically
A very simple test you can conduct in your office can identify most of these patients. Ask your patient to slide their lower jaw forward until they are in an edge to edge positioning with their incisors. Instruct them to lightly touch and hold this position for one minute.
If their mandible begins to shake or tremble, this is highly diagnostic of sleep-related bruxism.
Managing Patients with Sleep-Related Bruxism
If you suspect your patient might suffer from this condition, it would be prudent to refer them to a dentist in your region for further assessment and treatment. The Luco Hybrid device is FDA cleared for the treatment of sleep-related bruxism and to aid in the treatment of associated tension and migraine headaches in adults (18 +). To find a dentist in your region trained in using mandibular advancement appliances, click here for the AADSM directory search. Most dentists have the training and knowledge to fabricate a Luco Hybrid device for a patient.
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