Medical Conditions and Bruxism

ADHDOne of the most common childhood disorders that can continue through adolescence and into adulthood.23 A person is unable to control behaviour due to difficulty in processing neural stimuli, accompanied by an extremely high level of motor activity.17 In ADHD, bruxism is caused by extensive sleep disturbances and medications used to treat the disorder.24

AutismA neurodevelopmental disorder described by impaired social interaction, verbal and non-verbal communication and restricted and repetitive behaviour. Bruxism can be caused by the antipsychotic medications used in its treatment, high stress and anxiety experienced with autism.25

Brain Injury – There are many conditions that fall into this category. The most common include: strokes, brain damage, dementia or Alzheimer’s disease and traumatic brain injuries, including concussions. Bruxism is a secondary disorder of these conditions.4

Cerebral PalsyConsidered a neurological disorder caused by a non-progressive brain injury or malformation that occurs during development of the brain. This condition primarily affects body movement and muscle coordination. Bruxism is a secondary disorder due to accompanying abnormal conditions in the oral cavity. These patients usually have a higher incident of crowding, variable sizes, shapes and misaligned teeth, all which can promote bruxing. They also experience frequent seizures and are more prone to head and mouth trauma, biting the lips and cheeks and grinding the teeth. Cerebral palsy patients can have trouble swallowing, chewing and can also be more susceptible to gagging and choking.26

DepressionA mental illness that causes sadness. A patient experiences a mood of sadness or a more severe condition of deep depression with possible suicidal thoughts. Patients may only have one episode depending on a particular life situation or with most people it is a reoccurring condition. Episodes may last a few months to many years. The state of mind including unconscious unresolved emotions and medications taken for depression may cause bruxing. Depressed individuals wanting to forget their problems tend to turn to alcohol and/or drugs, which is another source of bruxism.27

Down SyndromeAlso known as Trisomy 21, is a genetic disorder caused by all or part of a third copy of the chromosome 21. This condition is usually associated with physical growth delays, characteristic facial features and mild to moderate intellectual disability. These patients tend to have smaller than average teeth with shorter roots, missing teeth, and a Class III occlusion with crowding. This crowding results in some permanent teeth being unable to erupt. Bruxism is a common side effect of these oral conditions.28

FibromyalgiaFibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood changes. Many people suffering from Fibromyalgia also experience sleep disturbances which increases the possibility of nocturnal bruxing. Seventy-five percent of patients with fibromyalgia have Temporomandibular Joint Disorder (TMD) leading to pain in the face, neck, shoulders and back. This disorder increases in severity with bruxism. Since fibromyalgia can increase stress, sleep disturbances and pain, grinding and clenching may be a side effect of this condition. Wearing a night guard or orthotic occlusal plate usually lessens the discomfort of his condition.29

Obsessive-compulsive DisorderAn anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions) or behaviours that make them feel driven to do something (compulsion). Bruxism can be caused from the anxiety involved and from the side effects of the serotonin reuptake inhibitors medications used to treat this disorder.30,31

Parkinson’s DiseaseA chronic and progressive disorder of the central nervous system, which involves the malfunction and death of vital nerve cells–causing a movement disorder. This condition is often treated with Levodopa, also known as L-DOPA. The brain converts it into dopamine which aids in body movement. Bruxism is a side effect of the long-term use of the medication Levodopa.32

Sleep DisordersConditions include snoring, breathing pauses during sleep, sleep apnoea, obstructive sleep apnoea, sleep talking or mumbling and consistent nocturnal awakenings. Violent injurious behaviours during sleep may include hypnagogic and hypnopompic hallucinations, (visual, auditory or other sensory events that occasionally occur with the transition of falling asleep or waking up.)33 These sleep disorders, along with the previously discussed mini arousals, prevent a sound consistent sleep and tend to increase the risks of bruxing.

Alternately sleeping on the left or right side can determine right or left side bruxing. Sleeping on one side for a long time may induce unilateral bruxism. Sleeping in the horizontal supine position can lead to bilateral bruxism with a high level of posterior neck pain and stiffness.34

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