- Children younger than 11 years old; prevalence decreases with aging
- May be concomitant with wake-time bruxism
- Hypertrophy of the masseter and temporalis muscles
- Tongue indentation
- Tooth wear (occlusal facets, noncarious cervical dental lesions)
- Fracture of tooth tissues or restorations
- Linea alba heavily marked along the occlusal plane
- Commonly associated with teeth grinding sounds, which are the pathognomonic sign of SB,
as reported by patients, bed partners, parents or siblings
- Cervical muscle pain
- Jaw muscle tenderness or pain on digital palpation
- Morning headache
- Temporomandibular joint pain and/or jaw opening limitations
- Tooth hypersensitivity
- Inquire whether there are grinding sounds during sleep, at least 3-5 nights per week in the last 3 to 6 months.
- Obtain the patient's medical history in order to assess the presence/absence of comorbidities.
- Perform a clinical examination and look for the signs and symptoms mentioned above.
- Various questionnaires can be used to investigate the patient's general and oral health, sleep, and oral parafunctions, as well as the presence and characteristics of pain, headache, fatigue, depression, anxiety and stress.
- The use of questionnaires
- Some useful questions to assist with diagnosis
- Are you aware of frequently or occasionally clenching or grinding your teeth while you are asleep?
- Has anyone ever told you that you grind your teeth while you are asleep?
- Do you notice tension or fatigue in your facial, neck or upper back muscles?
- Do you notice any increased sensitivity to your teeth or gums when you wake up?
- Do you wake up with a headache or pain in your upper back or neck?
- Have you noticed wear on your teeth?
- In the presence of any of the above-listed signs and symptoms, the differential diagnosis may require an objective measure of SB diagnosis, such as an ambulatory electromyography (EMG) recording of the masticatory muscles during sleep or a polysomnography.These recordings can differentiate masticatory motor activity from myoclonia (associated with Parkinson disease or epilepsy) and other orofacial activities occurring during sleep (swallowing, coughing, smiling, lip sucking, jaw movements).
Based on the patient's dental and medical history and clinical evaluation, a diagnosis of sleep bruxism is determined.
- Restless legs syndrome
- Sleep apnea
- Rapid eye movement behaviour disorder
- Partial complex or generalized seizure disorders
- Idiopathic myoclonus
- Parasomnia (sleep talking, sleep walking)
- Familial nocturnal faciomandibular myoclonus
- Attention-deficit/hyperactivity disorder
- Gastroesophageal reflux disease
Common Initial Treatments
- To date, no preventive therapy has been proven to effectively cure sleep bruxism (SB).
- Treatment approaches aim at managing and preventing the harmful consequences of SB to the orofacial structures.
- After SB management, the damaged teeth and restorations can be treated with a restorative dentistry approach.
- Educate the patient about sleep bruxism and the importance of maintaining proper sleep and oral hygiene habits.
- Consider an occlusal splint to prevent further damage to the orofacial structures and to reduce symptoms.
- In the presence of suspected/diagnosed sleep apnea or snoring, a mandibular advancement appliance (MAA) should be considered.
- In the presence of psychosocial risk factors (stress or anxiety), consider stress management, muscle relaxation techniques, cognitive behaviour therapy or biofeedback.
- In the presence of exogenous risk factors (alcohol, nicotine, caffeine, drug use or abuse), advise the patient to consider changing their lifestyle habits.
- If SB is associated with medication use, consider an occlusal splint or MAA.
- In the suspected or confirmed presence of medical comorbidities, refer the patient to a medical specialist (respirologist, neurologist, psychiatrist, pediatrician, sleep disorder specialist).
- Follow-up with the patient on the management of SB-related signs and symptoms.
- In the case of an acute phase of SB, prescribe a muscle relaxant temporarily until the above-mentioned SB management can be applied.
- Provide both parents and the child with related information.
- As the orofacial structures are still developing, occlusal splint and MAA are contraindicated.
- If snoring or sleep apnea is suspected, refer the child to a medical specialist.
- Advise the patient to maintain good oral health, sleep hygiene and healthy lifestyle habits.
- Schedule regular checkups to prevent further damage to the orofacial structures.
- If a comorbidity is suspected, refer the patient to a medical specialist.