• 1901 - Karolyi , “traumatic neuralgia”

  • Beobachtungen über Pyorrhea Alveolaris, Osterrr.-ungar. Vrtljschr. Zahnh., 17: 279, 1901.

• 1907 - Marie y Ptietkieviez , “bruxomania”

  • Fils: La bruxomanie. Rev. De Stomat., 14:107 1907.

• 1931 - Frohman , “bruxism”

  • The aplication of psycoterapy to dental problems. Dent. Cosmos, 73:1117, 1931.

• 1962 - Drum , “parafunction”
  • Die praktische Bedentung der Parafunktionen Zahnärtzl. Prax. 13:238 ,1962

  • Parafunktionen und Autodestruktionsprozese “Die Quintessenz”, Berlin ,1969.

• 1971 - Ramfjord y Ash , “centric and eccentric bruxism”.
  • Oclusión 2ª Ed. Saunders. Philadelphia, 1971.

• The habit of gritting or rubbing of teeth, at day or night-time, with different intensity and persistence levels, in a certain space of time, unconsciously away from functional movements (parafunction).
• Neurophysiological disorder of the jaw movements which, in a progressive manner, destroys the dental tissue.
• The clinical repercussions can go far beyond the wearing out of teeth, affecting dental support structures, the cervico-cranial muscles and TMJ structures.
• Affects both male and female, teenagers and grown ups (although the latter may have begun in their teens), even very young children (do not mix this up with physiological attrition in deciduous dental pieces).
  

• The origin of bruxism has not been fully clear or explained.
• It seems that it obeys to multiple etiopathogenical factors.
• Among them, there are two which outstand above the others:
  • Occlusal interferences
  • Mental factor
• The most pathogenical interferences are:
• Drifting or gliding of centric lateral
• Interferences in balancing
• Psychical or mental factors work as potentiators of the symptoms (contributing factors). They are:
  • Anxiety
  • Stress
    • Stressful situations can potentiate this habit in a specific manner
    • Relaxing situations can reduce such habit in an occasional manner

• ABRASION: The lost of dental substance due to gritting or rubbing. (Bruxism and energetic brushing of teeth and gum)
• ATTRITION: The lost of dental substance due to functional wearing out or erosion (chewing).
• EROSION: The lost of dental substance because of chemical substances (vinegar, lemon, acid regurgitation of the stomach).
  

There are two types of bruxism:

• CENTRIC
  • Squeezers or tighteners
  • Especially at night-time
  • Eroding area limited to occlusal face
  • Lesser dental erosion
  • Major muscle affectation
• ECCENTRIC
  • Rubbing devices
  • Night-time
  • Eroding area exceeds occlusal face
  • Major dental erosion
  • Lesser muscle affectation
    

• Dental wearing out or erosion:
  • In centric bruxism: inverted cusps and wearing out of the neck of the teeth.
    

• In eccentric bruxism: the wearing out process is away from the functional area.

• In a study done by Powell and Zender in 1965 dental contacts were registered during sleeping hours.
• The non-bruxists standard registers presented an average 260 dental contacts in 8 sleeping hours. In the bruxists registers there were some 150 to 1500 dental contacts per hour (1200 to 12000 in 8 sleeping hours).
  

• Occlusal trauma
  • In centric bruxism
  • It can cause periodontitis and dental mobility.
    

• Dental hypersensitivity
  • In centric bruxism due to the loss of enamel in the neck of dental pieces.
    

• Pulpitis and pulpals necrosis
  • When the pulpal retracting mechanism fails (compensation mechanism before the erosion)
  • In eccentric bruxism

• Dental fractures
  • In centric bruxism
    • Vertical fractures

• Bone affectation
  • Centric bruxism: Bone reabsorption.

• Eccentric bruxism: Bone condensation and exostosis.

• Muscular affectation
  • Especially in centric bruxism
  • Pain and sensitivity in muscle elevators (maseter, temporal)
  • Functional limitation
  • It can affect the neck muscles

• ATM affectation
  • Due to loss of muscular synergy (especially from the meniscal instalment of the external Pterigoid)
    

• Loss of the vertical dimension of occlusion
  • In eccentric bruxism
  • Because of dental erosion
  • Esthetic problems
    

• Locating the dental erosions by buccal exploration
• Associated clinic to parafunctional habit

• The key is early diagnosis
• It will be in function to the time of intauration of the habit the dental erosion and the associated clinic.

• REVERSIBLE
  • Contributing control factors
    • Control of the psychic factors that work as potentiators of the symptom:
      • Psichoterapy
      • Relaxation
      • Yoga
    • In the daytime tightener: deprogram such habit (tongue-palate exercises)
  • Medicine
    • Anxiolitics:
      • Diazepam (Valium ®)
      • Clorazepato dipotasic (Tranxilium ®)
      • Clonazepam (Rivotril ®)
    • Muscle relaxers:
      • Tetrazepam (Myolastan®)
      • Metocarbamol (Robaxisal ®)
  • Occlusal splints
    • Especially in night-time bruxism
    • They are also called splints or discharging plaques
    • Built of acrylic, generally the upper unit
    • They must fully cover the occlusal surface and the incisal edges of the incisors and canines
    • The width of the splint should be about 2 mm and its surface ought to be flat.
    • Maximum bilateral contacts must be obtained between the lower vestibular cusps and the plaque.
    • They are constructed with canine guide so that in laterality they only go into contact with the canines.
    • The objective of its use is:

      • Ovoiding dental erosion
      • Muscular decontraction

• IRREVERSIBLE
  • Occlusal adjustment
    • Apply only at initial stages of bruxism (very difficult to detect).
    • It consists in the detection and elimination of occlusal interferences, potentially responsible for installing the medical profile or symptom.
    • Getting rid of the interferences is done through the selective carving or shearing technique
    • The occlusal adjustment will be, in certain way, a prophylactic method that should be applied in dental treatments with the main intention of avoiding the genesis of interferences which could potentially spark off bruxim.
    • Once the habit is established, Occlusal adjustment is practically irrelevant.
  • Oral rehabilitation
  • In cases of great loss of vertical dimension or affectation of the TMJ
  • It must be based on physiological parameters: Hinge axis, RC, condylar paths, Bennett movement and type of occlusion.
  • Its realization is very complex and does not guarantee getting rid of bruxism.