Parafunctions
General:
A parafunction is a set of coordinated, but not finalized, activities.
Different oral parafunctions can exist:
The interposition of an object (pen, wire, nails)
Onychophagia
Bruxism which requires special attention.
Definitions:
Bruxism is a general term used to define parafunctional activities that include grinding, rubbing, and clenching of teeth.
- For the National College of Occlusodontology: “bruxism is a behavior characterized by involuntary motor activity of the masticatory muscles, continuous (clenching of teeth), or rhythmic (grinding of teeth), with occlusal contacts.”
- For Rozencweig: “bruxism is characterized by involuntary and unconscious contractions of the masticatory muscles, outside of the physiological function.”
- Recently Kato proposed the following definition: “Sleep bruxism is a parasomnia and a parafunctional oral activity, characterized both by the clenching of the jaws (tonic activity) and/or by a phasic activity of the masticatory muscles, repetitive, which results in the grinding of the teeth.”
Parasomnias include disorders that occur during sleep, such as: nightmares, sleepwalking.
Etiologies:
Although the etiology of bruxism has not been formally identified, there is a consensus that it has multifactorial causes.
- For a long time, occlusal factors were favored, thinking that occlusal interferences acted as a trigger zone to cause the various forms of bruxism.
- Then Rogh showed, by creating experimental interferences, that the role of dental malocclusions was secondary in the etiology of bruxism, and that occlusal corrections did not modify parafunctional episodes.
- Taking into account the patient’s personality type and stress level quickly became essential.
- Recently, studies have converged on sleep disorders as a major etiological factor, with sleep bruxism being associated with episodes of micro-awakening linked to the activation of the central autonomic nervous system, responsible for the motor activity of the masticatory muscles.
Sleeping position was also discussed.
Classification:
- Depending on the time of occurrence: we distinguish:
- Nocturnal bruxism
- Daytime bruxism.
These names are replaced by: sleep bruxism and wake bruxism.
- Depending on the position in which it manifests itself, we distinguish:
Parafunctions
- Centered bruxism: this is clenching
teeth in centric occlusion.
- Eccentric bruxism: this is the grinding of the
teeth during eccentric movements outside the PIM.
- Depending on the severity of the damage: Rozencweig classifies the pathology into:
- Stage 1: wear limited to the enamel, and to less than 3 pairs of teeth.
- Stage 2: wear of the enamel with the appearance of dentinal islands, less than 6 pairs of teeth.
- Stage 3: wear of enamel and dentin without islands, with more than 6 pairs of teeth.
- Stage 4: wear affecting the middle of the crown.
Stages 3 and 4 correspond to brycosis which involves a major psychological component “neurosis”.
- According to Kato: he distinguishes:
- Primary idiopathic bruxism: this corresponds to the state of clenching and/or grinding of the teeth.
- Secondary bruxism: it can be linked to a neurological or psychiatric pathology, or the taking and abuse of certain medications.
Symptoms:
- At the dental and periodontal level:
- Dental attrition
- Hypersensitivity
- Cracks
Parafunctions
- Coronary and/or root fractures
- Fractures and instability of dental or prosthetic restorations
- Amendment of the DVO
- Tooth mobility
- Gum recession may be encountered
- Periodontal pain.
- At the muscular level:
- Spasms and muscle pain in the elevator muscles
- Muscle hypertrophy visible especially on the temporalis and masseter
- Lockjaw.
- At the joint level:
- Asymmetrical condylar play
- Joint noises
- Pains
- Lockjaw.
- Other signs:
- Jugal, labial, or lingual indentations
- Headaches
- Orofacial pain
- Exostoses
- Concavities at the mandibular level (angle).
Diagnosis:
Positive: the latter is established through a rigorous clinical examination, which allows all the signs mentioned above to be brought together, with the anamnesis which aims to evaluate the patient’s lifestyle: professional overwork, high level of stress , habits of taking stimulants (alcohol, coffee).
Etiological: includes all etiologies.
Differential: can be done with:
- Epilepsy
- Parkinson’s disease
- Tardive dyskinesia.
Treatment :
- Preventive
- Curative:
- Immediate :
- Advice on healthy living
- Drug prescriptions: analgesics, NSAIDs (general and local), neuromuscular excitability stabilizers, muscle relaxants.
- Physiotherapy
- Mechanotherapy
- Physiotherapy
- Occlusal release plates or orthoses
- Psychotherapy
- Media:
- Dental reconstruction
- Occlusal rehabilitation.
Parafunctions
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.