Sleep bruxism is a term that refers to tooth grinding. It is characterized by flat worn teeth or deep grooves called abfractions at the gum line on the cheek side of the posterior teeth.
Grinding is referred to as rhythmic bruxism and clenching is referred to as tonic bruxism. Bruxism in the absence of a medical or psychiatric cause is referred to as primary. Bruxism associated with a neurological or psychiatric cause such as Parkinson’s, depression or as a drug side effect (Zoloft, Paxil, or Prozac) are classified as secondary. Iatrogenic means doctor caused and an example of iatrogenic bruxism is that caused by dental restorations in a less than excellent bite.
Sleep bruxism mainly occurs in light sleep Stage 1 and 2. Bruxism rarely occurs in REM (rapid eye movement) sleep because the increased muscle activity of grinding is inconsistent with muscle atonia that characterizes REM sleep. Sleep bruxism occurs in between 6-20% of the population with the lowest prevalence occurring in people over 65 years of age.
The diagnosis is confirmed by a dentist but can be reliably diagnosed based on a history of grinding noises during sleep reported by sleep partner, complaint of abnormal tooth wear, temporomandibular joint related pain and headaches, chewing discomfort, teeth hypersensitivity to cold, and masseter muscle hypertrophy. It is believed that sleep bruxism is involved in maintenance of airway patency during sleep.
Oral appliances for sleep bruxism that fit on the upper arch interfere with normal swallowing, aggravate respiratory disturbances and are less comfortable than those that fit on the lower arch. The function of most oral appliances for sleep bruxism is to prevent damage to the teeth, not to prevent the bruxism.
The appliance used by Dr. Allen Moses , called the “Mrs. Moses”, does control sleep bruxism to a greater extent than other intraoral bruxism devices. The “Mrs. Moses” is an acrylic laboratory-fabricated, custom interarch appliance. It captures the condyle and disc in physiologic position conducive to ligament healing, prevents condylar pathology, prevents reciprocal click and prevents bruxism. It relieves pain and deprograms muscles. It enlarges tongue space and facilitates correct swallow. It allows the masticatory muscles to remain passive and comfortable and not hyperactive. It supports patients both vertically and anteroposteriorly during sleep, allowing adequate room for the tongue, and prevents collapse of the pharyngeal musculature. It supports teeth in their exact relationship to each other, thus allowing no orthodontic movement to occur. It is very comfortable to wear.
"Mrs. Moses" Appliance
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