“Preventive medicine”, which derives its source from the prevention of the disease rather than its treatment, contributes to the increase in the number of healthy individuals and the country's economy. Unfortunately, in our country, in the fields of medicine and dentistry, this issue has not been adequately understood or correct policies have not been implemented. When we talk about preventive medicine in dentistry, the first things that come to our mind are fluoride applications to children, closing small cavities of the teeth (fissure sealant applications) and raising the awareness of patients with oral hygiene motivations. In addition to these practices, preventive practices that prevent teeth clenching, teeth grinding, reflux and similar diseases that cause damage to joints, digestive system and dental tissues are very important in dentistry. It has been determined in studies that many people tend to get bored and many of them do not come for check-ups because they have no complaints. Teeth clenching and grinding, which may be due not only to stress but also to many other reasons, is a habit that is very common today and actually has symptoms and treatment. It is defined as teeth grinding and clenching that occurs with activity. Continuous contact between the teeth as a result of the contraction of the chewing muscles is defined as "teeth clenching", and the rhythmic continuation of the chewing process without any substance in the mouth is defined as "teeth grinding". Teeth clenching or grinding may occur during the day or at night while sleeping. Significant differences have also been observed between the chewing strength of normal healthy individuals and individuals who clench their teeth.
While teeth clenching is more common during the day, teeth grinding along with clenching is more common during sleep. These movements occur during the transition from deep sleep to light sleep. It has been reported that these movements are more common in people with sleep disorders or light sleepers.
Many factors may play a role in teeth clenching and grinding. r, these are;
Closing disorders of teeth, dental treatments, entry of foreign objects into the mouth, stress, brain trauma, neurological diseases, genetic factors, sleep disorders, Parkinson's disease, cigarette alcohol addiction and some drugs. , intestinal parasites, allergies and endocrine diseases. Not only the teeth hitting each other for a long time, but also; Chemical factors such as gastroesophageal reflux, excessive vomiting (stomach acid coming to the mouth), excessive consumption of acidic foods and beverages (soda, cola, lemon, wine, coffee, vinegar, etc.) and use of narcotic materials also play a role in the wear of teeth.
Due to clenching and grinding, defects in the parts of the teeth close to the gums, cracks in the teeth, pain in the joints and chewing muscles, tooth sensitivity, in extreme cases, changes in the external appearance, bone resorption around the tooth root and related tooth loss may be observed. Frequent falling out of fillings, breakage of porcelain and implant losses are also very common problems.
Today, bruxism treatment approaches are grouped into 4 main groups:
1)Personalized:
- Biofeedback treatment: Practices such as muscle control, conscious rest, opening of blood vessels and control of brain waves are included in this treatment. The success of the treatment depends on the patient's desire to learn to control this physiological phenomenon, his regular practice and patience.
- Psychiatric treatment: Today, the use of psychiatric approaches in the treatment of bruxism is limited and will increase the problem of teeth grinding. When psychological reasons are suspected, patients can be referred to a psychiatrist to solve psychological reasons.
- Self-suggestion (auto-hypnosis), hypnosis and meditation: Although scientific studies are not very sufficient, hypnosis treatment is available today. It is used in many areas of dentistry. Patients need to be informed to believe that they will receive treatment, to trust their physicians, and to get rid of the dogmas that are misconceived in our society. is. The main purpose here is to reveal the patients' awareness of their habits subconsciously through suggestions. Although it is not very common, dentists use hypnosis in their treatments. Generally, it becomes clear whether the patient will respond to the treatment or not between 3-5 sessions.
- Prevention of bad habits: These are exercises taught to the patient to prevent habits in patients without joint disease.
2) Pharmacological treatment:The use of muscle relaxants is still controversial because their effects are short-term, their success rate is low, and they have side effects such as sleep. Drug treatment is appropriate because the teeth grinding and clenching seen in muscle contractions that cause long-term and severe pain of unknown origin and in very advanced bruxism cases (coma, brain trauma, amphetamine habit) are related to the central nervous system. In recent years, we have seen that Botulinum toxin (Botox) applications have become popular. In this method, with injections made into the patients' right and left jaw muscles and, in later cases, into their forehead muscles, the contraction of the chewing muscles decreases for a period of 1 to 6 months, and thus, they cannot produce enough muscle force to damage their teeth when clenching their teeth. Since the application in the treatment of bruxism is a temporary treatment rather than a problem solver and there are not enough studies, its use as a reliable and realistic method in routine clinical practice is still controversial.
3) Occlusal approaches: If there is an imbalance in the contact of the teeth with each other, balancing can be done by grinding the teeth. The most commonly used oral appliances for teeth clenching and grinding are hard plates made of transparent acrylic, which we mostly hear as night plates. Unfortunately, it should be noted that soft plates are also widely used in our country. Studies have proven that soft plates applied to bruxism patients cause more harm than good. Dentists should also be sensitive about this issue and refer their bruxism patients to a specialist. In the hard plates made Night plates given to the patient without any adjustment in the patient's mouth, soft plates made by the patients themselves, restorations made as a result of incorrect diagnosis and treatment, and joint problems that occur are among the problems that need to be solved in our country.
4) Other approaches: In addition to the treatments mentioned above, physical therapy and oral surgery techniques are applied. Exercises to improve mouth opening muscles and adenotonsillectomy are examples of these approaches.
It may not be a coincidence that the restorations in your mouth (porcelain or removable dentures) break or fall out, implants break, implant-supported dentures loosen or shake. It is not right to blame only the doctor or to think that the doctor used bad materials. If the patients to be implanted have bruxism, it is not a very correct approach to apply an implant without treating the bruxism. If you have clenching or grinding of your teeth and you do not want your dentures to break or your fillings to fall out, you should wear the appliances given to you correctly, regularly apply the exercises or suggestions given by your doctor, and get psychological support if necessary.
Finally, it is important to say that there is no single treatment for bruxism.
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