| rett syndrome is a unique and puzzling disorder noted in females and is possibly caused by fundamental failures in critical brain connectivity during early infancy. The most frequent habits in rett syndrome are hand sucking or biting, bruxism and mouth breathing. Children with musculoskeletal disorders and children who suffer from mental retardation commonly grind their teeth. A five year old female case with rett syndrome is presented with significant bruxism in this article. ( info) |
2/86. Unusual horizontal and vertical root fractures of maxillary molars: an 11-year follow-up. Intra-alveolar root fractures of posterior teeth are rare when compared with other dental injuries. This case report describes one vertical and two horizontal root fractures of teeth 3, 14, and 15. The teeth all tested normal to cold and electric pulp tests. The patient reported no history of accidental trauma, and no signs of scarring were found. These fractures were discovered during a routine full-mouth radiographic survey. All teeth were asymptomatic and in good function. During the 11 yr that followed, there was no dental treatment, except for routine periodontal maintenance. The patient had one abscess that occurred after 9 yr on tooth 3, which had to be extracted. The upper left molars are surprisingly still in function and asymptomatic. Either occlusal or lateral trauma may be the cause of these fractures. This would strongly suggest night guard appliances for patients who clench or grind. A psychological evaluation of the patient might reveal neurosis, anxiety, or stress situations affecting teeth. ( info) |
3/86. Case report: treatment for a patient with a history of TMJ disorder. Establishing a knowledge-based protocol for the treatment of orthodontic patients who report a history of temporomandibular dysfunction can alert the practitioner to potential treatment pitfalls before they happen. While the joints can be extremely adaptive, some individuals are subject to painful and/or limited function. Others have acquired condylar positions that, if not recognized, could lead to serious alterations in the original treatment plan. Combining a thorough diagnostic protocol with a therapeutic regimen that seeks to establish a stable condylar and occlusal position-prior to initiating treatment- is essential. ( info) |
4/86. Antidepressant-induced bruxism successfully treated with gabapentin. BACKGROUND: Symptoms consistent with bruxism are a common chief complaint in dental practice. The authors describe a case of bruxism likely induced by the antidepressant venlafaxine and successfully treated with gabapentin. CASE DESCRIPTION: A case of bruxism, anxiety, insomnia and tremor is reported in a man with bipolar disorder that developed a few days after he initiated venlafaxine therapy for depression. The patient's psychiatrist prescribed gabapentin for anxiety symptoms, and shortly thereafter the man experienced a complete resolution of the bruxism. CLINICAL IMPLICATIONS: On the basis of this case and the available literature, the authors conclude that bruxism secondary to antidepressant therapy may be common. Thus, dentists should inquire about the use of these medications in patients who have bruxism. Gabapentin may offer promise in the treatment of this condition. ( info) |
5/86. buspirone as an antidote to SSRI-induced bruxism in 4 cases. BACKGROUND: One hypothesis to explain selective serotonin reuptake inhibitor (SSRI)-induced bruxism states that SSRIs increase extrapyramidal serotonin levels, thereby inhibiting dopaminergic pathways controlling movement. Previous reports have emphasized buspirone's postsynaptic dopaminergic effect as a partial antidote to the suppressed dopamine levels. case reports: Four patients, recently started on treatment with the SSRI sertraline, presented with new-onset complaints attributable to SSRI-induced bruxism. All 4 responded to adjunctive buspirone, a serotonin-1A (5-HT1A) receptor agonist, with relief of bruxism and associated symptoms. DISCUSSION: We expand the hypothesis put forth in previous reports by proposing that buspirone is not only acting postsynaptically in the extrapyramidal system, but also presynaptically on serotonergic neurons that influence masticatory modulation in the mesocortical tract. Our 4 cases support the concept of buspirone acting as a full agonist at the presynaptic 5-HT1A somatodendritic receptors located on the cell bodies of raphe serotonergic neurons that project to the ventral tegmental area (VTA) of the midbrain. These serotonergic neurons modulate the firing of the mesocortical tract, which itself projects from the VTA to the prefrontal cortex and acts on masticatory muscle activity through inhibiting spontaneous movements such as bruxism. While the literature is confusing and contradictory on definitions of bruxism and etiologies of incompletely understood movement disorders, we believe SSRI-induced bruxism is best conceptualized as a form of akathisia. ( info) |
6/86. Treating severe bruxism with botulinum toxin. BACKGROUND: Locally administered botulinum toxin, or BTX, is an effective treatment for various movement disorders. Its usefulness in treating bruxism, however, has not been systematically evaluated. SUBJECTS AND methods: The authors studied 18 subjects with severe bruxism and whose mean duration of symptoms was 14.8 /- 10.0 years (range three-40 years). These subjects audibly ground their teeth and experienced tooth wear and difficulty speaking, swallowing or chewing. Medical or dental procedures had failed to alleviate their symptoms. The authors administered a total of 241 injections of BTX type A, or BTX A, in the subjects' masseter muscles during 123 treatment visits. The mean dose of the BTX A was 61.7 /- 11.1 mouse units, or MU (range 25-100 MU), per side for the masseter muscles. RESULTS: The mean total duration of response was 19.1 /- 17.0 weeks (range six-78 weeks), and the mean peak effect on a scale of 0 to 4, in which 4 is equal to total abolishment of grinding, was 3.4 /- 0.9. Only one subject (5.6 percent) reported having experienced dysphagia with BTX A. CONCLUSION: The results of this study suggest that BTX administered by skilled practitioners is a safe and effective treatment for people with severe bruxism, particularly those with associated movement disorders. It should be considered only for those patients refractory to conventional therapy. Future placebo-controlled studies may be useful in further evaluating the potential of BTX in the treatment of bruxism. ( info) |
7/86. Can taste aversion prevent bruxism? The first part of this note sketches a biofeedback modality for the treatment of bruxism. A mildly aversive, safe liquid is inserted into, and sealed in, small, bilaterally sleeved, polyethylene capsules. Two capsules are attached to a simple dental appliance that comfortably and securely places them between the lower and upper back teeth. The appliance and capsules are worn at night or at other times when bruxism is suspected to occur. Whenever a sleeping or an awake patient attempts to brux, one or both capsules rupture and the liquid is released into the mouth. The liquid then draws the patient's conscious attention to, and forestalls, any attempt of teeth clenching or grinding. Variations of the method and device can be used to diagnose bruxism. The second part of this note describes the long-term application of this taste-based approach to one chronic bruxer. ( info) |
8/86. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach. BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance. ( info) |
9/86. arthrogryposis multiplex congenita in a patient with limited mouth opening: a case report. This report describes a case of arthrogryposis multiplex congenita and concomitant bruxism with limited mouth opening and pain in the temporomandibular joints (TMJ). A conservative treatment with a myorelaxing splint and physiotherapeutic exercises was prescribed resulting in improvement to the muscular and joint conditions and a reduction in pain. ( info) |
10/86. A case of anterior open bite developing during adolescence. Imaging studies have reported on the relationship between temporomandibular joint (TMJ) degeneration and facial deformity. These studies have suggested that mandibular growth is affected by TMJ degeneration, resulting in altered skeletal structure as mandibular retrusion. However, there are very few longitudinal case reports on TMJ osteoarthrosis (OA). Progressive open bite occurred in an adolescent patient with TMJ OA. Cephalometric analysis showed a downward and backward rotated mandible, and a labial inclination of the upper incisor. magnetic resonance imaging showed internal derangement without reduction and erosion in the right and the left condyles. Although the cause of open bite is unclear in this case, tongue thrusting, and internal derangements in the temporomandibular joint were suspected as causes of the open bite. ( info) |