Treating Bruxism And Clenching

Gordon J. Christensen  , D.D.S., M.S.D., PH.D. 
Am Dent Assoc, Vol 131, No 2, 233-235. © 2000  See full article Treating Bruxism And Clenching
(…) Tooth structure is rapidly destroyed by bruxism and clenching and creates very difficult treatment situations. Most dental restorations placed into the mouth of a patient with abusive chewing habits are short-lived because of breakage or wear. Many patients do not realize they have a bruxism/ clenching problem. Often, they have nearly destroyed their dentition before a dentist or dental hygienist educates them about their destructive chewing habit. What can be done to reduce the tooth destruction associated with bruxism or clenching?  (…)
Bruxism. People with bruxism are considered to grind their teeth together in eccentric positions (right and left working and nonworking, as well as canine and incisal guidance). It is extremely difficult to restore teeth in these patients, because a chewing position (centric occlusion) must be established at a location that is somewhat difficult to predict. Many practitioners provide patients with bruxism with a long centric and wide centric occlusion without much incisal guidance or canine rise. My most successful rehabilitations of patients with bruxism have used this concept.
Clenching. People with clenching tend to bite into centric occlusion and clench their teeth together without significant right, left or forward movement. In my observations, people who clench on a long-term basis often wear their anterior teeth severely and leave the posterior teeth less destroyed. Such worn dentitions have very steep incisal and canine guidance. These patients are relatively easy to rehabilitate; this requires opening and “retreading” of the dentition while maintaining the “worn-in” chewing position and incisal and canine guidance at the same angles as those that were present preoperatively.(…)
Treatment of the Middle-Aged Patient with Bruxism / Clenching
Commonly, patients are allowed to continue with their bruxism and clenching habits into midlife without being educated about their condition and without any preventive therapy. As a result, teeth are often worn into dentin to the degree that they are unsightly and sensitive. Depending on the pattern of wear, some or all of the teeth are worn to the degree that they require restorative therapy. An occlusal equilibration is usually required before restorative therapy begins. Abnormal occlusal prematurities are removed and a harmonious occlusion is established before the new restorations are placed.  (…) 
Conclusions
Bruxism and clenching have been present since the beginning of mankind. These conditions cause total destruction of the dentition if allowed to progress without patient education and/or preventive therapy. Conversely, proper patient education as soon as bruxism/ clenching is observed, acceptable restoration of affected teeth and wearing of an acrylic resin splint allow the patient with bruxism or clenching to live a normal life, without significant tooth wear or other dental handicaps. 
See full article Treating Bruxism And Clenching          
by Gordon J. Christensen, D.D.S., M.S.D., PH.D. 

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