Teaching patients how to stop bruxing habits

Teaching patients how to stop bruxing habits
Jeremy Shulman, D.D.S., M.S.  J Am Dent Assoc, Vol 132, No 9, 1275-1277. © 2001
Extracts:
There … is widespread agreement that bruxing and other nonfunctional jaw movement or posturing habits are major contributing causes of temporomandibular disorders (TMDs) …Occlusal modifications and splints are the most common initial therapies. … various types and designs of splints have been developed to help counteract the dysfunctional effects of bruxing habits, as aids in correction of nonideal jaw and occlusal relationships, or both. … treatment usually is focused on correcting the most visible and easily identifiable findings, such as occlusal and jaw relationship abnormalities, or it focuses on guarding against further damage. (…) 

What seems to be unexplained is that virtually no one is heeding the cardinal rules of medical management. Nowhere in the literature have I seen a TMD study or even anecdotal treatment recommendations to the effect that after an accurate diagnosis has been made, and any prevalent parafunctional habits have been identified, then proper treatment is to eliminate as many of the direct physical causes as possible.
I believe it is almost universally assumed that bruxism, once established as a habit, cannot be changed and that TMD has to be managed by alleviating symptoms, correcting related abnormalities, or both. I have been unable to find a single report or study of therapy designed solely to stop the para-functional bruxing habits themselves, which would allow scientific evaluation of symptom remission following elimination of these destructive habits. (…)   

If we educate patients about the mechanism whereby bruxing habits physically overstress the masticatory system beyond its ability to adapt (as so beautifully explained by Hans Selye1), they come to understand their role in unknowingly causing the symptoms, and also that they can expect immediate relief from symptoms if these harmful habits are eliminated. The key to success is effective communication with patients so that they thoroughly understand the problem and are provided with detailed instructions on how to stop the bruxing habits.

Therapy starts with a complete explanation of the dysfunctional symptoms and the cause-and-effect mechanisms of bruxing. This is followed by precise instruction in techniques for habit modification, both during the day and especially during sleep when clenching and grinding habits are prevalent. Clinicians should stress the importance of daytime awareness of bruxing or posturing habits, and instruct patients to say “Mississippi” every time the jaw is not in a resting posture, as is attained at the end of the word. To help in this reprogramming, a splint should be constructed, but dentists should not identify it as a guard, but as a nighttime (and daytime when needed) aid that serves as a tool for modified biofeedback training. (…)

Biofeedback splint. The splint is full coverage and flat plane, is absolutely smooth and shiny with no indentations, has no anterior occlusion (most bruxers grind on the front teeth and this possibility is eliminated), is adjusted to a height that allows the jaw to move and rest physiologically, and usually is mandibular for maximum comfort.2 Patients should be taught that teeth normally touch only during chewing or swallowing, and that opposing teeth rarely touch even during chewing (because of the food between them). The dentist needs to explain that it is proper for the teeth to touch the splint only at each swallow, and that the lower jaw should be in a resting position when not in function.

The clinician teaches the patient that any jaw posturing habits or tooth contacts other than those involved in chewing or swallowing are parafunctional. Patients must understand that the appliance serves to remind them of any such contact, since its mere presence as well as the difference in tooth contact sensation between when the splint is in place and when it is not in place present a sensory input to which they must react by dropping the mandible into a resting posture.  (…)
It might be hard to believe that such a simple, quick and noninvasive treatment really works, but once the proper diagnosis is made and major bruxing habits are eliminated, then the dysfunction is controlled and the symptoms disappear.  
See: Teaching patients how to stop bruxing habits 
Jeremy Shulman, D.D.S., M.S.   

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