睡眠磨耗综合征

牙磨耗常发生在夜间,牙磨耗虽然不是夜磨牙最严重的后果,却是患者睡眠姿式的反映和最容易查出的体征,作者将这些牙磨耗的体征和症状概括为睡眠磨耗综合症。正常人睡眠时下颌处于休息位,颌面肌肉松弛,牙无接触。夜磨牙患者的口颌系统紧张,下颌受到很大的压力,侧位或交替侧卧位是夜磨牙者最常见的睡眠姿势,左侧磨牙者一般向右睡,右侧磨牙者向左睡,单侧睡眠者表现为非工作侧受干扰,睡眠侧关节和肌肉疼痛。两侧睡眠者表现为双侧牙磨耗,关节和肌     

夜磨牙症患者咀嚼肌节律性运动特征与睡眠周期的关系

目的:研究夜磨牙症(sleep bruxim,SB)患者睡眠期咀嚼肌节律性运动(RMMA)的发生特征及其与睡眠周期的关系.方法:对30名SB患者、30名正常人进行连续2夜的多导睡眠监测,统计睡眠结构、睡眠效率、微觉醒指数以及磨牙指数.分析RMMA事件成群性,RMMA分布与睡眠周期的相关性.结果:SB患者微觉醒指数与正常...     

夜磨牙与微觉醒及心脏交感神经活动的关系

目的:研究夜磨牙(sleep bruxism,SB)患者睡眠期咀嚼肌节律性运动(RMMA)发生的微觉醒机制。方法 :对30名夜磨牙患者、30名正常人进行连续2夜的多导睡眠监测,研究RMMA事件与微觉醒(MA)的时间相关性;比较2组间RMMA指数及MA指数的差异;RMMA事件发生前60 s、前40 s、前20 s、前5 s,共5个时间点的各连续10个心动周期的平均心率,以及RMMA事件发生前后各5个心动周期的心率变化。结果:夜磨牙症患者微觉醒指数(7.72±1.21)与正常对照相似(7.53±1.33,P=0.5641);但咀嚼肌节律性运动频率,即磨牙指数[(6.10±1.05)次/h]约3倍于正常对照组[(1.81±0.39)次/h,P<0.0001)]。RMMA事件与MA存在高度时间相关性。夜磨牙患者RMMA事件发生前1个心动周期开始心率明显加快。结论:夜磨牙患者较正常人群有较高的RMMA频率,RMMA与睡眠微觉醒相关,磨牙事件发生时伴随明显的心脏交感神经活动增加。     

磨牙症患者磨损特征的研究

目的 观察磨牙症患者（牙合）磨损的部位与程度,分析磨牙运动的特征及相关的影响因素。方法 对64名磨牙症患者进行检查及模型分析,对每个牙磨损程度与部位进行评分比较。结果 左右同名牙磨损无差异,上下同名牙磨损不完全相同;尖牙的磨损最严重;侧方磨动所致的磨损远远大于前伸磨动所致的磨损;牙弓的中段磨损最严重。结论 磨牙运动主要以侧方运动为主,以尖牙磨损最严重,尖牙磨损对磨牙症的发生发展是一重要的促进因素。?     

国产无托槽隐形矫治器矫治牙列间隙配合修复1例报道

患者,女性,22岁,主诉牙列散在间隙、上下前牙前突。检查：面部比例协调、对称,上下唇肥厚、前突;牙龈薄弱;恒牙已完全萌出建[牙合]（ 除外）, 过小牙;右侧安氏I类磨牙、尖牙关系,左侧安氏II类磨牙、尖牙关系;下中线左偏2mm;前牙覆骀、覆盖正常;上牙弓间隙6．5ram,下牙弓间隙5．0ram,Bolton比不调,前牙比81．6％,     

023.牙齿咬合变异与囊内颞下颌关节紊乱:磨牙关系、侧导和非工作侧接触

[英]/Kahn J…∥J Prosthet Dent.-1999,82(10).-410～415 许多因素可引起颞下颌关节紊乱(temporoman dibular disorders,TMD),如结构异常、压力所致肌肉 活动过度、以及创伤所致关节负载过重等.但是对 于牙齿咬合因素一直不清楚.文献报道对于特殊的 导(尖牙保护与组牙功能 )、磨牙关系以及非 工作侧接触与TMD产生之间的关系是有争议的. 本文目的是对有症状囊内TMD患者的磨牙关系、侧 导以及非工作侧接触与无症状志愿者进行比较. 材料和方法研究对象为263名有症状TMD 患者和82名无症状志愿者.无症状志愿者符合下 列条件:①主观调查问卷表明无颌骨疼痛、关节杂 音、锁和TMD阳性病史.②临床牙科检查无与 TMD有关的常见症状和体征.有症状患者均有局 部关节疼痛和运动时疼痛或咀嚼时疼痛.让受试者 在牙椅上坐直,眶耳平面与地面平行,并嘱受试者从 正中开始向左和向右移动3 mm,使用咬合纸、牙 线或肉眼观察记录侧方移动和非工作侧接触.将1 个上、下尖牙接触的定为尖牙保护 ,2个或2个以 上牙齿接触的定为组牙功能 .磨牙关系根据安氏 分类进行划分.第一磨牙缺失者无分类.安氏Ⅱ类 中1分类和2分类的区分是通过临床检查和头部测 量法测定上颌切牙长轴倾斜度和水平覆盖大小进行 划分.所有受试者均作MRI扫描,根据有无盘移位 (disk displacement,DD)分为四组:①组:无症状志愿 者,正常MRI;②组:无症状志愿者,MRI表明DD;③ 组:有症状患者,正常MRI;④组:有症状患者,MRI 表明DD. 结果 4组磨牙关系均以安氏I类关系多 见.④组与①组相比,左侧磨牙关系以安氏Ⅱ类1 分类多见,二者间有显著差异.④组右侧以尖牙保 护多见,与①组有显著差异.①组的一点或多点 非工作侧接触比③组和④组多见,具有显著差异. 结论本研究提示没有系统的牙齿咬合差异 能够明确区分有症状患者与无症状患者.研究结果 表明磨牙关系、侧导、非工作侧接触这3种因素与囊 内颞下颌关节紊乱之间的关系是不明显的. [张玉玮摘刘顺利校]     

骨性Ⅱ类错牙合下颌牙弓与基骨形态相关性的三维测量研究

目的 用三维数字化模型测量的方法探讨骨性Ⅱ类错牙合畸形患者的下颌牙弓弓形与基骨弓形间的相互关系。方法 对35例骨性Ⅱ类错牙合畸形患者治疗前下颌模型进行扫描,获得三维数字模型,对右侧第一磨牙至左侧第一磨牙的FA点（代表牙弓）、WALA点（代表基骨）进行标定并映射到参考平面得到FA和WALA的映射点,分析其牙弓弓形与基骨弓形及其相关性,并对牙弓和基骨弓形进行曲线拟合。结果 骨性Ⅱ类的下颌牙弓弓形曲线与基骨弓形曲线相关度在尖牙区为0.534,磨牙区为0.873。牙弓与基骨尖牙间宽度的差异无统计学意义（P=0.481）,而牙弓与基骨磨牙间宽度的差异具有统计学意义（P<0.01）。牙弓弓形拟合曲线的曲率半径r为15.194,回归系数R2为0.912;基骨弓形拟合曲线的r为20.250,R2为0.947。结论 骨性Ⅱ类错牙合畸形患者下颌牙弓弓形与对应的基骨弓形在磨牙区高度相关,在尖牙区中度相关;基骨尖牙间宽度与牙弓尖牙间宽度无明显差异,基骨磨牙间宽度则明显大于牙弓磨牙间宽度。     

成人骨性反(牙合)患者口周肌压力

目的 :研究骨性反牙合患者的口周肌压力特征 ,了解口周肌压力与牙颌形态的相关性。方法 :以 2 0名成人骨性反牙合患者为研究对象 ,检测了姿势位时上下切牙区、尖牙区、磨牙区颊 (唇 )舌侧口周肌压力。结果 :与对照组相比 ,除了上下磨牙区舌侧口周肌压力外 ,骨性反牙合组中的口周肌压力大于对照组中对应区域口周肌压力 (P <0 .0 1)。骨性反牙合患者同一牙弓内左右两侧口周肌压力值无显著性差异 ,各测量区域颊侧压力均大于相应部位的舌侧压力 (P <0 .0 1) ;除了尖牙区唇侧外 ,上下对应区域口周肌压力下颌大于上颌 (P <0 .0 1) ;各牙位口周肌压力中 ,下颌唇侧的口周肌压力最大 (P <0 .0 1)。结论 :牙颌形态影响口周肌压力的大小 ,骨性反牙合患者口周肌压力的最显著的特征为姿势位时下切牙唇侧肌压力值最大。     

改良式固定平导矫治单侧后牙锁（牙合）

患者,女,19岁,主诉：左侧后牙不能咬合.患者全身健康状况良好,无既往患病史.一、临床检查正面观：面部左右不对称,上下唇自然闭合,侧面观：凸面型。恒牙列,18、28、48已萌出。前牙覆殆Ⅱ度,覆盖Ⅱ度,磨牙关系：左侧磨牙远中尖对尖,右侧磨牙近中;尖牙关系：左侧完全远中。左侧后牙锁胎,上中线右偏约2mm,下颌中线左偏1mm（图1）。牙龈无明显肿胀,口腔卫生一般。     

安氏Ⅱ~1错双期矫治

患者李某,女,12.5岁.牙齿不齐要求矫治(附图)。 临床检查: 正面观:面部左右对称,面下1/3稍短。 侧面观:颏部后缩,颏唇沟深。 口内检查:恒牙(牙合),左侧磨牙完全远中关系,右侧磨牙远中尖对尖关系.两侧尖牙呈远中关系。深覆(牙合)、深覆盖,下颌中线右偏2.5mm.双侧上颌侧切牙扭转60°上中切牙前突,上前牙排列不齐,上牙弓Ⅲ°拥挤。2舌向错位,下牙弓Ⅱ°拥挤。     

Oro-facial activities in sleep bruxism patients and in normal subjects: a controlled polygraphic and audio-video study

Summary  To our knowledge, the large spectrum of sleep motor activities (SMA) present in the head and neck region has not yet been systematically estimated in normal and sleep bruxism (SB) subjects. We hypothesized that in the absence of audio–video signal recordings, normal and SB subjects would present a high level of SMA that might confound the scoring specificity of SB. A retrospective analysis of several SMA, including oro-facial activities (OFA) and rhythmic masticatory muscle activities (RMMA), was made from polygraphic and audio–video recordings of 21 normal subjects and 25 SB patients. Sleep motor activities were scored, blind to subject status, from the second night of sleep recordings. Discrimination of OFA included the following types of activities: lip sucking, head movements, chewing-like movements, swallowing, head rubbing and scratching, eye opening and blinking. These were differentiated from RMMA and tooth grinding. The frequency of SMA per hour of sleep was lower in normal subjects in comparison with SB patients ( P  < 0·001). Up to 85% of all SMA in normal subjects were related to OFA while 30% of SMA in SB patients were related to OFA scoring ( P  < 0·001). The frequency of RMMA was seven times higher in SB patients than in normal subjects ( P  < 0·001). Several SMA can be observed in normal and SB subjects. In the absence of audio–video signal recordings, the discrimination of various types of OFA is difficult to achieve and may lead to erroneous estimation of SB-related activities.     

Bruxism and sleep efficiency measured at home with wireless devices

Summary  The present study comprised 101 (48 men) employees of the Finnish Broadcasting Company with or without irregular shift work, but all with a work week of five shifts in a row followed by 2 days off. The mean age of the subjects was 41·0 years (SD = 9·9). The BiteStrip, a single-use disposable EMG device was used for one night during the work week to detect sleep bruxism. The Actiwatch Plus actigraph was worn on the non-dominant wrist for the entire week to evaluate sleep. Total sleep time and fragmentation index, the latter as a measure of sleep efficiency was calculated for the present study. The BiteStrip scores among the participants were: 0 – no bruxism: 52·2% (according to the manufacturer, comparable to a sleep laboratory bruxism count of up to 39 over 5 h), 1 – mild: 29·3% (40–74 counts), 2 – moderate: 12·0%: (75–124 counts) and 3 – severe: 6·5% (>125 counts). Severe bruxers slept less during the work week than non-bruxers ( P  = 0·009), but severe bruxers slept slightly more than non-bruxers during days off. The group means of the sleep fragmentation index decreased from start towards the middle of the work week and increased during days off ( P  = 0·016). The levels of the fragmentation indices were consistently higher in accordance with bruxism severity ( P  = 0·013). It was concluded that bruxism has a coherent relationship with sleep efficiency and it can be detected at home with a low cost device.     

The excitability of the trigeminal motor system in sleep bruxism: a transcranial magnetic stimulation and brainstem reflex study

AIMS: Since sleep bruxism (SB) is characterized by grinding and clenching of the teeth during sleep and could be an exaggerated manifestation of normal spontaneous rhythmic masticatory muscle activity, the aim of this study was to obtain a neurophysiological assessment of the excitability of the central jaw motor pathways in patients with signs and symptoms suggestive of SB. METHODS: A total of 30 subjects diagnosed with SB on the basis of self-report of tooth grinding were studied using the "recovery cycle" of the masseter inhibitory reflex (MIR) elicited by electric and magnetic stimulation of the mental nerves and by recording the motor potentials evoked in masseter muscles by transcranial magnetic stimulation. Tests were done during daytime, when the subjects were awake. The data obtained were compared with data from a population of normal subjects. RESULTS: In the putative SB patients and in normal subjects, the MIRs evoked by single electric and magnetic stimuli were similar. With paired stimuli, the degree of suppression of the late silent period was significantly lower (P < .01) in the patients compared to normal subjects, particularly for magnetic stimuli, at various interstimulus intervals. No significant differences were found between the 2 groups of subjects in the masseter motor potentials evoked by transcranial magnetic stimulation. CONCLUSION: Although the data were only obtained during wakefulness in patients self-reporting signs and symptoms suggestive of SB, the findings suggest that an abnormal excitability of the central jaw motor pathways may be present in SB subjects. This increased excitability could derive from an impaired modulation of brainstem inhibitory circuits and not from altered cortical mechanisms. These results support the view that bruxism is mainly centrally mediated and that it involves subcortical structures. The study also indicates that use of the MIR elicited by the double-shock technique could be valuable in the evaluation of bruxism.     

Bruxism in Movement Disorders: A Comprehensive Review

Bruxism is an abnormal repetitive movement disorder characterized by jaw clenching and tooth gnashing or grinding. It is classified into two overlapping types: awake bruxism (AB) and sleep bruxism (SB). Theories on factors causing bruxism are a matter of controversy, but a line of evidence suggests that it may to some extent be linked to basal ganglia dysfunction although so far, this topic has received little attention. The purpose of this article was to review cases of bruxism reported in various movement disorders. The biomedical literature was searched for publications reporting the association of bruxism with various types of movement disorders. As a whole, very few series were found, and most papers corresponded to clinical reports. In Parkinsonian syndromes, AB was rarely reported, but seems to be exacerbated by medical treatment, whereas SB is mainly observed during non‐REM sleep, as in restless leg syndrome. AB is occasionally reported in Huntington's disease, primary dystonia, and secondary dystonia; however, its highest incidence and severity is reported in syndromes combining stereotypies and cognitive impairment, such as Rett's syndrome (97%), Down syndrome (42%), and autistic spectrum disorders (32%). Taken as a whole, AB seems to be more frequent in hyperkinetic movement disorders, notably those with stereotypies, and is influenced by anxiety, suggesting an involvement of the limbic part of the basal ganglia in its pathophysiology.     

Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro‐facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time‐consuming, most research testing this belief has relied on patient self‐report of SB. The current case–control study examined the accuracy of those self‐reports relative to laboratory‐based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self‐reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self‐report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self‐reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self‐report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self‐report to assess SB must be viewed with extreme caution.     

Could transient hypoxia be associated with rhythmic masticatory muscle activity in sleep bruxism in the absence of sleep‐disordered breathing? A preliminary report

Sleep bruxism (SB) is a repetitive jaw‐muscle activity characterised by clenching or grinding of the teeth during sleep. Sleep bruxism activity is characterised by rhythmic masticatory muscle activity (RMMA). Many but not all RMMA episodes are associated with sleep arousal. The aim of this study was to evaluate whether transient oxygen saturation level change can be temporally associated with genesis of RMMA/SB. Sleep laboratory or home recordings data from 22 SB (tooth grinding history in the absence of reported sleep‐disordered breathing) and healthy subjects were analysed. A total of 143 RMMA/SB episodes were classified in four categories: (i) no arousal + no body movement; (ii) arousal + no body movement; (iii) no arousal + body movement; (iv) arousal + body movement. Blood oxygen levels (SaO₂) were assessed from finger oximetry signal at the baseline (before RMMA), and during RMMA. Significant variation in SaO₂ over time (P = 0·001) was found after RMMA onset (+7 to +9 s). No difference between categories (P = 0·91) and no interaction between categories and SaO₂ variation over time (P = 0·10) were observed. SaO₂ of six of 22 subjects (27%) remained equal or slight increase after the RMMA/SB onset (+8 s) compared to baseline; 10 subjects (45%) slightly decreased (drop 0·01–1%) and the remaining (27%) decreased between 1% and 2%. These preliminary findings suggest that a subgroup of SB subjects had (i) a minor transient hypoxia potentially associated with the onset of RMMA episodes, and this (ii) independently of concomitant sleep arousal or body movements.     

Influence of experimental esophageal acidification on sleep bruxism: a randomized trial

The aim of this cross-over, randomized, single-blinded trial was to examine whether intra-esophageal acidification induces sleep bruxism (SB). Polysomnography with electromyogram (EMG) of masseter muscle, audio-video recording, and esophageal pH monitoring were performed in a sleep laboratory. Twelve healthy adult males without SB participated. Intra-esophageal infusions of 5-mL acidic solution (0.1 N HCl) or saline were administered. The frequencies of EMG bursts, rhythmic masticatory muscle activity (RMMA) episodes, grinding noise, and the RMMA/microarousal ratio were significantly higher in the 20-minute period after acidic infusion than after saline infusion. RMMA episodes including SB were induced by esophageal acidification. This trial is registered with the UMIN Clinical Trials Registry, UMIN000002923. Abbreviations: ASDA, American Sleep Disorders Association; EMG, electromyogram; GER, gastroesophageal reflux; LES, lower esophageal sphincter; NREM, non-rapid eye movement; REM, rapid eye movement; RMMA, rhythmic masticatory muscle activity; SB, sleep bruxism; SD, standard deviation; UES, upper esophageal sphincter.     

Bruxism defined and graded: an international consensus

To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw‐muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of ‘possible’, ‘probable’ and ‘definite’ sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.     

The Efficacy of Gabapentin versus Stabilization Splint in Management of Sleep Bruxism

Purpose : This study aimed to determine if the use of gabapentin is more efficacious than a stabilization splint with regard to the intensity of masseter muscle contractions and/or sleep quality for patients experiencing sleep bruxism (SB). Materials and Methods : Twenty patients with SB participated in this clinical study. They were randomly divided into two treatment groups: stabilization splint group (n = 10) and gabapentin group (n = 10). The first polysomnographic examination was performed before the beginning of the experiment for all the participants. At the end of a 2‐month period of stabilization splint therapy or gabapentin usage, a second polysomnographic recording was made. Results : Statistically significant reductions in the number of SB episodes per hour and per night, bruxism time index, total duration of SB episodes per night and number of SB episodes in stages NR I and NR II (p < 0.05) were observed in both groups after treatment. Both treatments significantly reduced the mean intensity of masseter muscle contractions during SB episodes. Moreover, the participants treated with gabapentin showed a significant improvement in total sleep time, slow wave sleep (stage III), and sleep efficiency (p < 0.05). Conclusions : Gabapentin could be an effective treatment modality in SBs, especially in those with poor sleep quality.     

Clinical phenotype of South–East Asian temporomandibular disorder patients with upper airway resistance syndrome

Clinical and radiographic characteristics of a subset of South East Asian temporomandibular disorder (TMD) patients with comorbid upper airway resistance syndrome (UARS) were documented in a multi‐center prospective series of 86 patients (26 men and 60 women / mean age 35.7 years). All had excessive daytime sleepiness, high arousal index and Apnoea‐Hypopnoea Index (AHI) <5. The mean body mass index was 20·1, mean arousal index 16·2, mean respiratory disturbance index 19·6, mean AHI 3·9 while the mean Epworth Sleepiness Scale was 14·8. Many had functional somatic complaints; 66·3% headaches, 41·9% neck aches, 53·5% masticatory muscle myalgia, 68·6% temporomandibular joint (TMJ) arthralgia while 90·7% reported sleep bruxism (SB). Unlike patients with obstructive sleep apnoea (OSA), hypertension was uncommon (4·7%) while depression was prevalent at 68·6% with short REM latency of <90 min and an increased REM composition >25% documented in 79·6% and 57·6% of these depressed patients, respectively. 65·1% displayed a posteriorly displaced condyle at maximum intercuspation with or without TMJ clicking. Most exhibited a forward head posture (FHP) characterised by loss of normal cervical lordosis (80·2%), C0–C1 narrowing (38·4%) or an elevated hyoid position (50%), and 91·9% had nasal congestion. We postulate the TMD‐UARS phenotype may have originally developed as an adaptive response to ‘awake’ disordered breathing during growth. Patients with persistent TMD and/or reporting SB should be screened for UARS and chronic nasal obstruction, especially when they also present with FHP. The lateral cephalogram is a useful tool in the differentiation of UARS from other OSA phenotypes.