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OROFACIAL PAIN
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
Original Article
Dumitru Romaniuc1a*,Valeriu Fala1b, Victor Lacusta2c, Gheorghe Bordeniuc1a, Paula Fala3d
1
Department of Therapeutic Dentistry,„Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
2
Department of Alternative and Complementary Medicine,„Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
3
Institute of Neurology and Neurosurgery, Chişinău, Republic of Moldova
a
PhD Fellow
b
DDS, PhD, MSc, Assoc. Prof.
c
PhD, Univ. Prof., Academician
d
Neurology resident
ABSTRACT DOI: 10.25241/stomaeduj.2018.5(1).art.3
Introduction: Bruxism is a widespread condition, affecting up to 85-90% of the general OPEN ACCESS This is an
population, and in 5% of these individuals, the grinding evolves into a clinical condition. Open Access article under the CC
In many cases, sleep bruxism is latent, the disorder may be identified by its consequences BY-NC 4.0 license.
Peer-Reviewed Article
(dental wear, etc.). This ascertains the need to develop diagnostic methods that may be able
to identify bruxism at the initial stages of the disorder. Citation: Romaniuc D, Fala V, Lăcustă
V, Bordeniuc G, Fala P. Manifestation of
Aim of the study: to determine the peculiarities of the clinical manifestation of primary sleep bruxism according to the age of
sleep bruxism (SB) based on the age of the patients. patients. Stoma Edu J. 2018;5(1):31-37.
Methodology: One hundred patients with primary SB (70 patients aged between 18- Academic Editor: Sever Toma Popa,
35 and 30 patients aged between 35-50) were investigated. The clinical features of DDS, PhD, Professor, “Iuliu Hațieganu”
University of Medicine and Pharmacy,
SB (algic syndrome, myogenic disorders, temporomandibular disorders, dental wear, Cluj-Napoca, Romania
psychoemotional disorders, sleep quality alterations) were also investigated. Received: November 22, 2017
Results: The expression of emotional stress in patients of various ages was almost identical. Revised: January 23, 2018
Acccepted: February 26, 2018
The highest clenching frequency and duration, as well as a higher clinical expression of Published: March 01, 2018
sleep bruxism was observed in patients under 35. The components of the algic syndrome
*Corresponding author: Dumitru
show a varied expression for different age groups – patients under 35 had more severe Romaniuc, PhD fellow, Department of
disorders of the nocturnal episodes and myogenic-spastic events; older patients (35-50) Therapeutic Dentistry, State University
of Medicine and Pharmacy „Nicolae
were characterized by a prevalence of local and diffuse myogenic structural disorders, Testemitanu”, 165, blvd. Stefan cel Mare,
arthrogenic pain and severe sleep disturbances. Chisinau, MD-2004, Republic of Moldova
Tel.: 00373-79-028707, Fax: 00373-
Conclusion: Electromyography and ultrasonography can reveal important morpho- 22-270536, e-mail: dima.romaniuc@
functional peculiarities of the masticatory muscles that are associated with the severity of icloud.com
SB in patients from different age groups. Copyright: © 2018 the Editorial Coun-
cil for the Stomatology Edu Journal.
Keywords: bruxism, electromyography, ultrasonography, temporomandibular disorders, diagnostics.
1. Introduction 13% in adolescents and youngsters, 3% in adults after
Bruxism is a parafunctional activity, characterized the age of 60 [11]. Some researchers consider that
by repetitive jaw-muscle clenches, tooth grinding, bruxism first identified in childhood may continue to
bracing/thrusting of the jaw, occurring either during persist with aging [13], others have established that
sleep (SB – sleep bruxism) or during wakefulness (AB – bruxism diminishes and disappears during adulthood
awake bruxism) [1]. Bruxism is a widespread condition [14]. The incidence of bruxism in 18-29 year-olds is
– around 85-90% of the general population grinds their 18.9% – awake bruxism in 10.4% of cases, sleep bruxism
teeth in certain periods of their life, and in 5% of these in 2.4% of cases and mixed bruxism in 6.1% of cases.
people, the grinding evolves into a clinical condition It has been established that patients aged between
[2,3]. The prevalence of bruxism varies greatly from 5% 20-29 show signs of bruxism most frequently (41.8%)
to 96%, which highlights that a varied range of criteria [15]. An analysis of 2,000 people showed that bruxism
and methods for diagnosing this condition are being is present in 18-year-olds in 13% of cases, and after
used [5,6]. An important aspect to this problem is the 65 years of age in only 3% at an approximately equal
age of the patients. The highest frequency of bruxism is frequency in men and women [16]. After the age of 65,
observed in the age group between 19-44, without any the prevalence of bruxism is about 10% with a dramatic
essential gender- based differences [7]. Bruxism may decrease with aging. The prevalence of bruxism in
be observed in children starting approximately from individuals aged between 35-44 is twice as high as the
the age of one [8] and it occurs in 7-15% of cases [9]. prevalence in 18-year-olds, respectively 4.12 ± 0.79%
The condition has its onset during childhood in 6.4% of vs. 2.73 ± 0.65%. Currently, there are no specific factors
cases, during school years in 2.5% of cases and during that are deemed responsible for the etiology of bruxism
the period of professional activity in 26.8% of cases [10]. [4]. It is being assumed that one of the causes of the
The prevalence of bruxism in children varies from 6.5% higher prevalence of night bruxism in young people
to 28% in various countries [11,12]. The authors, based is the presence of a higher level of anxiety and stress
on the analysis of various scientific literature data, have [11]. With aging, the microstructure of the masticatory
established a linear trend of decrease in the prevalence muscles essentially changes; signs of osteoporosis that
of bruxism in relation to age: 19% at the age of 3-10, are associated with the changes in the masticatory
Stomatology Edu Journal 31
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
muscles occur [17]. The thickness and hypertrophy of
Original Article the masticatory muscles also depend on the age of the
Table 1. The age of the patients with primary sleep bruxism according
to their gender.
patients [18, 19, 20]. Based on the age factor, the degree
Mean age of Mean age, yrs.
of severity is also various for the manifestations of sleep Researched
the group,
bruxism. It is being assumed that the peculiarities of groups
yrs.
Individuals Individuals
bruxism based on the age factor are manifested under under 35 over 35
the influence of cofactors (alcohol, caffeine, nicotine, Whole group 33.2 ± 1.15 26.6 ± 0.99 39.8 ± 1.07
etc.), professional activity, and especially stressful Women 30.4 ± 1.34 23.5 ± 1.02 37.3 ± 1.16
professions [6,12]. Currently, there are no sufficient
Men 36.0 ± 1.12 29.7 ± 1.25 42.3 ± 2.13
studies on the peculiarities of SB manifestation based
on the age of the patients, while the etiopathogenetic
non-cooperating patients.
causes of this phenomenon are not yet clear. A clinical-
The study regarding the influence of stressogenic
neurophysiological study of bruxism at various periods
professions on the degree of sleep bruxism
of life will allow the development of a diagnostic and a
manifestations was performed according to the criteria
treatment algorithm based on the age of the patients.
proposed by Nishimura [21].
Clinical signs and the subjective symptoms of sleep
We have applied questionnaires for the quantitative
bruxism are considered to be neither always present,
assessment of SB manifestations [22-25]: clinical
nor evident [4]. In many cases, sleep bruxism is latent
questionnaire, Fonseca questionnaire, multifactorial
(subclinical), without being revealed during common
questionnaire for bruxism associated pain, sleep
dental exam. In the subclinical variants of sleep bruxism,
quality questionnaire. For the quantitative assessment
the disorder is identified when various complications
of the emotional subjective feelings, we have used the
arise (dental abrasion, root fractures, etc.). This
Visual Analogue Scale (VAS).
ascertains the need of developing diagnostic methods
The dental abrasion degree was assessed, according
that may be able to identify bruxism in patients of
to the following score [22]: 0 – no abrasion; 1 – dental
various ages at the initial stages of the disorder, using
abrasion within enamel boundaries; 2 – dental abrasion
pathogenetically argumented methods.
with crown destruction less than one-third; 3 – dental
Purpose of the study – highlighting the peculiarities
abrasion with crown destruction more than one third.
of the clinical manifestations of primary sleep bruxism
In order to record the nocturnal motor episode, we have
according to the age of the patients.
applied the portable device SleepGuard SG5 (Hollistic
Inc., USA). It is used for five consecutive nights in order
to assess the average values of the motor indices: total
2. Materials and methods
clench time (TCT) during sleep and their number (TNC
The study has been approved by the Committee of
– total number of clenches).
Research Ethics of the „Nicolae Testemiţanu” State
We have determined the thickness of the masseter
University of Medicine and Pharmacy, Chişinău,
muscle following the recommendations in the scientific
Republic of Moldova (minutes no. 37/04.04.2016).
literature [18,19] by applying the Envisor C (Philips,
One hundred patients with primary sleep bruxism
Japan) equipment and a 7.5 MHz linear transducer. The
were investigated (Table 1).
masseter muscle thickness gradient (MTG) was calculated
The diagnosis of SB was performed following the
according to the formula:
current international criteria, including: 1) medical
history, 2) application of clinical questionnaires, 3)
dental clinical examination (intraoral and extraoral),
4) EMG assessment for a period of several days, 5) where: Gr - masseter muscle thickness during relaxation
recording of the SB nocturnal episodes for a period of (mm); Ga - masseter muscle thickness during maximum
several nights, 6) ultrasonographic examination of the jaw engagement (mm).
masticatory muscles. We have determined the echo-structure of the
Inclusion criteria: a positive clinical diagnosis of primary masseter muscle by analyzing the local and diffuse
sleep bruxism, confirmed by an objective recording echogenic features. Normally, the muscle is visualized
of the nocturnal episodes; occlusal type – Angle as hyperechogenic strips parallel to the long axis of
Class I; age of patients between 18-50; presence of the muscle. Muscle fascicles have a connective tissue
the patient’s consent to participate in the research; coating that creates an ultrasonographic picture of
cooperating patients. hyperechogenic bands. Any pathological change
Exclusion criteria: age was not within the established in muscles, fascia, and connective tissue manifests
limits; other clinical forms of bruxism (disorders of the itself through local and/or diffuse modifications of
nervous system – epilepsy, parkinsonism, etc.); the echogenicity. The trigger points are manifested by
presence of anomalies and inflammatory signs in the the occurrence of local pathological echogenicity,
stomatognathic system; the presence of signs of organic and the pathological changes in the masseter muscle
damage with the decompensation of the masticatory can be manifested through diffuse ecogenic zones
activity (EMG values during relaxation less than 30 µV); that increase, consequent to the increase in muscle
various acute and chronic diseases in the period of hypertrophy/hypotrophy, increase in the processes
exacerbation, parasitosis; alcoholism, drug addiction, of fibrosis, etc. For the quantitative assessment of the
toxicomania, mental illness; ongoing treatment with echogenic features, we have determined the total score:
psychotropic, anticonvulsant or miorelaxant drugs; lack normal echogenicity in the projection of the masseter
of the patient consent for participating in the research; muscle – 0 points; local pathological echogenicity – 1
32 Stoma Edu J. 2018;5(1): 31-37 http://www.stomaeduj.com
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
Table 2. Clinical manifestations of primary sleep bruxism vs. the age of patients vs. indices observed in healthy subjects.
Original Article
Primary sleep bruxism
Indices Healthy (n = 30) Entire group Age ≤35 Age >35 P1-2 P3-4
(n = 100) (n = 70) (n = 30)
Bruxism
0.10 ± 0.05 4.85 ± 0.28 5.41 ± 0.32 4.25 ± 0.24 < 0.001 < 0.05
questionnaire, points
Pain
1.18 ± 0.16 4.71 ± 0.25 5.09 ± 0.36 4.33 ± 0.31 < 0.001 NS
questionnaire, points
Fonseca
1.16 ± 0.39 52.02± 4.13 59.43 ± 4.42 44.61 ± 3.75 < 0.001 < 0.05
questionnaire, points
Ultrasound,
25.0 ± 0.45 28.4 ± 0.52 25.5 ± 0.55 31.3 ± 0.58 < 0.001 < 0.001
MTG index, %
Ultrasound,
0.23 ± 0.07 1.35 ± 0.10 1.10 ± 0.11 1.60 ± 0.10 < 0.001 < 0.01
echogenicity, units
Dental wear, units 0.26 ± 0.11 1.93 ± 0.19 1.87 ± 0.22 1.99 ± 0.15 < 0.001 NS
Note: NS – no statistical significance.
point; diffuse pathological echogenicity – 2 points. 6.2 ± 0.41 hours (p < 0.05).
The results obtained were processed using the Statistics The quality of nighttime sleep in patients with SB,
for Windows v.11.0 (StatSoft Inc., USA) specialized based on the self-assessment scores, was as follows
software package for statistical analysis. (statistically significant differences between values
observed in patients under 35 years of age in
comparison to older patients):
3. Results • normal sleep quality – 20 patients (28.6%)/4
In healthy people, highly stressful professions patients (13.3%), p > 0.05;
accounted for 30% of cases; VAS-stress expression of • borderline disorders – 38 patients (54.3%)/8
3.80 ± 0.35 points. In patients with SB, but from various patients (26.7%), p < 0.01;
age groups (18-50 years, n = 100), highly stressful • pathological sleep – 12 patients (17.1%)/18
occupations accounted for 24% of cases; VAS-stress – patients (60.0%), p < 0.001.
5.71 ± 0.31 points. In SB patients under 35, high stress The analysis of the clinical manifestations of SB, based
professions accounted for 21.4% of cases; VAS-stress on the clinical questionnaire has shown a higher value
– 5.99 ± 0.28 points. In SB patients over 35, highly of the clinical SB expression in patients under 35, when
stressful occupations accounted for 30% of cases; VAS- compared to older patients (Table 2). The frequency of
Stress – 5.43 ± 0.35 points. the positive responses, based on the SB questionnaire
This analysis revealed non-essential differences (p > (which reflected the condition of the patients in the
0.05) between healthy individuals and SB patients of last 6 months) was the following (the percentages
various age. Statistical differences of VAS-stress scores of clinical signs for patients under 35 are indicated in
among healthy individuals vs. patients with SB (n = a decreasing order, as compared to data from older
100) were significant (p < 0.01), and the differences patients):
between groups of patients with SB of various age • Tooth grinding during sleep, observed by life
were not significant (p > 0.05) with tendencies of more partners – 100% vs. 100%.
severe stress manifestation in patients under 35. • Tooth grinding during sleep (self-assessed by
TNC indices in healthy individuals were 3.4 ± 0.95; in patients) – 97.1% vs. 93.3% (p > 0.05).
patients with SB (n = 100) – 50.4 ± 5.96; in patients with • Pain and fatigue in masticatory muscles, after
SB under 35 – 65.4 ± 5.26; in patients with SB over 35 awakening – 60.0% vs. 36.7% (p < 0.05).
– 35.4 ± 6.44. The highest frequency of clenching was • Sensations of jaw tension or difficulties during
observed in younger patients. mouth opening, after awakening – 54.3% vs.
TCT indices in healthy subjects constituted 3.6 ± 0.68; in • 30% (p < 0.05).
patients with SB (n = 100) – 86.5 ± 7.93; in patients with • Pain felt in the temple region, after awakening –
SB under 35 – 110.5 ± 8.22; in patients with SB over 35 – 50.0% vs. 26.7% (p < 0.05).
61.5 ± 6.91. In a similar way, the highest clench duration • Teeth clenched together, after awakening – 44.3%
was observed in younger patients. vs. 23.3% (p < 0.05).
The length and quality of night sleep were closely • Dental or gingival pain, after awakening – 22.9%
related to the intensity of the psycho-emotional state. vs. 10.0% (p > 0.05).
Sleep duration in patients under 35 (18-35 years of age, • Dental mobility, after awakening – 18.6 % vs.
n = 70) showed statistically significant differences in 13.3% (p > 0.05).
comparison to the values observed in older patients In patients with SB under 35, ulcerations of the tongue
(35-50 years, n = 30), respectively: 7.9 ± 0.52 hours vs. were detected in 7.1% of cases vs. 6.7% in patients
Stomatology Edu Journal 33
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
aged over 35.
Original Article According to the multifactorial pain test developed by
the authors, the smallest values in healthy individuals
have the following scales: scale I – arthrogenic factor
(0.10 ± 0.05), autonomous factor, scale IV (0.10 ±
0.15), circadian factor, scale VI (0.10 ± 0.05) and the
pain duration factor, scale VIII (0.10 ± 0.05). In healthy
individuals, the highest values are presented by the
myogenous factor – scale II (0.27 ± 0.26) and the by the
psychoemotional factor – scale V (0.28 ± 0.06). Scale III
(locoregional irradiation factor) and VII (pain intensity
factor) have an intermediate position, due to their
degree of expression (0.13 ± 0.06).
The components of the algic syndrome in patients
with SB aged under 35 showed a pronounced
expression for the following factors (in a decreasing Figure 1. Bruxism-associated pain intensity in patients with primary sleep
order): myogenous (1.14 ± 0.12), circadian (0.99 ± 0.11), bruxism, according to the age of the patients.
psychoemotional (0.92 ± 0.11), pain duration (0.58 ± Note: the scales (factors) of the bruxism-associated pain: I – arthrogenic;
0.08); a moderate expression for the following factors: II – myogenous; III – loco-regional irradiation; IV – autonomous; V – psy-
pain intensity (0.58 ± 0.08), arthrogenic (0.33 ± 0.06); choemotional; VI – circadian; VII – pain intensity; VIII – pain duration; sta-
poor expression for the following factors: autonomous tistical significant differences between sleep bruxism patients under 35
vs. patients over 35 (* - p < 0.05, ** - p < 0.01). Blue dots – Sleep bruxism
(0.18 ± 0.03), loco-regional irradiation (0.16 ± 0.05). patients, under 35; Red dots – Sleep bruxism patients, over 35; Green line
For the patients aged 35 years or older, the expression of – Healthy subjects.
the algic syndrome was characterized by pronounced
psychoemotional manifestations (0.83 ± 0.13), circadian activity contributes to the occurrence of many SB
(0.82 ± 0.12), myogenous (0.71 ± 0.13), a longer disorders [26] and that people with SB have a much
duration (0.66 ± 0.11) and arthrogenic manifestations higher level of stress-sensitivity [27], we have analyzed
(0.65 ± 0.11); moderate for pain intensity (0.32 ± 0.02); the level of emotional stress (VAS) and the professions
poor expression for pain irradiation (0.18 ± 0.04) and of the patients, according to the stress level.
autonomous manifestations (0.16 ± 0.05). We have observed that the level of emotional stress is
The analysis of the masseter muscle thickness was an important index that is fundamentally different in
conducted based on the gender of the patients, healthy people and in patients with SB, but this index
because it was established that the differences of does not reflect the differences regarding the age of
these indices are statistically significant between men the investigated subjects, and some tendencies of
and women [18,19]. During the state of relaxation, increased stress levels in younger individuals can be
the masseter muscle thickness was 9.75 ± 0.27 mm observed.
for women under 35 and of 9.82 ± 0.26 mm for older With aging, there is an increase in the quantitative
women (p > 0.05). During jaw clenching, the values of and qualitative sleep disruptions. The interpretation
masseter thickness were: 13.12 ± 0.29 mm for younger of these data is difficult due to the fact that, as it has
women (< 35 years, n = 50), and for the ones over 35 been established that in healthy people, there are
(n = 18) – 14.75 ± 0.28 mm (p < 0.001). With aging, the significant changes in the sleep quality associated
increase of the masseter muscle thickness was also with aging, especially after the age of 30-35 – a longer
evident. period of time is needed to get asleep, sleep is far more
In men, during relaxation, the thickness of the masseter fragmented, with more frequent awakening episodes,
muscle was 10.71 ± 0.23 mm at the age of under 35 (n the duration is shorter. These features are particularly
= 20) and of 11.45 ± 0.22 mm – over 35 (n = 12, p < greatly increased in patients with SB.
0.05); during jaw clenching, the thickness of the muscle Pain in the masticatory muscles and in the
was of 14.52 ± 0.24 mm for individuals under 35 and of temporomandibular joint is one of the main causes
16.21 ± 0.28 mm for patients over 35 (p < 0.001). of dental visits [29]. For these reasons, a more precise
As it may be observed from Table 2, the thickness clinical diagnosis of the algic syndrome will contribute
gradient (relaxation-engagement) had a higher to more effective monitoring and treatment.
statistical significance in patients with SB, which are The phenomenon of tongue ulcerations can be
over 35. partially explained by the fact that the pressure exerted
by the bruxer’s tongue towards the teeth is much
higher compared to the one found in non-bruxers [28].
4. Discussion It has been established that the bioelectric activity
According to the proposed objectives, we have studied of the masticatory muscles may be associated with
the clinical peculiarities of SB, according to the age of muscle pain but may also present as a disorder that is
the patients – under 35 and older. This division was independent of the presence of pain and its intensity
made based on multiple literature data that reflects [29]. The relationship between pain and sleep bruxism
that the period of 35-40 years of age is the one where is still a matter of controversy, especially in regard
the prevalence of bruxism shows a considerable to whether a painful condition may affect the EMG
reduction [12]. activity during sleep [2]. Due to a massive nociceptive
Taking into account the fact that increased stress affinity from the structures of the stomatognathic
34 Stoma Edu J. 2018;5(1): 31-37 http://www.stomaeduj.com
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
system towards the somatosensory cortex, there currently, there is an overemphasis on SB as a causative
Original Article
occur various reflex activities, due to modifications of factor in tooth wear [4]. No valid correlations were
muscle tone and onset of myogenous pain. However, found between dental wear and the age of patients,
the correlations between reflex activity and pain the occlusal factors and the degree of temporo-
expression are not yet studied deeply. mandibular joint dysfunction. These data demonstrate
According to several research projects, there are no that wear is associated with various factors, including
statistically significant differences in the EMG indices cerebral factors. Moreover, a specific study has not
in patients, which feel pain in the masticatory muscles revealed any statistically significant differences in
compared to those with no pain [12,29]. The authors the bioelectric activity of masticatory muscles during
state that this phenomenon is due to central neuronal sleep between patients with and without signs of
adaptation mechanisms, modifications of the pain dental wear [31]. While assessing dental abrasion as a
modulation mechanisms and because of central diagnostic sign of SB, it is necessary to highlight other
sensitization phenomena. etiopathogenic factors; dental abrasion is not the main
It should be taken into account that various poorly criterion in the diagnosis of SB, because it can occur
expressed algic manifestations may be present for a in other pathologies as well (acid reflux, long-term
short term in healthy individuals as well. consumption of acidic juices, etc.) [30,31].
It is to be noted that myogenous pain in younger In summary, the following SB manifestations occur
patients is more pronounced than in older patients. This with a higher severity in patients under 35 years of
phenomenon was also observed by other researchers age (statistically significant), when compared to older
[8,9,12,30,31], who explain it through the processes of patients – p < 0.05):
adaptation to chronic pain observed in older people. • clinical signs of bruxism, assessed by means of the
The results demonstrate that the psychoemotional clinical questionnaire (p < 0,05);
factor (scale V), myogenous (scale II), circadian (scale • dysfunction of the temporomandibular joint,
VI), and pain duration (scale VIII) are quite pronounced assessed by means of Fonseca questionnaire (p <
in SB patients, that are either under or over 35. The pain 0.05),
pattern in patients under 35 may be characterized as • total number of clenches (TNC) (p < 0.001),
a psycho-emotionalmyogenous circadian pain and for • total duration of clenches (TCT) (p < 0.001).
the older patients as a psycho-emotional-myogenous- The following SB manifestations occur with a higher
arthrogenic circadian pain. severity in patients over 35 years of age (statistically
The data obtained confirm the results from the significant), when compared to younger patients – p <
scientific literature – consequent to aging (until 61 0.05):
years); an increase of the masseter muscle thickness • pathological thickness of the masseter muscle
can be observed [32]. (MM), determined by ultrasound (p < 0.001),
There are several hypotheses regarding this problem: • pathological echogenicity of the MM, determined
the increase of the masseter muscle thickness may by ultrasound (p < 0.01),
occur as a result to muscle edema, fat accumulation, • shorter sleep duration (p < 0.05), pathological
deficiency of protein metabolism, effects of quality of sleep (p < 0.001).
psychoactive substances (alcohol, nicotine, etc.). Under The results obtained show that there are important
the influence of previous inflammatory processes, the peculiarities of the clinical manifestations of primary
thickness of the muscle increases by approximately 4.3 sleep bruxism according to the age of the patients,
mm [32]. which can be detected by the application of clinical
Patients with SB show areas of muscle hypertonus and paraclinical diagnostic methods, mainly by
(trigger zones) in which ultrasonographic examination using technologies able to continuously monitor the
shows changes in the echo-structure, left/right bioelectric activity of the masticatory muscles and
asymmetry and modification of the masseter muscle the morpho-functional status of the stomatognathic
thickness. system through ultrasonography.
In patients with SB under 35, the presence of local
pathological echogenics is more frequent, which
in most cases corresponds to the localization of 5. Conclusions
the algic areas during palpation of the masseter 1. The expression of primary sleep bruxism is
muscles. In patients with SB over 35, besides the local influenced by the age of the patients: the younger
pathological echogenicity, quite frequently a diffuse patients (18-35 years of age) are characterized
pathological echogenicity was observed. In the by having more severe disorders regarding the
scientific literature, these aspects are being debated – it episodes of sleep bruxism, with more pronounced
has been established that during the first stages of the myogenous-spastic manifestations; older patients
disorders of the masseter muscle activity, local hypo- (35-50 years of age) are characterized by the
echogenic areas appear, which afterwards, due to the predominance of local and diffuse myogenic-
aggravation of the disturbances, transform into diffuse structural disturbances, with more pronounced
hyperechogenic zones [18]. arthrogenic pains, with more severe quantitative
An important dental index for SB is the presence of and qualitative disturbances of nighttime sleep.
dental abrasion. Surprisingly, there was no statistically 2. The expression of the emotional stress and the
significant correlations observed between the EMG quantitative manifestations of dental abrasion are
activity of the muscles and the degree of dental not essentially different in patients with primary
abrasion [33]. Some researchers consider that sleep bruxism based on the age factor.
Stomatology Edu Journal 35
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
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36 Stoma Edu J. 2018;5(1): 31-37 http://www.stomaeduj.com
MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
Original Article
Dumitru ROMANIUC
PhD Fellow
Department of Therapeutic Dentistry, Faculty of Dentistry
„Nicolae Testemiţanu” State University of Medicine and Pharmacy
Chişinău, Republic of Moldova
CV
Dr. Dumitru Romaniuc is a graduate of the State University of Medicine and Pharmacy "Nicolae Testemiţanu" of the Republic
of Moldova, Chisinau. From 2015, he is a PhD fellow at the "Nicolae Testemiţanu" University of Medicine and Pharmacy. During
his practice in general dentistry, he has published 28 articles and papers in national and international journals. He actively
participates in various conferences and scientific meetings, both at the national level and abroad. He has obtained a gold
medal at the Brussels Invention Fair (2015), a silver medal at the Geneva Invention Fair (2016), a gold medal at the InfoInvent
exhibition (2017). He is the author of 3 patents in the domain of dentistry.
Questions
1. Based on epidemiological data, what percentage of the general population is
affected by bruxism?
qa. Up to 85-90%;
qb. Less than 0.1%;
qc. Up to 20-30%;
qd. Approximately 40%.
2. What age group is affected by bruxism?
qa. Only adults;
qb. Mainly children;
qc. Only the geriatric population;
qd. All the age groups.
3. Which of the following is not one of the bruxism cofactors?
qa. Alcohol;
qb. Caffeine;
qc. Sleep;
qd. Nicotine.
4. After the age of 65, the prevalence of bruxism is:
qa. Up to 1%;
qb. Up to 60%, regardless of gender;
qc. The highest among the general population;
qd. Around 10% with a tendency to decrease in relation to age.
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Stomatology Edu Journal 37