Editing Bruxism (section)

==Diagnosis==
Early diagnosis of bruxism is advantageous, but difficult. Early diagnosis can prevent damage that may be incurred and the detrimental effect on [[quality of life]].<ref name="Shetty 2010" /> A diagnosis of bruxism is usually made clinically,<ref name="Kalantzis 2005" /> and is mainly based on the person's [[Medical history|history]] (e.g. reports of grinding noises) and the presence of typical signs and symptoms, including tooth mobility, tooth wear, masseteric hypertrophy, indentations on the tongue, hypersensitive teeth (which may be misdiagnosed as reversible [[pulpitis]]), pain in the muscles of mastication, and clicking or locking of the temporomandibular joints.<ref name="Shetty 2010" /> Questionnaires can be used to screen for bruxism in both the clinical and research settings.<ref name="Shetty 2010" />

For tooth grinders who live in a household with other people, diagnosis of grinding is straightforward: Housemates or family members would advise a bruxer of recurrent grinding.  Grinders who live alone can likewise resort to a sound-activated tape recorder.  To confirm the condition of clenching, on the other hand, bruxers may rely on such devices as the Bruxchecker,<ref>{{Cite journal |author=Kanji Onodera |author2=Toshimi Kawagoe |author3=Kenichi Sasaguri |author4=Cynthia Protacio-Quismundo |author5=Sadao Sato |date=2006|title=The use of a bruxChecker in the evaluation of different grinding patterns during sleep bruxism. (Clinical report)|journal=Cranio: The Journal of Craniomandibular Practice|volume=24|issue=4|pages=292–299|doi=10.1179/crn.2006.045|pmid=17086859|s2cid=41480506}}</ref> Bruxcore,<ref name="Shetty 2010" /> or a beeswax-bearing biteplate.<ref name=":2">{{Cite journal|date=2001|title=A bibliographical survey of bruxism with special emphasis on non-traditional treatment modalities|url=https://www.jstage.jst.go.jp/article/josnusd1998/43/2/43_2_73/_pdf|journal=Journal of Oral Science|volume=43|issue=2|pages=73–83|doi=10.2334/josnusd.43.73|pmid=11515601|last1=Nissani|first1=Moti|doi-access=free}}</ref>

The Individual (personal) Tooth-Wear Index was developed to objectively quantify the degree of tooth wear in an individual, without being affected by the number of missing teeth.<ref name="Shetty 2010" /> Bruxism is not the only cause of tooth wear. Another possible cause of tooth wear is acid erosion, which may occur in people who drink a lot of acidic liquids such as concentrated fruit juice, or in people who frequently vomit or regurgitate stomach acid, which itself can occur for various reasons. People also demonstrate a normal level of tooth wear, associated with normal function.<!--<ref name="Shetty 2010" />  --> The presence of tooth wear only indicates that it had occurred at some point in the past, and does not necessarily indicate that the loss of tooth substance is ongoing.<!--<ref name="Shetty 2010" />  --> People who clench and perform minimal grinding will also not show much tooth wear.<!--<ref name="Shetty 2010" />  --> Occlusal splints are usually employed as a treatment for bruxism, but they can also be of diagnostic use, e.g. to observe the presence or absence of wear on the splint after a certain period of wearing it at night.<ref name="Shetty 2010" />

The most usual trigger in sleep bruxism that leads a person to seek medical or dental advice is being informed by a sleeping partner of unpleasant grinding noises during sleep.<ref name=ICSD-R /> The diagnosis of sleep bruxism is usually straightforward, and involves the exclusion of dental diseases, temporomandibular disorders, and the rhythmic jaw movements that occur with seizure disorders (e.g. epilepsy).<ref name=ICSD-R /> This usually involves a dental examination, and possibly [[electroencephalography]] if a seizure disorder is suspected.<ref name=ICSD-R /> [[Polysomnography]] shows increased masseter and temporalis muscular activity during sleep.<ref name=ICSD-R /> Polysomnography may involve electroencephalography, electromyography, [[electrocardiography]], air flow monitoring and audio–video recording. It may be useful to help exclude other sleep disorders; however, due to the expense of the use of a sleep lab, polysomnography is mostly of relevance to research rather than routine clinical diagnosis of bruxism.<ref name="Shetty 2010" />

Tooth wear may be brought to the person's attention during routine dental examination. With awake bruxism, most people will often initially deny clenching and grinding because they are unaware of the habit. Often, the person may re-attend soon after the first visit and report that they have now become aware of such a habit.

Several devices have been developed that aim to objectively measure bruxism activity, either in terms of muscular activity or bite forces. They have been criticized for introducing a possible change in the bruxing habit, whether increasing or decreasing it, and are therefore poorly representative to the native bruxing activity.<ref name="Shetty 2010" /> These are mostly of relevance to research, and are rarely used in the routine clinical diagnosis of bruxism. Examples include the "Bruxcore Bruxism-Monitoring Device" (BBMD, "Bruxcore Plate"), the "intra-splint force detector" (ISFD), and [[electromyography|electromyographic]] devices to measure masseter or temporalis muscle activity (e.g. the "[[BiteStrip]]", and the "Grindcare").<ref name="Shetty 2010" />

===ICSD-R diagnostic criteria===
The [[International Classification of Sleep Disorders|ICSD-R]] listed diagnostic criteria for sleep bruxism.<ref name=ICSD-R /> The minimal criteria include both of the following:
* A. symptom of tooth-grinding or tooth-clenching during sleep, and
* B. One or more of the following:
** Abnormal tooth wear
** Grinding sounds
** Discomfort of the jaw muscles

With the following criteria supporting the diagnosis:
* C. [[polysomnography]] shows both:
** Activity of jaw muscles during sleep
** No associated [[epilepsy|epileptic]] activity
* D. No other medical or mental disorders (e.g., sleep-related epilepsy, which may cause abnormal movement during sleep).
* E. The presence of other sleep disorders (e.g., obstructive sleep apnea syndrome).

===Definition examples===
''Bruxism'' is derived from the [[Greek language|Greek]] word {{lang|grc|βρύκειν}} (''brykein'') "to bite, ''or'' to gnash, grind the teeth".<ref>{{cite encyclopedia|url=http://dictionary.reference.com/browse/bruxism|title=''Bruxism'' Origin|dictionary=[[dictionary.com]]|access-date=13 July 2015}}</ref><ref>{{OEtymD|bruxism}}</ref><ref>{{LSJ|bru/kw|βρύκειν|ref}}.</ref> People with bruxism are called ''bruxists'' or ''bruxers'' and the verb itself is "to brux". There is no widely accepted definition of bruxism.<ref name="LOBBEZOO 2006" /> Examples of definitions include:
{{blockquote|"Bruxism is a repetitive jaw-muscle activity characterized 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)."<ref>{{cite journal|last1=Lobbezzo|first1=F.|title=Bruxism defined and graded: an international consensus|doi=10.1111/joor.12011|pmid=23121262|volume=40|issue=1|journal=Journal of Oral Rehabilitation|pages=2–4|year=2013|doi-access=free}}</ref>}}{{blockquote|All forms of bruxism entail forceful contact between the biting surfaces of the upper and lower teeth. In grinding and tapping this contact involves movement of the mandible and unpleasant sounds which can often awaken sleeping partners and even people asleep in adjacent rooms. Clenching (or clamping), on the other hand, involves inaudible, sustained, forceful tooth contact unaccompanied by mandibular movements.<ref name=":0">{{Cite journal|last=Nissani|first=M.|date=2000|title=A Taste-Based Approach to the Prevention of Bruxism|journal=Applied Psychophysiology and Biofeedback|volume=25| issue =  1 |pages=43–54|doi=10.1023/A:1009585422533|pmid=10832509|s2cid=32738976}}</ref>}}{{blockquote|"A movement disorder of the [[mastication|masticatory system]] characterized by teeth-grinding and clenching during sleep as well as wakefulness."<ref name="Wassell 2008" />}}
{{blockquote|"Non-functional contact of the mandibular and maxillary teeth resulting in clenching or tooth grinding due to repetitive, unconscious contraction of the masseter and temporalis muscles."<ref name="Persaud 2013">{{cite journal |vauthors=Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K |title=An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions |journal=JRSM Short Reports |volume=4 |issue=2 |date=February 2013  |page=10 |pmid=23476731 |pmc=3591685 |doi=10.1177/2042533312472115}}</ref>}}
{{blockquote|"Parafunctional grinding of teeth or an oral habit consisting of involuntary rhythmic or spasmodic non-functional gnashing, grinding or clenching of teeth in other than chewing movements of the mandible which may lead to occlusal trauma."<ref name="Shetty 2010" />}}
{{blockquote|"Periodic repetitive clenching or rhythmic forceful grinding of the teeth."<ref name="Cawson 2002" /><ref>{{cite web|url=http://www.express.co.uk/life-style/health/713601/grinding-teeth-expert-reveals-long-term-damage-bruxism|title=Grinding your teeth? Expert reveals the long term damage you could be causing|first=Olivia|last=Lerche|date=23 September 2016}}</ref>}}

===Classification by temporal pattern===
{| class="wikitable" style="float:right; width:450px;"
|+ Comparison of typical features of sleep bruxism and awake bruxism.<ref name="Manfredini 2013" /><ref name="Shetty 2010" /><ref name="Macedo 2009" />  
|-
| || '''Sleep bruxism''' || '''Awake bruxism'''
|-
| Occurrence || While asleep, mostly during periods of sleep arousal || While awake
|-
| Time–intensity relationship || Pain worst on waking, then slowly gets better || Pain worsens throughout the day, may not be present on waking
|-
| Noises || Commonly associated || Rarely associated
|-
| Activity || Clenching and grinding || Usually clenching, occasionally clenching and grinding
|-
| Relationship with stress || Unclear, little evidence of a relationship || Stronger evidence for a relationship, but not conclusive
|-
| Prevalence (general population) || 9.7–15.9% || 22.1–31%
|-
| Gender distribution || Equal gender distribution || Mostly females
|-
| Heritability || Some evidence || Unclear
|}
Bruxism can be subdivided into two types based upon when the parafunctional activity occurs – during sleep ("sleep bruxism"), or while awake ("awake bruxism").<ref name="Macedo 2009">{{cite journal |last = Macedo |first = Cristiane R |author2=Machado MAC|author3=Silva AB|author4=Prado GF |editor1-first = Cristiane R |editor1-last = MacEdo |title = Pharmacotherapy for sleep bruxism |journal = Cochrane Database of Systematic Reviews |date = 21 January 2009 |doi = 10.1002/14651858.CD005578 }}</ref> This is the most widely used classification since sleep bruxism generally has different causes to awake bruxism, although the effects on the condition on the teeth may be the same.<ref name="ICSD-R" /> The treatment is also often dependent upon whether the bruxism happens during sleep or while awake, e.g., an occlusal splint worn during sleep in a person who only bruxes when awake will probably have no benefit.<ref name="Cawson 2002" /> Some have even suggested that sleep bruxism is an entirely different disorder and is not associated with awake bruxism.<ref name="Macedo 2009" /> Awake bruxism is sometimes abbreviated to AB,<ref name="Shetty 2010">{{cite journal |vauthors=Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC |title=Bruxism: a literature review |journal=Journal of Indian Prosthodontic Society |volume=10 |issue=3 |pages=141–8 |date=September 2010  |pmid=21886404 |pmc=3081266 |doi=10.1007/s13191-011-0041-5}}</ref> and is also termed "diurnal bruxism",<ref name="Shetty 2010" /> DB, or "daytime bruxing". Sleep bruxism is sometimes abbreviated to SB,<ref name="Shetty 2010" /> and is also termed "sleep-related bruxism",<ref name="ICSD-R" /> "nocturnal bruxism",<ref name="ICSD-R" /> or "nocturnal tooth grinding".<ref name="ICSD-R" /> According to the [[International Classification of Sleep Disorders]] revised edition (ICSD-R), the term "sleep bruxism" is the most appropriate since this type occurs during sleep specifically rather than being associated with a particular time of day, i.e., if a person with sleep bruxism were to sleep during the day and stay awake at night then the condition would not occur during the night but during the day.<ref name="ICSD-R">{{cite web |title = International classification of sleep disorders, revised: Diagnostic and coding manual. |url = http://www.esst.org/adds/ICSD.pdf |publisher = Chicago, Illinois: American Academy of Sleep Medicine, 2001. |access-date = 16 May 2013 |archive-url = https://web.archive.org/web/20110726034931/http://www.esst.org/adds/ICSD.pdf |archive-date = 26 July 2011 }}</ref> The ICDS-R defined sleep bruxism as "a stereotyped movement disorder characterized by grinding or clenching of the teeth during sleep",<ref name="ICSD-R" /> classifying it as a [[parasomnia]]. The second edition (ICSD-2) however reclassified bruxism to a "sleep related movement disorder" rather than a parasomnia.<ref name="Macedo 2009" />

===Classification by cause===
Alternatively, bruxism can be divided into ''primary bruxism'' (also termed "[[idiopathic]] bruxism"), where the disorder is not related to any other medical condition, or ''secondary bruxism'', where the disorder is associated with other medical conditions.<ref name="Macedo 2009" /> Secondary bruxism includes [[iatrogenic]] causes, such as the side effect of prescribed medications. Another source divides the causes of bruxism into three groups, namely central or pathophysiological factors, psychosocial factors and peripheral factors.<ref name="Shetty 2010" /> The [[World Health Organization]]'s [[ICD-10|International Classification of Diseases 10th revision]] does not have an entry called bruxism, instead listing "tooth grinding" under [[somatoform]] disorders.<ref>{{cite web |title = International Classification of Diseases – 10th revision |url = http://apps.who.int/classifications/icd10/browse/2010/en#/F45.8 |publisher = World Health Organization |access-date = 18 May 2013 }}</ref> To describe bruxism as a purely somatoform disorder does not reflect the mainstream, modern view of this condition (see [[#Causes|causes]]).

===Classification by severity===
The ICSD-R described three different severities of sleep bruxism, defining mild as occurring less than nightly, with no damage to teeth or psychosocial impairment; moderate as occurring nightly, with mild impairment of psychosocial functioning; and severe as occurring nightly, and with damage to the teeth, temporomandibular disorders and other physical injuries, and severe psychosocial impairment.<ref name=ICSD-R />

===Classification by duration===
The ICSD-R also described three different types of sleep bruxism according to the duration the condition is present, namely acute, which lasts for less than one week; subacute, which lasts for more than a week and less than one month; and chronic which lasts for over a month.<ref name=ICSD-R />