Editing Bruxism (section)

===Prevention of dental damage===
Bruxism can cause significant tooth wear if it is severe, and sometimes dental restorations (crowns, fillings etc.) are damaged or lost, sometimes repeatedly.<ref name="Wassell 2008" /><ref name="Tyldesley 2003" /> Most dentists therefore prefer to keep dental treatment in people with bruxism very simple and only carry it out when essential, since any dental work is likely to fail in the long term.<ref name="Wassell 2008" /> [[Dental implant]]s, [[dental ceramics]] such as Emax crowns<ref>{{Cite journal|last1=Wang|first1=Rao-Rao|last2=Lu|first2=Cheng-Lin|last3=Wang|first3=Gang|last4=Zhang|first4=Dong-Sheng|date=13 December 2013|title=Influence of cyclic loading on the fracture toughness and load bearing capacities of all-ceramic crowns|journal=International Journal of Oral Science|volume=6|issue=2|pages=99–104|doi=10.1038/ijos.2013.94|pmid=24335786|pmc=5130053|issn=2049-3169}}</ref> and complex [[bridgework]] for example are relatively [[contraindication|contraindicated]] in bruxists.<ref name="Wassell 2008" /> In the case of crowns, the strength of the restoration becomes more important, sometimes at the cost of aesthetic considerations. E.g. a full coverage gold crown, which has a degree of flexibility and also involves less removal (and therefore less weakening) of the underlying natural tooth may be more appropriate than other types of crown which are primarily designed for esthetics rather than durability. Porcelain [[Veneer (dentistry)|veneers]] on the incisors are particularly vulnerable to damage, and sometimes a crown can be perforated by occlusal wear.<ref name="Wassell 2008" />

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Occlusal splints (also termed [[Mouthguard#Dentistry|dental guards]]) are commonly prescribed, mainly by dentists and dental specialists, as a treatment for bruxism. Proponents of their use claim many benefits, however when the evidence is critically examined in systematic reviews of the topic, it is reported that there is insufficient evidence to show that occlusal splints are effective for sleep bruxism<ref name="MacedoSilva2007">{{cite journal|last1=Macedo|first1=Cristiane R|last2=Silva|first2=Ademir B|last3=Machado|first3=Marco Antonio C|last4=Saconato|first4=Humberto|last5=Prado|first5=Gilmar F|title=Occlusal splints for treating sleep bruxism (tooth grinding)|journal=Cochrane Database of Systematic Reviews|issue=4|pages=CD005514|year=2007|volume=2010 |issn=1465-1858|doi=10.1002/14651858.CD005514.pub2|pmid=17943862|pmc=8890597 }}</ref> as well as bruxism overall.<ref name="Hardy Bonsor 2021 p=103621">{{cite journal | last1=Hardy | first1=Robert S. | last2=Bonsor | first2=Stephen J. | title=The efficacy of occlusal splints in the treatment of bruxism: A systematic review | journal=Journal of Dentistry | publisher=Elsevier BV | volume=108 | year=2021 | issn=0300-5712 | doi=10.1016/j.jdent.2021.103621 | page=103621| pmid=33652054 | hdl=2164/18144 | s2cid=232101474 | hdl-access=free }}</ref>
Furthermore, occlusal splints are probably ineffective for awake bruxism,<ref name="Cawson 2002" /> since they tend to be worn only during sleep. However, occlusal splints may be of some benefit in reducing the tooth wear that may accompany bruxism,<ref name="MacedoSilva2007"/> but by mechanically protecting the teeth rather than reducing the bruxing activity itself. In a minority of cases, sleep bruxism may be made worse by an occlusal splint. Some patients will periodically return with splints with holes worn through them, either because the bruxism is aggravated, or unaffected by the presence of the splint. When tooth-to-tooth contact is possible through the holes in a splint, it is offering no protection against tooth wear and needs to be replaced.

Occlusal splints are divided into partial or full-coverage splints according to whether they fit over some or all of the teeth. They are typically made of plastic (e.g. [[acrylate polymer|acrylic]]) and can be hard or soft. A lower appliance can be worn alone, or in combination with an upper appliance. Usually lower splints are better tolerated in people with a sensitive gag reflex. Another problem with wearing a splint can be stimulation of salivary flow, and for this reason some advise to start wearing the splint about 30 mins before going to bed so this does not lead to difficulty falling asleep. As an added measure for hypersensitive teeth in bruxism, desensitizing toothpastes (e.g. containing [[strontium chloride]]) can be applied initially inside the splint so the material is in contact with the teeth all night. This can be continued until there is only a normal level of sensitivity from the teeth, although it should be remembered that sensitivity to thermal stimuli is also a symptom of [[pulpitis]], and may indicate the presence of tooth decay rather than merely hypersensitive teeth.

Splints may also reduce muscle strain by allowing the upper and lower jaw to move easily with respect to each other. Treatment goals include: constraining the bruxing pattern to avoid damage to the [[temporomandibular joints]]; stabilizing the occlusion by minimizing gradual changes to the positions of the teeth, preventing tooth damage and revealing the extent and patterns of bruxism through examination of the markings on the splint's surface. A dental guard is typically worn during every night's sleep on a long-term basis. However, a meta-analysis of occlusal splints (dental guards) used for this purpose concluded "There is not enough evidence to state that the occlusal splint is effective for treating sleep bruxism."<ref>{{cite journal |author=Jagger R |title=The effectiveness of occlusal splints for sleep bruxism |journal=Evidence-Based Dentistry |volume=9 |issue=1 |pages=23 |year=2008 |pmid=18364692 |doi=10.1038/sj.ebd.6400569|doi-access=free }}</ref>

A ''repositioning splint'' is designed to change the patient's occlusion, or bite.{{Medical citation needed|date=May 2013}} The efficacy of such devices is debated. Some writers propose that irreversible complications can result from the long-term use of mouthguards and repositioning splints. Random controlled trials with these type devices generally show no benefit over other therapies.<ref>{{cite book |author1=Hylander, William L. |author2=Laskin, Daniel M. |author3=Greene, Charles B. |title = Temporomandibular disorders an evidence-based approach to diagnosis and treatment |publisher = Quintessence Pub |location = Chicago |year = 2006 |pages = 377–90 |isbn = 978-0-86715-447-4 }}</ref><ref>{{cite journal |vauthors=Dao TT, Lavigne GJ |title=Oral splints: the crutches for temporomandibular disorders and bruxism? |journal=Critical Reviews in Oral Biology and Medicine |volume=9 |issue=3 |pages=345–61 |year=1998 |pmid=9715371 |doi=10.1177/10454411980090030701|citeseerx=10.1.1.548.8929 }}</ref><ref name="Widmalm 1999">{{cite journal |author=Widmalm SE |title=Use and abuse of bite splints |journal=Compendium of Continuing Education in Dentistry |volume=20 |issue=3 |pages=249–54, 256, 258–9; quiz 260 |date=March 1999  |pmid=11692335}}</ref>
Another partial splint is the [[nociceptive trigeminal inhibition tension suppression system]] (NTI-TSS) dental guard. This splint snaps onto the front teeth only. It is theorized to prevent tissue damages primarily by reducing the bite force from attempts to close the jaw normally into a forward twisting of the lower front teeth. The intent is for the brain to interpret the nerve sensations as undesirable, automatically and subconsciously reducing clenching force. However, there may be potential for the NTI-TSS device to act as a [[Dahl appliance]], holding the posterior teeth out of occlusion and leading to their over-eruption, deranging the occlusion (i.e.  it may cause the teeth to move position). This is far more likely if the appliance is worn for excessive periods of time, which is why NTI type appliances are designed for night time use only, and ongoing follow-ups are recommended.{{citation needed|date=August 2018}}

A [[mandibular advancement device]] (normally used for treatment of [[obstructive sleep apnea]]) may reduce sleep bruxism, although its use may be associated with discomfort.<ref name="Huynh 2007">{{cite journal |vauthors=Huynh N, Manzini C, Rompré PH, Lavigne GJ |title=Weighing the potential effectiveness of various treatments for sleep bruxism |journal=Journal of the Canadian Dental Association |volume=73 |issue=8 |pages=727–30 |date=October 2007  |pmid=17949541 |url=http://www.cda-adc.ca/jcda/vol-73/issue-8/727.html}}</ref>