Navigating the Interconnected World of Tooth Wear, Bruxism, and Temporomandibular Disorders

Vincenzo Ronsivalle¹, Diana Russo², Marco Cicciù³, Maria Maddalena Marrapodi⁴, Giuseppe Minervini⁵

¹Department of Biomedical and Dental Sciences, Morphological and Functional images, University of Messina, G. Martino Polyclinic, Messina, Italy; Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania

²Oral Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy

³Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania

⁴Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

⁵Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India; Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy

Corresponding Author: Giuseppe Minervini, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India; Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy, Phone: +39 3289129558, e-mail: Giuseppe.minervini@unicampania.it; Diana Russo, Oral Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Caserta, Italy, Phone: +39 3345993347, e-mail: diana.russo2@unicampania.it

How to cite this article: Ronsivalle V, Russo D, Cicciù M, et al. Navigating the Interconnected World of Tooth Wear, Bruxism, and Temporomandibular Disorders. J Contemp Dent Pract 2024;25(10): 911–913.

Source of support: Nil

Conflict of interest: None

Keywords: Bruxism, Sleep disorders, Temporomandibular disorders, Tooth wear.

Dear Editor,

In the quiet of the night and the rush of the day, a silent epidemic erodes more than just enamel; it affects lives, confidence, and well-being. Tooth wear and bruxism, often overlooked in broader health discussions, demand our immediate attention not just as dental health issues but as indicators of deeper health and lifestyle concerns.^1–3 This editorial aims to shed light on the pervasive nature of tooth wear and bruxism, exploring their implications and urging a comprehensive approach to their management and prevention.

The intricate relationship between tooth wear, bruxism, and temporomandibular disorders (TMD) presents a nuanced challenge within the dental and public health arenas. These interconnected conditions not only impact individuals’ oral health, but also have profound implications for their overall quality of life.⁴ As we explore the many complexities with these issues, it will indeed be obvious that an integrated and holistic approach will be necessary for prevention, diagnosis, and treatment in effective management and care.

Tooth wear, the gradual loss of tooth structure, is a condition exacerbated by various factors, including bruxism the habitual grinding or clenching of teeth. While tooth wear can be a natural part of the aging process, bruxism accelerates this wear, leading to premature dental issues that can significantly affect an individual’s oral health.^5–7 The causes of bruxism are multifaceted, ranging from stress and anxiety to misaligned teeth or sleep disorders, highlighting the need for a comprehensive diagnostic approach.^8,9

Bruxism significantly contributes to the accelerated wear of teeth and is recognized as a major risk factor for the development of TMD. Temporomandibular disorders encompasses a complex array of conditions affecting the temporomandibular joint (TMJ) and surrounding musculature. These conditions often result in pain, challenges with chewing, and restricted jaw mobility, thereby profoundly impacting an individual’s daily activities and overall quality of life. The relationship between bruxism and TMD underscores a vicious cycle where pain can increase teeth grinding, which, in turn exacerbates TMD symptoms.¹⁰

The interplay between these conditions necessitates a multidisciplinary approach to treatment that addresses both the symptoms and underlying causes. Dental interventions, such as the use of mouth guards to protect against tooth wear from bruxism, are crucial. Nevertheless, these interventions should be supplemented with therapeutic approaches designed to mitigate the symptoms of TMD, including physical therapy, stress management strategies, and, when necessary, pharmacological treatments to address inflammation and pain.¹¹

Preventive measures play a critical role in managing the nexus of tooth wear, bruxism, and TMD. Public health initiatives should prioritize education on the importance of regular dental check-ups, which can facilitate early detection and intervention.^12–14 Furthermore, raising awareness about the impact of stress and anxiety on oral health can encourage individuals to adopt stress reduction techniques that may decrease the prevalence of bruxism.¹⁵

One of the most effective methods to prevent tooth wear from bruxism is the use of customized oral appliances, such as night guards. These devices, tailored to fit the individual’s mouth, act as a protective barrier between the upper and lower teeth, distributing the force exerted during grinding and preventing direct tooth-to-tooth contact. By wearing a night guard, individuals can significantly reduce the risk of tooth wear and other associated complications of bruxism.^16–19 Understanding that bruxism is often stress-related necessitates addressing the root cause of the condition. The various methods of stress management, such as exercise, meditation, yoga, and therapy, are all effective tools in the reduction of both frequency and intensity of a bruxism episode. Encouraging patients to find and adopt stress-reduction practices can have a very positive effect, not only in preventing tooth wear but also in improving overall well-being. Lifestyle adjustments, including reducing caffeine intake and avoiding alcohol, can decrease the likelihood of bruxism and, consequently, tooth wear. Behavioral therapies, such as biofeedback and habit-reversal techniques, offer additional avenues for individuals to gain control over bruxism. These methods can help patients recognize the triggers of their bruxism and implement strategies to stop the behavior, particularly during waking hours.^20–23 Investing in research to better understand bruxism and its management is crucial. Advances in technology, such as wearables that detect grinding activity, could revolutionize the early diagnosis and monitoring of bruxism. Furthermore, public awareness campaigns are essential to educate the broader community about the signs of bruxism, its effects on dental health, and the importance of seeking professional advice.^24–28

Collaborative research efforts are also vital in advancing our understanding of these conditions and their interconnections.²⁹ By examining the genetic, environmental, and psychological factors that contribute to tooth wear, bruxism, and TMD, the medical and dental communities can design more effective prevention and treatment strategies. These approaches aim to address the underlying causes of these conditions rather than merely managing their symptoms.^16,30–32

In conclusion, the challenges presented by tooth wear, bruxism, and TMD underscore the importance of an integrated healthcare approach that considers the patient as a whole. Going forward, it’s time that dental and medical professionals work in tandem and provide holistic care to all the needs of those multifaceted conditions. From the fostering of a better understanding of the complex interrelationships between oral health and general health will come the development of appropriate strategies for more effective approaches in prevention, early interventions, and management to maximize the quality of life in patients with these conditions.

REFERENCES

1. Wetselaar P, Manfredini D, Ahlberg J, et al. Associations between tooth wear and dental sleep disorders: A narrative overview. J Oral Rehabil 2019;46(8):765–775. DOI: 10.1111/joor.12807.

2. Koyano K, Tsukiyama Y, Ichiki R, et al. Assessment of bruxism in the clinic. J Oral Rehabil 2008;35(7):495–508. DOI: 10.1111/j.1365-2842.2008.01880.x.

3. Sivakumar S, Sivakumar G, Sundramoorthy AK. Factors influencing dental practitioners in the management of temporomandibular joint related disorders in clinical practice–A structural equation modelling approach. Open Dent J 2024;18:e18742106307033. DOI: 10.2174/0118742106307033240729092845.

4. Minervini G, Marrapodi MM, Cicciù M. Online bruxism-related information: Can people understand what they read? A cross-sectional study. J Oral Rehabil 2023;50(11):1211–1216. DOI: 10.1111/joor.13519.

5. Kapagiannidou D, Koutris M, Wetselaar P, et al. Association between polysomnographic parameters of sleep bruxism and attrition-type tooth wear. J Oral Rehabil 2021;48(6):687–691. DOI: 10.1111/joor.13149.

6. Gomes MC, Neves ÉT, Perazzo MF, et al. Evaluation of the association of bruxism, psychosocial and sociodemographic factors in preschoolers. Braz Oral Res 2018;32:e009. DOI: 10.1590/1807-3107bor-2018.vol32.0009.

7. Kataoka K, Ekuni D, Mizutani S, et al. Association between self-reported bruxism and malocclusion in university students: A cross-sectional study. J Epidemiol 2015;25(6):423–430. DOI: 10.2188/jea.JE20140180.

8. Fiorillo L, D’Amico C, Ronsivalle V, et al. Single dental implant restoration: Cemented or screw-retained? A systematic review of multi-factor randomized clinical trials. Prosthesis 2024;6(4):871–886. DOI: 10.3390/prosthesis6040063.

9. Blasi A, Nucera R, Ronsivalle V, et al. Asymmetry index for the photogrammetric assessment of facial asymmetry. Am J Orthod Dentofacial Orthop 2022;162(3):394–402. DOI: 10.1016/j.ajodo.2021.04.030.

10. Alshadidi AAF, Alshahrani AA, Aldosari LIN, et al. Investigation on the application of artificial intelligence in prosthodontics. Applied Sciences 2023;13(8):5004. DOI: 10.3390/app13085004.

11. Langaliya A, Alam MK, Hegde U, et al. Occurrence of temporomandibular disorders among patients undergoing treatment for obstructive sleep apnoea syndrome (OSAS) using mandibular advancement device (MAD): A systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. J Oral Rehabil 2023;50(12):1554–1563. DOI: 10.1111/joor.13574.

12. Hussain A, Rizvi M, Vohra U, et al. Prevalence of bruxism among the students of Gulf Medical University: A cross-sectional questionnaire study. J Pharm Bioallied Sci 2021;13(Suppl 1):S501–S505. DOI: 10.4103/jpbs.JPBS_644_20.

13. Almeida LE, Cicciù M, Doetzer A, et al. Mandibular condylar hyperplasia and its correlation with vascular endothelial growth factor. J Oral Rehabil 2023;50(9):845–851. DOI: 10.1111/joor.13487.

14. Uzunçıbuk H, Marrapodi MM, Meto A, et al. Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross-sectional study. J Oral Rehabil 2024;51(3):500–509. DOI: 10.1111/joor.13614.

15. Lo Russo L, Guida L, Mariani P, et al. Effect of fabrication technology on the accuracy of surgical guides for dental-implant surgery. Bioengineering 2023;10(7):875. DOI: 10.3390/BIOENGINEERING10070875.

16. Riley P, Glenny A-M, Worthington HV, et al. Oral splints for temporomandibular disorder or bruxism: A systematic review. Br Dent J 2020;228(3):191–197. DOI: 10.1038/s41415-020-1250-2.

17. Kitagawa K, Kodama N, Manda Y, et al. Effect of masseter muscle activity during wakefulness and sleep on tooth wear. J Prosthodont Res 2021;66(4):551–556. DOI: 10.2186/jpr.JPR_D_21_00171.

18. Fathima F. Association of occlusal wear facets in patients with temporomandibular disorders. Bioinformation 2020;16(12):1060–1068. DOI: 10.6026/973206300161060.

19. Ronsivalle V, Nucci L, Bua N, et al. Elastodontic appliances for the interception of malocclusion in children: A systematic narrative hybrid review. Children 2023;10(11):1821. DOI: 10.3390/children10111821.

20. Nekora-Azak A, Yengin E, Evlioglu G, et al. Prevalence of bruxism awareness in Istanbul, Turkey. Cranio 2010;28(2):122–127. DOI: 10.1179/crn.2010.017.

21. Jan HEY, Al Zahidy HA, Yousef REO. A critical review on the relation and impact of bruxism and prosthetic treatment. Egypt J Hosp Med 2017;66:261–268. DOI: 10.12816/0034662.

22. Yoshida Y, Suganuma T, Takaba M, et al. Association between patterns of jaw motor activity during sleep and clinical signs and symptoms of sleep bruxism. J Sleep Res 2017;26(4):415–421. DOI: 10.1111/jsr.12481.

23. Jain A, Bhusari P, Alasqah M, et al. A comparative analysis of open flap debridement with and without autogenous periosteal graft as a barrier membrane for the treatment of class II furcation involvement in mandibular molars: A case-control study. Open Dentistry Journal 2024;18: e18742106319512 DOI: 10.2174/0118742106319512240810170409.

24. Li Y, Yu F, Niu L, et al. Associations among bruxism, gastroesophageal reflux disease, and tooth wear. J Clin Med 2018;7(11):417. DOI: 10.3390/jcm7110417.

25. Karkazi F, Ozdemir F. Temporomandibular disorders: fundamental questions and answers. Turk J Orthod 2020;33(4):246–252. DOI: 10.5152/TurkJOrthod.2020.20031.

26. Yalçın Yeler D, Yılmaz N, Koraltan M, et al. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students. Cranio 2017;35(5):308–314. DOI: 10.1080/08869634.2016.1239851.

27. Kim JH, McAuliffe P, O’Connel B, et al. Development of bite guard for wireless monitoring of bruxism using pressure-sensitive polymer. In: 2010 International Conference on Body Sensor Networks. IEEE 2010:109–116. DOI: 10.1109/BSN.2010.62.

28. Talungchit S, Techapichetvanich K, Rungsiyanont S. The comparative study on the mental index and panoramic mandibular index in thai osteoporotic, osteopenic, and non-osteoporotic patients: A cross-sectional study. Open Dentistry Journal 2024;18:e18742106272786. DOI: 10.2174/0118742106272786240130161659.

29. Wibianty V, Tadjoedin FM, Lessang R, et al. The association between periodontal status and frailty in elderly individuals. Open Dentistry Journal 2024;18:e18742106284116. DOI: 10.2174/0118742106284116240304035832.

30. Gkantidis N, Dritsas K, Ren Y, et al. An accurate and efficient method for occlusal tooth wear assessment using 3D digital dental models. Sci Rep 2020;10:10103. DOI: 10.1038/s41598-020-66534-4.

31. Sonmezocak T, Kurt S. Detection of EMG signals by neural networks using autoregression and wavelet entropy for bruxism diagnosis. Elektronika ir Elektrotechnika 2021;27(2):11–21. DOI: 10.5755/j02.eie.28838.

32. Mashyakhy M, Adawi HA, Abu-Melha A, et al. A novel design for full-coverage crown to assist for future endodontic treatment: A survey on difficulties of access cavity through crowns and pilot in-vitro study testing the new design. Open Dentistry Journal 2024;18:e18742106288080. DOI: 10.2174/0118742106288080240213113335.

________________________
© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.