Essence of Diagnosis and Management of Sleep Bruxism

Abstract

It is common knowledge for dentists that sleep bruxism can produce destructive symptoms in the stomatognathic system, such as tooth wear. However, if it is not clear whether those symptoms are truly caused by sleep bruxism, overtreatment may result. The American Academy of Sleep Medicine has classified the diagnosis by polysomnography as “Definite sleep bruxism”, “Probable sleep bruxism” by clinical signs, and “Possible sleep bruxism” by questionnaire. Clinically, the diagnosis should be made through objective evaluation using a wearable electromyograph or the International Classification of Sleep Disorders third edition criteria for diagnosis based on clinical signs (tooth grinding sounds during sleep and abnormal tooth wear or/and morning jaw symptoms). In addition, the underlying causes of sleep bruxism should be investigated. If it is associated with a background disease, such as secondary sleep bruxism, treatment should proceed in collaboration with medical professionals. If augmenting factors are present, sleep hygiene instructions should be provided. If these treatments are unsuccessful, a well-fitting, properly adjusted occlusal appliance (stabilization-type appliance) may be applied. However, once symptoms have improved, the patient should proceed to discontinue the occlusal appliance.