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53 Cards in this Set

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What is the definition of Diurnal/Nocturnal Parafunctional activity?
-Clenching, bracing, gnashing, grinding of teeth
What is the prevalence of Bruxism? Does male or female does it more often?
-Prevalence: 20%
-Female > Male
What are the two types of Bruxism?
-Wake Bruxism (AB)
-Sleep Bruxism (SB)
What is the usual orofacial activities?
-Chewing, speaking, swallowing
What can awake Bruxism be associated with?
-Parkinson's or neurodegenerative disease
What is Sleep Bruxism characterized by?
-Tooth grinding / clenching
-No gender difference
-1 in 5 sleep bruxers also brux when awake
What is the sub-classification of Sleep Bruxism?
1. Simple
2. Complex

1. Primary
2. Secondary/Iatrogenic
What is the difference b/t sub-class of simple and complex?
-Simple: Sleep bruxis,. periodic limb movt. during sleep

-Complex: REM behavior disorder, epileptic motor activity
What is the difference b/t sub-class of simple and complex?
-Primary: Prevalence: 14-18% children, 8% adults, 3% elderly

-Secondary: medical disorder, medication/drug use
What can exacerbates Sleep Bruxism?
-Smoking, caffeine, alcohol
-Type A personality, anxiety
-Sleep disorder (snoring, sleep apnea)
Sleep can be divided into non-REM & REM sleep, what is the difference b/t it?
-Non-REM= light stages 1+2, deep stages 3+4
-REM= active sleep
What long is 1 cycle of REM sleep.
-90-110 mins
Which part of sleeping does Sleep Bruxism occur?
-SB occurs mainly during stage 1+2
-10% SB occur during REM
Sequence of physiological events in relation to micro-arousals, which precedes from when?
-From 4-8 min before rhythmic masticatory muscle activity (RMMA) ass. to sleep bruxism-tooth grinding in human sleep
What is the older theories of pathophysiology?
-Occlusion, Stress, Dopamine
What is the newer theories of pathophysiology?
-Circadian rhythm influences
-Neurotransmitters
-Genetics
Much evdience support role of occlusion in the genesis of bruxism? (T/F)
-False: little evidence
How long is tooth contacted during the day and when sleeping?
-17.5 min / day
-8 min/ 8 hr sleep
Relief from symptoms after occlusal equilibration or ortho tx is insufficient proof to justify extensive tx (T/F)
True
What is the consequences of Bruxism?
-Grinding sound
-Tooth destruction, Breakage of dental restoration
-Induce or exacerbate TMD
-Induce or exacerbate TTH (Tension type Headache)
What is the characterisitc of Tension-type headache?
-lasting 30 mins --> 7 days
-bilateral
-pressing/tightening
-mild to moderate pain
-no nausea or vomiting
-Photophobia, phonophobia
-Chronic TTH
What is describe as chronic TTH?
- > 15 days per month for > 3 month
Prevalence of headache in Orafacial pain pt is 72.7% (T/F)
True
-Prevalence of TMD in headache pop. is 56.1%
-TM is ass. with headaches
-RCT splint vs. Amitriptyline in cTTH: Both significantly reduce headache frequency and severity (T/F)
True
What are the clinical findings of Bruxism?
-History: of unusual oromandibular activity, sound when sleeping
-Tooth wear: bruxofacet, tooth sensitivity
-Tooth mobility
-Cheek or tongue indentation
-Masticatory msucle hypertrophy
-TMD symptoms: clicking/locking TMJ pain
Jaw muslce hypertrophy is directly tmperoal linked with bruxism?
-False: May have no direct temporal link with bruxism
What is Masticatory Msucle EMG?
-Protable MEG measurement system
-Bitestrip: Contain a small EMG detector-analyzer
-Grindcare: a small EMG detector-analyzer w/ biofeedback fx
What is the gold standard?
-Polysomnography
What is the Research Diagnostic Criteria for moderate-severe SB?
1. SB reported by sleep partner > 5 nights/wk
2. Tooth wear/dentine exposure/masseter hypertrophy
3. Positive polygram
What the definition of Temporomandibular disorders?
-A collective term embracing a number of clinical problems involing the
- masticatory musculature
- TMJ & ass. structures
- Both
What are the 2 types of Event?
-Local: change in sensory/ proprioceptive input
-Systemic: illness, emotional stress
What is the 1. Predisposing factors, 2. Precipitating/Initiating factors, 3. Perpetuating factors?
1. Predisposing factors: Incr. risk of TMD
2. Initiating Factors: Cause of onset of TMD
3. Perpetuating factors: Interfere w/ healing/ enhance progression of TMD
What are factors ass. with onset of TMD pain?
-Multiple pre-existing pain conditions
-Female
-Self-reported bruxism
-Depression
What is the Etiologic considerations for Bruxism?
-Occlusion / Orthopedic instability
-Trauma
-Emotional Stress
-Deep pain input
-Muscle hyperactivity
What are the activities of Masticatory system?
-Functional: Eating, speaking, swallowing
-Parafunctional: Bruxism, oral habits
Polysomnography can distinguish b/t TMD bruxers and Control Bruxers (T/F)
False: No difference in Polysomnography
Tooth wear can differetiate bruxers form non-bruxers (T/F)
False: No differentiate
Amt. of bruxism was NOT associated with more severe muscle pain (T/F)
True
Incisal tooth wear was NOT significantly associated w/ TMD (T/F)
False
Bruxism CAN be a perpetuating factor (T/F)
True
Describe EMG-activated alarms (Biofeedback)?
-1. Stop biofeedback --> Return to Pre-tx bruxism levels
-2. Alarm interfere w/ sleep
-Low level electrical stimulation of CN 5
What are example of Pharmacotherapy?
-Dopamine agonists (L-dopa)
-TCA (Amitriptyline)
-SNRI (effexor)
-SSRI
-Sedative & anxiolytic (clonazepam)
-Botox
Example of Orthopedic Appliance Therapy?
-Interocclusal splints
-Occlusal splints
-Bruxism appliances
-Night guards
-Bite guards
-Bite plane
-Orthotics
-Orthoses
What is an Orthopedic Appliance thereapy?
-Removal device fits over occlusal surfaces of teeth in 1 arch precise occlusal contact w/ opposing teeth
-Reversible & noninvasive
What is the uses of Occlusal Splints?
-Alter occlusal relationship
-Redistribute occlusal forces
-Prevent teeth wear
-Reduce bruxism & parafunctions
-TX masticatory muscle pain & dysfunction
-Alter structural relationshps in TMJ
What are types of Splints?
-Stabilization splints (Muscle relaxation Splint)
-Anteiror Positioning (Repositioning Splint/Orthopedic Repositioning Splint)
-Anteiror Bite Plane
-Posterior Bite Plane
-Pivoting Splint
-Soft Splint
When the splint is in place, what happen with the condyles?
-Condyles in musculoskeletally stable position, teeth contact evenly & simultaneously
-Canine guidance
-AIM: eliminate orthopedic instability b/t occlusal psotion & TMJ position
What is the Advantages of Maxillary Stabilization splint?
-Cover more tissue = more stable, retentive, and less likely to break
-Easier to achieve occlusion in Class II or III
-Lower teeth contact on flat surface = more stable
-Easier to locate CR position
What is the Advantages of Mandibular Stabilization splint?
-Aesthetics
What is the criteria for Stabilizaiton splint?
-Good fit, stable, retentive
-In CR. mandibular buccal cups contact flat surface
-Protrusive and lateraltrusive on canine
-Mandibular posterior teeth contact splint only in CR
-Upright position
-Splint occlusal surface is flat
-Splint polished
What are three dental reasons why splint therapy decrease TMD symptoms?
-Alteration of occlusal condition
-Alteration of condylar position
-Increase in vertical dimension
Overall effect of a splint =
-Physical action of the splint + Psychological context in which it is given
What possible TX for painless bruxer w/o TMJ?
-Soft splint
-Stabilization splint