Bruksizm: Etiyoloji, Tanı, Tedavi
Özet
Bruksizm, uyku esnasında ya da uyanıkken ortaya çıkan, diş gıcırdatma ve sıkma ile karakterize, istem dışı parafonksiyonel bir çene kası hareketidir. Genç nüfusta daha sık rastlanan bu rahatsızlığın prevalansı, uyanıklık bruksizminde yaklaşık %20, uyku bruksizminde ise %8-16 düzeyindedir. Etiyolojisi kesinleşmemekle birlikte stres, anksiyete, merkezi sinir sistemi faktörleri, genetik ve D vitamini eksikliği gibi çoklu faktörlerin etkili olduğu düşünülmektedir. Klinik muayenelerde dental aşınmalar, masseter kas hipertrofisi ve eklem ağrıları en belirgin semptomlar arasında yer alır. Teşhis aşamasında anketler, klinik bulguların değerlendirilmesi, intraoral cihazlar ve elektromiyografi (EMG) kullanılırken, en spesifik ve kesin tanı yöntemi uyku laboratuvarlarında gerçekleştirilen polisomnografidir. Tedavi süreci hastaya özgü ve multidisipliner bir yaklaşımla planlanır. Günümüzde rahatsızlığı tamamen ortadan kaldıracak spesifik bir tedavi bulunmasa da semptomları hafifletmek, dental aşınmaları önlemek ve çene eklemini korumak amacıyla oklüzal apareyler (gece plakları) sıklıkla tercih edilmektedir. Ayrıca miyofasiyal ağrıları azaltmak için fizik tedavi teknikleri, stres yönetimi, uyku hijyeninin artırılması ve ileri vakalarda motor aktiviteleri ile ağrıyı azaltan botulinum toksini (botoks) uygulamaları gibi farmakolojik yöntemlerden yararlanılmaktadır.
Bruxism is defined as an involuntary parafunctional jaw muscle movement characterized by tooth grinding and/or clenching that can occur during sleep or wakefulness. More common in the younger population, the prevalence rates in the adult population are approximately 20% for awake bruxism and 8-16% for sleep bruxism. Although its etiology remains definitive, it is considered to be associated with multifactorial causes such as stress, anxiety, central nervous system factors, and vitamin D deficiency. In clinical examinations, abnormal dental wear, masseter muscle hypertrophy, and temporomandibular joint pain are among the most prominent symptoms. For diagnosis, questionnaires, clinical findings, intraoral devices, and electromyography (EMG) are utilized, whereas polysomnography conducted in a sleep laboratory is currently accepted as the most specific and definitive method. The treatment process varies depending on the etiology and symptoms, requiring a multidisciplinary approach. While there is currently no specific cure to completely stop bruxism, occlusal appliances are highly recommended to distribute masticatory forces, reduce symptoms, and prevent dental attrition. Furthermore, physical therapy techniques to relieve muscle pain, stress reduction, improving sleep hygiene, and pharmacological interventions such as botulinum toxin infiltrations to reduce jaw contraction frequency and pain levels are effectively utilized.
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