第8章 磨牙症（双语）

nullnull磨 牙 症 (Bruxism)磨 牙 症 (Bruxism)null磨牙症（Bruxism）null磨牙症(Bruxism) “To grind the teeth, a clenching of the teeth, associated with forceful jaw movements, resulting in rubbing, gritting, or grinding together of the teeth, usually during sleep.” null 人在非生理功能状态下咀嚼肌产生不自主的收缩,使上下颌牙产生彼此磨动或紧咬,使下颌生理休息位中断的现象,属副功能运动(Parafunction)。null分 类时间:白天磨牙 夜磨牙牙齿接触类型:紧咬牙---正中磨牙症 磨动牙齿---非正中磨牙症发生率9.78%~30.7% 青少年多见 Approximately 50% to 96% of adults experience bruxism 15% of children acquire this behavior. 上海市儿童患病率38.4% (陈玉琴，2004）nullHigher rates in patients with mental retardation and OSA Self reporting underestimates prevalence Asking bed partner is a more reliable indicator Most accurate estimate of bruxism is elicited from the direct dental examination Prevalence increases to 10 - 20 % of the general examination ( Dental literature ) M = F, some reports: F > M Familial pattern null第一节 磨牙症的病因null1. 牙合因素 2. 精神、神经因素 3. 咀嚼系统的神经肌肉功能紊乱 4. 内分泌与药物因素 5. 遗传因素 6. 局部刺激因素 7. 磨牙症与牙周炎 8. 其他病 因null1.牙合因素牙合干扰:RCP与ICP间牙合干扰 非工作侧牙合干扰 早接触 长期缺牙 不良修复体 单侧咀嚼 其他null咬合紊乱异常刺激机 制CNS阈值↓肌张力↑下颌运动↑磨牙null2. 精神神经因素精神紧张牙合紊乱咀嚼肌紧张磨牙症TMJ损害牙体组织磨损 牙周组织创伤+Bruxims as a Marker for Psychological DisordersBruxims as a Marker for Psychological DisordersCommon in Patients with Psychological Stress “Type A” Personality Difficulties handling emotions, especially anger / stress Aggressive, controlling, obsessive Driving Lifestyle Introverted Hostile Stress is a huge factor when it comes to bruxing. In fact the mouth can show stress before any other area of the body. The more stress, the more bruxing and the harder the bruxing. Bruxism is a “release phenomenon” of emotional stressnullnull夜磨牙患者快速动眼睡眠期比非磨牙患者多 散在发生于各个睡眠阶段 与睡觉姿势有一定关系 （张雪峰等.夜磨牙患者的多导睡眠监测研究.口腔颌面修复学杂志,2007；7（1）：58-61)null3.咀嚼系统的神经肌肉功能紊乱升颌肌esp. 咬肌功能亢进紧咬牙或磨牙关节内压力增加非正中磨动紧咬牙null4.内分泌与药物:肾上腺素、多巴胺 Involvement of the dopamine pathways 5.遗传：常染色体显性遗传 Monozygotic Twins (23%) 6.局部刺激：局部机械、理化刺激 7.牙周炎 8.其他：变态反应等 中医：心胃火盛、痰浊上扰或风邪客于牙床筋脉之间 null结 论 牙合干扰密切相关 精神、神经因素有关 牙合干扰与精神因素有协同作用 咀嚼系统神经肌肉功能紊乱是关键null第二节 磨牙症的临床表现及危害性null一、磨牙症的临床表现症 状:磨牙 grinding Daytime Bruxism is usually semi / voluntary 紧咬牙 口腔相关组织损伤:牙体 牙周 颌面肌 Tooth wear & fracture Tooth structure breakdown Damaged teeth Locking / clicking of jaws ( TMJ ) Tooth mobility Change in facial morphology 其他 null体 征:牙齿磨耗面超过功能范围 前牙:覆牙合丧失 后牙:牙尖锐利 磨耗不均匀 牙本质暴露、牙髓症状 紧咬牙:杯状咬合面 牙体牙列---颌面部肌肉---咬肌发达 咬肌、颞肌、翼内肌压痛TMJ---TMD头痛等nullEnamel DestructionTooth Decaynull牙体组织损伤null前后牙磨耗面nullnull磨牙造成的牙颈部缺损null 二、磨牙症的危害性牙体组织---不均匀磨耗 牙本质过敏 垂直距离下降牙周组织---牙周创伤 牙周炎症 牙槽骨增生颌面肌---咀嚼肌过分疲劳 肌痛及触压痛 颈背肌肉痛颈背部肌肉平衡作用null垂直距离降低（mid-face collapse syndrome)Important in children as it may lead to gross maxillofacial malformationsnull磨牙症导致的舌侧牙槽骨增生null磨牙症与TMD ---咀嚼肌功能亢进 咀嚼肌功能紊乱 关节间隙减小、压力增大 前牙覆牙合消失 （李雪铃，林雪峰.磨牙症与颞下颌关节紊乱病关系的研究.国际口腔医学杂志,2007；34（1）：59－61） 咀嚼系统破坏的弱链理论（Mehta)牙合力牙----牙周组织----咀嚼肌----TMJnull第三节 磨牙症的诊断及治疗null一、磨牙症的诊断主诉：磨牙 牙髓牙周症状 肌肉痛 TMD病史：磨牙史 紧咬牙史 不良修复史等查体：精神紧张 牙齿非功能性磨损 牙体牙周损害 牙槽骨增生 肌肉触诊nullViolent repetitive grinding of the teeth Frequency: 1 / sec Associated with a loud unpleasant sound which may result in an arousal May occur during all stages of sleep: Especially Stage II, REMnull磨牙症问诊试卷null辅助诊断：上下牙接触记录：时间比正常人多 牙合力比最大紧咬大 颌面部EMG：咬肌、颞肌电位高 肌电幅值大 大脑皮质EEG：慢波睡眠少 大脑皮质电活动增加 TMDnullBiteStripnullcomparable to a sleep lab brux count 0 - no bruxism: 39 over 5 hours 1 - mild: 40 and 74 over 5 hours 2 - moderate: 75 and 124 over 5 hours 3 - severe: 125 over 5 hours E - error in study null分级：轻度---3~5 中度---6~10 重度---11以上1.牙存在磨损小面 2.近6个月听见夜磨牙 3.白天紧咬牙 4.白天肌紧张和僵硬 5.醒来肌紧张和僵硬 6.睡眠时因磨牙或紧咬牙苏醒 7.咬肌或颞肌肥厚 8.醒来咬肌疲劳9.白天咬肌疲劳 10.夜间或清晨关节锁结 11.醒来颈背疼痛 12.醒来咬肌、颞肌疼痛 13.醒来疲劳、睡眠不佳 14.醒来牙痛不适 15.近来修复体缓慢松动null二、磨牙症的治疗null对因---消除紧张 消除异常咬合 降低咀嚼肌张力及活动 对症---降低咀嚼肌张力及活动 防止牙齿磨损原 则：null方 法：1.咬合板:神经-肌肉反射控制作用稳定咬合板:6个月 松弛咬合板:降低升颌肌紧张度 弹性咬合板 尖牙高牙合型咬合板:16岁以上患者nullnull稳定咬合板null松弛咬合板nullNTI clenching suppression systemnull软弹性咬合板null2.调牙合:牙合因素为病因者 3.肌松弛:理疗、局部封闭 4.行为治疗： Visual imagery Relaxation tapes before going to sleep Deep breathing exercise 5.药物治疗： INTENDED FOR SHORT TERM USE ONLY Benzodiazepines（苯并二氮） β - Adrenergic Antagonists Botulinum Toxin-A (BTX-A)（肉毒菌毒素－A） 6.其他:牙周治疗、针灸nullBiofeedback Appliance Uses audio signal May disturb sleep of bed partner Biofeedback：通常以听觉或视觉方式，给个体一个或多个有关生理学变量(如心跳、血压或皮肤温度)的信息，并使个体对所选定的生理学变量得到某些自主控制的过程。Head-band: Brux Care LLC RnullWakeful EMG Feedback: Attach to skin in close proximity to involved muscleInformation about EMG activity is fed to a computer monitorPatient is asked to consciously lower the level of EMG activity below a “threshold line” that is visible on a computer screenReduce tension à reduce bruxismnullsound alarm setup A typical sound alarm setup for bruxism Use a strain gauge between teeth When pressure exceeds a predetermined Level —Alarm is activatedProblem: HabituationnullLiquid - filled bilaterally sleeved capsuleDental appliance equipped with rods to which a capsule can be attached Capsule is filled with capsaicinoids / salt, etc Capsule ruptures during bruxingnull冠延长术 冠修复 夹板null