Exercise Clinical Trial
Official title:
Assessment The Effects of Proprioceptive Neuromuscular Facilitation, Myofascial Releasing Maneuvers and Home Exercises on Pain and Jaw Function in Patients With Bruxism
This study was planned to evaluate the effects of proprioceptive neuromuscular facilitation, myofascial releasing maneuvers and home exercises on pain and jaw function in patients with bruxism aged 16-50 years .
Bruxism is different from temporomandibular joint disease because of long periods of muscle
contraction. It is considered an eloquent contributory factor in the etiology of
temporomandibular disorders (TMD). The incidence of bruxism is estimated to be approximately
between 5% and 10% of the adult population. Especially long term contraction of masseter,
temporalis and medial pterygoid muscle cause restriction of opening mouth, problem of closing
the jaw, problems of chewing, articulation, movement of tongue. Bruxism is common illness
which is seen with in mood disorders such as anxiety and depression. According to Orofacial
Pain Guidelines, Bruxism is a diurnal or nocturnal parafunctional activity including
clenching, bracing, grinding and gnashing of the teeth. An oral habit consisting of
involuntary rhythmic or spasmodic nonfunctional horizontally and vertically gnashing,
grinding or clenching of teeth, in other than chewing movements of the mandible, this may
bring about occlusal trauma.
The factors involving anatomical- morphological, psychophysiological, pathophysiological
factors and other cause diurnal or nocturnal bruxism. Researchers say that genetics account
for 30 to 50 percent of bruxism with nocturnal or diurnal and behaviour, environmental
account for the remainder. Dental malocclusion, anatomical- morphological differences,
anomalies of the oro-facial region (condyles height asymmetry, hypognathism, larger cranial,
bizygomatic width, rectangular form of dental arch of maxilla, rectangular morphology of
face) psychophysiological reasons including stress in which result from emotional, physical,
psychosocial stimulation, anxiety, depression, psychosomatic disorders, personality disorders
such as hyperactivity, hysteria, aggressiveness, tendency of perfectionist affect oral
function and cause bruxism . Sleep disturbances known as especially sleep apnea, behaviour
disorder during REM ( rapid eye movement) and Non-REM (non- rapid eye movement) sleep
stimulate of nocturnal bruxism. Consume of drug such as antidepressants (SSRI) have
suppression and stimulate effects on patients seen. Vulnerable disorders of central
dopaminergic neurotransmission, hemifacial spasm, stroke brain haemorrhage, Huntington
chorea, Parkinson disease give rise to bruxism. While the acute use of L- dopa drugs inhibits
bruxism activity, the chronic use of L- dopa in patients with Parkinson lead to bruxism. This
situation is same effect with antiepileptic drugs. According to some criteria bruxism may be
categorized by when it appears awake bruxism which is presented when the person is awake,
sleep bruxism which is presented when the person is sleep and combined bruxism which is
presented when seen two situations . By etiology researcher classified with primary or
idiopathic bruxism which no apparent cause is known. Secondary bruxism occurs with diseases
(coma, ictus, cerebral palsy), medicinal products (e.g. antipsychotic medication), drugs
(such as amphetamines, ecstasy). Bruxism classified motor activity type of tonic, phasic,
combined and by current or past presence such as past bruxism, current or present bruxism.
Sleep bruxism major seen during REM and Non- REM sleep and is the most common type of bruxism
than others. Its incidence has been the highest in childhood (vitally 14%) and decreases from
about 8% in younger adults to almost 3% in elderly people called negative correlation . In
awake bruxism is an involuntary activity of the jaw muscles that is characterized, by jaw
clenching, by tooth gnashing and/or grinding. During sleep bruxism, both clenching and tooth
grinding are observed. Sleep bruxism can lead to tooth destruction, temporomandibular pain
and crepitation, headaches and grinding sounds . A lot of patients are complain of jaw
tightness and grinding sounds daily or nightly, while others said these infrequently. In
cases of severe and frequent sleep bruxism, the variation of the number of episodes per hour
of sleep is 25%, and the variation of tooth-grinding frequency is 53.5%. Symptoms of bruxism
are abnormal tooth wear, teeth gliding or clenching, sounds because of clenching and gliding,
gingival inflammation, headache, ocular pain, limited opening of mouth, decrease of salivary
flow, erythema, photosensitivity, tinnitus, ear plugging sensation, temporomandibular pain
(TMP), destruction and click sounds. When overtime in patients have chronic bruxism will
bring about hypertrophy of masseter and temporal muscles. Therefore, patients facial
appearance seems either too square or too masculine. One of the general symptoms are jaw
clicking, when opening of mouth; oral muscle deviation to one side, pain in cheek muscles,
uncontrollable movement of jaw. Effects of bruxism on throat are swallowing difficulties,
voice irregularities, frequence coughing, feeling of foreign things in throat. In addition it
causes neck problems such as pain of the shoulders and ache of back, lack of mobility,
stiffness, pain of neck. Facial changing are seen patients with bruxism skin and facial
muscles atrophy due to not using, vermilion thighs, dropping corners of mouth., Treatment of
bruxism includes botulinum toxin, using occlusal splint, perioral rejuvenation and an
antidepressant drugs. Our study shows that self-care, Proprioceptive neuromuscular
facilitation exercise, myofascial thingness and home exercise including facial muscle
stimulation for weight transform between bilateral side. Mainly self-care is more important
than others. Therefore, we informed patients about causes, etiology, triggered effects,
prevalence, incidence of bruxism, normal treatment of bruxism and our treatment stages and
goals. It includes that patients are aware of bruxism. When the patients who have bruxism
diagnosis, feel pain on face muscle, they need to use ice on jaw muscle. In addition they
avoid eating rigid, hard stick, candy and nuts. Also, they avoid chewing gum and elastic
rating, avert jaw movement forward. They should sleep the least 8 hours and need to learn
stretching exercise to restore of the facial muscle and joints. In addition flexibility and
stretching training of orbicularis oris and oculi, extensor muscle stabilization exercises
are used for bruxism treatment. Main purpose of this study is to evaluate of the effects of
proprioceptive neuromuscular facilitation , myofascial releasing maneuvers and home exercises
on temporomandibular joint pain and jaw function in patients with bruxism.
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