HJAR Sep/Oct 2023

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2023 59 Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas York Times. June 9, 2021. https://www.nytimes . com/2021/05/19/magazine/the-pandemic-was- bad-for-our-teeth-will-it-change-oral-health- forever.html 7 Sutin, A.R.; Terracciano, A.; Ferrucci, L.; Costa, Jr., P.T. “Teeth Grinding: Is Emotional Stability related to Bruxism?” Journal of Research in Perssonal- ity 44, no. 3 (June 2010): 402-405. doi: 10.1016/j. jrp.2010.03.006 8 Mozhdeh, M.; Caroccia, F.; Moscagiuri, F.; et al. “Evaluation of Knowledge among Dentists on Symptoms and Treatments of Temporoman- dibular Disorders in Italy.” Internatioanl Journal of Environmental Research and Public Health 17, no. 23 (Nov. 25, 2020): 8760. doi: 10.3390/ ijerph17238760 9 Ferneini, E. M. “Temporomandibular Joint Dis- orders (TMD).” Journal of Oral and Maxillofacial Surgery 79, issue 10 (October 2021): 2171-2172. doi: https://doi.org/10.1016/j.joms.2021.07.008 10 Alrizqi, A.H.; Aleissa, B.M. “Prevalence of Tem- poromandibular Disorders Between 2015-2021: A Literature Review.” Cureus 15, no. 4 (April 2, 2023): e37028. doi: 10.7759/cureus.37028 11 Lipsky, M.S.; Su, S.; Crespo, C.J.; Hung, M. “Men and Oral Health: A Review of Sex and Gender Dif- ferences.” American Journal of Men’s Health 15, no. 3. (May-June 2021):15579883211016361. doi: 10.1177/15579883211016361 12 Sajjanhar, I.; Goel, A.; Tikku, A.P.; Chandra, A. “Odontogenic pain of non-odontogenic origin: A review.” International Journal of Applied Dental Sciences 3, no. 3 (2017). https://www.oraljournal . com/pdf/2017/vol3issue3/PartA/3-2-37-236.pdf 13 Thayer, M.L.T.; Ali, R. “The dental demolition derby: bruxism and its impact - part 2: early man- agement of bruxism.” British Dental Journal 232 (May 27, 2022): 703-710. https://doi.org/10.1038/ s41415-022-4249-z 14 Thayer, M.L.T.; Ali, R. “The dental demolition derby: bruxism and its impact - part 3: repair and reconstruction.” British Dental Journal 232 (June 10, 2022): 775-782. https://doi.org/10.1038/ s41415-022-4293-8 15 Garrett, A.R.; Hawley, J.S. “SSRI-associ- ated bruxism: A systematic review of pub- lished case reports.” Neurology. Clinical Prac- tice 8, no. 2 (April 2018):135-141. doi: 10.1212/ CPJ.0000000000000433 16 Fricton, J. “How SSRIs can Trigger Teeth Grind- ing and Bruxism.” Head & Neck Pain Clinic. March 31, 2023. https://mhnpc.com/2023/03/31/ssris- and-teeth-grinding-can-trigger-bruxism/ 17 Bond, E.C.; Mackey, S.; English, R.; et al (editors). Temporomandibular Disorders: Priorities for Re- search and Care. (Washington, D.C.: The National Academies Press, U.S, March 12, 2020) https:// www.ncbi.nlm.nih.gov/books/NBK557986/ 18 Al-Groosh, D.H.; Abid, M.; Saleh, A.K. “The re- lationship between orthodontic treatment and temporomandibular disorders: A dental special- ists' perspective.” Dental Press Journal of Ortho- dontics 27, no. 1 (April 11, 2022): e2220406. doi: 10.1590/2177-6709.27.1.e2220406.oar 19 Warburton, G. “Internal Derangements of the Temporomandibular Joint.” Oral and Maxil- lofacial Surgery for the Clinician (Singapore: Springer, Feb. 15, 2021): 1361-1380. https://doi. org/10.1007/978-981-15-1346-6_63 but there is no guarantee that this will help or hinder TMD. 18 Restorative intervention can be ex- tremely difficult as in the case of a heavy bruxer. After the dentition has been recon- structed, an occlusal appliance is required to protect the teeth. With an anatomical is- sue, such as internal derangement of the jaw, surgery is the last option but is sometimes required. A type of internal derangement is a displacement of the disc, which can pre- cipitate intermittent locking or restriction of motion of the jaws. 19 The key is early inter- vention before the disc becomes damaged to the point of surgical repair or replacement. There are numerous medical conditions and diseases that are associated with brux- ism. ADHD, autism, cerebral palsy, depres- sion, down syndrome, obsessive-compul- sive disorder, and Parkinson’s disease can all have an associated bruxism habit that may present. There are numerous associations between oral health and overall health, and treating TMD is no exception. Managing this complex condition separately or indepen- dently without considering both oral health and overall health is not possible. n REFERENCES 1 Morris, A.; Grabowski, P.; Al Talib, T.; and Abubakr, N.H. (2023) “Retrospective Analysis of the Cor- relation between TMD, Headache and Bruxism.” Open Journal of Stomatology 13, no. 4 (April 2023): 125-133. doi: 10.4236/ojst.2023.134010 2 Lomas, J.; Gurgenci, T.; Jackson, C.; Campbell, D. “Temporomandibular dysfunction.” Australian Journal of General Practice 47, no. 4 (April 2018): 212-215. doi: 10.31128/AFP-10-17-4375 3 Hazra, R.; Srivastava, A.; Kumar, D.; Khattak, A. “Current trends in temporomandibular disorder management: A prosthodontist's perspective.” Journal of Dentistry Defence Section 16, no. 2 (July-December 2022): 146-150. doi: 10.4103/ jodd.jodd_8_21 4 Cleveland Clinic. “Temporomandibular Joint (TMJ) Disorders.” Last reviewed May 15, 2023. https://my.clevelandclinic.org/health/ diseases/15066-temporomandibular-disorders- tmd-overview 5 Mayo Clinic. “TMJ disorders.” Dec. 28, 2028. https://www.mayoclinic.org/diseases-conditions/ tmj/symptoms-causes/syc-20350941 6 Tingley, K. “The Pandemic Was Bad for Our Teeth. Will it Change Oral Health Forever?” New more damage it can do to the dentition and irritate the jaw, inducing pain. Once identi- fied, discontinuation or use of another phar- macologic agent is appropriate to maintain the healthy status of the oral cavity and joint. There are, however, some specific types of tricyclic anti-depressants and muscle relax- ers, such as methocarbamol, that are con- sidered to have therapeutic effects related to TMD-relatedmuscle clenching. 16 Finding the right drug is essential but can be challenging. Other combinations of clenching of the muscles and bruxing can trigger headaches. The key is recognizing the association of what comes first followed by outcomes. There are numerous triggers for people, and they are individualized as in “one does not fit all.”Thus, the account of historical informa- tion is most important in what the patient communicates. Assisting the patient in be- coming aware of clenching or bruxing their teeth during the day is much easier than knowing bruxing is occurring nocturnally. Therapy and intervention come in two forms. These are preventive and restorative. The goal is to prevent damage and protect the patient and dentition without doing harm, or “primumnon nocere.” 13 Preventive measures are varied and include being on a soft diet for a period of time to reduce muscle activ- ity, changing medications, behavior modifi- cations, physical therapy, massage therapy, and protecting teeth with oral appliances. Oral appliance therapy is designed on a case-by-case basis. Sometimes it is for pro- tection of dentition, while other appliances may need to open the bite to a comfortable position or reposition the jaws. Orthodon- tics can be both preventative or restorative, depending on the severity if a malocclusion is identified as being an issue. Research has declared that orthodontic repositioning of teeth does not prevent TMD. 17 However malocclusion can be corrected orthodon- tically to allow better function of the teeth,