Bruxism is a psychopathophysiological disorder of orofacial muscle activity which is defined by American Academy of Orofacial Pain as "a diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth".1 The excessive and frequent nocturnal bruxist activity, unlike physiological muscular activity during sleep, results in non-physiological wear (attrition) of occlusal surfaces.2,3
In multifactorial and often controversial bruxism etiology, peripheral (morphological) and central (physchological and pathophysiological) etiological factors can be distinguished.4 The most common morphological factors, such as occlusion (in particular occlusal discrepancies), along with the anatomy of the orofacial system have been considered more traditional than evidence based medicine and dentistry bruxism causative factors.4,5
Bruxism is related to a great number of pathophysiological factors. During sleep, sudden awakening or a change in intensity of sleep may occur. That is "arousal response". Then, a generalized change of body activity occurs: higher heart rate, changes in breathing rhythm, peripheral vasoconstriction and muscular hyperactivity, including bruxism.6 Changes of the central neurotransmitter system in the nigrostriatal projection can cause the muscular activity disorders. Drug therapy can also induce bruxism: L-dopa, neuroleptics and serotonin reuptake inhibitors (SSRI). Numerous substances such as amphetamines, amphetamine-like substances, nicotine and alcohol can play a major role in the etiology of bruxism, which has been particularly explained by effects via dopamine system.7
Behavioral disorders and affective psychological factors, anxiety being one of the most prominent together with emotional stress, caused by sociological and psychological factors, can induce bruxism.8
Dentistry and alcohol consuming
Alcoholism is a progressive mental disease with social and health consequences. The addiction to alcohol is more difficult to observe in early stages of alcoholism due to some traditional reasons related to alcohol consuming, which can have adverse side effects in dental treatment. Alcohol consumption leads to a great number of systemic disorders, such as malnutrition and hypovitaminosis, neurological disorders, pathological changes in the digestive, cardiovascular and respiratory system.9,10
Besides the poor oral hygiene, consumption of alcohol may cause oral diseases, periodontal diseases and premature tooth loss. Alcoholics are exposed to a higher risk of orofacial trauma (for example, jaw fractures), fractures and even losing the removable dentures while under the influence of alcohol.11
The aim of this paper is to give a case report on Michigan splint treatment of a very severe bruxism in a female patient who was under psychiatric therapy due to alcohol consuming, which caused a psychoorganic syndrome.
A previously treated 62 year old psychiatric female patient was referred to the Prosthodontic Department, School of Dental Medicine, University of Zagreb for prosthodontic treatment. She exhibited a pronounced teeth abrasion.
Taking her case history with the assistance of her son and from the available medical records of her previous psychiatric treatments, we found out that she had been an alcoholic for many years (F 10.2 diagnosis by the International Classification of Diseases - ICD) and subsequently developed a pyschoorganic syndrome with characteristics of depression (F 10.7 diagnosis by the ICD). Although she has had the alcohol addiction problem for many years, her psychiatric treatment started in 2001. She was hospitalized for three months at the alcoholism ward and discharged in better health condition with recommendation to take 20 mg of fluoxetine in the morning and 3x5 mg of diazepam. In the same year, she was coming regularly for a check-up in the Psychiatric patient clinic accompanied by her son who reported her abstinence from alcohol, but also less communication and more passiveness in behavior. …