MANIFESTATION OF SLEEP BRUXISM ACCORDING TO THE AGE OF PATIENTS
Original Article aged over 35. According to the multifactorial pain test developed by the authors, the smallest values in healthy individuals have the following scales: scale I – arthrogenic factor( 0.10 ± 0.05), autonomous factor, scale IV( 0.10 ± 0.15), circadian factor, scale VI( 0.10 ± 0.05) and the pain duration factor, scale VIII( 0.10 ± 0.05). In healthy individuals, the highest values are presented by the myogenous factor – scale II( 0.27 ± 0.26) and the by the psychoemotional factor – scale V( 0.28 ± 0.06). Scale III( locoregional irradiation factor) and VII( pain intensity factor) have an intermediate position, due to their degree of expression( 0.13 ± 0.06). The components of the algic syndrome in patients with SB aged under 35 showed a pronounced expression for the following factors( in a decreasing order): myogenous( 1.14 ± 0.12), circadian( 0.99 ± 0.11), psychoemotional( 0.92 ± 0.11), pain duration( 0.58 ± 0.08); a moderate expression for the following factors: pain intensity( 0.58 ± 0.08), arthrogenic( 0.33 ± 0.06); poor expression for the following factors: autonomous( 0.18 ± 0.03), loco-regional irradiation( 0.16 ± 0.05). For the patients aged 35 years or older, the expression of the algic syndrome was characterized by pronounced psychoemotional manifestations( 0.83 ± 0.13), circadian( 0.82 ± 0.12), myogenous( 0.71 ± 0.13), a longer duration( 0.66 ± 0.11) and arthrogenic manifestations( 0.65 ± 0.11); moderate for pain intensity( 0.32 ± 0.02); poor expression for pain irradiation( 0.18 ± 0.04) and autonomous manifestations( 0.16 ± 0.05). The analysis of the masseter muscle thickness was conducted based on the gender of the patients, because it was established that the differences of these indices are statistically significant between men and women [ 18,19 ]. During the state of relaxation, the masseter muscle thickness was 9.75 ± 0.27 mm for women under 35 and of 9.82 ± 0.26 mm for older women( p > 0.05). During jaw clenching, the values of masseter thickness were: 13.12 ± 0.29 mm for younger women(< 35 years, n = 50), and for the ones over 35( n = 18) – 14.75 ± 0.28 mm( p < 0.001). With aging, the increase of the masseter muscle thickness was also evident. In men, during relaxation, the thickness of the masseter muscle was 10.71 ± 0.23 mm at the age of under 35( n = 20) and of 11.45 ± 0.22 mm – over 35( n = 12, p < 0.05); during jaw clenching, the thickness of the muscle was of 14.52 ± 0.24 mm for individuals under 35 and of 16.21 ± 0.28 mm for patients over 35( p < 0.001). As it may be observed from Table 2, the thickness gradient( relaxation-engagement) had a higher statistical significance in patients with SB, which are over 35.
4. Discussion According to the proposed objectives, we have studied the clinical peculiarities of SB, according to the age of the patients – under 35 and older. This division was made based on multiple literature data that reflects that the period of 35-40 years of age is the one where the prevalence of bruxism shows a considerable reduction [ 12 ]. Taking into account the fact that increased stress
Figure 1. Bruxism-associated pain intensity in patients with primary sleep bruxism, according to the age of the patients. Note: the scales( factors) of the bruxism-associated pain: I – arthrogenic; II – myogenous; III – loco-regional irradiation; IV – autonomous; V – psychoemotional; VI – circadian; VII – pain intensity; VIII – pain duration; statistical significant differences between sleep bruxism patients under 35 vs. patients over 35(*- p < 0.05, **- p < 0.01). Blue dots – Sleep bruxism patients, under 35; Red dots – Sleep bruxism patients, over 35; Green line – Healthy subjects.
activity contributes to the occurrence of many SB disorders [ 26 ] and that people with SB have a much higher level of stress-sensitivity [ 27 ], we have analyzed the level of emotional stress( VAS) and the professions of the patients, according to the stress level. We have observed that the level of emotional stress is an important index that is fundamentally different in healthy people and in patients with SB, but this index does not reflect the differences regarding the age of the investigated subjects, and some tendencies of increased stress levels in younger individuals can be observed. With aging, there is an increase in the quantitative and qualitative sleep disruptions. The interpretation of these data is difficult due to the fact that, as it has been established that in healthy people, there are significant changes in the sleep quality associated with aging, especially after the age of 30-35 – a longer period of time is needed to get asleep, sleep is far more fragmented, with more frequent awakening episodes, the duration is shorter. These features are particularly greatly increased in patients with SB. Pain in the masticatory muscles and in the temporomandibular joint is one of the main causes of dental visits [ 29 ]. For these reasons, a more precise clinical diagnosis of the algic syndrome will contribute to more effective monitoring and treatment. The phenomenon of tongue ulcerations can be partially explained by the fact that the pressure exerted by the bruxer’ s tongue towards the teeth is much higher compared to the one found in non-bruxers [ 28 ]. It has been established that the bioelectric activity of the masticatory muscles may be associated with muscle pain but may also present as a disorder that is independent of the presence of pain and its intensity [ 29 ]. The relationship between pain and sleep bruxism is still a matter of controversy, especially in regard to whether a painful condition may affect the EMG activity during sleep [ 2 ]. Due to a massive nociceptive affinity from the structures of the stomatognathic
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Stoma Edu J. 2018; 5( 1): 31-37 http:// www. stomaeduj. com