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