Melike GÜLEÇ, Melek TAŞSÖKER, Sevgi Özcan ŞENER

Bruksizmin tanı ve tedavisinde güncel yaklaşımlar

Bruksizm, çiğneme ve öğütme gibi fonksiyonel bir amaç olmaksızın dişlerde gerçekleştirilen sıkma ve/veya gıcırdatma hareketinin adıdır. Etiyolojide genel olarak morfolojik, psikolojik ve parafonksiyonel faktörler suçlanmaktadır. Ancak subjektif olması yönüyle bruksizm tanısında dünya genelinde kabul görmüş ortak bir görüş bulunmamaktadır. Bruksizm uyku esnasında veya uyanıkken gerçekleşebilir. Uyku bruksizmi cinsiyete bağlı farklılık göstermezken, uyanıkken gerçekleşen bruksizm daha çok kadınlarda görülmektedir. Bruksizm, dişlerde fraktür ve aşınmalar, periodontal dokularda destek kaybı ve mobilite, çiğneme sisteminde ve orofasial bölgede ağrı ile temporomandibular eklem disfonksiyonu gibi problemlere yol açabilmektedir. Bruksizm tanısında temel olarak beş yöntem uygulanmaktadır. Bunlar; anket yöntemi, klinik gözlem, ağız içi apareyleri, çiğneme kaslarının elektromyografik analizi, polisomnografi (PSG)’dir. Bu yöntemlerin içinde PSG ile değerlendirme gold standart olarak kabul edilmesine rağmen belirli limitasyonları bulunmaktadır. Klinik gözlemde temel olarak diş aşınmaları ve yumuşak dokuda görülen değişiklikler izlenmektedir. Diş aşınmaları oluşumuna etki eden faktörlere göre abfraksiyon, atrizyon, korozyon ve abrazyon olarak adlandırılmaktadır. Aşınma derecesi fazla olan, dişin spesifik fonksiyonunu yapamadığı, ağrı ve hassasiyete sebep olduğu ve diş dokusundaki kaybın restorasyon gerektirecek seviyeye geldiği durumlar patolojik diş aşınması olarak adlandırılır. Bruksizmin etiyolojisindeki farklılıklar tedavilerinde de farklı yaklaşımlar gerektirir. Günümüzde bruksizm tedavi yaklaşımları; kişiye yönelik yaklaşımlar (bilişsel-davranışsal terapi), farmakolojik yaklaşımlar ve oklüzal yaklaşımlar olarak özetlenebilir. Bu çalışmanın amacı, bruksizmin güncel tanı ve tedavi prensiplerini sunmaktır.

Anahtar Kelimeler:

Bruksizm, etiyoloji

Current concepts of diagnosis and treatment of bruxism

Bruxism is the name of the action of clenching and/or grinding performed on teeth without a functional purpose such as chewing and grinding. In etiology, morphological, psychological and parafunctional factors are generally accused. However, due to its subjective nature, there is no universally recognized common opinion in the diagnosis of bruxism. Bruxism can occur during sleep or while awake. Sleep bruxism does not vary depending on sex but awake bruxism is seen mostly in women. Bruxism can cause problems such as wear and fractures in teeth, loss of periodontal support and mobility, pain in the masticatory system and orofacial region, and temporomandibular joint dysfunction. There are basically five methods for bruxism diagnosis. These are questionnaire method, clinical observation, intraoral appliances, electromyographic analysis of masticator muscles and polysomnographic evaluation (PSG). Although PSG evaluation is accepted as the gold standard among these methods, it has some limitations. Clinical observation is mainly based on tooth wear and changes in soft tissues. Abfraction, attrition, corrosion and abrasion are named according to the factors affecting the formation of tooth wear. Conditions where the degree of wear is high, the tooth is unable to perform its specific function, the cause of pain and sensitivity, and the level of loss of tooth tissue that requires restoration is called pathological tooth wear. Differences in the etiology of bruxism require different approaches on treatment. Current bruxism treatment approaches are personal approaches (cognitive-behavioral therapy), pharmacological approaches and occlusal approaches. The aim of this study is to present current diagnosis and treatment principles of bruxism.

Keywords:

Bruxism, etiology,

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