Bruxism/teeth grinding

Bruxism/teeth grinding

Definition:
Bruxism (BRUK-siz-um) is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth together during the day or grind them at night, which is called sleep bruxism.
Bruxism may be mild and may not even require treatment. However, it can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems. Because you may have sleep bruxism and be unaware of it until complications develop, it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Symptoms:
Signs and symptoms of bruxism may include:

• Teeth grinding or clenching, which may be loud enough to awaken your sleep partner
• Teeth that are worn down, flattened, fractured or chipped
• Worn tooth enamel, exposing deeper layers of your tooth
• Increased tooth sensitivity
• Jaw pain or tightness in your jaw muscles
• Tired jaw muscles
• Earache — because of severe jaw muscle contractions, not a problem with your ear
• Headache
• Chronic facial pain
• Damage from chewing on the inside of your cheek
• Indentations on your tongue

When to see a doctor
See your doctor or dentist if:

• Your teeth are worn, damaged or sensitive
• You have pain in your jaw, face or ear
• Others complain that you make a grinding noise while you sleep

If you notice that your child is grinding his or her teeth — or has other signs or symptoms of this condition — be sure to mention it at your child's next dentist appointment.

Causes:
Doctors don't completely understand what causes bruxism. Possible physical or psychological causes may include:

• Anxiety, stress or tension
• Suppressed anger or frustration
• Aggressive, competitive or hyperactive personality type
• Abnormal alignment of upper and lower teeth (malocclusion)
• Other sleep problems
• Response to pain from an earache or teething (in children)
• Complication resulting from a disorder, such as Huntington's disease or Parkinson's disease
• An uncommon side effect of some psychiatric medications, including certain antidepressants

Complications:
In most cases, bruxism doesn't cause serious complications. But severe bruxism may lead to:

• Damage to your teeth (including restorations and crowns) or jaw
• Tension-type headaches
• Facial pain
• Temporomandibular disorders — which occur in the temporomandibular joints (TMJs), located just in front of your ears and felt when opening and closing your mouth

Treatments and drugs:
In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't grind or clench their teeth badly enough to require therapy. However, if the problem is severe, treatment options include certain therapies and medications.

Therapies

• Stress management. If you grind your teeth because of stress, you may be able to prevent the problem with professional counseling or strategies that promote relaxation, such as exercise and meditation. If your child grinds his or her teeth because of tension or fear, it may help your child to talk about his or her fears just before bed or to relax with a warm bath or a favorite book.
• Dental approaches. If you or your child has bruxism, your doctor may suggest a mouth guard or protective dental appliance (splint) to prevent damage to the teeth.
• Splints are usually constructed of hard acrylic and fit over your upper or lower teeth. Some dentists may make them right in the office, while others may send them to a laboratory to be made.
• Mouth guards are available over-the-counter and from your dentist. Your dentist can make a custom mouth guard to fit your mouth. Mouth guards are less expensive than are splints, they are softer than splints, and over time they may dislodge during teeth grinding. In addition, mouth guards may actually increase bruxism in some people.
• Correcting misaligned teeth may help if your bruxism seems to be associated with dental problems. In severe cases — when tooth wear has led to sensitivity or the inability to chew properly — your dentist may need to use overlays or crowns to entirely reshape the chewing surfaces of your teeth. Reconstructive treatment can be quite extensive and although it will correct the wear, it may not stop the bruxism.
• Behavior therapy. Once you discover that you have bruxism, you may be able to change the behavior by practicing proper mouth and jaw position. Concentrate on resting your tongue upward with your teeth apart and your lips closed. This should keep your teeth from grinding and your jaw from clenching. Ask your dentist to show you the best position for your mouth and jaw.

If you're having a hard time changing your habits, you may benefit from biofeedback, a form of complementary and alternative medicine that uses a variety of monitoring procedures and equipment to teach you to control involuntary body responses.

Medications
In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime. If you develop bruxism as a side effect of an antidepressant medication, your doctor may change your medication or prescribe another medication to counteract your bruxism. OnabotulinumtoxinA (Botox) injections may help some people with severe bruxism who haven't responded to other treatments. However, more research is needed, as this treatment hasn't been thoroughly studied.

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Broken wrist/broken hand

Broken wrist/broken hand

Definition:

A broken wrist or broken hand is a break or crack in one of the many bones within your wrist and hand. The most common of these injuries occurs in the wrist when people try to catch themselves during a fall and land hard on an outstretched hand.

Risk factors for a broken wrist or broken hand range from participation in certain sports — such as American football, soccer, skiing or snowboarding — to having osteoporosis, a condition in which bones become thinner and more fragile.
It's important to treat a broken wrist or broken hand as soon as possible. Otherwise, the bones may not heal in proper alignment, which can affect your ability to perform everyday activities, such as grasping a pen or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

Symptoms:

If you have a broken wrist or broken hand, you may experience these signs and symptoms:

• Severe pain that tends to increase during gripping or squeezing
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent wrist or crooked finger
• Stiffness or inability to move your fingers or thumb
• Numbness or coldness in your hand

When to call a doctor
If you think you may have a broken wrist or hand, see a doctor immediately, especially if you have numbness, swelling or trouble moving your fingers. Delays in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Causes:

A direct blow or crushing injury to your hands and wrists can break any of the bones in them. Common causes include:

• Falls. Falling onto an outstretched hand is one of the most common causes of a broken wrist or broken hand.
• Sports injuries. Many wrist or hand fractures occur during contact sports or sports in which you might fall onto an outstretched hand — such as in-line skating or snowboarding. Finger fractures are common with baseball, basketball and football.
• Motor vehicle crashes. High-velocity injuries that can occur during motor vehicle crashes may cause wrist or hand bones to fracture into many pieces, requiring surgical repair.

Complications:

Complications of a broken wrist or broken hand are rare, but they may include:

• Ongoing stiffness, aching or disability. Stiffness, pain or aching in the affected area generally goes away a month or two after your cast is removed or after surgery, but you may have some permanent stiffness or aching if your injury was severe. It may also take a few months to regain your ability to use your hand and fingers normally. Be patient with your recovery, and talk to your doctor about exercises that might help or for a referral to physical or occupational therapy.
• Osteoarthritis. Fractures that extend into the joint may cause arthritis years later. If your wrist or hand starts to hurt or swell long after a break, see your doctor for an evaluation.
• Nerve or blood vessel damage. Trauma to the wrist or hand can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems

Treatments and drugs:

If the broken ends of the bone aren't aligned properly, your doctor will need to manipulate the pieces back into their proper positions — a process called fracture reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization
Restricting the movement of a broken bone in your wrist or hand is critical to proper healing. To do this, you may need a splint or a cast.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If you're experiencing severe pain, you may need an opioid medication, such as codeine.

Therapy
After your cast or splint is removed, you'll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in your wrist and hand. Rehabilitation can help, but it may take up to several months — or even longer — for complete healing of severe injuries.

Surgical and other procedures
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as plates, rods or screws, or bone grafts to maintain proper position of your bones during healing. These internal fixation devices may be necessary if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint
• A fracture that is the result of a crushing accident

In some cases, the surgeon may immobilize your fracture by using an external fixation device. This consists of a metal frame with two or more pins that go through your skin and into the bone on either side of the fracture.

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