Kato T, Thie N M, Montplaisir J Y, Lavigne G J
Facultés de médecine dentaire, médecine, Université de Montréal, Québec, Canada.
Dent Clin North Am. 2001 Oct;45(4):657-84.
Several issues remain to be clarified in the future research and management of SB. It is important to differentiate SB from other normal sleep orofacial activities and concomitant sleep disorders. Other orofacial activities may obscure the diagnosis of SB and may give an ambiguous clinical picture when evaluating treatment efficacy. Laboratory recordings provide a more specific diagnosis. Most of the clinical signs (e.g., tooth wear, masseter hypertrophy) are not exclusive to SB but could be concomitant with other habits or activities during wakefulness. No pathologic features in the central nervous system, such as a dysfunction of the dopaminergic system, have been observed in SB patients. Recent neurophysiologic studies have suggested that SB is a powerful microarousal event associated with central and autonomic nervous system activity during sleep. The additive contribution of psychosocial stress cannot be overlooked. There have been no recent major breakthroughs in SB management. Cognitive and behavioral managements, which include stress management, lifestyle changes, or improved coping mechanisms, may be beneficial. Oral splint appliances are useful to protect teeth from damage. A few medications (e.g., benzodiazepines, muscle relaxants) may be helpful for a short-term period, particularly when there is secondary pain, but controlled studies are needed to assess their efficacy, safety, and patient acceptance and tolerance.
在未来对磨牙症（SB）的研究和管理中，仍有几个问题有待澄清。区分磨牙症与其他正常睡眠中的口面部活动及并发的睡眠障碍很重要。其他口面部活动可能会掩盖磨牙症的诊断，并且在评估治疗效果时可能会给出模糊的临床表现。实验室记录能提供更具体的诊断。大多数临床体征（如牙齿磨损、咬肌肥大）并非磨牙症所特有，而是可能与清醒时的其他习惯或活动同时存在。在磨牙症患者中未观察到中枢神经系统的病理特征，如多巴胺能系统功能障碍。最近的神经生理学研究表明，磨牙症是一种与睡眠期间中枢和自主神经系统活动相关的强烈微觉醒事件。心理社会压力的附加作用不可忽视。在磨牙症的管理方面，最近没有重大突破。认知和行为管理，包括压力管理、生活方式改变或改善应对机制，可能会有帮助。口腔矫治器有助于保护牙齿免受损伤。一些药物（如苯二氮䓬类、肌肉松弛剂）短期内可能有帮助，特别是在有继发性疼痛时，但需要对照研究来评估它们的疗效、安全性以及患者的接受度和耐受性。
