Bruxism and orofacial movements during sleep.

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.