Clinical and physiological aspects of bruxism and its rational pharmacotherapy

Objective. Clinical-neurophysiological and neuropsychological examination of patients with bruxism was conducted to determine the functional condition of the peripheral and central trigeminal nerve and to justify the combined therapy.

Materials and methods. 26 patients (14 women and 12 men) aged 20 to 50 years with complaints and typical neurological symptoms of bruxism were examined. The control group consisted of 30 volunteers in the age from 24 to 35 years, who underwent a comprehensive examination as part of a medical check-up, who did not have severe somatic, neurological or mental diseases and did not have complaints of impaired function of the masticatory muscles. Clinical and neurological, electrophysiological and neuropsychological diagnostic methods were used in the trial. Quantitative sensory testing was performed using TSA II device (Medoc, Israel), and temperature sensitivity thresholds were determined using the Marstok method on symmetrical facial areas according to the Zelder zones. Diagnostics of the functional condition of the masticatory muscles was carried out using a computer neuroelectromyograph M-Test ‘DX-Systems’ and a computer system for analyzingelectromyographic records. Electroencephalography (EEG) was performed using 16-channel computer electroencephalography system. C. D. Spielberger scale adapted by Yu. L. Khanin (C. D. Spielberger, 2010) was used to determine the level of anxiety. The results were processed using Statistica and Microsoft Excel 2015 programs.

Results. Patients with bruxism had a high level of personal anxiety, which was found in 73 % of the participants. Determination of the thresholds of cold sensitivity on the faces of patients with bruxism showed a lower threshold of cold sensitivity in the lateral parts and a higher threshold in the oral parts. Electromyography of masticatory muscles showed an increase in the duration of mastication period, a decrease in the masticatory rhythm, a decrease in masticatory efficiency, and irrational functioning of the masticatory muscles of varying severity in the patients of the examined group. Assessment of brain biopotentials showed an increase in the ascending activating effects of nonspecific median brain structures (72 %). The data obtained helped to obtain a comprehensive assessment of functional condition of the trigeminal nerve in patients with bruxism and to justify pharmaceutical therapy aimed at both the muscular apparatus (muscle relaxants) and the peripheral and central parts of the trigeminal nerve (antiepileptic drugs) in combination with a medicine that has a stabilizing effect on the functional condition of neurons and normalization of bioelectric processes in the central nervous system (correctors of metabolism).

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