Diagnosis and Management of Bruxism / 수면정신생리

Bruxism is defined as 'diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth'. Bruxism and clenching are two of the most common contributing factors in patients with temporomandibular disorders and craniofacial pain disorders. Even though many studies report the high prevalence of bruxism, its cause is still not clear. Occlusal interference has been regarded as a major etiologic factor. Nowadays, psychological stress and sleeping disorders are generally regarded as major possible etiologic factors. More than likely, the cause is multifactoral and overlapping, which makes it difficult for the practitioner to apply comprehensive and effective management strategies. Although dentists and psychologists generally believe that effective treatment is best achieved with a better understanding of the etiology of a given disorder, for now treatment for this type of disorder must proceed without a clear understanding of etiology. To overcome this obstacle, evidence-based comprehensive management protocols based on accumulated scientific findings should be provided. In this presentation, epidemiology, etiology, and the characteristics of bruxism are reviewed. Diagnostic procedures and management strategies focused on occlusal appliances and behavioral approaches are also discussed.

The effect of topical application with steroid and cyclosporine on oral lichen planus patients

The purpose of this study was comparing the effectiveness in the topical applications of cyclosporine with that of steroid, the conventional and standard drug in the treatment of oral lichen planus. 21 patients with oral lichen planus were treated with cyclosporine (n=11) or steroid (n=10) by random allocations. They were recalled 2 weeks, 4 weeks, and 8 weeks after initial treatments. In each recall, the lesion size, clinical symptoms like pain or burning sensation, and side effects were evaluated. The differences of these measurements were compared and the effects of each drug were checked. In reticulation types, steroid showed higher effectivity than cyclosporine and this difference was significant statistically. But in erythema type lesions, either drug showed no significant recovery, statistically. However, the effect of cyclosporine was thought to be more effective. The pain of the lesions was significantly decreased by cyclosporine but not by steroid. The decrease of burning sensation was more dependant upon steroid than cyclosporine, but no statistical relationship could be found. There were no clinical side effects. There was limitation to draw in conclusion due to small pool of this study group. But with the results, this suggestion could be proposed that either drug might be superior to another in effectivity in a specific lesion type or patient symptom, so selection and usage of one drug in a specific case could be better than universal application of one drug in all cases.