Rough notes of a clinical oral presentation of our comprehensive published review article.
PLEASE download and CITE the published version as a reference. The published review is downloadable below.
HS Bracha MD. .............................................................................
INTENSE, PROLONGED JAW CLENCHING; it can be clinically observed during fear or rage in developmentally disabled individuals (and may be mistaken for dystonia). displays of jaw clenching can also be seen in preverbal healthy toddlers, which may also be a manifestation of fear or rage in the preverbal period. such clench- ing displays, both in patients with mental retardation and in healthy preverbal toddlers, precdict imminent actual bit- ing of others. ..................>
ALSO, ANECDOTALLY, INFORMATION FROM EMERGENCY DEPARTMENTS suggests that physically assaulted individuals, and especially sexually assaulted individuals, may use biting as a means of self-defense.22 This may even be relevant in the assessment of individuals presenting in emergency departments with severe human bites, especially to the head and neck.
TEMPORAL-LIMBIC STRUCTURES AND JAW CLENCHING
We posit a second role for jaw clenching in the distressed/anxious individuals based on recent literature3.29 We hypothesize that jaw clenching increases the blood flow to anterior temporal lobe structures during acute activation of the limbic fear circuits. Jaw clenching may increase the blood flow to the hemodynamically vulnerable temporal lobe structures especially the hippocampus by pumping blood through the temporal bone emissary veins, thus enhancing immediate memory retrieval and night time memory consolidation and also conferring survival advantage during activation of the limbic fear-circuits in expect tion of situations requiring the freeze, flight, fight, fright acute fear response.18,19,30 This is consistent with new research, 29,31-33 which demonstrates a possible beneficial affect of masticatory movements (eg, non-nutritive chewing) on both hippocampal function and hippocampal structure.
Based on pioneering work by Dr Andrew Gallup and associates which they concluded that yawning causes 'cooling of the brain', we propose that another way to produce such emmisery vein blood flow to the temporal lobe is yawning.). INTENTIONAL YAWNING may suppress the urge to clench.
And remind people of the habit of police investigators (see Hollywood movies) to bite on a toothpick while concentrating and which prevents clenching-induced damage to the teeth. Tell man that women find biting a wooden toothpick sexually attractive.
And strongly recommend non-nutritive gum such as SPRY green tea flavored dental defense system gum to reduce systemic inflammation and minimize contact between upper and lower teeth.
..... IMPLICATIONS FOR PSYCHIATRIC DIAGNOSIS.
Assessment Implication: “Hard to Hide” and “Hard to Fake” Physical Signs of Stress and Anxiety In addition to shifting focus from disorders to spec- trums, Psychiatry needs to include a larger number of physical examination signs in the “Associated Physical Examination Findings” sec tions of the DSM text and possiblly as subcriteria for the diagnoses of some disorders. Assessments of anxiety spectrum disorders currently depends almost exclusively on retrospective self-report. Extensive psychometric literature has demonstrated that paper and pencil instruments (particularly questionnaires and also structured interviews) for trait anxiety and recent subjective distress can be highly vulnerable to both over-reporting35-37 and under-reporting.37-42 This diminishes both the positive predictive value and the negative predictive value of questionnaires and structured interviews. We posit that easily observable physical signs, such as incisor tooth wear, may augment the clini- cal assessment of fear-circuitry disorders such as posttraumatic stress disorder (PTSD).......
. In clinical psychiatric settings, objective physical “hard to hide” signs of stress-induced and fear-circuitry dis- orders are also rare. Wear of the incisors’ enamel invari- ably results from chronic grinding and may be one such hard to hide sign. Clinicians practicing in settings where individuals tend to under-report symptoms due to stigma, cultural, or other reasons, may especially benefit from hard-to-hide indica- tors of under-reported anxiety. Self-imposed cultural barriers of access to men- tal healthcare may also exist in other “bushido” (warrior) male cultures. The United States Armed Forces active duty-enlisted personnel appears to be another American male culture that under-reports emotional distress due to stigma and deep-rooted beliefs about masculinity. This can impede clinical assessment (eg, suicide risk), early intervention, and primary prevention......
....Furthermore, incisor tooth wear is also a “hard- to-fake” indicator of anxiety. Such objective signs are much needed in the clinical armamentarium in settings, such as litigation and compensation and substance abuse treatment centers where patients may over-report anxiety symptoms. Assessment of observable signs of clenching-grinding can be easily incorporated into the examination of the anxious patient in psychiatric medicine and general medi- cal settings, as well as in substance abuse settings. Even before tooth wear is noted in incisors, bilat- eral hypertrophy and tenderness of the masseter and especially the temporalis muscle can often be identi- fied by inspection and palpation in acutely distressed patients unaware of their clenching.
Please download and please cite the full text tutorial review article that expands on this lecture. It is below. Also since you read this presentation all the way to the end you obviously found it useful So please recommend it. You will help your friends and colleagues notice it.