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Hypnotherapy in the Treatment of the Chronic Nocturnal Use of a Dental Splint Prescribed for Bruxism

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Abstract

A behavioral medicine case is described in which the patient was treated with a combined approach involving both hypnoanalytic and hypnobehavioral techniques. A 55-year-old man with bruxism was referred after 10 years of craniomandibular treatment because of his dependency on a dental splint prescribed for nocturnal use. A projective hypnoanalytic exploration helped to uncover and consequently resolve an earlier conflict that had been reactivated in the patient's work situation and which had become a constant source of mental and muscular tension. The hypnoanalytic exploration was followed by a cognitive-behavioral hypnotic intervention that was tape-recorded and prescribed for bedtime practice. Pre- and posttherapy psychological, physiological, and self-report measurements corroborated the patient's sense of well being that came with his newly found ability to sleep without the dental splint. The importance of considering multiple etiological factors in the treatment of such psychosomatic disorders as bruxism is discussed.
... Hastanın bu sorunlarını hafifletebilmek için sıklıkla kullanılan yöntem, ona kendi kendini rahatlatmanın basit bir prosedürünü öğretmektir. Hipnoz ile kişinin kendini kontrol etmesi ve rahatlatması sağlanabilir[28]. ...
... La littérature qui se rapporte à l'hypnose dans la gestion du bruxisme est presque entièrement constituée d'études de cas (Michael, 2012 (Somer, 1991). ...
Thesis
De tous temps, l’hypnose a suscité fascination et interrogations. Elle connaîtaujourd’hui un regain d’intérêt dans le monde médical. En France, sa pratique enodontologie est encore assez peu développée.L’imagerie médicale a permis de mettre en évidence l’activation de certaines zonescérébrales lors du processus d’hypnose et ainsi donner plus de poids à cettetechnique. En témoignent les nombreuses formations qui sont proposées auxprofessionnels de santé aujourd’hui.L’objectif de ce travail est d’informer le chirurgien dentiste des différentesapplications de l’hypnose et ainsi d’optimiser la prise en charge du patient avecl’aide d’arbres décisionnels.
... The literature on the effect of hypnorelaxation on masticatory orofacial pain is scarce and mostly anecdotal. [16][17][18][19][20][21]25 Several clinicians have described the role of hypnosis in the treatment of bruxism and TMD, 22,26 but the literature lacks controlled comparative studies that evaluate the effect of hypnosis compared to other accepted modes of treatment (eg, occlusal appliance) or to the mere effect of time. ...
Article
Hypnorelaxation has a potentially beneficial effect in the treatment of masticatory myofascial pain disorders (MPD). However, there are no data regarding the efficacy of hypnorelaxation in the treatment of MPD compared with other accepted modes of treatment (such as occlusal appliance) or with the mere effect of time. The purpose of the present study was to evaluate the effectiveness of hypnorelaxation in the treatment of MPD compared with the use of occlusal appliance and/or to minimal treatment. The study population consisted of 40 female patients with myofascial pain who were allocated to 1 of 3 possible treatment groups: (1) hypnorelaxation (n = 15), (2) occlusal appliance (n = 15), and (3) minimal treatment group (n = 10). Both active treatment modes (hypnorelaxation and occlusal appliance) were more effective than minimal treatment regarding alleviating muscular sensitivity to palpation. However, only hypnorelaxation (but not occlusal appliance) was significantly more effective than minimal treatment with regard to the patient's subjective report of pain on the Visual Analog Scale. Hypnorelaxation is an effective mode of treatment in MPD, especially with regard to some of the subjective pain parameters.
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Among the mastication system disorders bruxism is a parafunctional behavior that comes from psychophysiological origin. Epidemiologic studies have reported great variability of bruxism prevalence. The factors that could cause bruxism is highly controversial. There are different opinions on this issue. The etiologic factors of bruxism include stress, malnutrition, allergic and endocrinologic diseases, central nervous system disorders, genetic factors, medicines, malocclusion, and wrong dental treatment. The aim of treatment of bruxism is to prevent damage that may occur on teeth and in the temporomandibular joint and to eliminate pain. Dental treatment, physical therapy, pharmacological treatment and behavioral and cognitive therapy can be considered for this purpose of treatment. This review summarizes the etiologic factors, epidemiology, diagnosis, and current treatment approaches of patient with bruxism. [Archives Medical Review Journal 2016; 25(2.000): 241-258]
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This study investigated the effectiveness of arousal and arousal + overcorrection to treat bruxism in a 28-year-old male with a 6-month history of bruxing and a 24-year-old female with a 3-month history of bruxing. An A-B-A-B-A-BC-A multiple baseline design across subjects with follow-ups was used to evaluate the effectiveness of the interventions. Results indicated that, although arousal reduced the frequency of bruxing in both subjects, it did not completely eliminate the behavior. The addition of overcorrection to arousal resulted in a complete cessation of bruxing. The discussion focuses on the possible mechanisms of action and directions for further evaluation of the combined procedure.
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A study was conducted to compare the personality characteristics of a group of patients with temporomandibular joint problems with a control group. Results indicated that a number of the characteristics tested could be identified with the problem group.From the standpoint of the dentist treating a patient with TMJ problems, the importance of recognizing psychologic factors cannot be overemphasized. This study shows that the responsibility of the dentist is not discharged merely by treating occlusal and habit patterns. The dentist should recognize the problems of his patients and should refer them to competent therapists for adjunctive treatment. The involvement of trained medical and dental personnel, aware of the interrelationship of the psychophysiologic problems in this and other dental difficulties, can serve to improve treatment.An attempt will be made with a population of clinical patients to further refine the determination of those factors which differentiate the TMJ patient from ‛nor-mal” patients. It is the ultimate hope to provide the dentist with a means by which pertinent personality factors can be determined as a corroboration of other characteristics of the TMJ dysfunction syndrome.
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The relationship between occlusal disharmony and pain in the temporomandibular joint and adjacent muscles was tested clinically and electromyographically before and after occlusal adjustment on 32 patients. Various degrees of bruxism associated with psychic tension and occlusal interferences were observed in all of the patients. Clinically, all patients experienced relief of the pain and discomfort after complete occlusal adjustment. Electromyographically, a harmonious and well-synchronized contraction pattern of the temporal and masseter muscles was recorded after the adjustment.
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A highly significant reduction in bruxism has been obtained using a biofeedback system. The concept that the etiology of bruxism is related to emotional stress is supported as biofeedback has been successful in controlling other stress-related parameters. The form of biofeedback used as an audible tone derived from amplified electromyographic data, relayed to the subject via an earpiece. Future work will be concerned with learning potential and the control of parafunctional activity; further investigation into the correlation between E.E.G. patterns and masticatory E.M.G. activity is necessary.
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Within the limits of this study and with the reported assumption that the recorded EMG activity is related to bruxism, the results of this investigation suggest that the effect of biofeedback in reducing EMG activity is more consistent than an occlusal adjustment, possibly due to differences in the cause of the initial heightened EMG activity in the group of subjects studied.
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One hundred bruxers were evaluated for bruxing activity before, during, and after treatment with a portable electromyograph (EMG). A six-month post-treatment follow-up of bruxing activity was obtained. Experimental treatment groups consisted of diurnal biofeedback, nocturnal biofeedback, massed negative practice, and splint therapy. A no-treatment control group was included. The comparative efficacy of treatments was determined by analyses of variance. Both EMG-measured frequency of bruxing episodes and duration of bruxing activity decreased significantly for nocturnal biofeedback and splint therapy treatments but not for massed negative practice, diurnal biofeedback (relaxation), or the no-treatment control group. The two-week treatment effects were transient, and bruxing activity generally returned to baseline levels when treatment was withdrawn. These findings are consistent with the findings of previous researchers with regard to nocturnal biofeedback and splint therapy but differ from previous findings for massed negative practice therapy.