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Yıl:2009; Cilt: 47; Sayı: 4>> Özet
TAM METİN
Yeni Symposium; 2009;47(4):218-224
Psikiyatride Bruksizm
M Kuloğlu, O Ekinci
Fırat Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Elazığ
Bruksizm diş sıkma ve/veya gıcırdatma ile karakterize olup, popülasyonun yaklaşık yüzde 8 ilâ 21'ini etkileyen ve sık görülen bir klinik durumdur. Bruksizm başlıca tekrarlayıcı çene kasları kasılması ile oluşan ritmik çiğneme kas aktiviteleri ile ilişkilidir. Günümüzde bruksizmin altında yatan nörokim-yasal mekanizmalar tam olarak anlaşılamamıştır. Ancak eldeki bilgiler patofizyolojisinde sıklıkla dopaminerjik ve serotoninerjik sistem arasındaki dengesizliğin rol oynayabileceğini düşündürmektedir. Psikiyatrik hastalar rutin olarak çeşitli psikotrop ilâçlarla tedavi edilirler. İnsanlarda ve hayvanlarda dopaminerjik, serotoninerjik ve adrenerjik sistemi etkileyen çeşitli moleküllerin bruksizmi iyileştirdiği veya kötüleştirdiği öne sürülmüştür.
İlaçlarla ilişkili bruksizm diş bütünlüğünün kaybı, geriye dönüşsüz temporomandibuler eklem hasarı, ciddi baş ve yüz ağrısı gibi yıkıcı nitelikte sağlık sorunlarına yol açabilir. Bununla birlikte çeşitli ilâçlarla bruksizm arasında bir ilişki olduğunu öne süren raporlar az sayıda ve vak'a raporlarıyla sınırlıdır. Bruksizmin etiyoloji ve tedavisine yönelik çalışmaların sayısı gün geçtikçe artsa da, bu klinik problem hala anlaşılması zor ve tartışmaya açık bir konu olarak karşımızda durmaktadır. Bu gözden geçirme yazısında bruksizmin oluş nedenleri, eşlik eden psikiyatrik tanılar, psikotrop ilâçların etkileri ve güncel tedavi yaklaşımları literatür bilgileri ışığında tartışılmıştır.
Bruxism in Psychiatry
Bruxism, which is characterized by clenching and/or grinding of the dentition, is a common condition affecting approximately 8 to 21 percent of the population. Bruxism is mainly associated with rhythmic masticator muscle activity characterized by repetitive jaw muscle contractions. The neurochemical mechanisms underlying sleep bruxism are little understood at present. However, recent pharmacologic evidence suggests that the imbalance between dopaminergic and serotoniner-gic system may be involved in the pathophysiology of bruxism. Psychiatric patients are routinely treated with various psychotropic drugs. It has been suggested that various substances related to the dopaminergic, serotoninergic and adrenergic systems ameliorate or exacerbate bruxism in humans and animals. Bruxism associated with drugs can be destructive, resulting in severe consequences to health that include destruction of tooth structure, irreversible harm to the temporoman-dibular joint, severe myofascial pain, and muscle contraction headache. However, reports concerning a possible association between bruxism and various psychotropic drugs are scarce and mostly anecdotal.
Although an increasing number of studies on the etiology and management of bruxism, this clinical problem is still difficult to understand and as a subject open to discussion in our stands. In this review article, the effect of psychotropic drugs on bruxism, its etiology, comorbid psychiatric diagnosis and current treatment methods are discussed with the light of previous literature.

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