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The Behavioral Side of Clenching

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Stress and Orality

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Abstract

When patients become aware of their oral parafunction, they often call upon the sagacity of the clinician and ask the key question: “Why do I constantly clench my teeth?” This refers to a larger problem of necessary adaptation to stressors and to a more specific problem, that is, verbal expression. It involves the oral sphere and the stomatognathic system as parts of the main interhuman communication process. Clenching may instead correspond with an isometric contracture state (hypertonic mood) under the influence of non-adjusted psychoemotional stress. It generates a situation of “acting inhibition” towards one’s surroundings.

Due to their key physiological role in the oral sphere’s physiology, the paired V nerves seem to make some strong, constant, frequent impacts through overstimulation and nociception to the central trigeminal and non-trigeminal nervous structures. The different and amazing clinical impacts of clenching are more and more enlightened. So to unearth and eliminate this deleterious parafunction must be a constant thought of clinicians.

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Notes

  1. 1.

    The periaqueducal grey (PAG) matter serves as a link between sensory and motivation-controlling structures on the one hand and the periambigual reticular formation coordinating the activity of the different phonatory muscles on the other. The PAG matter receives a glutamatergic input from several sensory areas, such as the mediofrontal cortex, amygdala, hypothalamus, locus coeruleus, vestibular nuclei, superior and inferior colliculi, nucleus tracti solitarii, nuclei nervi trigemini (n. mesencephalicus, n. spinalis) [7, 11]. In introverted persons, is there an inhibiting phenomenon at the (PAG) level under psycho-emotional influences (Fig. 7)? Are women more sensitive to these disturbances since higher glutamate sensitivity was noted in females’ TMJ receptors [14]?

  2. 2.

    Some central nervous structures, particularly limbic structures, add an emotional impact to the adaptive system between information analysis and elaboration of response. The limbic system receives two kinds of immediate information: the first kind concerns the external environment (sensory afferents), the second concerns the internal environment (individual physiological parameters, those recorded by the hypothalamus). The limbic system usually compares these inputs from surroundings with the memorized data and adds its own emotional touch to the situation [32]. This phenomenon modulates the equilibrium between activation and inhibition as it exists at the hypothalamic or reticular levels. When this equilibrium is disturbed by unpleasant emotional factors, it affects preferentially the posterolateral hypothalamus and the corpus amygdaloideum; in this case, patients will show a rather aggressive behavior. Inversely when the ventromedial hypothalamus is affected, an action inhibition may occur. Those two situations (inhibition, aggressiveness) are not incompatible because they can affect the same patient at different moments. For some TMD patients, tension caused by expectation [13] with severe clenching may represent a behavioral starting point from which aggressive episodes occasionally occur, particularly when faced with enduring blocked situations. Hyperemotional and/or perfectionist patients cannot find a quick adequate solution to solve the problem they face. Frustration may constitute a psychological ransom, when the neocortex does not exercise its modulatory control on the limbic system and the RF. It can also be an involvement of the limbico-reticular tract: the limbic system which manages feelings and memory plays a major role in reticular activity. As for reticulo-limbic projections under painful circumstances, a condition of suffering involves two types of neurons in the rostroventromedial nuclei (RVM) of the bulbar RF (Fig. 8):

    • The off-type neurons tend to slow down the nociceptive trigeminal input from the nucleus subcaudalis; this happens with minimal or occasional input (habituation phenomena through suprasegmental pain control)

    • On the contrary, the on-type neurons tend to amplify the nociceptive responses when severe pain persists such as in TMD; here it seems that some closed circles are operating with pathophysiological components such as limbic and emotional factors, trigeminal spasticity and overstimulation, and reticular overactivity [35].

    Orofacial behaviors are always associated with emotions and their expression in the stomatognathic system: language, mimics, and gesture [5]. A close link must be considered between psycho-emotional factors and stomatognathic behavior [53] particularly in parafunctional situations. Reciprocal connections between the hypothalamus and amygdala do exist. From a clinical point of view, it is generally admitted that complex syndromes involving emotional factors may appear [27]. Above all, the amygdala seems to represent a modulator for the hypothalamus. Furthermore, stressful situations and their memory can implicate the hippocampus through the phenomenon of long-term potentiation in which the hippocampic neurons have the ability to develop excitative postsynaptic potentials during very long periods of time, even several months [40]. The main interconnections between the limbic structures in the memory process are better known today. Considering their hypothalamic projections, excessive and nociceptive parafunctional trigeminal afferents (severe clenching) may well interfere in hypothalamo-hippocampic connections.

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  1. Université de la Méditerranée Aix-Marseille, Marseille, France

    Francis Hartmann & Gérard Cucchi

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Hartmann, F., Cucchi, G. (2014). The Behavioral Side of Clenching. In: Stress and Orality. Springer, Paris. https://doi.org/10.1007/978-2-8178-0271-8_10

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  • DOI: https://doi.org/10.1007/978-2-8178-0271-8_10

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