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+[[File:IMG0103.jpg|left|225x225px]]Una breve descrizione del bruxismo, per non perdere tempo su dati comuni alla maggior parte dei colleghi e per cultura personale per i non addetti ai lavori, è sufficiente far riferimento a Wikipedia che, ovviamente, non sarà esaustiva per i nostri scopi, ma, in sostanza, da questa superficiale panoramica si evince che se da un lato il bruxismo è un fenomeno complesso dall'altro gli sforzi si sono concentrati quasi esclusivamente sui fattori occlusali e dentali, tralasciando un aspetto quello della funzionalità del sistema nervoso trigeminale.
+Come al solito ci troviamo di fronte allo stesso problema di vaghezza del linguaggio verbale come accadde per la paziente Mary Poppins, ed in effetti, il 'Bruxismo' potrebbe essere solo un termine convenzionale per distinguerlo da un termine quale il 'Tremore' ma essenzialmente il codice macchina potrebbe non essere in relazione al significato verbale. Cercheremo di descrivere dettagliatamente questo concetto per il 'Bruxismo'
-[[File:IMG0103.jpg|left|thumb|225x225px]]A brief description of bruxism, in order not to waste time on data common to most colleagues and for personal culture for non-experts, is sufficient to deepen the topic on  [[wikipedia:Bruxism#cite_ref-Wassell_2008_1-0|Wikipedia]] which, obviously, will not be exhaustive for our purposes., but, substantially, from this overview of the database research it is clear that if on the one hand bruxism is a complex phenomenon on the other the efforts have concentrated almost exclusively on occlusal and dental factors in general, leaving out one aspect, essential in our opinion, that of functionality of the trigeminal nervous system.
+Proprio seguendo l'ormai acclamato modello 'Masticationpedia', ci apprestiamo a presentare un paziente affetto da 'Bruxismo' da 15 anni a cui i colleghi odontoiatri hanno ovviamente dato il significato codificato del bruxismo e gestito il caso con un bite plane occlusale. Seguiremo, ovviamente, la stessa tabella di marcia seguita per la nostra paziente Mary Poppins affetta da "spasmo emasticatorio".{{ArtBy|
-As usual we are faced with the same problem of vagueness of verbal language as happened with the patient Mary Poppins,the 'Bruxism' may just be a conventional term to be distinguished from a term such as 'Tremor' but essentially the machine code may not be related to the verbal meaning.
-Precisely by following the now acclaimed 'Masticationpedia' model, we are preparing to present a patient suffering from 'Bruxism' for 15 years and whose dental colleagues have obviously seen the significance given to the disorder, managed with an occlusal bite plane.In presenting this clinical case, of course, we will follow the same roadmap followed with our patient Mary Poppins suffering from 'Haemasticatory Spasm'.{{ArtBy|
 | autore = Gianni Frisardi
-| autore2 = Riccardo Azzali
+| autore2 =
 | autore3 = Flavio Frisardi
 }}
-==Introduction==
+Iniziamo nel farci alcune domande specifiche: Il bruxismo è un'attività parafunzionale orale,<ref name="Wassell 20082">Wassell R, Naru A, Steele J, Nohl F (2008). ''Applied occlusion''. London: Quintessence. pp. 26–30. ISBN <bdi>9781850970989</bdi>.</ref> cioè, non è correlato fisiologicamente alla normale funzione come mangiare o parlare?; Il bruxismo è un comportamento comune nonostante le segnalazioni di prevalenza vanno dall'8% al 31% nella popolazione generale?<ref>Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F (2013). "Epidemiology of bruxism in adults: a systematic review of the literature". ''Journal of Orofacial Pain''. '''27''' (2): 99–110. doi:10.11607/jop.921. <nowiki>PMID 23630682</nowiki>.</ref> Diversi sintomi sono comunemente associati al bruxismo, tra cui dolori muscolari della mascella, mal di testa, denti ipersensibili, usura dei denti e danni ai restauri dentali (ad esempio corone e otturazioni)?<ref>Tyldesley WR, Field A, Longman L (2003). ''Tyldesley's Oral medicine'' (5th ed.). Oxford: Oxford University Press. p. 195. ISBN <bdi>978-0192631473</bdi>.</ref>I sintomi possono essere minimi, senza che il paziente sia consapevole della condizione. Se non si interviene, dopo un po' molti denti iniziano a logorarsi fino a scomparire completamente, la domande che sorge è: i denti si usurano ugualmente nel ciclo della vita anche senza digrignamento? <blockquote>Una teoria chiamata 'Tegotis' studiata da un gruppo di ricercatori Neozelandesi<ref>Every, RG. The significance of extreme mandibular movements. Lancet 1960; (2):37-39</ref><ref>Every, RG. The teeth as weapons. Lancet 1965; (1):685-688</ref>che recentemente è stata revisionata<ref>C G Murray, G D Sanson. Thegosis--a critical review. Aust Dent J. 1998 Jun;43(3):192-8. doi: 10.1111/j.1834-7819.1998.tb00164.x.
-A brief description of bruxism, in order not to waste time on data common to most colleagues and for personal culture for non-experts, is sufficient to deepen the topic on  [[wikipedia:Bruxism#cite_ref-Wassell_2008_1-0|Wikipedia]] which, obviously, will not be exhaustive for our purposes. Let's start, therefore, by asking ourselves some specific questions: Is bruxism an oral parafunctional activity,<ref name="Wassell 20082">Wassell R, Naru A, Steele J, Nohl F (2008). ''Applied occlusion''. London: Quintessence. pp. 26–30. ISBN <bdi>9781850970989</bdi>.</ref> that is, is it not physiologically related to normal function such as eating or speaking? Is bruxism a common behavior despite reports of prevalence ranging from 8% to 31% in the general population?<ref>Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F (2013). "Epidemiology of bruxism in adults: a systematic review of the literature". ''Journal of Orofacial Pain''. '''27''' (2): 99–110. doi:10.11607/jop.921. <nowiki>PMID 23630682</nowiki>.</ref> Several symptoms are commonly associated with bruxism, including jaw muscle pain, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations (e.g., crowns and fillings)?<ref>Tyldesley WR, Field A, Longman L (2003). ''Tyldesley's Oral medicine'' (5th ed.). Oxford: Oxford University Press. p. 195. ISBN <bdi>978-0192631473</bdi>.</ref> Symptoms may be minimal, without the patient being aware of the condition. If no action is taken, after a while many teeth begin to wear out until they disappear completely, the question that arises is: do teeth wear out equally in the life cycle even without grinding?<blockquote>A theory called 'Thegosis' studied by a group of New Zealand researchers<ref>C G Murray, G D Sanson. Thegosis--a critical review. Aust Dent J. 1998 Jun;43(3):192-8. doi: 10.1111/j.1834-7819.1998.tb00164.x.</ref> has always maintained that bruxism is a physiological function that increases masticatory capacity and organic muscle strength, therefore, where is the boundary between physiology and pathology?</blockquote>They seem irrelevant questions but let's see what can be deduced from the literature. There are, of course, multiple factors<ref>Cawson RA, Odell EW, Porter S (2002). ''Cawsonś essentials of oral pathology and oral medicine''(7th ed.). Edinburgh: Churchill Livingstone. pp. 6, 566, 364, 366. ISBN <bdi>978-0443071065</bdi>.</ref><ref name=":02">Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC (September 2010). "Bruxism: a literature review". ''Journal of Indian Prosthodontic Society''. '''10''' (3): 141–8. doi:10.1007/s13191-011-0041-5. PMC 3081266. <nowiki>PMID 21886404</nowiki>.</ref> of which many theories are sometimes excessively supported and it is for this reason that we questioned Pubmed on specific keywords:<blockquote>
-*'Bruxism'- The query was answered with 1750 results in 10 years<ref>Bruxism: https://pubmed.ncbi.nlm.nih.gov/?term=bruxism&filter=datesearch.y_10</ref> and 882 results combining the two keywords 'Bruxism AND sleep bruxism'.<ref>Bruxism AND sleep bruxism.  https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+&filter=datesearch.y_10</ref>
+</ref> ha sempre sostenuto che il bruxismo sia una funzione fisiologica che aumenta la capacità masticatoria e la forza muscolare organica, dunque,  dove è il confine tra fisiologia e patologia?</blockquote>
-*'Bruxism AND sleep bruxism AND stress' - We had a dramatic reduction to 96 results<ref>Bruxism AND sleep bruxism AND stress: https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+stress&filter=datesearch.y_10</ref> which made us wonder if there was an occlusal cause.
-*'Bruxism AND sleep bruxism AND occlusal factor'- We had 32 results<ref>Bruxism AND sleep bruxism AND occlusal factor.https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+occlusal+factor&filter=datesearch.y_10</ref> that led us to wonder if there were any anxiety-producing causes in the phenomenon.
+Sembrano quesiti irrilevanti ma vediamo in letteratura cosa si evince. Coesistono, sicuramente, molteplici fattori.<ref>Cawson RA, Odell EW, Porter S (2002). ''Cawsonś essentials of oral pathology and oral medicine''(7th ed.). Edinburgh: Churchill Livingstone. pp. 6, 566, 364, 366. ISBN <bdi>978-0443071065</bdi>.</ref><ref name=":02">Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC (September 2010). "Bruxism: a literature review". ''Journal of Indian Prosthodontic Society''. '''10''' (3): 141–8. doi:10.1007/s13191-011-0041-5. PMC 3081266. <nowiki>PMID 21886404</nowiki>.</ref> di cui molte teorie a volte risultano eccessivamente sostenute ed è per questo motivo che abbiamo interrogato Pubmed su specifiche keywords:<blockquote>
-*'Bruxism AND sleep bruxism AND anxiety syndromes'- The reduction became more marked with 12 results<ref>Bruxism AND sleep bruxism AND  anxiety syndrome. https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+anxiety+syndromes&filter=datesearch.y_10</ref> so that between stress and forms of anxiety we wondered if the phenomenon was somehow attributable to a form of neuro-excitability of the Central Nervous System.
+* '''<nowiki/>''''Bruxism'''<nowiki/>'-''' L'interrogazione ha risposto con 1750 risultati in 10 anni.<ref>Bruxism: https://pubmed.ncbi.nlm.nih.gov/?term=bruxism&filter=datesearch.y_10</ref> e 882 risultati unendo le due keywords 'Bruxism AND sleep bruxism'.<ref>Bruxism AND sleep bruxism.  https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+&filter=datesearch.y_10</ref>
-*'Bruxism AND sleep bruxism AND trigeminal motoneuron'- and with immense surprise only two fantastic scientific papers came out that of İnan R et al.<ref>Rahşan İnan, Gülçin Benbir Şenel, Figen Yavlal, Derya Karadeniz, Ayşegül Gündüz, Meral E Kızıltan. Sleep bruxism is related to decreased inhibitory control of trigeminal motoneurons, but not with reticulobulbar system. Neurol Sci. 2017 Jan;38(1):75-81.doi: 10.1007/s10072-016-2711-x. Epub 2016 Sep 14.</ref> and that of Jessica M D'Amico et al.<ref name=":12">Jessica M D'Amico, Ş Utku Yavuz, Ahmet Saraçoglu, Elif Sibel Atiş, Monica A Gorassini, Kemal S Türker. Activation properties of trigeminal motoneurons in participants with and without bruxism. J Neurophysiol. 2013 Dec;110(12):2863-72. doi: 10.1152/jn.00536.2013. Epub 2013 Sep 25.</ref> which we propose as a sub-chapter of Masticationpedia for its important specific scientific contribution on the excitability of trigeminal motor neurons in bruxism.</blockquote>Substantially, from this overview of the database research it is clear that if on the one hand bruxism is a complex phenomenon on the other the efforts have concentrated almost exclusively on occlusal and dental factors in general, leaving out one aspect, essential in our opinion, that of functionality of the trigeminal nervous system.<blockquote>From a synthetic extraction of the contents of the article by Jessica M D'Amico et al.,<ref name=":12" /> which we recommend following in its entirety as reading in the dedicated sub-chapter, it is highlighted that the discharge of neurons in the raphe nuclei, in the locus coeruleus, in the subcoeruleus and in A5/A7 cells, they release serotonin and norepinephrine and facilitate PIC (persistent internal ionic currents referred to as 'PIC') to the trigeminal motor neuron pool. These episodes increase during micro-awakenings (Leung and Mason 1999,<ref>Leung CG, Mason P. Physiological properties of raphe magnus neurons during sleep and walking. J Neurophysiol 81: 584–595, 1999 [PubMed]</ref> Sakai and Crochet 2001,<ref>Sakai K, Crochet S. Differentiation of presumed serotonergic dorsal raphe neurons in relation to behaviour and wake-sleep states. Neuroscience 104: 1141–1155, 2001 [PubMed] [Google Scholar]</ref> Takahashi et al., 2010<ref>Takahashi K, Kayama Y, Lin JS, Sakai K. Locus coeruleus neuronal activity during the sleep-waking cycle in mice. Neuroscience 169: 1115–1126, 2010 [PubMed] [Google Scholar]</ref>). Individuals with bruxism experience an increase in the number of micro-awakenings during sleep (Kato et al. 2001,<ref>Kato T, Rompre PH, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: an oromotor activity secondary to microarousal. J Dent Res 80: 1940–1944, 2001 [PubMed] [Google Scholar]</ref> 2003,<ref>Kato T, Montplaisir JY, Guitard F, Sessle BJ, Lavigne GJ. Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. J Dent Res 82: 284–288, 2003 [PubMed] [Google Scholar]</ref> 2011<ref>Kato T, Masuda Y, Yoshida A, Morimoto T. Masseter EMG activity during sleep and sleep bruxism. Arch Ital Biol 149: 478–491, 2011 [PubMed] [Google Scholar]</ref>) with a probable increase in the monoaminergic drive towards trigeminal motor neurons. Accordingly, drugs such as serotonin reuptake inhibitors and amphetamines, which increase norepinephrine and serotonin levels, respectively, increase episodes of involuntary activity in bruxist participants (Lavigne et al. 2003,<ref>Lavigne GJ, Kato T, Kolta A, Sessle BJ.Neurobiological mechanisms involved in sleep bruxism. Crit Rev Oral Biol Med 14: 30–46, 2003 [PubMed] [Google Scholar]</ref> See and Tan 2003<ref>See SJ, Tan EK. Case Report: severe amphetamine-induced bruxism: treatment with botulinum toxin. Acta Neurol Scand 107: 161–163, 2003 [PubMed] [Google Scholar]</ref>) and the amplitude of PICs in motor neurons of the limbs (D'Amico et al. 2013,<ref>D'Amico JM, Murray KC, Li Y, Chan KM, Finlay MG, Bennett DJ, Gorassini MA. Constitutively-active 5HT2/α1 receptors facilitate muscle spasms after human spinal cord injury. J Neurophysiol 109: 1473–1484, 2013 [PMC free article] [PubMed] [Google Scholar]</ref> Udina et al. 2010<ref>Udina E, D'Amico J, Bergquist AJ, Gorassini MA.Amphetamine increases persistent inward currents in human motoneurons estimated from paired motor unit activity. J Neurophysiol 103: 1295–1303, 2010 [PMC free article] [PubMed] [Google Scholar]</ref>).
+* '''<nowiki/>''''Bruxism AND sleep bruxism AND stress'''<nowiki/>'-''' Abbiamo avuto una notevole riduzione a 96 risultati <ref>Bruxism AND sleep bruxism AND stress: https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+stress&filter=datesearch.y_10</ref> che ci hanno indotto a chiederci se ci fossero cause di tipo occlusale.
+* '''<nowiki/>''''Bruxism AND sleep bruxism AND occlusal factor'''<nowiki/>'-''' Abbiamo avuto 32 risultati <ref>Bruxism AND sleep bruxism AND occlusal factor.https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+occlusal+factor&filter=datesearch.y_10</ref> che ci hanno indotto a chiederci se ci fossero causa di tipo ansiogene nel fenomeno.
+* '''<nowiki/>''''Bruxism AND sleep bruxism AND anxiety syndromes'''<nowiki/>'-''' La riduzione si è fatta più marcata con 12 risultati<ref>Bruxism AND sleep bruxism AND  anxiety syndrome. https://pubmed.ncbi.nlm.nih.gov/?term=%27Bruxism+AND+sleep+bruxism+AND+anxiety+syndromes&filter=datesearch.y_10</ref> al che tra stress e forme di ansia ci siamo chiesti se il fenomeno fosse in qualche modo riconducibile ad una forma di neuro eccitabilità del Sistema Nervoso Centrale.
+* '''<nowiki/>''''Bruxism AND sleep bruxism AND trigeminal motoneuron'''<nowiki/>'-''' e con immensa sorpresa sono usciti soltanto due fantastici lavori scientifici quello di İnan R et all.<ref>Rahşan İnan, Gülçin Benbir Şenel, Figen Yavlal, Derya Karadeniz, Ayşegül Gündüz, Meral E Kızıltan. Sleep bruxism is related to decreased inhibitory control of trigeminal motoneurons, but not with reticulobulbar system. Neurol Sci. 2017 Jan;38(1):75-81.doi: 10.1007/s10072-016-2711-x. Epub 2016 Sep 14.</ref> e quello di Jessica M D'Amico et all.<ref name=":12">Jessica M D'Amico, Ş Utku Yavuz, Ahmet Saraçoglu, Elif Sibel Atiş, Monica A Gorassini, Kemal S Türker. Activation properties of trigeminal motoneurons in participants with and without bruxism. J Neurophysiol. 2013 Dec;110(12):2863-72. doi: 10.1152/jn.00536.2013. Epub 2013 Sep 25.</ref> che proponiamo come sub-capitolo di Masticationpedia per il loro importante contributo scientifico specifico sull'eccitabilità dei motoneuroni trigeminali nel bruxismo.
+</blockquote>Sostanzialmente, da questa panoramica di ricerca su database si evince che se da un lato il bruxismo è un fenomeno complesso dall'altro gli sforzi si sono concentrati quasi esclusivamente sui fattori occlusali ed in generale odontoiatrici lasciando fuori un aspetto, secondo noi essenziale, quello della funzionalità del sistema nervoso trigeminale.<blockquote>Da una sintetica estrazione dei contenuti dell'articolo di Jessica M D'Amico et all.<ref name=":12" />, che consigliamo di seguire integralmente come lettura nel sub-capitolo dedicato, si evidenzia che la scarica di neuroni nei nuclei del rafe, nel locus coeruleus, nel subcoeruleus e nelle cellule A5/A7, rilasciano serotonina e norepinefrina e facilitano il PIC ( correnti ioniche interne persistenti denominate 'PIC') al pool di motoneuroni trigeminali. Questi episodi aumentano durante i microrisvegli (Leung e Mason 1999,<ref>Leung CG, Mason P. Physiological properties of raphe magnus neurons during sleep and walking. J Neurophysiol 81: 584–595, 1999 [PubMed]</ref> Sakai e Crochet 2001,<ref>Sakai K, Crochet S. Differentiation of presumed serotonergic dorsal raphe neurons in relation to behaviour and wake-sleep states. Neuroscience 104: 1141–1155, 2001 [PubMed] [Google Scholar]</ref> Takahashi et al., 2010<ref>Takahashi K, Kayama Y, Lin JS, Sakai K. Locus coeruleus neuronal activity during the sleep-waking cycle in mice. Neuroscience 169: 1115–1126, 2010 [PubMed] [Google Scholar]</ref>). Gli individui con bruxismo sperimentano un aumento del numero di microrisvegli durante il sonno (Kato et al. 2001,<ref>Kato T, Rompre PH, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: an oromotor activity secondary to microarousal. J Dent Res 80: 1940–1944, 2001 [PubMed] [Google Scholar]</ref> 2003,<ref>Kato T, Montplaisir JY, Guitard F, Sessle BJ, Lavigne GJ. Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. J Dent Res 82: 284–288, 2003 [PubMed] [Google Scholar]</ref> 2011<ref>Kato T, Masuda Y, Yoshida A, Morimoto T. Masseter EMG activity during sleep and sleep bruxism. Arch Ital Biol 149: 478–491, 2011 [PubMed] [Google Scholar]</ref>) con un probabile aumento del drive monoaminergico verso i motoneuroni del trigemino. Di conseguenza, i farmaci come gli inibitori della ricaptazione della serotonina e delle anfetamine, che aumentano rispettivamente i livelli di norepinefrina e serotonina, aumentano gli episodi di attività involontaria nei partecipanti Bruxisti (Lavigne et al. 2003,<ref>Lavigne GJ, Kato T, Kolta A, Sessle BJ.Neurobiological mechanisms involved in sleep bruxism. Crit Rev Oral Biol Med 14: 30–46, 2003 [PubMed] [Google Scholar]</ref> See e Tan 2003<ref>See SJ, Tan EK. Case Report: severe amphetamine-induced bruxism: treatment with botulinum toxin. Acta Neurol Scand 107: 161–163, 2003 [PubMed] [Google Scholar]</ref>) e l'ampiezza dei PIC in motoneuroni degli arti (D'Amico et al. 2013,<ref>D'Amico JM, Murray KC, Li Y, Chan KM, Finlay MG, Bennett DJ, Gorassini MA. Constitutively-active 5HT2/α1 receptors facilitate muscle spasms after human spinal cord injury. J Neurophysiol 109: 1473–1484, 2013 [PMC free article] [PubMed] [Google Scholar]</ref> Udina et al. 2010<ref>Udina E, D'Amico J, Bergquist AJ, Gorassini MA.Amphetamine increases persistent inward currents in human motoneurons estimated from paired motor unit activity. J Neurophysiol 103: 1295–1303, 2010 [PMC free article] [PubMed] [Google Scholar]</ref>).
+Sempre sullo stesso tenore neurobiologico dei GABA e del Glutammato, si esprime la considerazione di Andrisani G.<ref>Andrisani Giovanni, Andrisani Giorgia . The neurophysiological basis of bruxism.Heliyon. 2021 Jul 3;7(7):e07477. doi: 10.1016/j.heliyon.2021.e07477.eCollection 2021 Jul.
+</ref> che lascia un pò tutti sorpresi, e cioè 'the bruxism is not a parafunction, and it functions to activate la formazione reticolare ascendente (ARAS) per regolarizzare la perdita dei neurotrasmettiri quali noradrenaline, dopamine, serotonin, acetylcholine and glutamate.
+E' emerso da un altro interessante studio di M C Verhoeff et al.<ref>M C Verhoeff, M Koutris, M K A van Selms, A N Brandwijk, M S Heres, H W Berendse, K D van Dijk, F Lobbezoo. Is dopaminergic medication dose associated with self-reported bruxism in Parkinson's disease? A cross-sectional, questionnaire-based study.Clin Oral Investig. 2021 May;25(5):2545-2553. doi: 10.1007/s00784-020-03566-0.Epub 2020 Sep 12.
+</ref> che nonstante sia presente il bruxismo nei soggetti affetti da Parkinson ciò non è associato alla dose del farmaco dopaminergico.
+Mentre per Merete Bakke et al.<ref name=":0">Merete Bakke, Tove Henriksen, Heidi Bryde Biernat, Torben Dalager, Eigild Møller . Interdisciplinary recognizing and managing of drug-induced tardive oromandibular dystonia: two case reports.Clin Case Rep. 2018 Sep 26;6(11):2150-2155. doi: 10.1002/ccr3.1548.eCollection 2018 Nov.
+</ref> l'esposizione ad agenti bloccanti del recettore della dopamina come antipsicotici, farmaci antitosse e antiemetici possono indurre distonia compreso il bruxismo rendendo complessa la diagnosi differenziale tra disturbi simili e forse correlati come il morbo di Parkinson, il tremore essenziale, la sindrome di Tourette, i disturbi temporomandibolari, il bruxismo notturno.</blockquote>[[File:IMG0103.jpg|thumb|'''Figura 1:''' Patient affected by day and night bruxism|300x300px]]La conclusione, purtroppo, rimane quella di sempre e cioè che la manifestazione esterna di un disturbo organico e/o funzionale è un effetto macroscopico che trasferisce nel tempo una serie di abnomarlità mesoscopiche del sistema. Qui abbiamo potuto testare soltanto alcune di questi fenomeno mesoscopici neurobiologici ma il risultato clinico deve essere interpretato come fenomeno di insieme perchè alle attuali conoscenze scientifiche non è possibile pesare la valenza fisosipatologica dei neurotrasmettitori, del PIC, dei nuclei della base, della formazione reticolare ascendente ecc. Certo è che una anormalità in uno di questi siti può generare un 'Codice criptato' come messaggio in linguaggio macchina del Sistema Nervoso Centrale che di per se potrebbe non essere il 'Bruxismo' bensì una forma di 'Ipereccitabilità Neuromotoria'
+Come al solito siamo di fronte allo stesso problema di vaghezza del linguaggio verbale come è capitato per la paziente Mary Poppins. Il 'bruxismo' potrebbe essere solo un termine convenzionale per essere distinto da un altro termine quale  il 'Tremore' ma sostanzialmente il codice macchina potrebbe non essere correlato al significato verbale.
+Proprio seguendo l'ormai conclamato modello 'Masticationpedia', ci apprestiamo a presentare un paziente affetto da 'Bruxismo' da ben 15 anni e che i colleghi odontoiatrici hanno, ovviamente, dato significatività al disturbo e di conseguenza gestito con un bite plane occlusale.
+Anche in questo caso clinico la diagnosi differenziale, come riportato da Merete Bakke et al.,<ref name=":0" /> rimane molto complessa.
-Again on the same neurobiological tenor of GABA and Glutamate, the consideration of Andrisani G.<ref>Andrisani Giovanni, Andrisani Giorgia . The neurophysiological basis of bruxism.Heliyon. 2021 Jul 3;7(7):e07477. doi: 10.1016/j.heliyon.2021.e07477.eCollection 2021 Jul.</ref> is expressed which leaves everyone somewhat surprised, namely 'the bruxism is not a parafunction, and it functions to activate the ascending reticular formation (ARAS) to regulate the loss of neurotransmitters such as noradrenaline, dopamine, serotonin, acetylcholine and glutamate.
+Nel presentare questo caso clinico ( figura 1), ovviamente, seguiremo la stessa roadmap seguita con la nostra paziente Mary Poppins affetta da 'Spasmo Emimasticatorio' Il soggetto era un uomo di 32 anni affetto da marcato bruxismo notturno e diurno e OP cronico bilaterale prevalente nelle regioni temporoparietali, con maggiore intensità e frequenza a sinistra.
-It emerged from another interesting study by M C Verhoeff et al.<ref>M C Verhoeff, M Koutris, M K A van Selms, A N Brandwijk, M S Heres, H W Berendse, K D van Dijk, F Lobbezoo. Is dopaminergic medication dose associated with self-reported bruxism in Parkinson's disease? A cross-sectional, questionnaire-based study.Clin Oral Investig. 2021 May;25(5):2545-2553. doi: 10.1007/s00784-020-03566-0.Epub 2020 Sep 12.</ref> that although bruxism is present in subjects with Parkinson's this is not associated with the dose of the dopaminergic drug.
-While for Merete Bakke et al.<ref name=":0">Merete Bakke, Tove Henriksen, Heidi Bryde Biernat, Torben Dalager, Eigild Møller . Interdisciplinary recognizing and managing of drug-induced tardive oromandibular dystonia: two case reports.Clin Case Rep. 2018 Sep 26;6(11):2150-2155. doi: 10.1002/ccr3.1548.eCollection 2018 Nov.</ref> exposure to dopamine receptor blocking agents such as antipsychotics, antitussives and antiemetics can induce dystonia including bruxism making the differential diagnosis between similar and possibly related disorders such as Parkinson's disease, essential tremor, Tourette's syndrome, temporomandibular disorders, nocturnal bruxism.</blockquote>[[File:IMG0103.jpg|thumb|'''Figure 1''': Patient suffering from severe diurnal and nocturnal bruxism|300x300px]]The conclusion, unfortunately, remains the same and that is that the external manifestation of an organic and/or functional disturbance is a macroscopic effect which transfers a series of mesoscopic abnormalities of the system over time. Here we were able to test only some of these neurobiological mesoscopic phenomena but the clinical result must be interpreted as a whole phenomenon because current scientific knowledge does not allow us to weigh the physiopathological value of the neurotransmitters, the PIC, the basal nuclei, the ascending reticular formation, etc. . What is certain is that an abnormality in one of these sites can generate an 'encrypted code' as a message in machine language of the Central Nervous System which in itself could not be 'Bruxism' but a form of 'Neuromotor Hyperexcitability'
-As usual we are faced with the same problem of vagueness of verbal language as happened with the patient Mary Poppins,the 'Bruxism' may just be a conventional term to be distinguished from a term such as 'Tremor' but essentially the machine code may not be related to the verbal meaning.
-Precisely by following the now acclaimed 'Masticationpedia' model, we are preparing to present a patient suffering from 'Bruxism' for 15 years and whose dental colleagues have obviously seen the significance given to the disorder, managed with an occlusal bite plane.
-Also in this clinical case the differential diagnosis, as reported by Merete Bakke et al.,<ref name=":0" /> remains very complex.
-In presenting this clinical case (figure 1), of course, we will follow the same roadmap followed with our patient Mary Poppins suffering from 'Haemasticatory Spasm'. The subject was a 32-year-old man suffering from pronounced nocturnal and diurnal bruxism and chronic bilateral OP prevalent in the temporoparietal regions, with greater intensity and frequency on the left side. Neurological examination showed a contraction of the masseter muscles with pronounced stiffness of the jaw, diplopia and loss of visual acuity in the left eye, left gaze nystagmus with a rotary component, papillae with blurred borders and positive bilateral Babynski's, and polykinetic tendon reflexes in all four limbs.{{bib}}
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+[[Category:Pathology of temporomandibular joints, muscles of mastication and associated structures]]
+[[Category:Sleep disorders]]