{"id":23704,"date":"2026-08-10T13:53:35","date_gmt":"2026-08-10T10:53:35","guid":{"rendered":"https:\/\/innovationmedical.ro\/?p=23704"},"modified":"2026-08-10T13:59:30","modified_gmt":"2026-08-10T10:59:30","slug":"ma-trezesc-cu-maxilarul-inclestat-ce-se-intampla-cu-mine-in-timpul-noptii","status":"publish","type":"post","link":"https:\/\/innovationmedical.ro\/en\/ma-trezesc-cu-maxilarul-inclestat-ce-se-intampla-cu-mine-in-timpul-noptii\/","title":{"rendered":"M\u0103 trezesc cu maxilarul \u00eencle\u0219tat. Ce se \u00eent\u00e2mpl\u0103 cu mine \u00een timpul nop\u021bii?"},"content":{"rendered":"
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\u201eDoamna doctor, m\u0103 trezesc diminea\u021ba cu maxilarul \u00een\u021bepenit, ca \u0219i cum a\u0219 fi \u021binut din\u021bii \u00eencle\u0219ta\u021bi toat\u0103 noaptea. Nu-mi amintesc nimic, nu simt c\u0103 fac ceva \u2014 dar diminea\u021ba am dureri de t\u00e2mpl\u0103, uneori \u0219i de g\u00e2t, \u0219i partenerul meu spune c\u0103 m\u0103 aude scr\u00e2\u0219nind.”<\/p>

\u00a0<\/p>

Aud povestea asta constant, aproape identic\u0103 de la un pacient la altul. Persoana nu simte c\u0103 face nimic \u2014 bruxismul nocturn nu e o alegere con\u0219tient\u0103, e ceva ce se \u00eent\u00e2mpl\u0103 *f\u0103r\u0103* participarea ta, \u00een somn. \u0218i tocmai asta \u00eei sperie pe mul\u021bi: cum poate corpul s\u0103 genereze o for\u021b\u0103 at\u00e2t de mare, repetat, toat\u0103 noaptea, f\u0103r\u0103 ca tu s\u0103 \u0219tii?<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce este, de fapt, bruxismul\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Defini\u021bia acceptat\u0103 interna\u021bional descrie bruxismul ca activitate repetitiv\u0103 a mu\u0219chilor masticatori\u00a0\u2014 str\u00e2ngere sau scr\u00e2\u0219nire a din\u021bilor sau \u00eempingere\/proptire a mandibulei. Poate ap\u0103rea \u00een somn (bruxism de somn) sau \u00een stare de veghe (bruxism diurn) \u2014 \u0219i sunt, de fapt, dou\u0103 fenomene diferite, cu mecanisme diferite.<\/p>

Bruxismul diurn e mai aproape de ce ne imagin\u0103m intuitiv: \u00eencle\u0219tare con\u0219tient\u0103 sau semi-con\u0219tient\u0103, \u00een momente de concentrare sau tensiune. Bruxismul de somn e altceva \u0219i e mult mai pu\u021bin despre „stres”, cum se crede \u00een general.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce se \u00eent\u00e2mpl\u0103, de fapt, \u00een timpul nop\u021bii\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Aici e partea care surprinde majoritatea pacien\u021bilor: bruxismul de somn nu e declan\u0219at direct de stres, ci de un proces numit micro-trezire (micro-arousal)\u00a0 o reactivare scurt\u0103, de c\u00e2teva secunde, a creierului \u0219i inimii, care se \u00eent\u00e2mpl\u0103 natural de mai multe ori pe noapte la toat\u0103 lumea, mai ales \u00een tranzi\u021bia c\u0103tre somnul REM.<\/p>

La persoanele cu bruxism, \u00een minutele dinaintea acestor micro-treziri cre\u0219te activitatea sistemului nervos simpatic, practic, corpul intr\u0103 brusc \u00eentr-un mic puseu de alert\u0103. Ritmul cardiac urc\u0103, tonusul mu\u0219chilor g\u00e2tului cre\u0219te, iar apoi, secven\u021bial, se activeaz\u0103 mu\u0219chii maseter \u0219i temporal \u2014 cei care \u00eenchid mandibula. Rezultatul: episoade ritmice de contrac\u021bie muscular\u0103, de aproximativ 1 Hz, care pot include \u0219i scr\u00e2\u0219nitul propriu-zis.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Cu alte cuvinte: nu tu decizi s\u0103 str\u00e2ngi din din\u021bi noaptea. E un mecanism controlat central, legat de arhitectura somnului, nu de voin\u021ba ta \u0219i de asta nici nu-\u021bi aminte\u0219ti.\u00a0Stresul \u0219i anxietatea r\u0103m\u00e2n factori asocia\u021bi \u2014 la persoanele stresate, episoadele tind s\u0103 fie mai frecvente \u0219i mai intense \u2014 dar bruxismul de somn nu e „doar” o reac\u021bie la stres. E un fenomen neurofiziologic mai complex, \u00een care stresul e un contributor, nu singura cauz\u0103.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce sim\u021bi diminea\u021ba \u0219i de ce\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Consecin\u021bele cele mai frecvente pe care le v\u0103d la pacien\u021bi:<\/p>

– durere sau blocaj la nivelul maxilarului, mai ales diminea\u021ba<\/p>

– dureri de t\u00e2mpl\u0103 sau cap, tip tensiune<\/p>

– uzur\u0103 vizibil\u0103 a din\u021bilor, uneori fisuri sau sensibilitate<\/p>

– tensiune sau durere \u00een musculatura g\u00e2tului<\/p>

– oboseal\u0103 muscular\u0103 a maxilarului, ca dup\u0103 un efort<\/p>

– ocazional, zgomote sau disconfort la nivelul articula\u021biei temporo-mandibulare<\/p>

\u00a0<\/p>

Nu toat\u0103 lumea cu bruxism de somn ajunge s\u0103 aib\u0103 simptome \u2014 mul\u021bi oameni scr\u00e2\u0219nesc din din\u021bi noaptea f\u0103r\u0103 s\u0103 \u0219tie, f\u0103r\u0103 durere \u0219i f\u0103r\u0103 uzur\u0103 vizibil\u0103. Intensitatea \u0219i frecven\u021ba episoadelor variaz\u0103 mult de la o persoan\u0103 la alta, la fel \u0219i pragul individual de a dezvolta simptome.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce e corect \u0219i ce e prea simplu despre investiga\u021bii\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Mul\u021bi pacien\u021bi vin convin\u0219i c\u0103, dac\u0103 au maxilarul \u00eencle\u0219tat sau simt pocnete, urm\u0103torul pas obligatoriu e un RMN. Nu chiar.<\/p>

Ce e adev\u0103rat: RMN-ul r\u0103m\u00e2ne investiga\u021bia de referin\u021b\u0103 pentru evaluarea discului articular \u0219i a \u021besuturilor moi ale ATM \u2014 poate ar\u0103ta dac\u0103 discul e deplasat, dac\u0103 revine la loc la deschiderea gurii, dac\u0103 exist\u0103 inflama\u021bie. CT-ul, \u00een schimb, e superior pentru os \u2014 util dac\u0103 suspect\u0103m artroz\u0103 avansat\u0103 sau modific\u0103ri structurale ale condilului. Radiografia simpl\u0103 are utilitate limitat\u0103 aici \u2014 poate rata multe modific\u0103ri \u0219i nu arat\u0103 deloc discul articular.<\/p>

Ce e prea simplu: ideea c\u0103 „RMN-ul vede tot ce nu v\u0103d radiografia \u0219i CT-ul” \u2014 adev\u0103rat doar pentru \u021besuturile moi. Nu exist\u0103 o singur\u0103 investiga\u021bie bun\u0103 pentru orice situa\u021bie; fiecare are rolul ei.<\/p>

Ce lipse\u0219te adesea din discu\u021bie: multe persoane au deplasare de disc la RMN f\u0103r\u0103 s\u0103 aib\u0103 durere sau limitare func\u021bional\u0103, sunt modific\u0103ri care exist\u0103 \u0219i la oameni complet asimptomatici. De aceea, un simplu pocnet la mandibul\u0103, f\u0103r\u0103 durere \u0219i f\u0103r\u0103 blocaj, nu justific\u0103 de rutin\u0103 un RMN.\u00a0RMN-ul are sens atunci c\u00e2nd exist\u0103 durere persistent\u0103 f\u0103r\u0103 alt\u0103 explica\u021bie, blocaje repetate ale mandibulei, limitare clar\u0103 a deschiderii gurii\u00a0sau c\u00e2nd rezultatul chiar poate schimba planul de tratament. Dac\u0103 bruxismul nocturn vine doar cu tensiune muscular\u0103 matinal\u0103, f\u0103r\u0103 aceste semne, examenul clinic e de obicei suficient pentru orientarea diagnosticului \u0219i a tratamentului.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce se poate face\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Tratamentul porne\u0219te aproape mereu conservator:<\/p>

–\u00a0terapie laser antiinflamatorie \u0219i decontracturant\u0103<\/p>

– gutier\u0103\u00a0ocluzal\u0103 de noapte, adaptat\u0103 individual \u2014 protejeaz\u0103 din\u021bii de uzur\u0103 \u0219i reduce solicitarea muscular\u0103<\/p>

– lucrul pe igiena somnului, unde e relevant<\/p>

– tehnici de reducere a tensiunii musculare<\/p>

– corectarea contactelor dentare dezechilibrate, atunci c\u00e2nd acestea contribuie la suprasolicitare<\/p>

– \u00een cazuri selectate, evaluarea colaborativ\u0103 cu somnologia, mai ales dac\u0103 exist\u0103 suspiciune de apnee \u00een somn asociat\u0103<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce rol are fotobiomodularea\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Laserul terapeutic (PBM) e din ce \u00een ce mai studiat ca adjuvant pentru durerea muscular\u0103 asociat\u0103 bruxismului \u0219i disfunc\u021biilor ATM. Nu trateaz\u0103 cauza central\u0103 a bruxismului \u2014 asta r\u0103m\u00e2ne un fenomen legat de arhitectura somnului \u2014 dar poate ajuta la reducerea tensiunii \u0219i durerii musculare acumulate, integrat \u00eentr-un plan mai amplu care include gutiera \u0219i, unde e cazul, gestionarea factorilor de stres.<\/p>

La Innovation Medical Center, folosim tehnologie THOR Photomedicine ca parte a evalu\u0103rii \u0219i tratamentului disfunc\u021biilor ATM asociate bruxismului \u2014 al\u0103turi de gutier\u0103 personalizat\u0103, analiz\u0103 ocluzal\u0103 \u0219i, atunci c\u00e2nd e relevant, evaluare postural\u0103.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ce arat\u0103 studiile\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Defini\u021bia \u0219i clasificarea bruxismului folosite azi vin dintr-un consens interna\u021bional de exper\u021bi, actualizat succesiv \u2014 bruxismul de somn e definit ca activitate ritmic\u0103 a mu\u0219chilor masticatori, cu prag de diagnostic gradat (posibil, probabil, cert).<\/p>

Mecanismul micro-trezirilor \u0219i al activ\u0103rii simpatice premerg\u0103toare episoadelor de bruxism a fost documentat polisomnografic \u2014 studiile arat\u0103 o cre\u0219tere a activit\u0103\u021bii cardiace simpatice cu c\u00e2teva minute \u00eenainte de debutul episodului, urmat\u0103 de activarea mu\u0219chilor maseter \u0219i temporal.<\/p>

Pe partea de tratament, un studiu randomizat pe copii cu bruxism de somn a comparat fotobiomodularea cu LED infraro\u0219u fa\u021b\u0103 de gutiera ocluzal\u0103, monitoriz\u00e2nd activitatea electromiografic\u0103 a mu\u0219chilor masticatori. Alte trialuri randomizate pe adul\u021bi cu disfunc\u021bie temporo-mandibular\u0103 \u0219i durere miofascial\u0103 \u2014 inclusiv una care a comparat direct dou\u0103 lungimi de und\u0103 laser \u2014 au ar\u0103tat reduceri semnificative ale durerii \u0219i \u00eembun\u0103t\u0103\u021biri ale func\u021biei mandibulare dup\u0103 fotobiomodulare.<\/p>

Referin\u021be:<\/p>

– Lobbezoo F, et al. *Bruxism defined and graded: an international consensus.* J Oral Rehabil, 2013. \u2014 https:\/\/pubmed.ncbi.nlm.nih.gov\/23121262\/<\/p>

– Lobbezoo F, et al. *International consensus on the assessment of bruxism: Report of a work in progress.* J Oral Rehabil, 2018. \u2014 https:\/\/pubmed.ncbi.nlm.nih.gov\/29926505\/<\/p>

– Huynh N, et al. *Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic\u00a0activity.* J Sleep Res, 2006. \u2014 https:\/\/pubmed.ncbi.nlm.nih.gov\/16911037\/<\/p>

– Lavigne GJ, et al. *Genesis of sleep bruxism: motor and autonomic-cardiac\u00a0interactions.* Arch Oral Biol, 2007. \u2014 https:\/\/pubmed.ncbi.nlm.nih.gov\/17313939\/<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Mit sau realitate?\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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\u201eScr\u00e2\u0219nesc din din\u021bi pentru c\u0103 sunt stresat\/<\/strong>\u0103<\/strong>, deci dac\u0103 m\u0103 relaxez, dispare complet<\/strong>.” \u2014 Par\u021bial mit. Stresul influen\u021beaz\u0103 frecven\u021ba \u0219i intensitatea episoadelor, dar bruxismul de somn e un fenomen neurofiziologic legat de arhitectura somnului, nu doar o reac\u021bie la stres.<\/p>

\u00a0<\/p>

\u00a0\u201eDac\u0103 scr\u00e2\u0219nesc din din\u021bi, sigur am nevoie de RMN<\/strong>.” \u2014 Mit. RMN-ul are sens doar \u00een prezen\u021ba unor semne specifice \u2014 durere persistent\u0103, blocaje, limitare clar\u0103 a deschiderii gurii. Simplul bruxism, f\u0103r\u0103 aceste semne, nu \u00eel justific\u0103 de rutin\u0103.<\/p>

\u00a0<\/p>

\u00a0\u201eDac\u0103 nu simt nimic diminea\u021ba, nu am bruxism<\/strong>.” \u2014 Mit. Mul\u021bi oameni au episoade de bruxism de somn f\u0103r\u0103 s\u0103 dezvolte simptome vizibile sau con\u0219tientizate.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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\u00centreb\u0103ri pe care le primesc des\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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De ce nu-mi amintesc nimic din timpul nop\u021bii?<\/strong><\/p>

Pentru c\u0103 bruxismul de somn e controlat central, legat de micro-trezirile naturale ale somnului \u2014 nu e o activitate con\u0219tient\u0103 pe care ai putea s\u0103 \u021bi-o aminte\u0219ti.<\/p>

\u00a0<\/p>

Partenerul meu aude scr\u00e2\u0219nit, dar eu nu simt nimic. E grav?<\/strong><\/p>

Nu neap\u0103rat. Prezen\u021ba sunetului nu \u00eenseamn\u0103 automat c\u0103 exist\u0103 leziuni sau c\u0103 e nevoie de tratament complex \u2014 depinde de context, de uzura dentar\u0103 \u0219i de eventualele simptome.<\/p>

\u00a0<\/p>

Poate bruxismul s\u0103 fie legat de apneea \u00een somn?<\/strong><\/p>

Da, la unele persoane exist\u0103 o leg\u0103tur\u0103 \u2014 bruxismul poate ap\u0103rea ca parte a procesului de restabilire a respira\u021biei dup\u0103 episoade de obstruc\u021bie. Dac\u0103 exist\u0103 \u0219i sfor\u0103it puternic sau pauze respiratorii observate de altcineva, merit\u0103 discutat.<\/p>

\u00a0<\/p>

C\u00e2t de repede se vede efectul unei gutiere sau al tratamentului?<\/strong><\/p>

Variaz\u0103. Unii pacien\u021bi simt o reducere a tensiunii musculare \u00een c\u00e2teva zile – s\u0103pt\u0103m\u00e2ni; uzura dentar\u0103 necesit\u0103 monitorizare pe termen mai lung.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Bruxismul nocturn nu e un semn de sl\u0103biciune \u0219i nu e „doar stres”, e un fenomen al somnului, controlat de creier, \u00een afara voin\u021bei tale. Dar asta nu \u00eenseamn\u0103 c\u0103 trebuie doar suportat. Odat\u0103 identificat\u0103 cauza \u0219i contextul \u2014 musculatura, ocluzia, calitatea somnului \u2014 se poate construi un plan care protejeaz\u0103 din\u021bii, reduce tensiunea \u0219i, de multe ori, \u00eembun\u0103t\u0103\u021be\u0219te \u0219i calitatea somnului \u00een sine.<\/p>

La Innovation Medical Center\u00a0evaluarea bruxismului \u0219i a disfunc\u021biilor ATM asociate integreaz\u0103 examenul clinic, analiza muscular\u0103 \u0219i ocluzal\u0103, \u0219i atunci c\u00e2nd semnele o justific\u0103 investiga\u021biile imagistice potrivite, nu automate.<\/p>

\u00a0<\/p>

Schedule a comprehensive evaluation<\/p>

\ud83d\udccd Bucharest \u2013 www.innovationmedical.ro<\/p>

\ud83d\udcde 0753 666 111<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Autor: Dr. Anca Adam,<\/p>

Medic Specialist \u00een Medicin\u0103 Fizic\u0103 \u0219i de Reabilitare, compartiment recuperare neurologic\u0103 \u0219i disfunc\u021bii ATM\/TMJ, Expert Acupunctur\u0103 Laser & Competen\u021b\u0103 Medicin\u0103 Tradi\u021bional\u0103 Chinez\u0103 (Tai Yuan, China), Termografie Medical\u0103 (Barcelona, Spania) \u2014 LSO (Laser Safety Officer) AALZ Aachen, Germania.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

\u201eDoamna doctor, m\u0103 trezesc diminea\u021ba cu maxilarul \u00een\u021bepenit, ca \u0219i cum a\u0219 fi \u021binut din\u021bii \u00eencle\u0219ta\u021bi toat\u0103 noaptea. Nu-mi amintesc nimic, nu simt c\u0103 fac ceva \u2014 dar diminea\u021ba am dureri de t\u00e2mpl\u0103, uneori \u0219i de g\u00e2t, \u0219i partenerul meu spune c\u0103 m\u0103 aude scr\u00e2\u0219nind.” \u00a0 Aud povestea asta constant, aproape identic\u0103 de la un […]<\/p>\n","protected":false},"author":7,"featured_media":23705,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[47],"tags":[],"class_list":["post-23704","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-disfunctii-cranio-mandibulare"],"_links":{"self":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/23704","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/comments?post=23704"}],"version-history":[{"count":4,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/23704\/revisions"}],"predecessor-version":[{"id":23713,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/posts\/23704\/revisions\/23713"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/media\/23705"}],"wp:attachment":[{"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/media?parent=23704"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/categories?post=23704"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/innovationmedical.ro\/en\/wp-json\/wp\/v2\/tags?post=23704"}],"curies":[{"name":"WordPress","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}