The interplay of academic procrastination, self-generated stress, and self-reported bruxism among medical and dental students: a cross-sectional study

BACKGROUND

Academic procrastination (AP), a common behavior among students, is influenced by factors such as fear of failure, task aversiveness, anxiety, and stress. Self-generated stress (SGS) refers to the subjective experience of tension that occurs in response to an existing situation. Individuals often overestimate the difficulty and attainability of a task, resulting in increased stress and extended stress duration. SGS can worsen mental and physical health problems, including bruxism. Therefore, this study investigates the possible underlying connections by examining the relationship between AP, SGS, and self-reported (SR) bruxism in medical and dental students.

METHODS

The present cross-sectional study was undertaken among a sample of 379 students pursuing medical and dentistry degrees in Turkey. The questionnaire, including the Academic Procrastination Scale-Short Form, SR bruxism Scale, and SGS Scale, was administered to the students. According to the responses given to the SR bruxism Scale, 3 types of SR bruxism groups were created as sleep, awake, and compound. A comparative analysis was conducted on AP, SGS, and SR bruxism among medical and dental students. Furthermore, the associations among AP, SGS, and SR bruxism were assessed using the utilization of correlation tables and regression analysis.

RESULTS

The prevalence of awake bruxism was higher among dental students (46.6%) compared to medical students (34.7%), suggesting a faculty-dependent trend. A significant positive correlation was observed between SGS and AP (r = 0.212, p < 0.001). Median AP values differed significantly based on awake bruxism (p = 0.007) and compound bruxism (p = 0.013), but not sleep bruxism (p = 0.352). SGS exhibited statistically significant differences across all SR bruxism types: sleep (p < 0.001), awake (p < 0.001), and compound (p < 0.001). Multiple regression analysis identified SGS as a significant risk factor for SR bruxism, with a one-unit increase in stress score elevating the SR bruxism risk by 1.086 times.

CONCLUSIONS

This study revealed that self-generated stress significantly increases the risk for the development of SR bruxism. A significant relationship was found between academic procrastination and self-generated stress, and this relationship was particularly associated with an increased risk for the development of compound and awake bruxism. Stress-reducing therapy methods should be recommended for students to both increase academic success by reducing academic procrastination and prevent the negative effects of stress-related SR bruxism.

Bruxism awareness and self-assessment in dental clinical students: a questionnaire-based study

BACKGROUND

Bruxism is a recurrent parafunctional habit characterized by clenching or grinding teeth and/or jaw contractions. It is quite common among dental students and is associated with psychosocial factors such as stress and anxiety. This study aimed to compare bruxism awareness and self-assessment among clinical students with and without bruxism.

METHODS

This study included systemically healthy individuals aged 18 to 27 years. Intraoral and extraoral examinations were performed on 128 4th- and 5th-grade dental students with (64) and without bruxism (64), 4th and 5th-grade dental students at Bolu Abant İzzet Baysal University who met the inclusion criteria. The diagnosis of bruxism was based on the 2018 International Consensus and data collected through a validated 33-item questionnaire covering general information and bruxism awareness. The questionnaire included multiple-choice questions on bruxism types, risk factors, symptoms, and impact on periodontal tissues. Statistical analyses were performed via IBM SPSS Statistics, and p < 0.05 was considered statistically significant.

RESULTS

Clenching and teeth grinding during sleep, tooth wear, muscle fatigue, pain in the temples, jaw pain, joint trismus, neck pain, and jaw joint pain and clenching while awake were significantly different in bruxism patients (p < 0.05). There was no significant difference between the two groups in terms of bruxism type, symptoms, treatment methods, periodontal tissues, occlusal trauma, diagnostic methods, or the relationship between lifestyle and bruxism (p > 0.05). While 71.9% of those diagnosed with bruxism stated that they had bruxism, 68.8% of those who were not diagnosed stated that they did not have bruxism.

CONCLUSION

Although dental students are aware of bruxism, their understanding of its multifactorial nature and treatment options needs improvement. Increasing this knowledge could reduce the prevalence of bruxism among dental students and improve patient care.

CLINICAL TRIAL REGISTRATION

The clinical trial was retrospectively registered on ClinicalTrials.gov under the identifier NCT06583044, with a registration date of 03/09/2024. https://register.

CLINICALTRIALS

gov/prs/beta/studies/S000EUYA00000023/recordSummary .

Evaluation of fractal analysis and radiomorphometric measurements of mandibular bone structure in bruxism and non-bruxism paediatric patients

OBJECTIVES

The goal of this examination was to compare the impact of probable sleep/awake bruxism on the mandibular trabecular bone structure by fractal analysis (FA) with digital panoramic radiograph (DPR) and radiomorphometric measurements in paediatric patients with bruxism.

METHODS

The examination included 130 participants with 63 patients with probable sleep/awake bruxism and 67 control groups. Bilateral regions of interest (ROI) in three regions were examined as ROI1: mandibular ramus, ROI2: mandibular angulus, ROI3: anterior to the molar teeth. Radiomorphometric measurements were taken of the mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI). p < 0.05 was approved for statistical significance.

RESULTS

The ROI-1, ROI-2, and ROI-3 values were defined to be statistically significantly high in the bruxism group (p < 0.05). No significant difference was found between the groups in the other values (p > 0.05). There was no difference in the age and gender for any of the parameters (p > 0.05).

CONCLUSION

In children and adolescents, the mandibular trabecular bone can be affected by bruxism. FA can be used as an auxiliary method for finding the mandibular trabecular differences of patients with bruxism in paediatric dentistry just as it can for adults.

Temporomandibular disorders: INfORM/IADR key points for good clinical practice based on standard of care

OBJECTIVE

To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR).

METHODS

An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points.

RESULTS

The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment.

CONCLUSIONS

The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

What do Brazilian paediatric dentists know about bruxism in children? Cross-sectional study

PURPOSE

Little is known about the knowledge of paediatric dentists on bruxism in children. The aim of this cross-sectional study was to assess the knowledge of paediatric dentists on the concept, associated factors of bruxism and management of sleep bruxism (SB) in children'.

METHODS

An electronic questionnaire was sent to paediatric dentists in the state of Goiás, Brazil. Information was collected on (1) characteristics of the participants; (2) the concept of bruxism; (3) diagnosis; (4) associated factors; (5) strategies for the management of SB; and (6) updated knowledge on bruxism in children. The data were analysed descriptively.

RESULTS

Fifty-seven paediatric dentists participated (10.7% of the total number of professionals). A high level of agreement was found with statements on the concepts of SB (94.7%) and awake bruxism (96.5%). The main strategy for the diagnosis was the combination of a parental report and a clinical examination (79.0%). Most participants indicated that bruxism is associated with anxiety/stress (96.5%), screen use (93%), airway obstruction (91.2%), and sleep apnoea (91.2%). In suspected cases of bruxism, the dentists would send the child for assessment by other health care providers (87.7%). The management options frequently indicated were the use of an occlusal splint, aromatherapy, and homeopathy. More than 70% of them considered themselves to be updated on the issue and sought information through scientific articles and discussions with colleagues.

CONCLUSION

Paediatric dentists have knowledge on the concept of bruxism and associated factors. However, further information is needed on the management of this condition in children.

Sleep Disorders Affecting Prognosis of Dental Treatment

This study provided an overview of the knowledge on the main sleep-related disorders and conditions affecting the prognosis of dental treatment: sleep bruxism (SB), obstructive sleep apnea (OSA), and gastroesophageal reflux disease (GERD). Current scientific evidence seems to suggest that these phenomena (ie, SB, OSA, GERD) belong to a circle of mutually relating sleep disorders and conditions where dental practitioners can play a key role in diagnosis and treatment.

Stress is simultaneously related to sleep and temporomandibular disorders

PURPOSE

This study aimed to clarify the relationship between the oral environment and psychological factors as predictor variables of sleep quality, in addition to inferring the relevant mechanisms of sleep and temporomandibular disorders (TMDs) by analyzing the relationship between TMDs and stress.

METHODS

This cross-sectional study analyzed data from 1,032 participants, comprising 420 men and 612 women, from the 2017 Iwaki Health Promotion Project using multiple regression analysis. The primary endpoints were the scores of each item in the Pittsburgh Sleep Quality Index (PSQI) and its sum. Predictor variables included the number of teeth; TMDs; stress, assessed using the World Health Organization-5 (WHO-5); sleep bruxism; and oral health-related quality of life, assessed using the oral health impact profile-14 (OHIP14). The confounding factors included age, body mass index, and alcohol intake.

RESULTS

Multiple regression analysis revealed that TMDs (β value = 0.293, p = 0.034) and stress (β value = 1.3, p < 0.001) were significantly correlated with the PSQI total score. In addition, TMDs were significantly correlated with stress (β value = 0.076, p = 0.007).

CONCLUSION

The significant relationship between sleep and TMDs suggests that mental stress contributes to the development sleep disorders and consequently is associated with the development of TMD symptoms.

3D printed versus milled stabilization splints for the management of bruxism and temporomandibular disorders: study protocol for a randomized prospective single-blinded crossover trial

BACKGROUND

Nowadays, stabilization splints for the management of bruxism and temporomandibular disorders (TMD) can be produced utilizing a digital workflow comprising a digital impression of the teeth, digital splint design, and computer-aided manufacturing of the splints. The latter is usually a milling process, however, more recently 3D printing gained popularity due to its better cost and time efficiency. It remains unknown whether 3D printed stabilization splints are inferior to milled splints regarding clinical outcomes.

METHODS

This clinical trial assesses the non-inferiority of 3D printed occlusal splints compared to milled occlusal splints in a monocentric prospective randomized single-blinded crossover trial with two cohorts. One cohort includes 20 participants with bruxism, the other 20 participants with pain-related TMD, i.e., myalgia, myofascial pain, or arthralgia of the jaw muscles/the temporomandibular joint(s) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Michigan-type stabilization splints are fabricated in a digital workflow by milling or 3D printing using CE-marked materials within their intended purpose. The participants wear a milled and a 3D printed splint in a randomized order for 3 months each, with follow-up visits after 2 weeks and 3 months. Investigated outcome parameters are oral health-related quality of life (OHRQoL) evaluated by the Oral Health Impact Profile (OHIP-G14), participant satisfaction as rated on a visual analog scale, therapeutic efficacy, and technical result of the splints. In this context, therapeutic efficacy means antagonist wear and-in the TMD group-reduction of pain/disability assessed by the Graded Chronic Pain Scale (GCPS v2.0) and clinical assessment following the DC/TMD standard, while technical outcome measures splint fit, wear and fracture rate.

DISCUSSION

The trial will provide important information on the clinical outcome of 3D printed stabilization splints in comparison to milled splints and will, therefore, enable an evidence-based decision in favor of or against a manufacturing process. This, in turn, will guarantee for a maximum of the patient's OHRQoL during splint therapy, therapeutic efficacy, and longevity of the splints.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00033904. Registered on March 15, 2024.

The effects of dry needling and face yoga on pain, depression, function, and sleep quality in patients with temporomandibular dysfunction

CONTEXT

Temporomandibular joint dysfunction (TMD) poses significant challenges due to its diverse symptoms and impact on patients' daily lives.

OBJECTIVE

This study aimed to explore the effectiveness of two innovative interventions, dry needling and face yoga, in managing TMD-related issues such as pain, depression, and sleep quality.

DESIGN AND STUDY PARTICIPANTS

Ninety patients with TMD symptoms were enrolled in a prospective randomized controlled trial. The patients were divided into three groups: dry needling, face yoga, and a control group. Various assessments, including Visual Analog Scale for pain, Beck Depression Inventory for depression, and Pittsburgh Sleep Quality Index for sleep quality, were conducted before and 6 weeks after the interventions.

RESULTS

A decrease in pain levels and a statistically significant increase in jaw joint movements (mouth opening, protrusive movement, lateral movements) were observed in the dry needling and face yoga groups after treatment (p <0.05). Additionally, improvements in sleep quality were observed (p <0.05).

CONCLUSION

Dry needling and face yoga interventions demonstrated efficacy in managing TMD symptoms, including pain relief and improved jaw movement. The findings suggest that these interventions can be valuable additions to the treatment regimen for patients suffering from TMD-related issues. However, further research is warranted to explore the long-term effects and mechanisms underlying these interventions in TMD management.

Sleep bruxism in children main methods of treatment: a systematic review with meta-analysis

Sleep bruxism is both masticatory muscle activities characterized by repeated or prolonged tooth contact as well as bracing or thrusting of the jaw. This meta-analysis evaluates the differences between sexes and which therapy is most effective in treating bruxism. A literature search was performed on PubMed, Lilacs, Web of Science and Scopus, and articles published from 2000 to 2022 were considered according to the keywords entered. The term "Bruxism" has been combined with "Children" using the boolean connector AND. At the end of the research, 1462 studies were identified from the search conducted on the three engines. Only four were chosen to draw up the present systematic study. The Forrest plot found that photo biomodulation therapy has a higher efficacy (Odds Ratio (OR) 0.10; 95% Confidence Interval (CI) from 0.03 to 0.43), followed by treatment with hydroxyzine (OR 0.19; 95% CI from 0.03 to 1.04). The average between girls and boys with bruxism is 18.5 for boys and 19.5 for girls. This meta-analysis showed that treatment by photobiomodulation has more significant effects on bruxism, followed by treatment with hydroxyisalazine. However, this meta-analysis has limitations due to the diversity of treatment evaluation methods.

Botulinum toxin for bruxism treatment: a nationwide study among oral and maxillofacial surgeons in Germany

INTRODUCTION

This study aimed to evaluate the use of botulinum toxin (BTX) for the treatment of bruxism in oral and maxillofacial surgery in Germany.

MATERIAL AND METHODS

A dynamic online questionnaire comprising 7 to 25 questions was formulated to gather general and specific information regarding using BTX to treat bruxism. The questionnaire underwent internal and external assessments for validation. Subsequently, it was distributed to 906 oral and maxillofacial surgeons (OMFS) affiliated with the German Association for Oral and Maxillofacial Surgery (DGMKG). Weekly reminders were dispatched over four weeks to enhance response rates. Participation in the study was voluntary and anonymized. Descriptive methods were employed for data analysis.

RESULTS

107 OMFS participated in the study, yielding a response rate of 11.81%. On average, 17 patients with bruxism were per month, with 4 of these patients receiving BTX therapy. BTX administration was frequently accompanied by splints and physiotherapy (35.51% of participants). Botox® (Allergan) was the preferred BTX preparation, utilized by 40.79% and reconstituted with saline by 92.11% of participants. The masseter muscles were primarily targeted for BTX treatment (67.57% of participants), averaging 29 BTX (Allergan-) units per side. Injection points for each masseter muscle typically amounted to six per side, preferred by 30.67% of participants. Follow-up assessments post-BTX treatment were conducted regularly, predominantly after four weeks, by 36% of participants. In 8% of cases, additional BTX injections were necessary due to inadequate outcomes. Side effects were reported in 4% of cases, commonly manifesting as a non-disturbing reduction in bite force. Most participating OMFS (61.84%) using BTX for bruxism therapy regarded bruxism treatment with BTX as evidence-based. Notably, 97.37% of respondents expressed their willingness to recommend BTX-based bruxism treatment to their colleagues. Overall, the efficacy of BTX therapy for bruxism was rated as good (53.95%) and very good (40.79%).

CONCLUSION

The use of BTX for the management of bruxism among OMFS in Germany has demonstrated efficacy. Substantial variances in certain facets of bruxism treatment employing BTX have been observed.

CLINICAL RELEVANCE

Additional research endeavors are warranted to comprehensively investigate distinct elements of BTX therapy for bruxism, including the optimal dosage of BTX units and the precise localization of injection sites across various muscles.

The impact of print orientation and graphene nanoplatelets on biaxial flexural strength and cytotoxicity of a 3D printable resin for occlusal splints

OBJECTIVES

3D printing found its way into various medical applications and could be particularly beneficial for dentistry. Currently, materials for 3D printing of occlusal splints lack mechanical strength compared to polymethyl methacrylate (PMMA) used for standard milling of occlusal splints. It is known that print orientation and graphene nanoplatelets (GNP) can increase biaxial strength in a variety of materials. Thus, the aim of this study was to assess if adjustment of print orientation and addition of GNP improve biaxial strength and if they affect cytotoxicity of a 3D printable resin for occlusal splints.

METHODS

Specimens were printed vertically and horizontally with a stereolithography (SLA) printer and multilayered GNP powder was added to the resin at different concentrations. Printed specimens were characterized by Raman spectroscopy, optical profilometer analysis and scanning electron microscopy. Biaxial strength was evaluated by biaxial flexural testing. Cytotoxicity of specimens on L929 and gingival stromal cells (GSC) was assessed by the toxdent test, the resazurin-based toxicity assay and live-dead staining.

RESULTS

Horizontally printed specimens showed significantly higher biaxial strength and lower deformation. GNP did not improve biaxial strength and material deformation of 3D-printed resins. None of the specimens were cytotoxic to L929 cells or GSC.

SIGNIFICANCE

Print orientation in SLA printing has a significant impact on biaxial strength and material deformation. 3D printable materials can reach comparable or even improved biaxial strength compared to PMMA when using the optimal print orientation while GNP has no beneficial effects on the biaxial strength of resins for 3D printing of occlusal splints.

Actual state of the diurnal masseteric electromyogram: Differences between awareness and non-awareness of awake bruxism

PURPOSE

This study aimed to elucidate the relationship between diurnal masseter muscle activity and awareness of diurnal awake bruxism (d-AB) by conducting a comparative analysis of electromyographic (EMG) data from individuals with and without awareness of diurnal awake bruxism (d-AB), utilizing EMG data gathered from multiple subjects.

METHODS

Unilateral masseter electromyography (EMG) recordings were performed during the daytime using an ultraminiature wearable EMG device. A total of 119 participants (59 with awareness of diurnal tooth clenching [d-TC] and 60 without awareness of d-TC) were included. Waveforms longer than 0.25 s with the two amplitude conditions, exceeding twice the baseline and >5% of maximum voluntary clenching, were extracted. In addition, the number of bursts and episodes (groups of bursts), burst duration, and burst peak amplitude were calculated for each participant.

RESULTS

There were no significant differences in the EMG parameters between the groups with and without awareness of d-TC. Additionally, the frequency distribution of the number of EMG waveforms exhibited wide ranges and substantial overlap between the two groups.

CONCLUSIONS

The variability in the number of bursts and episodes, burst peak amplitude, and burst duration among subjects suggests the need for an objective classification of d-AB severity based on EMG values. The absence of significant differences and large overlap in frequency distributions between the groups with and without awareness of d-TC indicate difficulty in predicting muscle activity solely based on awareness of d-AB.

Is there a relationship between the presence of external root resorption in second molars adjacent to impacted mandibular third molars with awake bruxism and masticatory muscle activity?

OBJECTIVES

This study aimed to assess whether awake bruxism and masticatory muscle activity could be related to external root resorption (ERR) in second molars adjacent to impacted mandibular third molars.

MATERIALS AND METHODS

Sixty patients, with requests for a cone-beam, computed tomography, were divided into two groups: ERR (patients with ERR in the second molar, n = 30), and control group (n = 30). Awake bruxism was assessed through the Oral Behaviors Checklist (OBC) and an ecological momentary assessment (EMA). Surface electromyography (EMG) was used to assess the masseter and anterior temporal muscle function. Normality and homogeneity of variances were demonstrated. Descriptive analysis was performed, using the T-test and Chi-square test to compare the characteristics of the groups. A multiple regression model was performed.

RESULTS

The ERR group presented more non-functional oral activities related to awake bruxism than the control group, according to OBC (p = 0.027) and EMA (p = 0.035). In addition, the ERR group had higher EMG activity than the control group in rest and isotonic protocols (p < 0.05).

CONCLUSIONS

Awake bruxism and greater masticatory muscle activity seem to be related to the presence of ERR in second molars adjacent to impacted mandibular third molars.

CLINICAL RELEVANCE

The results of the present study can reinforce the theory that triggering ERR in the second molars adjacent to impacted mandibular third molars may be related to mechanical forces coming from the masticatory function.

Risk of Dental Implant Failures May Be Higher in Bruxers Than Nonbruxers

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Häggman-Henrikson B, Ali D, Aljamal M, Chrcanovic BR. Bruxism and dental implants: A systematic review and meta-analysis. J Oral Rehabil. 2024 Jan;51(1):202-217. 10.1111/joor.13567. Epub 2023 Aug 17. PMID: 37589382.

SOURCE OF FUNDING

None.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Effects of different interventions on bruxism: an overview of systematic reviews

OBJECTIVE

This study aimed to evaluate, qualify, and summarize evidence presented in systematic reviews (SR) on treatments for bruxism.

METHODS

The overview was conducted using the PICO strategy: children, adolescents, and adults with bruxism (P) were submitted to different treatments (I) compared to other treatments, placebo, or no treatment (C) in order to evaluate incidence, prevalence, and number of episodes of bruxism (O). The search was carried out in six databases and gray literature up to July 2023. Data were extracted, and the ROBS tool was used, followed by a descriptive synthesis of the results.

RESULTS

A total of 31 SR were included. Sixteen showed a positive effect on episodes of bruxism (BE), while two had negative, one had neutral, and nine had inconclusive effects. Using the risk of bias in systematic reviews tool (ROBIS), risk of bias varied from low (n = 23) to high (n = 5) among the SR. Pharmacological treatment, oral rehabilitation, and other therapeutic approaches presented inconclusive or negative effects on BE, while oral appliances showed controversial effects. Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE.

CONCLUSION

Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE; there is still a lack of studies to support the safe and long-term use of these therapies.

REGISTRATION NUMBER

PROSPERO CRD42021273905.

MR sialographic assessment of the masseter muscle and the ductal kinking in patients with recurrent parotitis

Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen's duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.

Temporomandibular Disorders, Bruxism and Headaches

Temporomandibular disorders (TMDs) and headache disorders are highly prevalent in the population. TMDs can present headache symptoms as a secondary headache and, in addition, be comorbid with primary headache disorders. This overlap has significant clinical implications for which it is essential for the physician to be aware, and they should screen for the potential presence of TMDs in a headache patient. Bruxism is a parafunctional behavior also prevalent in the population which has a role in TMDs and may influence headache symptomatology, but it is still necessary to clarify this relationship.

Investigation of masticatory muscle thickness and mechanosensitivity of cervical and masticatory muscles in myofascial temporomandibular disorder patients with bruxism: A cross-sectional study

OBJECTIVE

Bruxism is a common problem associated with temporomandibular disorders (TMD). The aim of this study was to compare a patient group with Myofascial TMD and bruxism and a healthy control group in terms of masseter and temporal muscle thickness (clenching and resting), mechanosensitivity of neck and jaw muscles, craniofacial pain, and disability and emotional stress status.

METHODS

The study included 31 patients with myofascial TMD and bruxism (19 females, 12 males) with a mean age of 29.96 ± 8.12 years (range, 18-45 years), and a control group of 31 healthy subjects (19 females, 12 males) with a mean age of 27.58 ± 9.39 years years (range, 18-45 years). Masseter and temporal muscle thicknesses were evaluated with a mobile ultrasound device both at rest and when clenching the jaw. The mechanosensitivity values between the upper trapezius, obliquus capitis inferior, masseter and temporal muscles were measured with a digital algometer device. Craniofacial pain and disability level were evaluated with the Craniofacial Pain and Disability Index (CFPDI), and emotional stress levels with the Perceived Stress Scale-14 (PSS-14).

RESULTS

No difference was determined between the two groups in respect of the clenching and resting ratios of muscle thickness in any muscle (p > 0.05). The mechanosensitivity values in all muscles were lower in the myofascial TMD group than in the healthy group (p < 0.05). The CFPDI and PSS-14 scores were higher in the myofascial TMD group (p < 0.05). There was a moderate positive correlation between CFPDI, PSS-14 and Bruxism Frequency Score (p < 0.05).

CONCLUSION

The difference in mechanosensitivity and CFPDI values between the myofascial TMD patients with bruxism and the healthy control group indicates that the problem in this patient group has effects in the craniocervical and cervical regions. In addition, the correlation between CFPDI, PSS-14 and Bruxism Frequency Score in myofascial TMD patients suggests that this problem may be affected by the interaction of different parameters.

Can botulinum toxin injection alleviate the pain of bruxism? A Bayesian network analysis and a single-arm analysis

Background/purpose

There is inconsistent evidence regarding whether the botulinum toxin A (BTA) injection can relieve pain caused by bruxism. This study aimed to estimate the efficiency of BTA injection in relieving pain caused by bruxism at different follow-up periods.

Materials and methods

Five electronic databases were searched from 2005 to 2022 using search terms related to botulinum toxin and bruxism. Only controlled clinical trials were included. Two investigators reviewed each article and discussed any disagreements until a consensus was reached. Pain outcomes as evaluated by the visual analogue scale (VAS) were subjected to single-arm and Bayesian network meta-analyses. Pooling data were measured by a random-effects model.

Results

Eleven studies with a total of 365 bruxism patients were included. According to the single-arm analyses of the pooled data, the reduction in bruxism-related pain after BTA injection measured 4.06 points (95% CI = 3.37 to 4.75) on the VAS, and the pain relief was significant in the first 6 months after treatment (P < 0.01). According to the Bayesian analysis, BTA also resulted in significantly greater pain relief than oral splinting (mean difference (MD), -1.5; 95% credible interval (CrI) = -2.7 to -0.19) or saline injection (MD, -3.3; 95% CrI = -6.2 to -0.32).

Conclusion

BTA significantly relieves the pain of bruxism for 6 months after injection, and its therapeutic efficacy was higher than that of oral splinting. Nevertheless, further long-term follow-up randomized controlled trials comparing BTA with other management or drugs are warranted.

Sleep bruxism: The past, the present, and the future-evolution of a concept

BACKGROUND

The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded.

TYPES OF STUDIES REVIEWED

The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles.

RESULTS

There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.

Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers

To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.

The relationship between pregnancy and temporomandibular disorder (TMD) through diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a case-control cross-sectional study

INTRODUCTION

This study focuses on temporomandibular disorders (TMDs), which affect the temporomandibular joint and related muscles and have multiple causes. Recent studies have examined the connection between menstrual cycles, estrogen levels, and TMDs, but results are inconsistent, highlighting the need for more research. The aim is to explore the prevalence of TMDs in pregnant women and consider how hormonal changes during pregnancy might influence these disorders.

METHODS

In this cross-sectional case-control study, we compared 32 pregnant women with 35 non-pregnant women. We evaluated several TMD-related factors such as pain levels, chronic pain classification, scores on the Jaw Functional Limitation Scale-20 and Oral Behaviors Checklist, and psychological health. We used various statistical methods including descriptive statistics, chi-square tests, linear regression, and adjustments for multiple comparisons to analyze the data.

RESULTS

Pregnant women showed different pain perceptions, generally reporting less pain and lower severity. Nonetheless, these differences were not uniform across all TMD-related measures. Linear regression did not find a consistent link between pregnancy and TMD scores, except for chronic pain grade, which was not significant after adjusting for multiple comparisons. There was a significant relationship between depression and TMD severity, emphasizing the need to consider mental health in TMD evaluations.

DISCUSSION

The findings suggest that pregnancy is neither a risk nor a protective factor for TMD. Differences in pain perception, functional status, and psychological health were observed in pregnant women but were not consistent for all TMD-related aspects. The role of estrogen in TMJ health and TMD risk is complex and requires further study. The research highlights the necessity of including mental health, especially depression, in TMD assessments. More comprehensive research with larger sample sizes is essential to better understand the connections between pregnancy, TMD, and hormones, aiming to improve TMD management in pregnant women and others.

Sixty-month comperative evaluation of a glass hybrid restorative and a composite resin in non-carious cervical lesions of bruxist individuals

OBJECTIVE

To compare the clinical performance of a glass hybrid (GH) restorative and a nano-ceramic composite resin (CR) in the restoration of non-carious cervical lesions (NCCLs) of bruxist individuals in a 60-month randomized clinical trial.

MATERIALS AND METHODS

Twenty-five bruxist candidates having NCCLs were recruited in this clinical study. The depth, height (cervico-incisal), width (mesio-distal), internal angles of the NCCLs, degree of tooth wear (TWI) and gingival index (GI) were measured. One hundred-and-forty-eight NCCLs were restored either with a GH restorative (Equia Forte Fil) or a CR (Ceram.X One Universal). Modified USPHS criteria was used to evaluate restorations after 1 week and 12, 24, 36 and 60 months. Pearson's Chi-Square, Fisher's Exact and Cochran Q tests were run for analysis. Survival rates of the restorations were compared with Kaplan-Meier analysis (p < 0.05).

RESULTS

After 60 months, 97 restorations in 15 patients were examined. The recall rate was 60.0%. Retention rates were 73.5% for CR and 66.7% for GH. A total of 29 restorations were lost (13CR (26.5%), 16GH (33.3%)). There was not a significant difference between tested restoratives in retention (p = 0.464), marginal adaptation (p = 0.856) and marginal discoloration (p = 0.273). There was no relationship between internal angle, depth, height or width and retention of the GH or CR restorations (p > 0.05). The increase in retention loss and marginal discoloration of both restorations over time were significant (p < 0.001). Sensitivity or secondary caries were not detected after 60 months.

CONCLUSION

GH and nano-ceramic CR showed similar clinical performances in NCCLs after 60 months in patients with bruxism.

CLINICAL SIGNIFICANCE

After 60 months, CR and GH materials showed clinically acceptable performances in restoration of NCCLs in patients with bruxism.

Effects of bruxism on temporomandibular joint internal derangement in patients with unilateral temporomandibular joint pain: The role of magnetic resonance imaging diagnostics

OBJECTIVE

This study compared temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings between bruxism and control groups with unilateral TMJ pain as well as the TMJ MRI findings for the painful and non-painful sides of individuals in the two groups.

METHODS

Clinical and MRI findings of patients seen at Uşak University, Dentistry Faculty, Department of Oral and Maxillofacial Surgery for unilateral TMJ pain between 2017 and 2020 were analyzed. Bruxism was diagnosed based on clinical findings and patient history. The MRI variables were disc/condyle relationship (normal, disc displacement with reduction, or disc displacement without reduction), disc structure (normal and abnormal), condyle degeneration type (normal, moderate, or severe), and joint effusion (absent or present). Pain was recorded based on a visual analog scale (VAS) numbered between 0 and 10. Statistical analyses were performed using IBM SPSS. The data were distributed non-normally according to the results of Kolmogorov-Smirnov tests. The Mann-Whitney U test was used to compare age and VAS. Chi-square tests were used to compare categorical variables. Statistical significance was defined as p < 0.05.

RESULTS

This study assessed the MRI records of 558 cases of TMJ pain. No significant differences in disc/condyle relation, disc structure, condyle structure, or effusion were observed between the control and bruxism groups (p > 0.05). However, a significant difference in TMJ MRI findings was observed between the painful and non-painful sides of each individual in the control and bruxism groups (p = 0.001, p < 0.001 and p = 0.004, p < 0.001, respectively).

CONCLUSION

The results of this study established a relationship between the painful side for each patient and TMJ MRI findings. In particular, individuals with bruxism had a higher rate of TMJ internal derangement and effusion on the painful side.