The Relationship between Oral Health-Related Quality of Life and Body Mass Index in an Older Population from Southern Italy: The Salus in Apulia Study

BACKGROUND

The assessment of oral health-related quality of life (OHRQoL) evaluated the impact of an individual's oral health on the patient's physical and psychosocial status. We evaluated the association between subjective OHRQoL, measured with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and unfavorable body mass index (BMI) (i.e., too high or too low) in a large population-based study on older adults from Southern Italy. Moreover, we assessed which of the seven OHIP-14 domains was the most strongly associated with an unfavorable BMI.

METHODS

We used data on a subpopulation of the Salus in Apulia Study, including 216 older adults. BMI < 18.4 kg/m2 and >30 kg/m2 were classified as unfavorable, while values between 18.5 and 30 kg/m2 were classified as ideal.

RESULTS

A higher OHIP-14 total score increased the risk of an unfavorable BMI (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.15). In the model adjusted for age, sex, education, hypertension, carbohydrate consumption, and alcohol consumption, this finding was confirmed with a higher OHIP-14 total score increasing the risk of an unfavorable BMI (OR: 1.10, 95% CI: 1.01-1.22), and higher age linked to a decreased risk of an unfavorable BMI (OR: 0.89, 95% CI: 0.82-0.97). In a random forest regression model, the most important predictive domains/sub-scales of OHIP-14 in the mean decrease in the Gini coefficient for unfavorable BMI were, in order of decreasing importance, physical pain, functional limitation, psychological discomfort, physical disability, social disability, psychological disability, and handicap.

CONCLUSIONS

In older age, negative OHRQoL, particularly linked to the physical pain domain, increased the risk of being underweight or overweight and obesity.

Overtreatment "Successes"--What Are the Negative Consequences for Patients, Dentists, and the Profession?

AIMS

To describe how some management practices in the field of orofacial musculoskeletal disorders (also described as temporomandibular disorders [TMDs]) are based on concepts about occlusal relationships, condyle positions, or functional guidance; for some patients, these procedures may be producing successful outcomes in terms of symptom reduction, but in many cases, they can be examples of unnecessary overtreatment.

METHODS

The authors discuss the negative consequences of this type of overtreatment for both doctors and patients, as well as the impact on the dental profession itself. Special focus is given to trying to move the dental profession away from the old mechanical paradigms for treating TMDs and forward to the more modern (and generally more conservative) medically based approaches, with emphasis on the biopsychosocial model.

RESULTS

The clinical implications of such a discussion are apparent. For example, it can be argued that the routine use of Phase II dental or surgical treatments for managing most orofacial pain cases represents overtreatment, which cannot be defended on the grounds of symptom improvement (ie, "successful" outcomes) alone. Similarly, there is enough clinical evidence to conclude that complex biomechanical approaches focusing on the search for an ideal specific condylar or neuromuscular position for the management of orofacial musculoskeletal disorders are not needed to produce a positive clinical result that is stable over time.

CONCLUSION

Typically, overtreatment successes cannot be easily perceived by the patients or the treating dentists because the patients are satisfied and the dentists feel good about those outcomes. However, neither party knows whether an excessive amount of treatment has been provided. Therefore, both the practical and ethical aspects of this discussion about proper treatment vs overtreatment deserve attention.

EPA Consensus Project Paper: The Relationship Between Prosthodontic Rehabilitations and Temporomandibular Disorders

AIM

The aim of this systematic review is to evaluate the relationship between prosthodontic treatment and temporomandibular disorders (TMD).

MATERIALS AND METHODS

Two clinical questions have been raised. Can prosthodontic treatment be used as a strategy to manage temporomandibular disorders? Is there any causal relationship between prosthodontic rehabilitation and the onset of TMD? A systematic search was performed in four medical databases to identify Clinical Trials (CT) and Randomized Clinical Trials (RCT) that could answer the two clinical questions.

RESULTS

Any articles fulfilling the inclusion criteria were found. Therefore, the best available evidence on TMD management and aetiology is discussed in a scoping review with focus on the relationship with prosthodontic treatment.

CONCLUSIONS

Based on current scientific evidence, prosthetic rehabilitation cannot be proposed as a treatment option for TMD patients, based on the effectiveness of other more conservative options as well as the absence of association between features of dental occlusion and TMD. Thanks to the high neuro plastic adaptation skills of the stomatognathic system, prosthodontic rehabilitation cannot be identified as a direct cause of TMD, but clinicians should pay caution when performing relevant occlusal modifications.

Outcomes of Endodontic-Treated Teeth Obturated with Bioceramic Sealers in Combination with Warm Gutta-Percha Obturation Techniques: A Prospective Clinical Study

The objective of this clinical study was to collect short-term endodontic outcomes of endodontic-treated teeth (ETT) obturated with different kinds of bioceramic sealers used in combination with warm gutta-percha obturation techniques. Methods: A total of 210 endodontic treatments in 168 patients were performed. At baseline, 155 sample teeth (73.8%) showed symptoms (tenderness or pain to percussion) and 125 (59.5%) showed periapical radiolucency. Periapical radiolucency was present in 125 cases (59.5%); of these, 79 showed a lesion of 5 mm or bigger (63.2%) while lower than 5 mm in 46 cases (36.8%). Regarding ETT with radiolucency, 105 of them (84%) were in coincidence with their need for retreatment and the other 20 (16%) were necrotic teeth. The obturation techniques that were used in this study were: the continuous wave of condensation technique in 75% of cases, and carrier-based technique in 25%. Four bioceramic sealers were used: CeraSeal in 115 cases, BioRoot in 35 cases, AH Plus Bio in 40 cases, and in 20 cases, BIO-C SEALER ION. Preoperative and recall radiographs of the roots were each assigned a periapical index (PAI) score by 2 blinded, independent, and calibrated examiners. The teeth were divided into outcome categories based on the following classification: healed, unhealed, and healing. The healed and healing categories were classified as success, and the unhealed category was classified as failure on the basis of loose criteria. Minimum follow-up period was 18 months. Results: The overall success rate was 99%, with 73.3% healed, 25.7% healing, and 0.95% not healed. The success rate was 100% for initial treatment and 98.2% for retreatment. Fifty-four (N = 54) teeth showed ongoing healing. All of them were retreatment cases with periapical lesions. Regarding the success (healed and healing) versus not healed, no significant difference was found between teeth with or without periapical lesions (p < 0.05). A statistically significant difference in the distribution of healed, healing, and not-healed teeth was found between the groups of teeth with baseline lesions < 5 mm and >5 mm in diameter (p < 0.01) and those with sealer groups (p < 0.01). The success rate of used bioceramic sealers was not statistically significant different (99.1%, 100%, 97.5% and 100%, respectively, for CeraSeal, BioRoot, AH Plus Bio, and BIO-C SEALER ION). Nonetheless, the distribution of healed, healing, and not-healed teeth was different between teeth sealed with different materials (p < 0.01). From the findings of this clinical study, the following conclusion can be drawn: a correct filling of root canals made with warm gutta-percha technique combined with a bioceramic sealer allows a high success rate in endodontically treated teeth.

Dental practitioner approaches to bruxism: Preliminary findings from the national dental practice-based research network

OBJECTIVE

Bruxism is a repetitive masticatory muscle activity. This study investigates dental practitioners' approaches to bruxism assessment and treatment in practices.

METHODS

A brief 5 question questionnaire ("Quick Poll") on bruxism was conducted.

RESULTS

A total of 397 practitioners responded. More than half (55%) initiated treatment for bruxism on one to three patients per month. The majority believed that stress (97%) and sleep patterns (82%) affected bruxism in their patients. Interestingly, 96% offered an occlusal guard/appliance and 46% made occlusal adjustments.

CONCLUSION

This study highlights inconsistencies in practitioner approaches to bruxism assessment and management in clinical settings, suggesting gaps in practitioner knowledge evidenced by the varied responses.

ABBREVIATIONS

PBRN - Practice-Based Research NetworkMMA - Masticatory muscle activitySB - Sleep bruxismAB - Awake bruxismTMJ - Temporomandibular jointOSA - Obstructive sleep apnea.

Temporomandibular Disorders Within the Context of Sleep Disorders

This paper provided an overview of the knowledge on the relationship between temporomandibular disorders (TMDs) and the main sleep conditions and disorders of dental interest, namely, sleep bruxism (SB), sleep apnea, and gastroesophageal reflux disease (GERD). It emerged that although the topic of SB as a possible detrimental factor for the stomatognathic structures has been the most studied, evidence is growing that SB, obstructive sleep apnea, and GERD, all belong to a circle of mutually interacting sleep disorders and conditions that, in turn, may be associated with TMDs. The pathophysiology of the cause-and-effect relationships, if existing, has to be elucidated yet.

Temporomandibular Joint Disorder Comorbidities

Comorbidity is a distinct additional condition that either existed or exists during the clinical course of a patient afflicted by the condition/entity in question. The clinician attempting to manage temporomandibular joint disorder (TMD) and TMD pain must realize that recognition and management of the comorbidities are essential to the successful management of the same with optimal pain control. When TMD presents with multiple comorbidities, the task for the clinician becomes more complex. It is the hope of the authors that this condensed version of TMD-associated comorbidities acts as a primer for understanding the significance of the same in pain management.

How dental teams can help patients with temporomandibular disorders receive general dental care: An International Delphi process

BACKGROUND

Many patients with temporomandibular disorders (TMD) find it difficult to undergo dental care due to challenges caused by their condition, previous temporomandibular joint surgery or invasive dental procedures, and the impact of comorbid conditions. Managing routine dental care for some patients with TMD can be seen as challenging by some dental practitioners.

OBJECTIVE

The objective of this study was to work with patients experiencing TMD and clinicians to co-produce recommendations aimed at helping general dentists to provide routine dental care for patients with TMD.

METHODS

A modified Delphi process was used to co-produce recommendations. Six patients experiencing TMD, patient advocates and seven clinicians took part, including international TMD clinicians. Two meetings were held with patient participants, mediated by a trained facilitator. Recommendations suggested by patient participants were distributed to clinicians who were asked to add additional suggestions, but not to modify patients' recommendations unless to aid clarity. Additional themes were identified from the existing literature, and the recommendations were then reviewed by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) consortium.

RESULTS

Recommendations were given to support patients before, during and after dental treatment. Participants identified specific and practical recommendations to help patients with TMD receive routine dental care, but also emphasised the need for professionals to listen sensitively to patients' concerns and work with patients in an empathetic and non-judgmental way.

CONCLUSION

These recommendations, co-developed with patients experiencing TMD, should help dental professionals to provide supportive general dental care for patients with TMD.

Ecological Momentary Assessment of Awake Bruxism Behaviors: A Scoping Review of Findings from Smartphone-Based Studies in Healthy Young Adults

BACKGROUND

The recent introduction of ecological momentary assessment (EMA) smartphone-based strategies has allowed achieving some interesting data on the frequency of different awake bruxism (AB) behaviors reported by an individual in the natural environment.

OBJECTIVE

The present paper aims to review the literature on the reported frequency of AB based on data gathered via smartphone EMA technology.

METHODS

On September 2022, a systematic search in the Pubmed, Scopus and Google Scholar databases was performed to identify all peer-reviewed English-language studies assessing awake bruxism behaviors using a smartphone-based Ecological Momentary Assessment. The selected articles were assessed independently by two authors according to a structured reading of the articles' format (PICO).

RESULTS

A literature search, for which the search terms "Awake Bruxism" and "Ecological Momentary Assessment" were used, identified 15 articles. Of them, eight fulfilled the inclusion criteria. The results of seven studies using the same smartphone-based app reported a frequency of AB behaviors in the range between 28.3 and 40% over one week, while another investigation adopted a different smartphone-based EMA approach via WhatsApp using a web-based survey program and reported an AB frequency of 58.6%. Most included studies were based on convenience samples with limited age range, highlighting the need for more studies on other population samples.

CONCLUSIONS

Despite the methodological limits, the results of the reviewed studies provide a standpoint for comparison for future studies on the epidemiology of awake bruxism behaviors.

Prevalence of oral behaviours in general dental patients attending a university clinic in Italy

BACKGROUND

Oral behaviors represent a diverse array of habits beyond the physiological behaviors of the stomatognathic system.

OBJECTIVE

To describe the prevalence of different oral behaviors, as reported with the Oral Behavior Checklist (OBC-21), in a convenience sample of patients attending an Italian university clinic for routine dental cares.

METHODS

In this study, charts of adult patients presenting to the dental department of a regional hospital in Trieste, Italy, from January 2018 and January 2019 were reviewed. Patients with complete files were retrieved, and those with orofacial pain complaints were excluded. OBC-21 scores and grades (score of 0 corresponding to no risk, 1-24 to low risk, and higher than 24 to high risk) were analyzed and stratified according to age and sex.

RESULTS

Data from a total of 1424 patients were reported. The overall mean OBC score was 13.3 ± 9.9, with 6.7% no-risk grade, 79.6% low-risk grade, and 13.7% high-risk grade. In general, mean OBC scores decreased with increasing age. Females showed a higher frequency of high-risk grade than males. Most frequent prevalent habits included yawning (73.1%), eating between meals (66.9%) and chewing food on one side only (63.3%). Other behaviors were also highly prevalent, including pressing, touching, or holding teeth together other than while eating (52.7%) and awake clenching (47.5%).

CONCLUSION

A low-risk grade of oral behaviors has been found to be frequent in our sample. Future studies are warranted to confirm these findings in larger, representative general populations and to assess if any of these habits are linked to negative effects on the stomatognathic system.

Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location.

Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.

Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations

Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.

Correlation between Apnea Severity and Sagittal Cephalometric Features in a Population of Patients with Polysomnographically Diagnosed Obstructive Sleep Apnea

Background and Objective: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder featuring a repeated closure of the upper airway during sleep. Craniofacial anatomy is a potential risk and worsening factor for OSA. This study aims to assess the relationship between cephalometric features of craniofacial morphology and OSA severity in a population of patients with OSA. Material and Methods: A sample of forty-two patients (n = 42, M = 76%, mean age = 57.8 ± 10.8) with a polysomnographically (PSG) confirmed diagnosis of OSA were recruited and underwent cephalometric evaluation of 16 cephalometric variables. In addition, the apnea−hypopnea index (AHI), oxygen desaturation (SatMin), Epworth sleepiness scale (ESS), and body mass index (BMI) were assessed. Then t-tests were performed to compare the values of all cephalometric variables between two AHI severity-based groups (mild-to-moderate = AHI ≤ 30; severe = AHI > 30). Single- and multiple-variable regression analyses were performed to assess the associations between AHI scores and cephalometric features. Results: Mean AHI, SatMin, and BMI were 31.4 ev/h, 78.7%, and 28.1, respectively. The cephalometric variables were not significantly different between the two OSA-severity groups (p > 0.05). Multiple-variable regression analyses showed that gonial angle and nasopharynx space were negatively associated with AHI, explaining 24.6% of the total variance. Conclusion: This investigation reported that severity of AHI scores in patients with OSA showed a negative correlation with gonial angle and nasopharynx space. As a general remark, although maxillofacial anatomy can be a predisposing factor for OSA, disease severity depends mainly upon other variables.

Gut Bless Your Pain—Roles of the Gut Microbiota, Sleep, and Melatonin in Chronic Orofacial Pain and Depression

Background. Increased attention has been paid to the gut–brain axis recently, but little is known so far regarding how this translates into pain susceptibility. Aim. The aim of this review is to determine whether gastroenterological disorders and sleep disorders (directly or indirectly) contribute to an increased susceptibility to depression and chronic orofacial pain. Method. A search was performed in the U.S. National Library of Medicine (PubMed) database in order to find studies published before 19 December 2021. We used the following terms: gut microbiome, OR sleep quality, OR melatonin, OR GERD, OR IBS, AND: depression OR chronic pain, in different configurations. Only papers in English were selected. Given the large number of papers retrieved in the search, their findings were described and organized narratively. Results. A link exists between sleep disorders and gastroenterological disorders, which, by adversely affecting the psyche and increasing inflammation, disturb the metabolism of tryptophan and cause excessive microglial activation, leading to increased susceptibility to pain sensation and depression. Conclusions. Pain therapists should pay close attention to sleep and gastrointestinal disorders in patients with chronic pain and depression.

Effects of Botulinum Toxin Type A on the Psychosocial Features of Myofascial Pain TMD Subjects: A Randomized Controlled Trial

AIMS

To determine the effects of botulinum toxin type A (BoNT-A) on the psychosocial features of patients with masticatory myofascial pain (MFP).

METHODS

A total of 100 female subjects diagnosed with MFP were randomly assigned into five groups (n = 20 each): oral appliance (OA); saline solution (SS); and three groups with different doses of BoNT-A. Chronic pain-related disability and depressive and somatic symptoms were evaluated with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis II instruments at baseline and after 6 months of treatment. Differences in treatment effects within and between groups were compared using chi-square test, and Characteristic Pain Intensity (CPI) was compared using two-way ANOVA. A 5% probability level was considered significant in all tests.

RESULTS

Most patients presented low pain-related disability (58%), and 6% presented severely limiting, high pain-related disability. Severe depressive and somatic symptoms were found in 61% and 65% of patients, respectively. In the within-group comparison, BoNT-A and OA significantly improved (P < .001) scores of pain-related disability and depressive and somatic symptoms after 6 months. Only the scores for pain-related disability changed significantly over time in the SS group. In the between-group comparison, BoNT-A and OA significantly improved (P < .05) scores of all variables at the final follow-up when compared to the SS group. No significant difference was found between the BoNT-A and OA groups (P > .05) for all assessed variables over time.

CONCLUSION

BoNT-A was at least as effective as OA in improving pain-related disability and depressive and somatic symptoms in patients with masticatory MFP.

Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence?

AIMS

To systematically review the scientific literature for evidence concerning the clinical use of botulinum toxin (BTX) for the management of various temporomandibular disorders (TMDs).

METHODS

A comprehensive literature search was conducted in the Medline, Web of Science, and Cochrane Library databases to find randomized clinical trials (RCT) published between 2000 and the end of April 2021 investigating the use of BTX to treat TMDs. The selected articles were reviewed and tabulated according to the PICO (patients/problem/population, intervention, comparison, outcome) format.

RESULTS

A total of 24 RCTs were selected. Nine articles used BTX injections to treat myofascial pain, 4 to treat temporomandibular joint (TMJ) articular TMDs, 8 for the management of bruxism, and 3 to treat masseter hypertrophy. A total of 411 patients were treated by injection of BTX. Wide variability was found in the methods of injection and in the doses injected. Many trials concluded superiority of BTX injections over placebo for reducing TMD pain levels and improving maximum mouth opening; however, this was not universal.

CONCLUSION

There is good scientific evidence to support the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. Studies with improved methodologic design are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs.

Oral frailty and neurodegeneration in Alzheimer's disease

Frailty is a critical intermediate status of the aging process with a multidimensional and multisystem nature and at higher risk for adverse health-related outcomes, including falls, disability, hospitalizations, institutionalization, mortality, dementia, and Alzheimer's disease. Among different frailty phenotypes, oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions. We briefly reviewed existing evidence on operational definitions of oral frailty, assessment and screening tools, and possible relationships among oral frailty, oral microbiota, and Alzheimer's disease neurodegeneration. Several underlying mechanism may explain the oral health-frailty links including undernutrition, sarcopenia linked to both poor nutrition and frailty, psychosocial factors, and the chronic inflammation typical of oral disease. Oral microbiota may influence Alzheimer's disease risk through circulatory or neural access to the brain and the interplay with periodontal disease, often causing tooth loss also linked to an increased Alzheimer's disease risk. On this bases, COR388, a bacterial protease inhibitor targeting Porphyromonas gingivalis implicated in periodontal disease, is now being tested in a double-blind, placebo-controlled Phase II/III study in mild-to-moderate Alzheimer's disease. Therefore, oral status may be an important contributor to general health, including Alzheimer's disease and late-life cognitive disorders, suggesting the central role of preventive strategies targeting the novel oral frailty phenotype and including maintenance and improvement of oral function and nutritional status to reduce the burden of both oral dysfunction and frailty.

Temporal relationship between sleep-time masseter muscle activity and apnea-hypopnea events: A pilot study

BACKGROUND

Obstructive sleep apnea (OSA) is the most common sleep disorder due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with arousals and snoring. Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals. Given the potentially severe consequences and complications of apnea, the concurrent high prevalence of SB in daily dental practice, getting deeper into the correlation between these phenomena is worthy of interest..

STUDY OBJECTIVES

The aim of this study was to investigate the correlation between SB-related masseter muscle activity (MMA) and apnea-hypopnea events as well as to assess their temporal sequence.

METHODS

Thirty (N = 30) patients with sleep respiratory disorders and clinical suspicion of sleep bruxism (SB) were recruited. Ambulatory polygraphic recording was performed to detect apnea-hypopnea events (AHEs) and sleep bruxism episodes (SBEs). Pearson test was used to assess the correlation between apnea-hypopnea index (AHI) and SB index (SBI). A 5-s time window with respect to the respiratory events was considered to describe the temporal distribution of SBEs. Furthermore, SBI was compared between groups of patients with different AHI severity (i.e., mild, moderate and severe) using ANOVA.

RESULTS

On average, AHI was 27.1 ± 21.8 and SBI 9.1 ± 7.5. No correlation was shown between AHI and SBI. Most of SBEs (66.8%) occurred without a temporal relationship with respiratory events. Considering OSA, 65.7% of SBEs occurred within 5 s after AHEs, while in the case of central apnea (CA) 83.8% of SBEs occurred before the respiratory event. The participants with severe apnea (N = 9) show a tendency to have higher bruxism indexes when compared to patients with mild (N = 11) and moderate apnea (N = 10).

CONCLUSIONS

Findings suggest that: 1. At the study population level, there is no correlation between AHI and SBI, as well as any temporal relationship between SBEs and respiratory events. 2. Specific patterns of temporal relationship might be identified with future studies focusing on the different types of apnea-hypopnea events and bruxism activities.

Psychosocial and Behavioral Factors in Awake Bruxism-Self-Report versus Ecological Momentary Assessment

The issue of psychosocial factors and concurrent conditions associated with AB is a relatively new approach in the study of Awake Bruxism (AB). In the present study a population of 84 dental students were assessed for probable AB with two modes of AB assessment: Single point self-report (SR) and ecological momentary assessment through a designated smartphone application (BA). The two assessment modes were compared with regard to their ability to phenotype subjects as far as the following psychosocial and behavioral variables are concerned: Gender; depression; somatization; oral behaviors; chronic pain and associated pain symptoms in the head, neck and scapula. Two-way ANOVA showed main effect of SR for the following variables: Chronic Pain Intensity score (F_(1,49) = 6.441, p < 0.02), migraine/headache (F_(1,81) = 7.396, p < 0.01), pain in neck (F_(1,81) = 6.726, p < 0.05), pain in scapula (F_(1,81) = 8.546, p < 0.005) and the oral behaviors of pushing the tongue forcefully against the teeth (F_(1,81) = 5.222, p < 0.05) and inserting the tongue between the upper and lower teeth (F_(1,81) = 5.344, p < 0.03). The effect of SR on the habit of chewing gum was borderline (F_(1,81) = 3.369, p = 0.07). Main effect of BA was found for depression (F_(1,81) = 6.049, p < 0.05), while the effect of BA on somatization was borderline (F_(1,81) = 3.657, p = 0.059). An interaction between SR and BA groups could be observed for the behavior of biting, chewing or playing with the tongue, cheeks or lips (F_(1,81) = 4.117, p < 0.05). The results suggest that a combination of a single-point self-report referring to the past 30 days, and an ecological momentary assessment supplying information about the actual timing of the report, can help us to better assess AB, as well as increase our ability to define the phenotype of subjects with AB as far as psychosocial and behavioral factors are concerned.

Utility of Smartphone-based real-time report (Ecological Momentary Assessment) in the assessment and monitoring of awake bruxism: A multiple-week interval study in a Portuguese population of university students

PURPOSE

The Ecological Momentary Assessment (EMA) concept was the basis for developing a smartphone application for the on-time report of awake bruxism (AB) activities. This study aims to monitor AB report over time in a population of healthy young adults.

METHODS

A population of young adults recruited among dental students in good general health was recruited. All answered to a questionnaire, including the Oral Behavior Checklist (OBC-1). They were then monitored with a smartphone application for AB report during seven consecutive days and completed three further observation periods (EMA-1, 2 and 3) at one-month intervals. After the third period (EMA-3), participants answered again the OBC questionnaire (OBC-2). Changes over time were described, and Pearson Correlation test was performed to assess the correlation between EMA and OBC items reports. A significance level of p = .01 was set.

RESULTS

Thirty-one University students completed the study protocol. Answers to the OBC showed an increase in the prevalence of self-reported bracing and teeth clenching from the first to second report (38.7%-54.8% and 77.4%-90.3%, respectively). A slight increase in the 'relaxed' condition (62.5%-69.0%) was observed with EMA-based smartphone application over time. No correlation between OBC items and EMA was detected between OBC-1 and EMA-1. A moderate positive correlation in bracing report (+0.509, p = .01) and weak positive correlation in teeth contact report (+0.380, p = .05) were found between OBC-2 and EMA-3.

CONCLUSION

Using a smartphone-based approach to AB report may be helpful to monitor AB over time and increase an individual's awareness to recognise actions such as bracing and teeth contact concerning the single-time report.

Smartphone-based evaluation of awake bruxism behaviours in a sample of healthy young adults: findings from two University centres

A smartphone-based ecological momentary assessment (EMA) strategy was used to assess the frequency of awake bruxism behaviours, based on the report of five oral conditions (ie relaxed jaw muscles, teeth contact, mandible bracing, teeth clenching and teeth grinding). One hundred and fifty-three (N = 153) healthy young adults (mean ± SD age = 22.9 ± 3.2 years), recruited in two different Italian Universities, used a dedicated smartphone application that sent 20 alerts/day at random times for seven days. Upon alert receipt, the subjects had to report in real-time one of the above five possible oral conditions. Individual data were used to calculate an average frequency of the study population for each day. For each condition, a coefficient of variation (CV) of frequency data was calculated as the ratio between SD and mean values over the seven recording days. Average frequency of the different behaviours over the seven days was as follows: relaxed jaw muscle, 76.4%; teeth contact, 13.6%; mandible bracing, 7.0%; teeth clenching, 2.5%; and teeth grinding, 0.5%. No significant differences were found in frequency data between the two University samples. The relaxed jaw muscles condition was more frequent in males (80.7 ± 17.7) than in females (73.4 ± 22.2). The frequency of relaxed jaw muscles condition over the period of observation had a very low coefficient of variation (0.27), while for the different awake bruxism behaviours, CV was in a range between 1.5 (teeth contact) and 4.3 (teeth grinding). Teeth contact was the most prevalent behaviour (57.5-69.7). Findings from this investigation suggest that the average frequency of AB behaviours over one week, investigated using EMA-approach, is around 23.6%.

Histopathology of the temporomandibular joint disc: Findings in 30 samples from joints with degenerative disease

Aim

The aim of this study is to show the anatomical and histological features of the displaced temporomandibular joint (TMJ) disc in joints with degenerative disease.

Methods

This study was performed on a total of 30 TMJ discs extracted from 22 patients, who underwent surgical discectomy after failure of conservative non‐surgical treatment regimens to control pain and/or limited range of motion. All joints had imaging signs of an anteriorized disc position and degenerative joint disease. Samples of the extracted discs were stored in formalin, cut into 3 micron‐thick sections imbedded in paraffin and processed with hematoxylin‐eosin.

Result

All the samples present irreversible morphologic and histological alterations. The macroscopical evaluation showed that 14 discs were worn and fragmented in several parts, and one disc was perforated. Morphological alterations with deformation and degenerative signs were shown in all discs, which were all severely worn and compromised. Histologically, various alterations were found, such as pre‐fibrous sclerosis with myxoid degeneration and collagen deposits (N = 25), an increase in fibro‐hyaline and fibrous tissues, with loss of elasticity (N = 25), scattered calcifications (N = 15), and synovial inflammation with microvascular proliferation and increased cellularity, presence of lymphocytes, histiocytes and plasma cells (N = 18). After the intervention, all patients reported decreased pain levels and showed improved function at 6 months.

Conclusion

These observations suggest that degenerative joint disease is accompanied by a anteriorized discs featuring abnormal macroscopical and histological changes. From a clinical viewpoint, this may suggest that, when treatment escalation leads to consider TMJ surgery, total discectomy is the most reasonable approach.