Relationship of self-reported sleep bruxism and awake bruxism with chronotype profiles in Italian dental students

OBJECTIVES

A cross-sectional study was performed to assess the association between possible sleep bruxism (SB) and awake bruxism (AB) with sleep characteristics and chronotype (i.e. circadian cycle preference).

METHODS

One-hundred-nineteen young adults filled out a self-reported questionnaire to assess SB and AB, a questionnaire about daily life aspects, as well as the Morningness-Eveningness Questionnaire (MEQ) to profile chronotype.

RESULTS

The frequency of self-reported SB and AB was 25.2% and 37.0%, respectively. Both SB and AB were significantly more frequent in females than males. Most participants had an intermediate chronotype profile (n = 85; 71.4%). Neither SB (p = 0.556) nor AB (p = 0.334) were associated with chronotype. Nightmares were more prevalent among individuals with possible SB (38.3%). Difficulty concentrating in daily activities was more frequently reported among individuals with AB (51.9%).

CONCLUSION

There was no association between possible SB and AB or the chronotype profiles among Italian dental students.

Association of possible sleep bruxism in children with different chronotype profiles and sleep characteristics

Sleep bruxism (SB) in children has been associated with several sleep characteristics, which may alter their sleep pattern. This change affects the internal biological clock and consequently the chronotype profile. The aim of this study was to evaluate the existence of an association between possible SB in children with specific chronotype profiles and sleep characteristics. The study included 207 parents/guardians of children aged between 3 and 12 years who were waiting for their children's dental treatment at the Pediatric Dentistry Clinic of the Federal University of Rio de Janeiro, Brazil. A questionnaire on the socio-demographic characteristics of parents and children as well as on the features of the children's sleep was applied. In addition, the CIRENS scale (Circadian Energy Scale) was completed by the parents to identify the children's chronotype. A chi-squared test was used to determine the association between possible SB, the chronotype, and sleep characteristics. A multiple logistic regression model was implemented to observe the influence of chronotype, age, and other independent variables on the possible SB. The logistic regression model demonstrated that nocturnal agitation (p = 0.009; OR = 3.42) and nightmares (p = 0.045; OR = 3.24) were associated with possible SB in children. Although no significant association (p = 0 .089) between the chronotype profile and possible SB was observed in the 3 to 5 years age group, a proportional difference was observed between the chronotype categories in this age group-12.5% of children with SB had a morning type, while 26.4% had an intermediate type and 47.8% an evening type compared to those without possible SB. Nocturnal agitation and nightmares were associated with possible SB. In addition, young children with an evening chronotype had a tendency toward possible SB.

Agreement between jaw-muscle activity measurement with portable single-channel electromyography and polysomnography in children

BACKGROUND

Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment. High economical costs, complex technical equipment, and unfamiliar laboratory setting limit its use in children.

AIM

To determine the night-to-night variability of electromyography (EMG) episodes during a five-night recording with the GrindCare Measure (GCM), and the agreement in the assessment of masticatory muscle activity (MMA) between GCM and PSG in children.

DESIGN

Forty-seven children from clinics of Universidad CES participated. Each participant was assessed with GCM for five consecutive nights. The last night, children underwent a single-night PSG study, together with the GCM. Spearman correlation coefficients were used to analyze data.

RESULTS

The frequency of SB occurrence was 'sometimes' in 12 (25.5%) and 'usually' in 19 (40.4%) children. Simultaneous measurements with GCM and PSG obtained during the fifth night of measurement were not significantly correlated. Correlation between GCM total EMG episodes and EMG episodes/h and PSG total SB episodes, SB episodes/h, total bursts and burst/h measured with PSG was also not significant.

CONCLUSION

EMG measurement with GCM was not accurate to detect PSG/SB in children. There was not advantage of multiple assessment for five nights with GCM, reducing the impact of night-to-night EMG episodes' variability on the GCM/PSG correlation.

Oro-facial pain and temporomandibular disorders classification systems: A critical appraisal and future directions

It is a difficult undertaking to design a classification system for any disease entity, let alone for oro-facial pain (OFP) and more specifically for temporomandibular disorders (TMD). A further complication of this task is that both physical and psychosocial variables must be included. To augment this process, a two-step systematic review, adhering to PRISMA guidelines, of the classification systems published during the last 20 years for OFP and TMD was performed. The first search step identified 190 potential citations which ultimately resulted in only 17 articles being included for in-depth analysis and review. The second step resulted in only 5 articles being selected for inclusion in this review. Five additional articles and four classification guidelines/criteria were also included due to expansion of the search criteria. Thus, in total, 14 documents comprising articles and guidelines/criteria (8 proposals of classification systems for OFP; 6 for TMD) were selected for inclusion in the systematic review. For each, a discussion as to their advantages, strengths and limitations was provided. Suggestions regarding the future direction for improving the classification process with the use of ontological principles rather than taxonomy are discussed. Furthermore, the potential for expanding the scope of axes included in existing classification systems, to include genetic, epigenetic and neurobiological variables, is explored. It is therefore recommended that future classification system proposals be based on combined approaches aiming to provide archetypal treatment-oriented classifications.

Association of dietary habits and parental-reported sleep tooth grinding with tooth wear in children with mixed dentition

BACKGROUND

Tooth wear has a multifactorial etiology, thus it should be assessed within a multiple-variable framework. The objective of this investigation was to assess the association of dietary habits and parental-reported sleep tooth grinding (STG) with tooth wear in children with mixed dentition.

METHODS

One hundred twenty-one (N = 121) subjects (mean age 9.6 years) participated in a cross-sectional study. Wear of 1637 teeth was evaluated using the screening module of the Tooth Wear Evaluation System (TWES). Parental-report of STG was evaluated by means of the Children's Sleep Habits Questionnaire (CSHQ), whilst dietary habits were investigated by means of the Health Behaviour in School-Aged Children Food-Frequency Questionnaire (HBSC-FFQ). Data were analyzed with the Spearman correlation test and ordinal-multiple-variable regression analyses. Odds Ratio (OR) and ordinal OR were obtained for the independent variables included in the models.

RESULTS

Parental-report of STG is not associated with tooth wear in the mixed dentition; some dietary habits were found to be correlated with specific tooth wear patterns, but the correlation values were weak. Associations were found between dietary habits and the increase-to-increase severity of occlusal/incisal and non-occlusal/non-incisal tooth wear of some teeth (OR > 2).

CONCLUSIONS

A strong correlation of dietary habits and sleep tooth grinding with tooth wear in the mixed dentition was not demonstrated. However, dietary habits showed to have effects in terms of increase-to-increase severity.

A Rare Case of Misdiagnosed Silent Lung Cancer with Solitary Metastasis to the Temporomandibular Joint Condyle

This article describes the case history of a 59-year-old female patient who sought advice for temporomandibular joint (TMJ) pain and sounds but who was actually diagnosed with a primary lung cancer with metastasis to the TMJ. The patient had a history of TMJ pain and deflection in jaw movement that progressively worsened over a few months and did not improve with the usual standard of care treatment provided by an orofacial pain practitioner. Magnetic resonance and computed tomography (CT) prescribed at a tertiary clinic showed an osteolytic bone mass within the right TMJ condyle. The neoformation was surgically removed and histologic assessment revealed it was a metastasis of a silent lung carcinoma. Thorax CT confirmed the presence of a formation within the apical segment of the right lung superior lobe. While this scenario of a silent lung cancer metastasis to the TMJ condyle mimicking classical symptoms of temporomandibular disorders (TMD) is rare, it does indicate that the path to differential diagnosis is often difficult in TMD and orofacial pain patients, and that practitioners managing such patients should be aware of the variegate spectrum of possible TMD-mimicking conditions to avoid dangerous diagnostic delays.

Kieferorthopädische Maßnahmen haben keinen Einfluss auf Kiefergelenkstörungen

Zielsetzung Untersuchung, ob Patienten mit diagnostizierten Kiefergelenkstörungen (TMDs) vergleichbar häufig eine kieferorthopädische Behandlung in der Anamnese haben, wie Personen ohne TMDs und Untersuchung, ob Patienten mit idealer kieferorthopädischer Behandlung in der Vorgeschichte weniger häufig Symptome zeigen als Patienten mit einer nicht idealen Therapie.

Material und Methoden Es wurden 2 Gruppen zusammengestellt, eine Studien- bzw. TMD-Gruppe und eine Kontrollgruppe, mit gleicher Alters- und Geschlechtszusammensetzung. Bei den Patienten mit einer kieferorthopädischen Behandlung in der Anamnese wurde anhand normaler Werte bei 5 Okklusionsparametern zwischen einer idealen und einer nicht idealen kieferorthopädischen Behandlung unterschieden.

Ergebnisse In Bezug auf eine kieferorthopädische Behandlung in der Anamnese ergab sich keine klinisch signifikante Korrelation mit den einzelnen Kiefergelenkstörungen (Muskelschmerzen, Gelenkschmerzen, Diskusverlagerung, Arthrosen), wobei der Wert für den Koeffizienten Phi (Θ) zwischen 0,120 und 0,058 lag. Bei den Patienten mit einer kieferorthopädischen Behandlung in der Anamnese war die Korrelation mit ideal oder nicht ideal verlaufener Behandlung im Allgemeinen klinisch nicht oder nur sehr schwach relevant.

Schlussfolgerungen Die Ergebnisse der vorliegenden Studie bestätigen, dass kieferorthopädische Maßnahmen keine klinisch signifikanten Auswirkungen auf Kiefergelenkstörungen haben. Die sehr niedrigen Werte für eine Korrelation zwischen einer oder keiner kieferorthopädischen Behandlung in der Anamnese mit idealen oder nicht idealen Ergebnissen und den unterschiedlichen Kiefergelenkstörungen lassen darauf schließen, dass eine kieferorthopädische Behandlung bei der Entstehung von Kiefergelenkstörungen keine Rolle spielen kann.

Diagnostic accuracy of the use of parental-reported sleep bruxism in a polysomnographic study in children

BACKGROUND

Polysomnography (PSG) is the gold standard for sleep bruxism (SB) diagnosis. PSG/SB children's criteria are not available; thus, parental-report SB is widely used.

AIM

Assessing the diagnostic accuracy of parental report of sleep tooth grinding (STG) with a PSG/SB diagnosis in children, adopting adult criteria.

DESIGN

Thirty-seven children from clinics of Universidad CES were included. Parents filled the Children's Sleep Habits Questionnaire (CSHQ) assessing the single-observation report - CSHQ - of STG with a No/Yes answer and five ordinal answers. A 5-day diary reporting the presence/absence of STG (multiple-observation report) was also completed. Each child underwent a single-night PSG study. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios, Spearman correlation coefficient, and Cohen's kappa coefficient were used to analyze data.

RESULTS

Single observation, using No/Yes answer, showed acceptable specificity and NPV, while low PPV and sensitivity. Accuracy and likelihood ratios were low. When using the five ordinal answers, weak correlation and fair agreement (r = 0.34 and κ = 0.40) with PSG/SB adult criteria were found. Multiple-observation evaluation of STG presented moderate correlation and agreement (r = 0.50 and κ = 0.48).

CONCLUSIONS

Although multiple-observation report achieved better agreement than single-observation report, our results failed supporting the validity of report strategies for the diagnosis of SB in children, as an equivalent of PSG/SB adult criteria.

Current Concepts of Bruxism

Bruxism is a common phenomenon, and emerging evidence suggests that biologic, psychologic, and exogenous factors have greater involvement than morphologic factors in its etiology. Diagnosis should adopt the grading system of possible, probable, and definite. In children, it could be a warning sign of certain psychologic disorders. The proposed mechanism for the bruxism-pain relationship at the individual level is that stress sensitivity and anxious personality traits may be responsible for bruxism activities that may lead to temporomandibular pain, which in turn is modulated by psychosocial factors. A multiple-P (plates, pep talk, psychology, pills) approach involving reversible treatments is recommended, and adult prosthodontic management should be based on a common-sense cautionary approach.

Sleep behaviors in children with different frequencies of parental-reported sleep bruxism

OBJECTIVE

Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB.

METHODS

Parents of 1475 Colombian children, aged 9.8±1.6years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn's post-hoc tests, based on the normality of outcome variables.

RESULTS

Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer.

CONCLUSION

Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed.

CLINICAL SIGNIFICANCE

Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence.

Frequency of temporomandibular disorders diagnoses based on RDC/TMD in a Polish patient population

OBJECTIVE

To assess the frequency and age distribution of Axis I and Axis II diagnoses among Polish patients with temporomandibular disorders (TMD).

METHOD

One hundred sixty-three (n = 163) consecutive adult patients seeking TMD treatment were assessed based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. Descriptive statistics on the frequency of diagnoses and mean age of the diagnostic groups was performed.

RESULT

Frequency of muscle disorders, disc displacements, and other joint disorders was 56.9, 48.9, and 31%, respectively. Disc displacement was the most common diagnosis in younger patients. Severe somatization and depression were shown in 11.9 and 15.8% of patients, respectively. Only 10.5% of the patients showed severe pain-related impairment. Females tended to have higher psychosocial scores than males.

DISCUSSION

The frequency of Axis I TMD diagnoses in Polish patients is similar to other populations, whereas Axis II findings slightly differ from previous reports from other countries.

A comparison trial between three treatment modalities for the management of myofascial pain of jaw muscles: A preliminary study

OBJECTIVES

To compare three treatment modalities for the management of myofascial pain of jaw muscles.

METHODS

Thirty (N = 30) patients with low pain-related impairment were randomly assigned to receive laser therapy (LST), oral appliance therapy (OA), or counseling (CSL). Visual Analog Scale (VAS) pain levels and the Muscular Index (MI) of the Craniomandibular Index were the outcome variables, which were assessed at baseline, at three weeks, three months, and six months.

RESULTS

At six months, improvement in the MI was maintained both in the LST (p = .025) and OA groups (p < .001). As for VAS values, positive changes were still shown for LST (p = .001), and were also shown for the OA (p = .002) and CSL groups (p = .048).

CONCLUSIONS

Despite differences in the short-term effectiveness of LST and OA, with respect to CSL alone, all three treatment groups improved at six months. This suggests that active treatments should be directed to maximize the positive changes in the short-term period.

Personality traits are potentially associated with the presence of chronic temporomandibular joint pain in patients without effusion as determined by T-2 weighted magnetic resonance

OBJECTIVE

The study aimed at investigating personality traits in chronic temporomandibular joints (TMJ) pain patients with and without joint effusion.

METHODS

Two groups of chronic TMJ pain patients were recruited. The TMJ pain control group was composed of patients showing magnetic resonance imaging (MRI) signs of TMJ effusion, while the TMJ pain test group included patients with chronic TMJ pain seemingly not justified, due to the absence of MRI-detected disorders. A third set of pain free individuals was selected as a comparison group. All patients completed a personality assessment with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) instrument, and the between-group differences were assessed for significance by performing an analysis of variance test.

RESULTS

Patients of the TMJ pain test group had higher scores than subjects belonging to the TMJ pain and pain-free control groups in almost all of the MMPI-2 clinical scales. A significant difference was shown for the scales related to concerns about physical health (Scale 1-Hs; F = 7.74; p = .001) and physical symptoms (Scale 3-Hy; F = 8.43; p = .001).

CONCLUSIONS

Chronic TMJ pain patients without MRI-detected TMJ effusion have a different personality profile than patients with TMJ effusion and pain-free individuals, regarding high levels of concerns about physical health and physical symptoms.

CLINICAL IMPLICATIONS

This study has important clinical implications for temporomandibular disorders practitioners, providing suggestions that symptoms in the TMJ area are not only related to a physical disorder. The possible existence of a psychologically modulated condition in patients who refer pain in the TMJ area without signs of effusion should be carefully taken into consideration.

Dental Angle class asymmetry and temporomandibular disorders

OBJECTIVES

The aim of this study was to determine whether there is an association between the presence of asymmetric molar or canine Angle classes on the two sides and the presence of temporomandibular joint dysfunction (TMD).

MATERIALS AND METHODS

Participants to the study were divided into two groups: TMD group (90 patients) or a control group (58 patients). In the TMD group, clinical assessment for TMD was performed according to the Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines by the same two trained examiners. In both groups, all subjects underwent an assessment of dental occlusion, focusing on the assessment of bilateral canine and molar Angle class relationship. The study protocol was reviewed and approved by the Institutional Review Board of the University of Padova, and each participant gave written consent to take part in the investigation.

RESULTS

TMJ pain was diagnosed in 58, disk displacement in 96, arthrosis in 17, and muscle pain in 46 individuals. Molar Angle class was symmetrical in 86 individuals and asymmetrical in 62 subjects. Molar Angle class was not correlated with any of the TMD diagnoses. Canine Angle class was correlated with TMJ arthrosis. Correlation values with the other TMD diagnoses were low and were not significant.

CONCLUSIONS

It can be suggested that an association between dental Angle class asymmetry and TMDs does not exist and that the role of dental asymmetries as a factor correlated with the presence of TMD signs and symptoms is minimal.

Prevalence of static and dynamic dental malocclusion features in subgroups of temporomandibular disorder patients: Implications for the epidemiology of the TMD-occlusion association

OBJECTIVE

The hypothesis that dental malocclusions may be a risk factor for temporomandibular disorders (TMD) has been greatly debated in the literature. Whilst the association between features of dental occlusion and TMD has been proven weak, if existing, it seems that the transfer of such knowledge into clinical practice is yet to be completed. This study evaluated the prevalence of static and dynamic malocclusion features in a population of TMD patients and compared it with literature data on the general population.

METHOD AND MATERIALS

A total of 625 consecutive TMD patients (75% female; aged 34.2 ± 6.7 years, range 25-44 years) were examined and were clustered into four groups on the basis of pain absence (ie, disk displacement and/or arthrosis without pain), or pain presence within the muscles and/or the temporomandibular joint (TMJ). As for the occlusal features, posterior crossbite, excessive overbite, anterior open bite, excessive overjet, and molar and canine asymmetry were recorded as static malocclusion findings. Medio-/laterotrusive interferences and slide length from retruded contact position (RCP) to maximum intercuspation (MI) ≥ 2 mm were also recorded as dynamic malocclusion findings. The ɸ correlation coefficient assessed the strength of the correlation between each occlusal feature and the presence of pain-related TMD condition.

RESULTS

No significant correlation was seen between the various malocclusion findings and the presence of any pain-related TMD condition, with ɸ values ranging from -0.081 to +0.043 for molar asymmetry and laterotrusive interferences, respectively. The prevalence findings in this TMD population were within the range reported from general population studies.

CONCLUSIONS

In adult subjects, static or dynamic malocclusion findings show similar prevalence irrespective of the presence of any specific pain-related TMD condition. Also, the prevalence values are similar to the available data at general population level. Based on the above, general practitioners should note that occlusal features may not be considered a discriminant factor for TMD.

Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid

OBJECTIVE

The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis.

METHODS

Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol.

RESULTS

A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol.

CONCLUSIONS

A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.