An 8-year prospective clinical investigation on the survival rate of feldspathic veneers: Influence of occlusal splint in patients with bruxism

OBJECTIVES

The aim of this study was to perform a 8-year prospective clinical investigation on the survival rate of feldspathic ceramic veneers, as well as analyse the influence of the occlusal splint in patients with parafunctional bruxism.

METHODS

Three hundred and sixty-four veneers fabricated using conventional feldspathic ceramic were provided in 64 patients. The patient sample included 40 individuals with bruxism. During the follow-up period, the effect of wearing the occlusal splint on the incidence of failure (fracture and/or debonding) in patients with bruxism was also assessed. The survival rate of veneers was determined using the Kaplan-Meier estimator. Statistical significance was set at p < 0.05 with a confidence interval of 95%.

RESULTS

The occurrence of fracture for the feldspathic veneers tested in this study was 7.7%, while only 1.9% of the total number of veneers debonded. The overall survival rate was 93.7% after 3 years, 91% after 5 years, and 87.1% after 8 years. Patients with bruxism using an occlusal splint showed a survival rate of 89.1% after 7 years, while the survival rate in patients with bruxism using no occlusal splint was 63.9% (p < 0.05).

CONCLUSION

This study confirmed that feldspathic veneers may represent a suitable clinical solution for indirect aesthetic restorations. Such a treatment may be an option also for those patients affected by bruxism, as long as they regularly wear an occlusal splint. However, patients with bruxism using no occlusal splint may still present a potential high-risk of failure and/or debonding.

Influence of respiratory allergy and restless sleep on definite sleep bruxism: a cross-sectional clinical study

OBJECTIVE

This cross-sectional clinical study evaluated the associations between sociodemographic, occupational, clinical conditions, psychological and sleep quality variables on definite sleep bruxism (SB).

METHODS

All records obtained from adults (aged 20-60 years) and the elderly (aged >60 years) who had undergone polysomnography (PSG) at a private medical outpatients' clinic from July 2017 to February 2018 were reviewed. Data from a questionnaire, based on the criteria of the American Academy of Sleep Medicine (AASM), were also gathered. Definite SB data pattern distribution was analyzed, and multivariate Poisson regression with robust variance was used to assess the associations between definite SB diagnosis, determined via PSG recordings, and the independent variables. A significance level of 5% was adopted.

RESULTS

A total of 240 individuals were included in the study and the SB prevalence was 7.08% (n = 17). The adjusted Poisson regression analysis revealed association between definitive SB and individuals with respiratory allergy (PR = 3.63; 95% CI:1.01-13; P = 0.047) and restless sleep (PR = 2.97; 95% CI:1.04-8.50; P = 0.042).

CONCLUSION

This study found associations between definite SB and clinical conditions (respiratory allergy) and sleep behavior (restless sleep). Knowledge regarding factors associated with definite SB can contribute to decision making in the clinical setting and management strategies involving a multidisciplinary approach.

Childhood Trauma, Quality of Life, Sleep Quality, Anxiety and Depression Levels in People with Bruxism

Introduction

The aim was to investigate the relation between sociodemographic features, anxiety, depression, sleep quality, childhood trauma experiences, and quality of life and bruxism determining the risk factors in people with bruxism.

Methods

A total of 200 people were included in the study. Of the patients, 100 were diagnosed with bruxism and 100 were included in the control group. Sociodemographic Data Form, Hospital Anxiety Depression Scale (HAD), The Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Scale (CTS), Short Form-36 Quality of Life Scale (SF-36) were used.

Results

While there was no significant difference between the case group and the control group in terms of age, gender, marital status, and working status, there was a significant difference between educational levels. When the groups were compared a significant difference was found with regard to HAD-A (p<0.05), HAD-D (p<0.01), PSQI (p<0.01) and CTS (p<0.05) scores. While a significant difference was found when KF-36 subscales were examined, with regard to Physical Function (p<0.01), Pain (p<0.05), Social Function (p<0.05) and Mental Health (p<0.01) scores, no significant difference was detected between the subscales of Role Strength (p>0.05), General Health (p>0.05), Vital Energy (p>0.05) and Emotional Role (p>0.05). Regression analysis shows, (PSQI), HAD-D CTS scores predicted bruxism.

Conclusion

Higher depression scale scores, bad sleep quality, traumatic childhood experiences increase the risk for bruxism. Paying attention to the mental state of people diagnosed with bruxism in the treatment process and incorporating the psychiatrists in this process may increase the success rate of the treatment.

Sleep bruxism and oral health-related quality of life in children: A systematic review

Sleep bruxism (SB) is a masticatory muscle activity during sleep that can cause several consequences to the stomatognathic system. This systematic review investigated the impact of SB on oral health-related quality of life (OHRQoL) of 0- to 6-year-old children. Literature search was undertaken through PubMed/MEDLINE, LILACS, Scopus, TRIP, Livivo databases, and grey literature. The search was conducted with no publication year or language limits. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias. The quality of evidence was assessed using GRADE. From 185 potentially eligible studies, three were included in the review. All studies were conducted in Brazil, published between 2015 and 2017, and used the B-ECOHIS instrument to evaluate OHRQoL. Two studies found no association between SB and OHRQoL, whereas one showed a significant negative impact of SB on the OHRQoL of children. SB was associated with respiratory problems, presence of tooth wear, dental caries, malocclusion as well as income and pacifier use. Risk of bias ranged from moderate to high, and the quality of evidence was judged as very low. The evidence is currently insufficient for definitive conclusions about the impact of SB on OHRQoL of children.

Interventions to reduce bruxism in children and adolescents: a systematic scoping review and critical reflection

The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism.

Association of oral parafunctional habits with anxiety and the Big-Five Personality Traits in the Saudi adult population

Background

Oral parafunctional habits are related to any abnormal hyperactivity of the oromandibular system. They are prevalent in all societies in varying intensity and have potential physical and psychological implications. The aim of this study was twofold: (1) to determine the prevalence of various types of oral parafunctional habits in the Saudi adult population, and (2) to examine their association with and the level of anxiety and personality factors.

Methods

This cross-sectional study was conducted with an electronic data collection form distributed to the public through social media. The questionnaire comprised of the following: (a) demographic information, (b) the Hamilton Anxiety Rating Scale (HAM-A), (c) the Ten-Item of Big-Five Personality Traits, (d) a list of oral parafunctional habits. Data were analysed using a Pearson’s Chi square and binary logistic regression.

Results

The participants reported several parafunctional habits including daily gum chewing (86%), lip/object biting (59%), clenching (45%), nail biting (36%) and grinding (32%). Males were 3 [2.3–3.7] times and younger age groups were 1.5 [1.1–2.0] times more likely to be associated with nail biting compared to their counter groups (adj.P < 0.001 and adj.P = 0.007). Lip/object biting was significantly 1.3 [1.1–1.7] times more prevalent in males (adj.P = 0.015). Participants who reported being extroverts were more likely to be associated with clenching (46.4%) (P = 0.024). An emotionally stable person was significantly less likely to be associated with nail biting (28.4%), grinding (24.9%), clenching (35.8%), and lip/object biting (48.4%) (P < 0.001each). Participants who reported conscientiousness and emotional stability were significantly less associated with TMD (P = 0.007, P < 0.001).

Conclusion

Oral parafunctional habits are highly prevalent in the Saudi adult population in varying degrees. Possible risk factors include males, younger age groups, single people, and being financially constrained.

Evaluation of the mandibular trabecular bone in patients with bruxism using fractal analysis

OBJECTIVE

The aims of this study were (1) to investigate the effect of bruxism on the fractal dimension (FD) of the mandibular trabecular bone through digital panoramic radiographs, and (2) to evaluate the effectiveness of fractal analysis as a diagnostic test for bruxism.

METHODS

One hundred and six bruxer and 106 non-bruxer patients were included in the study. Three bilateral regions of interest (ROI) were selected: ROI-1, the mandibular condyle; ROI-2, the mandibular angle; ROI-3, the-area between the apical regions of the mandibular second premolar and the first molar teeth. FD values for the bruxer and non-bruxer groups were compared for each ROI.

RESULTS

Only the FD measurements for the right mandibular condyle (ROI-1) showed a statistically significant difference (p = 0.041) between the bruxer and non-bruxer individuals. FD values measured in the bruxers (1.40 ± 0.09) were lower than in the non-bruxers (1.42 ± 0.08).

CONCLUSION

Fractal analysis may be a useful method for discerning trabecular differences in the condylar areas of bruxer individuals. In future studies, the unilateral mastication habits, the characteristics of dental wear, and the occlusal bite forces of individuals should be documented.

Quality of life of children with sleep bruxism

AIM

The aim of this study was to compare the Quality of life (QoL) of children with and without sleep bruxism in Chennai population.

MATERIALS AND METHODS

A cross-sectional study was conducted with participants of both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) from different regions of Chennai with the age range of 6-12 years. Parents/Caregivers answered a questionnaire in the waiting room. The QoL was assessed using the Oral Health Impact Profile (OHIP-14). OHIP-14 was analyzed by Mann-Whitney U test.

RESULTS

The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers (P > 0.005). There was a significant difference in QoL between the case and control group (<0.001). Bruxers had worse QoL than controls.

CONCLUSION

Sleep bruxism may be associated with a negative impact on QoL.

Single nucleotide polymorphisms in dopamine receptor D2 are associated with bruxism and its circadian phenotypes in children

Objective: To evaluate the association of bruxism phenotypes with single nucleotide polymorphisms in FKBP5, DRD2, ANKK1, and COMT.Methods: Clinical oral examination was performed to diagnose bruxism phenotypes in 150 children. DNA was collected from saliva. Logistic univariate regression, Chi-square, and Fisher's exact tests were performed (p < 0.05).Results: Bruxism was associated with DRD2 (p = 0.02). Tooth grinding while awake was associated with ANKK1 (p < 0.001), and tooth grinding while asleep was associated with DRD2 in the additive (p = 0.030) and dominant (p = 0.008) model. Tooth clenching while awake was associated with ANKK1 in the additive (p = 0.005) and dominant (p = 0.008) models, whereas tooth clenching while asleep was associated with ANKK1 (p < 0.001) and with COMT in the additive (p = 0.001) and dominant (p = 0.003) models.Discussion: Polymorphisms in DRD2, ANKK1, and COMT are associated with bruxism phenotypes.

Application of botulinum toxin in maxillofacial field: part I. Bruxism and square jaw

The application of botulinum in oral and maxillofacial surgery begins in 1982, where Jan Carruthers started using it for reducing the muscle mass and smoothing the skin, and since then it has been used for cosmetic purposes. In Korea, it is already being used by various specialties including dentistry (oral and maxillofacial surgery, oral medicine), plastic surgery, dermatology, ophthalmology, general surgery, and orthopedic surgery, etc. Each specialty approaches to Botox with its own medical indications. In this article, we will discuss the maxillofacial application of botulinum toxin, which includes theoretical and practical aspects of such as bruxism and square jaw.

Diagnosis and management of bruxism: Evaluation of clinical practices in France

Objective: The Evaluation of Clinical Practice (ECP) conducted with a sample of French general dental practitioners aimed to measure the methods used to diagnose and manage bruxism.Methods: The ECP was performed using a declarative online questionnaire-based anonymous survey (SurveyMonkey) of 1388 practitioners. Twenty-two questions were grouped in 5 categories: (1) Sociodemographic characteristics (Q1-6); (2) Knowledge of the prevalence and definition of bruxism (Q7-9); (3) Diagnostic approach (Q10-11) and management (Q12-Q13); (4) The use of occlusal splints (Q14-21); (5) Oral rehabilitation (Q22).Results: The answers obtained (233; 16.8%) revealed a wide disparity and insufficient diagnosis (e.g. only 41% looked for sleep disorders, 22.3% for consumption of stimulants, 3% for upper airway obstruction) and management of bruxism (e.g. only 21.9% of participants proposed cognitive-behavioral therapy).Discussion: The discrepancies detected, such as the use of inappropriate splints (30 to 70%), emphasize the need for more prompt research-to-practice transfer of new knowledge.

Finite element analysis of occlusal splint therapy in patients with bruxism

Background

Bruxism is among the habits considered generally as contributory factors for temporomandibular joint (TMJ) disorders and its etiology is still controversial.

Methods

Three-dimensional models of maxilla and mandible and teeth of 37 patients and 36 control subjects were created using in-vivo image data. The maximum values of stress and deformation were calculated in 21 patients six months after using a splint and compared with those in the initial conditions.

Results

The maximum stresses in the jaw bone and head of mandible were respectively 4.4 and 4.1 times higher in patients than in control subjects. Similar values for deformation were 5.8 and 4.9, respectively. The maximum stress in the jaw bone and head of mandible decreased six months after splint application by up to 71.0 and 72.8%, respectively. Similar values for the maximum deformation were 80.7 and 78.7%, respectively. Following the occlusal splint therapy, the approximation of maximum deformation to the relevant values in control subjects was about 2.6 times the approximation of maximum stress to the relevant values in control subjects. The maximum stress and maximum deformation occurred in all cases in the head of the mandible and the splint had the highest effectiveness in jaw bone adjacent to the molar teeth.

Conclusions

Splint acts as a stress relaxer and dissipates the extra stresses generated as well as the TMJ deformation and deviations due to bruxism. The splint also makes the bilateral and simultaneous loading possible and helps with the treatment of this disorder through regulation of bruxism by creating a biomechanical equilibrium between the physiological loading and the generated stress.

Investigation of the relationship between sleep disorders and xerostomia

OBJECTIVES

To investigate the relationship between sleep disorders, morning hyposalivation, and subjective feeling of dry mouth.

MATERIALS AND METHODS

A cross-sectional, observational, clinical study was carried out in a homogenous population sample which consists of Greek male soldiers without any medical history. After the application of oral modified Schirmer test, the sample was divided into a study group (n = 63) (MST < 25 mm/3 min) and a control group (n = 110) (MST ≥ 25 mm/3 min). In order to assess daytime sleepiness, risk of obstructive sleep apnea (OSA), sleep quality, sleep bruxism (SB), and subjective feeling of dry mouth, all the participants filled in the following scales in Greek version: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire (BQ), a SB questionnaire, and Xerostomia Inventory (XI) respectively. In every subgroup that came of ESS, PSQI, BQ, and SB questionnaire scoring, subjective feeling of dry mouth was evaluated, based on XI values.

RESULTS

Statistically significant difference (p < 0.001) through PSQI scores was found between the study and control group. In contrast, a statistically significant difference was not obtained for the scores of ESS (p = 0.293), BQ (p = 0.089), and SB questionnaire (p = 0.730). XI scores introduced statistically significant difference between the subgroups of PSQI (p < 0.001), BQ (p = 0.001), SB questionnaire (p = 0.004)  and statistically weak between the subgroups of ESS (p = 0.049).

CONCLUSIONS

This is the first research study so far suggesting that patients with morning hyposalivation exhibit poor sleep quality using an objective method. The present results have, also, shown that subjective feeling of dry mouth is related to excessive daytime sleepiness, poor sleep quality, high risk of obstructive sleep apnea, and sleep bruxism, but larger-scale studies are still needed.

CLINICAL RELEVANCE

These findings should keep dentists aware of a possible association between xerostomia and sleep disorders and support larger-scale studies.

Level of work stress and factors associated with bruxism in the military crew of the Peruvian Air Force

BACKGROUND

Military life leads to a great personal sacrifice and labor in the aircrew because they are constantly subjected to innumerable activities which have a great work pressure; therefore, the aim of this study was to determine the level of work stress associated with bruxism in the aircrew of the Peruvian Air Force.

METHODS

This was a cross-sectional study. A total of 204 crew members of the Peruvian Air Force from the Air Group were surveyed, and the stomatological clinical inspection was carried out. Each crew member was evaluated using the validated International Labor Organization-World Health Organization (ILO-WHO) Work Stress Scale, and clinical records were used to diagnose bruxism using the Smith and Knight wear index.

RESULTS

It was found that 93.7% (n = 191) of the crew members were men and 6.3% (n = 13) were women; and the percentage of intermediate-level stress was found to be high in the grade of non-commissioned officers, whereas in the officer grade, the level of stress was low. There was also a statistically significant association between the variables military grade, sex, and age group. The sub-officers presented a higher percentage in the category "with bruxism", while in the rank of officers the category of "non-bruxism" was the most prevalent.

CONCLUSIONS

This study showed a statistically significant association between the variable bruxism and the level of work stress between the military aviators of the Peruvian Air Force (p<0.001).

Tooth wear in patients treated with HIV anti-retroviral therapy

Background

The objective of this study was to elucidate the relationship between HIV anti-retroviral therapy and tooth wear.

Methods

Assessment of tooth wear was conducted both with a survey questionnaire and clinical assessment at Russell Street Dental Clinic in Portland, Oregon. The survey questionnaire comprised of questions on study participant’s gender, age, HIV status, current medications, awareness of tooth grinding or clenching, jaw soreness, tooth or gum soreness, and frequency of headaches. For the clinical evaluation, a dental provider recorded the degree of wear on each tooth using a scale of 0–3. An individual tooth-wear index was used to rank patients with regard to incisal and occlusal wear. Data analysis included descriptive analysis, tests of association and regression analysis using SPSS V.24.

Results

The study sample involved 93 patients (HIV + ve = 60, HIV–ve = 33) with age range of 20-90 yrs. (mean = 49 yrs., s.d = 13.3). 92 and 67% participants of the HIV + ve and HIV-ve groups, respectively, presented with tooth wear. The mean tooth wear index was higher in HIV + ve patients than HIV–ve patients (8.2 vs. 7.8), however, this difference was not statistically significant (p > 0.05). A significant, positive correlation was found between HIV presence and tooth wear index, after accounting for age (B = 0.71, p < 0.05). The number of years on anti-retroviral therapy alone was positively correlated with tooth wear index (R² = 0.116, p < 0.05). After controlling for age, years of anti-retroviral therapy use was positively correlated with tooth wear index (B = 0.047, p > 0.05).

Conclusions

The findings from this study suggest that HIV + ve patients, who are on anti-retroviral therapy have significant tooth wear, although more studies with larger sample size are needed to confirm this. There is a critical need to initiate a dialogue with medical providers about tooth wear as a possible side effect of antiretroviral therapy and to introduce appropriate preventive measures.

Early Effect of Implant-Supported Rehabilitation and Nocturnal Bruxism on Maximum Occlusal Force: A Cross-Sectional Study

This clinical study evaluated the early effect of oral rehabilitation with dental implants and nocturnal bruxism on maximum occlusal force (MOF), before sensorimotor adaptation. A consecutive sample consisted of 127 patients divided into three groups according to their dental state: G1- implant-supported fixed complete denture (IFCD) opposing to a small fixed prosthesis or natural dentition; G2- IFCD opposing to a complete denture; and G3- small fixed prosthesis or natural dentition in both arches. Clinical data were collected after prosthesis installation: systemic and oral health conditions, MOF, self-reported bruxism, and bruxism severity (low, moderate, severe). Data were analysed by ANOVA and Tukey-Krammer tests. Dental state and the interaction sex-bruxism had significant effect on MOF. G1 had higher MOF than G3, but G2 was not significantly different from G1 and G3. Men with bruxism had the highest MOF. The levels of bruxism severity did not have a significant effect on MOF. The results suggest that MOF varies as a function of dental state and the interaction sex-bruxism. However, presence and severity of bruxism alone does not affect MOF.

Complete rehabilitation of patients with bruxism by veneered and non-veneered zirconia restorations with an increased vertical dimension of occlusion: an observational case-series study

PURPOSE

To assess the clinical performance of the complete rehabilitation of a series of patients with bruxism treated by teeth- and implant-supported veneered and non-veneered zirconia restorations with an increased vertical dimension of occlusion (VDO).

METHODS

Ten patients with bruxism, aged 62-70 years, were treated with 108 veneered and 142 non-veneered zirconia restorations and attended the recall appointment. The mean observation period was 28.2 (±16.8) months. The patients were identified from records, and clinical details were retrieved from their files. In the recall appointment, the restorations were evaluated using modified California Dental Association (CDA) criteria. The periodontal probing depth, bleeding index, presence of caries and implant survival and success rate were recorded.

RESULTS

No biological complications were recorded for any restorations. The success and survival rate of all implants was 100%. The overall mean survival and success rate of all restorations was 99.6%. In the veneered group, the predominant complication was minor veneer chipping (13.9%) on the incisal edge, which required only polishing (grade 1); in the non-veneered group, the predominant failure was open proximal contacts between the implant restoration and adjacent teeth (9%); only one implant restoration needed repair. One restoration was replaced due to a horizontal tooth fracture.

CONCLUSIONS

Within the limitations of this study, we conclude that the survival and success rate of monolithic zirconia restorations installed in patients with bruxism was excellent, although the veneered zirconia restorations showed a high rate of minor veneer chipping, which required only polishing.

Bruxism Unconscious Oral Habit in Everyday Life

BACKGROUND

Bruxism is defined as an unconscious oral habit of rhythmical, unfunctional clenching, grinding and making chewy sounds with the teeth while making movements that are not part of the masticatory function and that lead to occlusal trauma.

AIM

The purpose of this article is to show the habit bruxism, in everyday life, reviewing literature data.

METHODS

Data was researched by using information on the internet on Researchgate, Pubmed, ScienceDirect, by analysing written articles and books and student books. From 200 articles that were analysed, 45 articles and two textbooks were involved in writing of this review article.

RESULTS

Results derived from the analyzed literature, classify the main consequences of bruxism, from fatigue, pain, wasting of the incisal edges and occlusal surfaces of the teeth to loss of teeth, dental implants, headaches, periodontal lesions and TMD (dysfunctions of the masticatory muscles and temporomandibular joint (TMJ)) in severe cases. All these problems negatively affect the quality of everyday life of the patient.

CONCLUSION

Bruxism as a parafunctional habit is present in everyday life needing a multidisciplinary approach for prevention of the teeth, bone and prosthetic restorations. The prevalence of bruxism is growing related to stress, drugs, changes in lifestyle, bad nutrition and sleep problems. The therapist should follow signs and symptoms to ensure the best treatment plan of the patient.

STXBP1 encephalopathy is associated with awake bruxism

Heterozygous mutations in syntaxin-binding protein 1 (STXBP1) gene are associated with early infantile epileptic encephalopathy 4 (EIEE4). This condition is characterized by epilepsy, developmental delay (DD), and various movement disorders. Herein, we will report 5 unrelated patients with different de novo mutations in STXBP1. In addition, we conducted an online survey through Facebook to identify the incidence of bruxism (BRX) in these patients. Four out of 5 patients (80%) presented with awake BRX (A-BRX). Bruxism was also reported in 81.4% (57/70) of the patients with STXBP1 encephalopathy through the online questionnaire. No consistent correlation was identified between the type of mutation and development of movement disorders or BRX. This is the first study to demonstrate A-BRX in patients with STXBP1 mutation. Given the role of STXBP1 in exocytosis of neurotransmitters and other manifestations of dopamine dysregulation in patients with STXBP1-EIEE4, we suggest that in patients with STXBP1 encephalopathy, A-BRX might be the result of the involvement of dopaminergic circuits.

Revisited relationships between probable sleep bruxism and clinical muscle symptoms

OBJECTIVES

Sleep bruxism (SB), characterized by repetitive jaw-muscle activity during sleep, is often suggested as a cause of temporomandibular disorders (TMD), orofacial pain, and headache. This study aimed to challenge the relationship between jaw-muscle electromyographic (EMG) activity during sleep and jaw muscle symptoms including pain by modulation of the levels of EMG activity. Contingent electrical stimulation (CES) using a portable single-channel EMG device was applied at different stimulus intensities to inhibit jaw muscle activity.

MATERIALS AND METHODS

Sixty probable sleep-bruxers, screened and confirmed by a 2-week use of a portable EMG device, were randomly allocated into one of 3 groups (High/Low/Placebo CES). At baseline and after 2 weeks CES intervention, the participants were asked to score pain intensity, as well as unpleasantness, fatigue, tension, soreness and stiffness in their jaw muscles, on 0-10 numerical rating scales (NRS).

RESULTS

Only in the High CES group, the number of EMG events/hour was significantly decreased (P = 0.024). Although the NRS scores of pain did not change, interestingly the NRS scores of unpleasantness (P = 0.037), tension (P < 0.001) and soreness (P = 0.004) in the High CES group and tiredness (P = 0.002) and soreness (P = 0.006) in the Low CES group were significantly decreased after the CES intervention compared to baseline.

CONCLUSION

High intensity CES demonstrated inhibitory effect on masticatory muscle EMG activity during sleep and was associated with significant decreases in jaw muscle symptoms (unpleasantness/tiredness/soreness) but not pain responses. These findings challenge the traditional concept that probable sleep bruxism is directly related to pain but appears related to more unspecific muscle symptoms.

Impact of sleep bruxism on training-induced cortical plasticity

PURPOSE

To investigate if sleep bruxism (SB) influences training-induced cortical plasticity and performance in terms of accuracy and precision of a tooth-clenching task (TCT).

METHODS

Thirty-eight participants were allocated into SB group (N=19) and control group (N=19) according to presence of SB based on a 2-week screening. The participants were instructed to perform a standardized TCT for 58min at three different force levels (10%, 20% and 40% of maximum voluntary contraction; MVC) in three series (first and third without visual-feedback and second with visual-feedback). Accuracy and precision of the TCT were calculated from actual bite force values. Transcranial magnetic stimulation was applied to elicit motor evoked potentials (MEPs) from the masseter and first dorsal interosseous muscle (FDI) before the TCT (pre-TCT-session) and 5-min after the TCT (post-TCT-session).

RESULTS

Accuracy was significantly dependent on the series and target force level (P<0.001), however, there was a significant decrease only in the control group at 10% MVC from first to third session (P<0.001). No significant differences between groups were observed for the precision of the TCT. Masseter MEPs in the SB group in the pre-TCT-session at 120% and 160% motor threshold were significantly lower than in the control group (P<0.05). Masseter MEPs of the control group in the post-TCT-session were significantly higher than the pre-TCT-session (P<0.05) but not SB. FDI MEPs were only dependent on stimulus intensity (P<0.001).

CONCLUSIONS

SB is associated with significant changes not only in excitability of corticomotor control but also motor learning of jaw movements and force control.

The Treatment of Hypersalivation in Rett Syndrome with Botulinum Toxin: Efficacy and Clinical Implications

INTRODUCTION

Subjects with Rett syndrome (RS) develop invariably severe motor deterioration resulting in swallowing difficulties that may produce excessive drooling. Hypersalivation can cause discomfort due to hygienic problems and may complicate with oral and respiratory dysfunctions. The aim of this study is to evaluate the response to treatment with botulinum toxin (BTX) for hypersalivation and to identify possible benefits of saliva reduction on oral motor and respiratory disorders of patients with RS.

METHODS

Five consecutive patients with RS and hypersalivation were treated with incobotulinumtoxin A injected in salivary glands with ultrasound guidance. Severity of excessive drooling was assessed with the Thomas-Stonell and Greenberg Scale (TGSC) and the clinical impact of the treatment was evaluated using three selected items of RS Assessment Rating Scale (R.A.R.S.): eating habits, dyspnoea and bruxism. Scale rating was performed before BTX injection (T0), 4 (T1) and 12 (T2) weeks after.

RESULTS

Scores of TGSC and R.A.R.S. (for eating and bruxism) were reduced significantly after therapy at T1.

CONCLUSIONS

BTX treatment for sialorrhea in RS is effective in reducing saliva production and may also improve oral motor functions.

Sleep, chronic pain, and opioid risk for apnea

Pain is an unwelcome sleep partner. Pain tends to erode sleep quality and alter the sleep restorative process in vulnerable patients. It can contribute to next-day sleepiness and fatigue, affecting cognitive function. Chronic pain and the use of opioid medications can also complicate the management of sleep disorders such as insomnia (difficulty falling and/or staying asleep) and sleep-disordered breathing (sleep apnea). Sleep problems can be related to various types of pain, including sleep headache (hypnic headache, cluster headache, migraine) and morning headache (transient tension type secondary to sleep apnea or to sleep bruxism or tooth grinding) as well as periodic limb movements (leg and arm dysesthesia with pain). Pain and sleep management strategies should be personalized to reflect the patient's history and ongoing complaints. Understanding the pain-sleep interaction requires assessments of: i) sleep quality, ii) potential contributions to fatigue, mood, and/or wake time functioning; iii) potential concomitant sleep-disordered breathing (SDB); and more importantly; iv) opioid use, as central apnea may occur in at-risk patients. Treatments include sleep hygiene advice, cognitive behavioral therapy, physical therapy, breathing devices (continuous positive airway pressure - CPAP, or oral appliance) and medications (sleep facilitators, e.g., zolpidem; or antidepressants, e.g., trazodone, duloxetine, or neuroleptics, e.g., pregabalin). In the presence of opioid-exacerbated SDB, if the dose cannot be reduced and normal breathing restored, servo-ventilation is a promising avenue that nevertheless requires close medical supervision.

Risk factors associated with reported bruxism among children and adolescents with Down Syndrome

Objective: Identify factors associated with the prevalence of reported bruxism in children/adolescents with Down Syndrome (DS). Methods: The study included 112 children/adolescents with DS and their parents/caregivers. Oral habits, pacifier/finger sucking, upper respiratory infections (<six months), and breathing type (nasal/buccal) were diagnosed. Reported bruxism was recorded through parents' report ("Does your child have audible teeth grinding?"). Results: Children/adolescents 8-12 years of age were 1.15 times more likely to belong to the group with reported bruxism (1.42-3.14). Children/adolescents 5-7 years of age were 3.38 times more likely to belong to the group with reported bruxism (1.26-9.03). Children/adolescents classified as mouth breathers were 2.87 times more likely to belong to the group with reported bruxism (1.18-6.98). Conclusion: Age and mouth breathing were associated with reported bruxism. Earlier interventions should be provided in order to limit and minimize possible damage that can affect childrens' quality of life.

Bruxism and oral health-related quality of life among male inmates in a penal institution, Mysore: A cross-sectional study

Background

One of the widespread problems of oral health is bruxism and is defined as a parafunctional habit with involuntary grinding and gnashing of the teeth occurring during sleep. However, bruxism is connected to anxiety and stress, but the published literature on bruxism among prison inmates is scanty. Objective: The objective of the study was to determine the prevalence of active sleep bruxism and its impact on oral health-related quality of life (OHRQoL) among inmates in Central Penal Institution, Mysore.

Materials and Methods

The study was cross sectional and conducted among eligible male inmates at Central Penal Institution, Mysore. The information on active sleep bruxism and OHRQoL was collected using a predesigned structured questionnaire by means of personal interview by a trained investigator. The active sleep bruxism was assessed using the criteria of American Academy of Sleep Medicine and OHRQoL through modified oral health impact profile (OHIP-14). The data analysis was done using descriptive statistics, Chi-square test, t-test, analysis of variance, and linear regression model.

Results

A total of 212 male inmates aged between 18 and 80 years were considered for the study. The prevalence of active sleep bruxism among the study population was 31.6%. The mean OHIP-14 score was significantly higher (P < 0.001) among the inmates having active sleep bruxism (38.52 ± 12.8) suggesting a high oral health impact as compared to inmates without this disorder (31.67 ± 12).

Conclusion

The prevalence of active sleep bruxism was higher among the inmates of penal institution as compared to the general population. The active sleep bruxism had a negative impact on OHRQoL.