Association between sleep bruxism and stress symptoms in adults: A systematic review and meta-analysis

To synthesise and critically review the association between sleep bruxism (SB) and stress symptoms in adults. A systematic review was performed. The search was completed using seven primary electronic databases in addition to a grey literature search. Two reviewers blindly selected studies based on pre-defined eligibility criteria. Risk of bias of the included articles was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. RevMan 5.4 was used to perform the meta-analysis. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Ten studies were included for qualitative analysis, of which three were included for quantitative analysis. Three studies were evaluated to have low risk of bias, and seven were assessed with moderate risk of bias. Quality of evidence was classified as very low for all outcomes. Individuals with SB were found to have higher levels of some self-reported stress symptoms as assessed through questionnaires with a mean difference of 4.59 (95% CI 0.26-8.92). Biomarkers like epinephrine, norepinephrine, cortisol, adrenaline, dopamine, noradrenaline and prolidase enzyme levels also showed a positive association with SB. Although some associations were identified between probable SB and self-reported stress symptoms and biomarkers of stress in adults, given that the quality of evidence was found to be very low, caution should be exercised in interpreting these results. These findings suggest that additional and better designed studies are warranted in order to clarify the link between SB and stress.

Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population.

MATERIALS AND METHODS

Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses.

RESULTS

From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%).

CONCLUSIONS

The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR.

CLINICAL RELEVANCE

Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.

Bruxism: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism.

MATERIALS AND METHODS

A literature search limited to Clinical Trials, Randomized Controlled Trials, Systematic Reviews and Meta Analyses, with the key words bruxism, and prevalence identified 22 references, bruxism and causation 21, bruxism, and treatment 117, and bruxism and cure none.

RESULTS

Prevalence received 5 references which were relevant to the question researched. Causation received 11 relevant references, treatment 34 relevant references and cure none. Eighteen additional references were culled from the reference lists in the aforementioned articles.

CONCLUSIONS

Due to variations in demographics and the dependence on anamnestic data, the true prevalence of bruxism in any specific population is unknown. There is moderate evidence that psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism (SB) as well as caffeine, alcohol, and smoking. There is no consensus on what symptoms of SB or awake bruxism (AB) should be treated. There is some evidence that occlusal devices and bio feedback therapies can be utilized in SB treatment. There is conflicting evidence in the use of Botulinum toxin A and no compelling evidence for the use of drug therapy to treat SB. There is not an established cure for bruxism. The clinician is best served in using caution in the dental rehabilitation of patients with severe occlusal wear.

Emotional distress, psychosomatic symptoms and their relationship with institutional responses: A survey of Italian frontline medical staff during the Covid-19 pandemic

With the advent of Covid-19, health workers have been under constant physical and psychological pressure. Italy was among the first countries to face the health emergency in a period of great uncertainty about the virus and the ways to treat patients. The present study aims to analyse the levels of emotional distress (ED) and psychosomatic symptoms (PS) of Italian frontline health workers during the Covid-19 emergency, and their relationship with the evaluation of the institutional responses received. A survey was available online during the peak of health system overload. Health workers' ED, PS and perceived overall wellbeing were assessed, along with the perceived adequacy of the emotional support, hygiene and safety measures, and protection received from the national government, regional administration and local hospital. A total of 103 questionnaires were collected [Women: 51.5%; mean age, 41.8 years; SD: ±10,7; high-risk zone: 41.7%]. Correlation analyses were applied to investigate the relationship between the measures of emotional distress and psychosomatic symptoms; ANOVA was applied to compare these measures among groups from different risk zones and with different perceived emotional and safety protection. About half of the health workers showed medium or high scores on emotional exhaustion, exceeded the cut-off for medium, high or very high psychosomatic symptom burdens, felt they have never or rarely been protected by the institutional responses and judged the emotional support received as inadequate; 32% judged the safety and hygiene measures as insufficient. Significant associations were found between measures of ED, PS and perceived change in personal wellbeing. Differences in perceived institutional support and adequacy of hygiene and safety measures related to significant differences in PS and perceived change in personal wellbeing. ED and PS were widely experienced by frontline health workers. Physical and psychological symptoms were amplified by the perceived lack of institutional support. Ensuring PS and hygiene and safety measures is essential to prevent worsening of health and psychosomatic symptoms in frontline health workers.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.