Association between signs and symptoms of bruxism and presence of tori: a systematic review

Asymptomatic Symmetric Bilateral Mandibular Tori: A Case Study

Tori are reactive or developmental localized overgrowths of alveolar bone that are not cancerous. A thin, weakly vascularized mucosa surrounds a densely cortical, low-density mass of bone marrow known as tori or exostosis. Tori are more frequently observed in middle age. Both the maxilla (torus palatinus) and the mandible (torus mandibularis) exhibit tori. Difficulty in speaking and other issues are common obstacles associated with tori. Tori range in diameter from a few millimeters to several centimeters. Surgical excision of tori is the mainstay of treatment for large tori obstructing speech, mastication, or tongue position. The following case study includes a 36-year-old male patient with an association of mandibular canine and premolar regions with bony outgrowth.

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

BACKGROUND

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

TYPES OF STUDIES REVIEWED

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

RESULTS

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

CONCLUSIONS AND PRACTICAL IMPLICATIONS

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

The bruxism screener (BruxScreen): Development, pilot testing and face validity

BACKGROUND

To assess awake and sleep bruxism, the Standardised Tool for the Assessment of Bruxism (STAB) is currently being developed. The STAB will be a comprehensive tool for the detailed assessment of bruxism behaviour itself as well as of its possible consequences, causes, and comorbid conditions.

OBJECTIVE

Since the STAB cannot fully meet the 'A4 principle' for a bruxism assessment tool, i.e., being Accurate (reliable and valid), Applicable (feasible), Affordable (cost-effective), and Accessible (suitable for everyday clinical use), the Bruxism Screener (BruxScreen) has been developed to be used in large-scale epidemiological research projects and, especially, in general, dental practices.

METHODS

The BruxScreen consists of two parts: a questionnaire (BruxScreen-Q) to be completed by patients, and a clinical assessment form (BruxScreen-C) to be completed by dentists.

RESULTS

This paper describes the development of the BruxScreen and provides the outcomes of the pilot testing phase and the face validity assessment (i.e. that the first impressions of the tool indicate that it adequately reflects the construct to be measured).

CONCLUSION

The resulting BruxScreen is considered ready for more profound psychometric testing in the general dental setting.

Salivary signatures of oral-brain communication in sleep bruxers

Introduction

Microbiota and their interaction with hosts have been of great interest in brain research in recent years. However, the role of oral microbiota in mental illness and the underlying mechanism of oral-brain communication remains elusive. Sleep bruxism (SB) is an oral parafunctional activity related to the nervous system and is considered a risk factor for harmful clinical consequences and severe systemic conditions. Exploring the connection between oral microbiota and sleep bruxism may deepen our understanding of the complex relationship between oral-brain axis and provide insights for treatment.

Methods

In this study, salivary samples were collected from 22 individuals with SB and 21 healthy controls, and metagenomics with metabolomics was performed. Nonparametric Wilcoxon test were applied for the statistical analysis between the two groups. Microbial dysbiosis and altered oral metabolites were found in the SB individuals.

Results

The characteristic metabolite N-acetylglucosamine (GlcNAc) (VIP=8.4823, P<0.05) was correlated to a statistically lower Streptococcus mitis level in SB individuals. Salivary IFN-g level and IFN-g/IL-4 ratio were detected with significant changes in a chip assay. Amino acid metabolism pathways were upregulated, and the pathway with the largest number of differentially expressed genes is related to amino-tRNA charging pathway, while the most significantly enriched pathway is related to arginine biosynthesis. Neurotransmitter-associated pathways with glutamatergic and GABAergic synapses and cardiovascular system-related pathways were enriched in the SB group.

Discussion

These results indicate a possible neuroimmune regulatory network of oral-brain communication in SB, which helps explain the mechanism of the oral microbiome with the host in sleep bruxers and provides a reference for early clinical and therapeutic intervention to improve the diagnosis and treatment of SB and similar diseases.

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.

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.

[Bruxism: Classification, Diagnostics and Treatment]

Bruxism: Classification, Diagnostics and Treatment Abstract. Bruxism, the grinding or clenching of teeth, is common in the population. Stress, anxiety syndromes and genetic disposition seem to be dominant factors that lead to increased muscle tension. A distinction is made between two circadian manifestations, sleep and wake bruxism. Bruxism is a major risk factor for tooth structure and dentures. The diagnosis is based on a targeted medical history and examination. Sleep bruxism can be demonstrated by electromyography and video recording in the sleep laboratory. The treatment aims to protect the hard tooth substance and preserve the denture using occlusal splints. Relaxation exercises can improve bruxism. Specialized physiotherapy can improve tension, pain and restricted movement. Botulinum toxin treatment reduces the subjective complaints during the period of action.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses

OBJECTIVE

This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage.

METHODS

The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses.

RESULTS

Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry.

DISCUSSION

The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Differential Diagnosis of Periapical Radiopacities and Radiolucencies

Periapical pathoses represent changes noted at the apices of teeth within the alveolar process that are suspected on examination, visualized via imaging, and confirmed via histopathology. They can be bone forming or destructive. There are pathologic entities that show both types of changes at the apical regions. These lesions must be identified if they are odontogenic in origin because treatment modalities differ. This article discusses identification of radiopaque and radiolucent lesions noted on radiographs. The common opacities and lucencies are described. When required, advanced imaging is used to depict changes within the bone near the periapical regions of mandibular and maxillary teeth.

Changes in the temporomandibular joint disc and temporal and masseter muscles secondary to bruxism in Turkish patients

Objectives:

To analyze the relationships between temporalis and masseter muscle hypertrophy and temporomandibular joint (TMJ) disc displacement in patients with severe bruxism using magnetic resonance imaging (MRI).

Methods:

This retrospective study included 100 patients with severe bruxism, referred to the Department of Oral and Maxillofacial Surgery, University of Marmara and Istanbul Medipol University, Istanbul, Turkey, between January 2015 and December 2016. Patients underwent TMJ MRI with a 1.5-T system in open and closed mouth positions. The masseter and temporalis muscles were measured in the axial plane when the patient’s mouth was closed.

Results:

At its thinnest, the disc averaged was 1.11±0.24 mm. At their thickest, the masseter averaged was 13.65±2.19 mm and temporalis muscles was 12.98±2.4 mm. Of the discs, 24% were positioned normally, 74% were positioned anteriorly, and 2% were positioned posteriorly. The temporalis muscle was significantly thicker in patients with normally positioned discs than in those with anteriorly positioned discs (p=0.035).

Conclusions:

The temporalis muscle was significantly thicker in patients with normally positioned discs than in those with anteriorly positioned discs (p=0.035). Additional studies should be conducted to evaluate the relationships between all masticatory and surrounding muscles and disc movements in patients with bruxism.

The relationship between oral tori and bite force

OBJECTIVE

The relationship between bite force and torus palatinus or mandibularis remains to be explained. The major aim of this study was to determine the correlation between bite force and oral tori.

METHODS

The bite force of 345 patients was measured with a bite force recorder; impressions of the shape and size of the oral tori were taken on plaster models prior to orthodontic treatments. Subsequently, the relationship between oral tori and bite force was analyzed.

RESULTS

The size, shape, and incidence of torus palatinus was not significantly correlated with bite force. However, the size of torus mandibularis increased significantly in proportion to the bite force (p = 0.020). The occurrence of different types of oral tori was not correlated with the bite force.

DISCUSSION

The size of torus mandibularis provides information about bite force and can thus be used to clinically assess occlusal stress.