Wake‐Up Headache Is Associated With Sleep Bruxism

The effectiveness and predictors influencing the outcome of onabotulinumtoxinA treatment in chronic migraine: understanding from diverse patient profiles in a single session

Objective

This real-world study aimed to investigate how onabotulinumtoxinA affects the outcome of migraine, along with accompanying anxiety, depression, and bruxism among a group of patients with chronic migraine (CM) and define predictors of good response.

Methods

Patients diagnosed with CM who received onabotulinumtoxinA were included in this single-center, real-world retrospective cohort study. Monthly headache days (MHDs), monthly migraine days (MMDs), headache intensity (numeric rating scale-NRS) and headache characteristics were evaluated at baseline and 12 weeks post-treatment. Patient-reported outcome measures (PROMs) included Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6) scores, 12-item Allodynia Symptom Checklist (ASC-12), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Response to onabotulinumtoxinA (% reduction in MHDs) and treatment-related adverse events (TRAEs) were also evaluated. OnabotulinumA was applied to the masseter muscles in patients complaining of bruxism.

Results

A total of 72 patients (mean ± SD age: 36.3 ± 8.5 years; 91.7% were female) diagnosed with CM were included. OnabotulinumtoxinA revealed significant decrease in median (IQR) MHDs [from 20(15-25) at baseline to 6(4-10), p < 0.001], MMDs [from 9(6-12) to 3(1-6), p < 0.001] and NRS [from 9(8-10) to 7(6-8), p < 0.001], and the MIDAS [from 54(30-81) to 16(7-24), p < 0.001], HIT-6 [from 67(65-69) to 58(54-64), p < 0.001], ASC-12 [from 6(1.5-9) to 2(0-9), p = 0.002], BAI [from 12(6.5-19) to 9(3-17), p < 0.001] and BDI [from 11(6.5-17) to 3(2-7) p < 0.001] scores at 12 weeks post-treatment. Patients complaining of bruxism received onabotulinumtoxinA injections in the first n = 27 (37.5%) and 12. week post-treatment n = 19 (70.4%) periods. Overall, 70.8% of patients responded (≥50% reduction in MHDs), while 29.2% did not (<50% reduction). Both groups showed similar characteristics in demographics, migraine history, baseline PROMs scores, comorbidities, and prior treatments.

Conclusion

OnabotulinumtoxinA is an effective treatment option that rapidly improves migraine outcomes, disability, and impact while also alleviating comorbid depression and/or anxiety. This study's noteworthy finding is that onabotulinumtoxinA is effective in a majority of CM patients, irrespective of their prior treatment history, migraine characteristics, or concurrent comorbidities. Furthermore, we identified no specific predictors for a favorable response to onabotulinumtoxinA. Applying onabotulinumtoxinA to the masseter muscles can relieve discomfort associated with concurrent bruxism; however, it does not impact migraine outcomes.

Origami-Inspired Conductive Paper-Based Folded Pressure Sensor with Interconnection Scaling at the Crease for Novel Wearable Applications

Drawing inspiration from origami structures, a pressure sensor was developed with unique interconnection scaling at its creases crafted on a conductive paper substrate, paving the way for advanced wearable technology. Two screen-printed conductive paper substrates were combined face-to-face, and specific folds were introduced to optimize the sensor structure. The Electrical Contact Resistance (ECR) was systematically analyzed across different fold numbers and crease gaps, revealing a notable trade-off: while increasing the number of folds expanded the sensing area, it also influenced the ECR, reaching a performance plateau. Strategic modifications in the sensor's design, including refining interconnections at the crease, enhanced its sensitivity and stability, culminating in a remarkable sensitivity of 3.75 kPa-1 at subtle pressure levels (0-0.05 kPa). This sensor's real-world applications proved to be transformative, from detecting bruxism and aiding in neck posture correction to remotely sensing trigger finger locking phenomena, highlighting its potential as a pivotal tool in upcoming medical diagnostics and treatments.

Bruxism and oro-facial pain not related to temporomandibular disorder conditions: Comorbidities or risk factors?

INTRODUCTION

Bruxism has historically been of particular interest to the field of dentistry, primarily due to the inferred damage it may cause to the dentition and supporting periodontal structures. The definition of bruxism itself has undergone multiple changes over time. In addition, the effects of bruxism as it relates to oro-facial pain conditions has remained a debatable topic.

PURPOSE

To review the available literature relating to bruxism and non-temporomandibular disorder (TMD) pain conditions.

METHODS

A literature search was conducted with the assistance of an expert librarian. The following databases were reviewed: PubMed, MEDLINE, EMBASE and Google Scholar. For additional references, articles were also retrieved by hand search from the selected papers. Any articles that were not published in English, or the focus were related to temporomandibular disorders were excluded.

CONCLUSIONS

While bruxism and certain headache conditions do tend to occur together frequently, evidence relating to any clear common pathophysiological mechanism has yet to be fully elucidated. Robust evidence as it relates to the relationship between bruxism and other non-TMD oro-facial pains is also lacking.

The development of the Standardised Tool for the Assessment of Bruxism (STAB): An international road map

This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.

Primary headache management in a multidisciplinary team - a pilot study

Tension-type headaches and migraines are bidirectionally related to dysfunctions of the cervical and masticatory muscles and some psychosocial factors. Our pilot study aimed to investigate the connections between primary headaches, bruxism, and psychosocial issues. In addition, we aimed to assess the effectiveness of a multidisciplinary approach in decreasing the intensity and frequency of headache episodes and bruxism. Sixty-seven patients previously diagnosed with primary headache and bruxism were divided into two similar groups. One group benefited from manual therapy alone, while the other received manual therapy and counseling sessions for three months. Statistical data analysis was conducted using SPSS, Version 24, using the paired Student's t-tests and McNemar's tests. After the three-month intervention period, we observed substantial improvements across various parameters. Some demonstrated statistically significant differences, while others did not reach statistical significance. When comparing the outcomes, the combined therapy proved more effective than manual therapy alone.

Prevalence of Possible Sleep Bruxism and Its Association with Social and Orofacial Factors in Preschool Population

The prevalence of bruxism in the preschool population varies according to different investigations. The aim of this study was to investigate the prevalence of sleep bruxism and its relationship with social and orofacial factors in children aged 3 to 5 years. Three hundred forty-three preschool children were divided into two groups, one with nocturnal bruxism, as reported by parents, and another without this disorder. Questionnaires were distributed to the parents to determine the children's family social status and parafunctional habits at the time of the study. The clinical inspection confirmed the presence of certain parafunctional habits and the children's occlusal characteristics. The data obtained were analysed using descriptive statistics such as frequency chi-square tests to identify the influence of qualitative variables. Of the total sample, 28.9% of preschoolers presented sleep bruxism. The highest prevalence was observed in boys (61.6%) at the age of 5 years (41.4%). Characteristics associated with this pathology were lip incompetence, open bite, crossbite, and overbite, with p < 0.05. Sleep bruxism in preschool children has a higher prevalence in boys and is more frequently expressed from 5 years of age. Open bite, overbite, and crossbite should be considered factors associated with parafunction.

Dental sleep-related conditions and the role of oral healthcare providers: A scoping review

Dental sleep medicine as a discipline was first described about a quarter of a century ago. Snoring, obstructive sleep apnea, sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux disease, and orofacial pain were identified as dental sleep-related conditions. This scoping review aimed to: i) identify previously unidentified dental sleep-related conditions; and ii) identify the role of oral healthcare providers in the prevention, assessment, and management of dental sleep-related conditions in adults. A systematic literature search was conducted in PubMed, Embase.com, Web of Science, and Cochrane. Studies that reported an actual or likely role of oral healthcare providers in the prevention, assessment, and/or management of sleep-related conditions were included. Of the 273 included studies, 260 were on previously listed dental sleep-related conditions; the other 13 were on burning mouth syndrome. Burning mouth syndrome was therefore added to the list of dental sleep-related conditions for the first aim and categorized into sleep-related orofacial pain. For the second aim, the role of oral healthcare providers was found to be significant in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; in the assessment and management of snoring, sleep-related orofacial pain, and oral dryness; and in the assessment of sleep-related gastroesophageal reflux condition.

Marginal bone loss around dental implants: comparison between matched groups of bruxer and non-bruxer patients: A retrospective case-control study

PURPOSE

To compare marginal bone loss (MBL) around dental implants in a group of bruxers in relation to a matched group of non-bruxers.

METHODS

The present record-based retrospective study included patients selected from individuals treated with dental implants at one specialist clinic in Malmö. Only implants not lost and with baseline radiographs taken within 12 months after implant placement and with a minimum of 36 months of radiological follow-up were considered for inclusion. Univariate linear regression models and a linear mixed-effects model were performed.

RESULTS

Two hundred and four patients (104 bruxers, 100 non-bruxers), with a total of 811 implants (416 in bruxers, 395 in non-bruxers) were included in the study. The results of the linear mixed-effects model suggested that bruxism, smoking, age, region of the jaws, implant diameter, and prosthesis type had a statistically significant influence on MBL over time. Individuals who are both bruxers and smokers showed greater MBL when compared to individuals who are either a bruxer or smoker, or neither (p < 0.001).

CONCLUSIONS

Bruxism is suggested to increase the risk of MBL over time, as well as higher age, smoking, and the combination of bruxism and smoking. Other factors that showed a correlation with increased MBL were implant diameter, region of the jaws, and prosthesis type, but it is not possible to draw robust conclusions for these factors, as the categories of these variables were very unbalanced.

Sleep Bruxism in Puerperal Women: Data from a Population-Based Survey

OBJECTIVE

To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil.

METHODS

A single, standardized questionnaire was given within the 48 h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis.

RESULTS

A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB.

CONCLUSION FOR PRACTICE

Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking.

Sleep-related factors and orofacial pain symptoms associated with rhythmic masticatory muscle activity frequency scored by polysomnography recordings: A case-control study

OBJECTIVE

This study aimed to evaluate the influence of the frequency of rhythmic masticatory muscle activity per hour (RMMA/h) scored by polysomnography (PSG) recordings on sleep-related factors and orofacial pain symptoms.

METHODS

According to RMMA/h frequency, participants were assigned either to the control group (i.e., CRMMA, n = 40); or the case group according to high (i.e., HRMMA, n = 12) or low (LRMMA, n = 28) RMMA/h frequency. Fisher's exact (nominal variables), One-way Analysis of Variance followed by post-hoc Tukey (continuous variables) and Poisson Regression tests were used to calculate orofacial pain symptoms and sleep-related breathing, behavior, and architecture differences between controls versus cases at a significance level of 5%.

RESULTS

The CRMMA differed from HRMMA and LRMMA subgroups considering orofacial pain, self-reported tooth clenching or grinding, obstructive sleep apnea (OSA), snoring, and most variables considering sleep architecture (P ≤ 0.05). Multivariate adjusted Poisson regression analysis revealed that bruxers, regardless of RMMA/h frequency, presented a significantly higher prevalence rate (PR) related to orofacial pain (PR 1.68; P = 0.025) and self-reported behavior (PR 1.71; P = 0.012).

CONCLUSION

Significant differences in N1, N2 and N3 stages, arousals, arousal per hour, and sleep onset latency variables were found comparing bruxer with high or low RMMA/h frequency. Compared to controls, bruxers presented higher PR related to headache and self-reported tooth clenching or grinding.

Variability of sleep bruxism-findings from consecutive nights of monitoring

OBJECTIVES

To determine sleep bruxism (SB) behavior during five consecutive nights and to identify correlations between SB episodes per hour (SB index) and sleep-time masseter-muscle activity (sMMA).

MATERIAL AND METHODS

Thirty-one participants were included in the study. Of these, 10 were classified as sleep bruxers (group SB-1) and nine as non-sleep bruxers (group non-SB). The bruxism status of these 19 patients was identified by means of questionnaires, an assessment of clinical symptoms, and electromyographic/electrocardiographic data (Bruxoff® device). The remaining 12 participants were also identified as bruxers, but based exclusively on data from the Bruxoff device (group SB-2). Data analysis included descriptive statistics and Spearman's correlation to assess the relationship between the SB index and sMMA.

RESULTS

Participants in group SB-1 showed an overall mean SB index of 3.1 ± 1.6 and a mean total sMMA per night of 62.9 ± 38.3. Participants in group SB-2 had an overall mean SB index of 2.7 ± 1.5 and a mean total sMMA of 56.0 ± 29.3. In the non-SB group, participants showed an overall mean SB index of 0.8 ± 0.5 and a mean total sMMA of 56.8 ± 30.3. Spearman's correlation yielded values of - 0.27 to 0.71 for the correlation between sMMA and SB index.

CONCLUSIONS

The data revealed variable SB activity and the absence of a reliable correlation between sMMA and the SB index.

CLINICAL RELEVANCE

The high variation in SB activity and lack of correlation between sMMA and the SB index should be considered when diagnosing SB.

TRIAL REGISTRATION

Clinical Trials [NIH], clinical trial no. NCT03039985.

Role of occlusal factors on probable bruxism and orofacial pain: Data from the 1982 Pelotas birth cohort study

OBJECTIVES

This study aimed to explore the association between occlusal features and temporomandibular disorder (TMD) pain complaints and probable awake or sleep bruxism METHODS: Path analysis was used to estimate direct, indirect and total effects of occlusal features on probable bruxism and pain-related TMD in adults aged 31 years from the 1982 Pelotas Birth Cohort. A total of 539 cohort members had an oral examination in 2013. Occlusal features were assessed through the Dental Aesthetic Index (DAI), orofacial pain complaints through the TMD pain screener and probable bruxism based on self-reports in combination with clinical findings.

RESULTS

Malocclusions were found in 28.8% of the participants, while awake bruxism was reported in 35.2%, sleep bruxism in 15.2%, and pain-related TMD in 52.5% of the sample. Occlusion had no direct effect on either awake bruxism [standardized coefficient (SC) -0.002; p = 0.995] or pain-related TMD (SC -0.06; p = 0.115). Conversely, probable awake bruxism was associated with pain-related TMD (SC 0.35; p < 0.001). Similar results were found when sleep bruxism was set as the mediator of interest, as malocclusion did not directly affect sleep bruxism (SC 0.05; p= 0.220) nor pain-related TMD (SC -0.06; p = 0.167). A direct effect of sleep bruxism on pain-related TMD was observed with an SC of 0.16 (p < 0.001).

CONCLUSION

Our findings suggested that malocclusion during adulthood did not directly influence probable awake or sleep bruxism nor TMD pain complaints. Instead, probable awake and sleep bruxism was associated with TMD pain complaints.

CLINICAL SIGNIFICANCE

Malocclusion did not impact the presence of bruxism nor TMD complaints in adulthood, but awake and sleep bruxism were associated with TMD pain complaints. The significance of malocclusion should be reconsidered in contemporary dentistry and oral rehabilitation.

Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model

Pain is a multidimensional experience comprising sensory-discriminative, affective-motivational, and cognitive-evaluative dimensions. Clinical and research findings have demonstrated a complex interplay between social burdens, individual coping strategies, mood states, psychological disorders, sleep disturbances, masticatory muscle tone, and orofacial musculoskeletal pain. Accordingly, current classification systems for orofacial pain require psychosocial assessments to be an integral part of the multidimensional diagnostic process. Here, we review evidence on how psychosocial and biological factors may generate and perpetuate musculoskeletal orofacial pain. Specifically, we discuss studies investigating a putative causal relationship between stress, bruxism, and pain in the masticatory system. We present findings that attribute brain structures various roles in modulating pain perception and pain-related behavior. We also examine studies investigating how the nervous and immune system on cellular and molecular levels may account for orofacial nociceptive signaling. Furthermore, we review evidence pointing towards associations between orofacial musculoskeletal pain and neuroendocrine imbalances, sleep disturbances, and alterations of the circadian timing system. We conclude with several proposals that may help to alleviate orofacial pain in the future.

Pressure Algometry Evaluation of Two Occlusal Splint Designs in Bruxism Management-Randomized, Controlled Clinical Trial

The aim of this pilot study was to evaluate the short-term effectiveness of two different occlusal devices and their impact on the pressure pain threshold (PPT) values among patients who reported to the Dental Prosthetics Outpatient Clinic of Pomeranian Medical University (Szczecin, Poland) and who were diagnosed with probable bruxism. Two groups were formed (A and B) to which patients were assigned randomly. Each group used a different occlusal splint for bruxism management. The occlusal appliance by Okeson, or the bimaxillary splint, was used overnight by each patient for 30 days of the study. The PPT was measured twice, at the first visit and after 30 days of using each occlusal device, with Wagner Paintest FPX 25 algometer. Bruxism was diagnosed based on data from the patient's medical history and from the physical examination. Nocturnal Bruxism Criteria according to the International Classification of Sleep Disorders (Third Edition) was used for the patient's evaluation. Results: similar pain factor (PF) reduction was observed in both the examined groups, regardless of the device used; canine guidance and no guidance were similarly effective in terms of increasing pain resilience.

Identifying predictive factors for sleep bruxism severity using clinical and polysomnographic parameters: a principal component analysis

STUDY OBJECTIVES

The aim was to identify predictive factors for sleep bruxism (SB) severity among polysomnographic parameters, salivary cortisol levels, temporomandibular disorders, age, and sex.

METHODS

Young adults (19-30 years) were screened for self-/roommate reports of teeth grinding/clenching during sleep associated with clinical signs of tooth wear. Individuals positive for both conditions were administered a polysomnographic exam to provide a definite diagnosis of SB (n = 28). Healthy participants without SB signs/symptoms were also included (n = 15). The Research Diagnostic Criteria for Temporomandibular Disorders was applied to determine functional, muscular, and articular domains of the Temporomandibular Index. Cortisol awakening levels were measured in saliva. Principal component analysis was used to extract the latent components emerging from polysomnographic results, and 2 regression models were adjusted to predict the number and duration of bruxism episodes.

RESULTS

Principal component analysis resulted in 4 components-C1: %N1, total sleep time, sleep efficiency, arousals/microarousals; C2: %N2, %N3; C3: periodic limb movements and apneas; C4: %REM and REM latency. The number of SB episodes/h was predicted by increasing muscular scores and C2 (decrease in %N2 and increase in %N3) (adjusted R² = 45%; P =.001). The total time of SB episodes was predicted by decreased articular and increased functional scores, age, and female sex (adjusted R² = 36%; P = 0.010). Salivary cortisol levels were not associated with SB severity and did not differ between groups.

CONCLUSIONS

The findings showed that SB severity was predicted by muscular and functional scores, female sex, and distinct polysomnographic patterns, contributing to the deeper knowledge of the underlying pathophysiology of SB severity; additionally, the findings can help to formulate health approaches that are specific to the patient and will better assist in treating this condition.