Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition

Pregnancy related factors and temporomandibular disorders evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD) axis II: a cross sectional study

INTRODUCTION

Temporomandibular disorder (TMD) is a multifaceted condition impacting the chewing system, with its frequency varying across different age groups and showing a higher incidence in women. The involvement of estrogen in TMD has been examined due to the presence of estrogen receptors in the TMJ area. However, the exact effect of estrogen on TMD is complex. During pregnancy, marked by significant hormonal fluctuations, the impact on TMD has been hypothesized but remains unclear due to inconsistent results from various studies.

METHODS

In this cross-sectional study, we enrolled 32 pregnant women consecutively. We gathered information on demographics, TMD evaluations (using the Graded Chronic Pain Scale, Jaw Functional Limitation Scale-20, and Oral Behaviors Checklist), and mental health assessments (including Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7). We employed descriptive statistics to summarize continuous and categorical data and used t-tests and chi-square tests for comparisons. We also conducted multivariate linear regression, adjusted for demographic factors, to investigate correlations.

RESULTS

The study group mainly consisted of women aged 30-35 (40.6%) and 25-30 (18.8%). Most participants had completed high school (50%) and were married (71.9%). A notable association was found between younger women (under 30) and higher levels of somatic symptoms (p = 0.008) and generalized anxiety (p = 0.015). Women in their second trimester showed lower severity of somatic symptoms (p = 0.04). A significant link was also observed between depression severity and somatic symptom severity (p = 0.01). However, we found no significant correlations with other TMD-related health aspects.

DISCUSSION

Our study identified significant associations between psychosomatic and psychological symptoms with variables like age and pregnancy trimester in pregnant women. However, it notably failed to establish a clear relationship between pregnancy-related factors and the severity of temporomandibular disorders (TMD). More comprehensive studies with larger participant pools are necessary to further validate and expand these findings.

Mouth Breathing and Its Impact on Atypical Swallowing: A Systematic Review and Meta-Analysis

The aim of this systematic review is the assessment of the effect of mouth breathing on the prevalence of tongue thrust. The review was performed according to the PRISMA 2020 checklist guidelines, and the protocol was registered with PROSPERO (CRD42022339527). The inclusion criteria were the following: studies of clinical trials and cross-sectional and longitudinal descriptive studies that evaluate the appearance of tongue thrust in patients with mouth breathing; healthy subjects of any age, race or sex; and studies with a minimum sample group of five cases. The exclusion criteria were the following: studies with syndromic patients, articles from case reports, and letters to the editor and/or publisher. Searches were performed in electronic databases such as The National Library of Medicine (MEDLINE via PUBMED), the Cochrane Central Register of Controlled Trials, Web of Science and Scopus, including studies published until November 2023, without a language filter. The methodological quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) tool was used for descriptive cross-sectional studies and cross-sectional prevalence studies. A meta-analysis was conducted on studies that provided data on patients' classification according to mouth breathing (yes/no) as well as atypical swallowing (yes/no) using Review Manager 5.4. From 424 records, 12 articles were selected, and 4 were eligible for meta-analysis. It was shown that there is no consensus on the diagnostic methods used for mouth breathing and tongue thrust. The pooled risk ratio of atypical swallowing was significantly higher in the patients with mouth breathing (RR: 3.70; 95% CI: 2.06 to 6.66). These studies have several limitations, such as the heterogeneity among the individual studies in relation to the diagnostic tools and criteria for the assessment of mouth breathing and atypical swallowing. Considering the results, this systematic review shows that patients with mouth breathing presented higher risk ratios for atypical swallowing.

Factors associated with preschool children's sleep bruxism

OBJECTIVE

To evaluate the prevalence of sleep bruxism, related factors, and quality of life of preschool children and their families.

METHOD

The sample was 475 children between 4 and 5 years old enrolled in schools in the city of Bauru-Brazil. Parents/legal guardians answered two questionnaires, one to assess the presence of bruxism and related factors and another that was the validated Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Intraoral clinical examination was performed by two trained examiners (Kappa = 0.82) within the school environment. The data were analyzed using statistics and the Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient. The significance level was p < 0.05.

RESULTS

The prevalence of sleep bruxism was 47.4%. The highest prevalence was related to Class I canines and marked overjet, oral habits, such as nail biting, lip biting, chewing gum, and mouth breathing. Children with agitated sleep, reports of headache, and those considered aggressive, anxious, and/or shy were also more related.Conclusion: In the studied sample, sleep bruxism prevalence was high and related to important oral and general factors. Data also indicated SB as the main factor that interfered in the OHRQoL of children and their families.

Craniomandibular Disorders in Pregnant Women: An Epidemiological Survey

Temporomandibular joint (TMJ) disorder has been reported to be 1.5 to two times more common in women than men. Such a gender-based difference could be attributed to behavioral, hormonal, anatomical, and psychological characteristics. Physiological hormonal differences between genders could be one of the possible explanations for the higher incidence of temporomandibular disorder (TMD) in women. As the plasma level of certain female hormones increases during gestation, it could be assumed that there is a higher prevalence of dysfunctional signs and symptoms in pregnant women. We performed an epidemiological survey based on screening for TMD in a group of 108 pregnant women and found that 72% of young women reported significant signs of TMJ disorders, 9% of the young women reported mild signs of TMJ disorders, and 19% of the included subjects reported no signs or symptoms of TMD. The presence of estrogen receptors in the temporomandibular joint of female baboons could be the basis of an explanation for the increased prevalence of dysfunction in young women reported in the literature and the high feedback we have seen of joint noises in pregnant women. On the basis of the present findings, it could be assumed that gestation period could represent a risk factor for craniomandibular dysfunctions.

Nonsurgical management of temporomandibular joint autoimmune disorders

Introduction

Temporomandibular disorders (TMD) are observed in a number of autoimmune diseases but limited studies have assessed the effect of autoimmune diseases on TMD. Therefore, the present review article was conducted to determine the effect of autoimmune diseases on TMD.

Methods

International databases, including Web of Sciences, PubMed and Scopus, were searched in order to find related articles. The search key words were; temporomandibular joint (TMJ) autoimmune disorders, TMJ, TMD, medical therapy and non-invasive, local and systemic management. Published articles from June, 2010 to June, 2019 were included in the review.

Results

A total of 11 related articles including rheumatoid arthritis (RA), lupus erythematosus and systemic sclerosis were found. All articles noted that TMJ has unique features that distinguishes it from other human body joints. Cases of TMJ injury and TMD require specific treatments. Therefore, early diagnosis of TMD is essential. It was also mentioned in the articles that the collagen-induced arthritis (CIA) method is a suitable method for investigating TMD and its relationship with RA. Treatment methods included oral steroids, Disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, methotrexate 75 mg, and combination therapy with methotrexate.

Conclusion

Based on the results of this study, TMD exists in some autoimmune diseases, including RA, lupus erythematosus and systemic sclerosis. Therefore, there should be an interdisciplinary collaboration between physicians and dentists in order to choose the best conservative treatment and medication therapy for TMD to reduce the progression and pain associated with this type of disorder.

Chronic nail biting, orthodontic treatment and Enterobacteriaceae in the oral cavity

Background

Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug resistance gram negative bacteria are on the rise globally. Several of the foodborne bacteria fall within the Enterobacteriaceae family but very few studies have explored these microbes in the oral cavity of children with chronic nail-biting habit or orthodontic treatment. The study aims to investigate oral load of Enterobacteriaceae in children with chronic nail-biting habit and or those undergoing orthodontic treatment.

Material and Methods

150 children (no nail-biting n=30, nail biting n=60, fixed orthodontic treatment n =30 and a combination of fixed orthodontic appliance use and nail-biting habit n =30) were assessed for culture based microbiological investigation. The concentrated oral rinse technique was used. The rinse was inoculated in MacConkey’s and Blood Agar. The gram stained culture was subjected to biochemical tests for sub-species identification using Biomerieux Vitek 2 Compact Automated Microbiological Analyzer. Fisher’s exact and Kruskal Wallis with post hoc analysis using Dunn method was performed to test association and difference between groups.

Results

Enterobacteriaceae was positive for 72% of the children. Of them, nail biting or orthodontic treatment group comprised 89%. Those with a combination of nail biting and undergoing orthodontic treatment exhibited highest CFU/ml and those without nail biting or orthodontic treatment exhibited the lowest. Three of the four organisms isolated tested positive in the orthodontic treatment group. E. coli was positive in 38% of the children while Klebsiella and E. cloacae were isolated exclusively in the orthodontic treatment group.

Conclusions

Chronic nail biting or the use of fixed orthodontic appliances is associated with higher incidence of Enterobacteriaceae in the oral cavity. Oral health professionals play an important role in preventing multi drug resistance infectious diseases.

Key words:Enterobacteriaceae, nail-biting, Onychophagia, orthodontic treatment.

Effect of injection of botulinum toxin on decreasing the symptoms and signs of masticatory muscles in patients with temporomandibular dysfunction

Background. Temporomandibular joint dysfunction (TMD) is a term that describes problems in the masticatory system, including the temporomandibular joint, the dento-muscular system and the supporting bones. Injection of botulinum toxin, as a noninvasive technique, might be useful in decreasing symptoms such as muscular spasm, dystonia, migraine headaches and TMD. Therefore, the aim of the present study was to evaluate the effect of injection of botulinum toxin on decreasing the symptoms and signs of masticatory muscles in patients with TMD.

Methods. A total of 61 patients were consecutively included in the present study in 2016‒2017. All the subjects received a 50-unit injection of Dysport botulinum toxin in the masseter muscles using an extraoral injection technique. The results of the injection were evaluated in terms of pain severity using VAS, clinical evaluations of the joint click through palpation and by determining the inter-incisal distance. The patients underwent follow-up examinations at 1-week, 3-month and 6-month intervals after injection. Data were analyzed with appropriate statistical tests.

Results. Comparison of pain severity and articular clicks at different intervals showed decreases in these parameters over time, with significant differences between the time intervals (P<0.05). Comparison of mouth opening at different intervals showed increases in mouth opening over time.

Conclusion. The results of the present study showed that injection of botulinum toxin can be used in patients with TMD as a non-invasive treatment modality

Association between bruxism and temporomandibular disorders in children: A systematic review and meta-analysis

BACKGROUND

Bruxism in children and its relation to the development of temporomandibular disorders (TMD) has not been clearly determined yet.

AIM

The objective of this systematic review was to evaluate the possible association between bruxism and TMD in children.

DESIGN

Seven databases were searched, and 497 articles were assessed. Methodological quality was assessed through Newcastle-Ottawa Scale. The meta-analysis was performed with the articles in which extraction of data was possible and the summary effect measure through odds ratio (OR) and respective 95% confidence intervals (CIs). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

RESULTS

Ten cross-sectional studies were included in the systematic review. Of these, 8 showed a statistically significant association between bruxism and TMD. Seven studies however presented a high risk of bias. The meta-analysis was performed with 3 articles and obtained an OR of 2.97 (95% CI ranging from 1.72-5.15), indicating that children with bruxism are 2.97 times more likely to present TMD, with very low level of certainty defined by GRADE.

CONCLUSIONS

Although the studies showed high risk of bias, the qualitative analysis of individual studies showed that the children with bruxism have greater chance of developing TMD.

Oral diseases and oral health related behaviors in adolescents living in Maasai population areas of Tanzania: a cross-sectional study

Background

Oral diseases, such as dental caries, tooth wear, dental erosion and periodontal diseases are major health problems in many societies. The study aim was to explore the association between oral health related behaviors and the presence of oral diseases in adolescents living in Maasai population areas in the northern part of Tanzania.

Methods

A cross sectional study was conducted in 2016 using one stage cluster sample design. A total of 989 adolescents were invited and 906 (91.6%; (Maasais n = 721, non Maasais n = 185) accepted the invitation and completed an interview and clinical oral examination in a school setting (mean age 13.4 years, SD 1.2, range 12–17 years). Chi-square test, bivariate analysis and logistic regression were performed to analyze data.

Results

Logistic regression revealed that: adolescents with low frequency of tooth cleaning (OR = 10.0, CI 4.3–20.0) was associated with poor oral hygiene and that more regular tooth cleaning (OR = 0.1, CI 0.04–0.14) and the use of plastic type of tooth brush (OR = 0.7, CI 0.53–0.99) were associated with less gingival bleeding. High consumption of biscuits (OR = 2.5, CI 1.7–3.8) was associated with presence of dental caries and the use of magadi (OR = 24.2, CI 11.6–50.6) as a food additive was the covariate for more severe dental fluorosis (TF grade 5–9). Regular intake of carbonated soft drinks (OR = 1.6, CI 1.1–2.5) and regular tooth cleaning (OR = 1.7, CI 1.1–2.6) were independently associated with dental erosion. Using teeth as a tool for: biting nails (OR = 1.9, CI 1.4–2.4), opening soda (OR = 1.8, CI 1.4–2.4) and holding needles (OR = 1.6, CI 1.3–2.1) were covariates for tooth wear. Adolescents who reported to clench/grind their teeth (OR = 2.3, CI 1.5–3.7) was the only covariate for TMD. In several of the investigated factors, there were significant differences between the Maasai and non Maasai ethnic groups.

Conclusion

Oral health related behaviors have a significant impact on oral diseases/conditions among adolescents attending primary schools in Maasai population areas with obvious differences in behavior between the Maasai and non Maasai ethnic groups. There is a need for addressing oral health and to encourage behaviors that promote good oral health and dental care service utilization in this society.

Pre-operative parafunctional or dysfunctional oral habits are associated with the temporomandibular disorders after orthognathic surgery: An observational cohort study

BACKGROUND

Temporomandibular disorders (TMDs) are frequent and disabling, and hence, preventing them is an important health issue. Combining orthodontic and surgical treatments for malocclusions has been shown to affect temporomandibular joint (TMJ) health. However, publications regarding the risk factors that predict negative TMJ outcomes after orthognathic surgery are scarce.

OBJECTIVE

Present prospective cohort study was conducted to identify an association between pre-operative dysfunctional/parafunctional oral habits and the presence of TMD symptoms after orthognathic surgery.

METHOD

We included 237 patients undergoing orthodontics and surgical treatment for malocclusions associated with dentofacial deformities within the Department of Oral and Maxillofacial Surgery of the University of Lille. Their parafunctional and dysfunctional oral habits were recorded through clinical examination along with the presence of TMD symptoms before and after the surgery. According to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) classification, the TMD symptoms studied were myalgia, arthralgia, disc displacement with or without reduction.

RESULTS

Multivariate analysis revealed significant associations among bruxism (odds ratio [OR] 3.17 [1.066; 9.432]), lingual interposition (OR 4.241 [1.351; 13.313]), as well as primary swallowing (OR 3.54 [1.225; 10.234]) and the presence of postoperative symptoms of myalgia. Moreover, a significant association was observed between the presence of any dysfunctional oral habit and postoperative disc displacement with reduction (OR 4.611 [1.249; 17.021]).

CONCLUSION

Bruxism and dysfunctional oral habits were shown to be risk factors for the presence of TMD symptoms also after combined orthodontic and surgical treatment. Treating such habits before orthognathic surgery should help prevent TMD.

Comparison of masticatory performance and tongue pressure between children and young adults

The aims of the present study were to evaluate whether there are significant differences in masticatory performance by gender and dental stage. We also determined the factors directly associated with the masticatory performance in children, and those directly associated with masticatory performance in young adults. The study included 180 subjects, ranging in age from 6 to 12 years or 20 to 33 years. The subjects were divided into three groups according to the Hellman developmental stage (III A, III B, or VA); the groups were the subdivided according to gender. The body mass index (BMI), maximum tongue pressure, and sum of decayed, missing, and filled teeth (DMFT) were determined in all subjects. To investigate masticatory performance, the total number and maximum projected area of chewed particles of the jelly materials were measured. Masticatory performance had the highest values at Stage VA in both males and females. Regarding the maximum tongue pressure in females, Stage III B had the highest value of all stages. Multiple regression analysis showed that masticatory performance was associated with DMFT index, maximum tongue pressure, and BMI in children. Among young adults, masticatory performance was associated with DMFT index and maximum tongue pressure. Better masticatory performance is directly associated with better dental status, a higher BMI, and tongue pressure in schoolchildren. Additionally, masticatory performance was well-correlated with tongue pressure in young adults, although maximum tongue pressure reached its peak before Stage VA in females. We suggest that females need training with respect to tongue pressure, by the mixed dentition stage.

Sleep Bruxism and Anxiety Impacts in Quality of Life Related to Oral Health of Brazilian Children and their Families

OBJECTIVE

This study aimed to assess the impact of parent reported sleep bruxism, trait anxiety and sociodemographic/socioeconomic features on quality of life related to oral health (OHRQoL) of children and their families.

STUDY DESIGN

Healthy children aged 3-7 years, with (n=34) and without (n=32) bruxism were select for this study. Data was collected by applying the following instruments: The Early Childhood Oral Health Scale (B-ECOHIS) and Trait-anxiety Scale (TAS). The sociodemographic/socioeconomic characteristics were obtained by interviews with parents. Multiple logistic regression tests were performed to observe the influence of sociodemographic/socioeconomic characteristics, bruxism and trait-anxiety on the children's OHRQoL.

RESULTS

No association between sleep bruxism and all evaluated sociodemographic/socioeconomic conditions, with exception of being the only child (p=0.029), were observed. Mean B-ECOHIS and TAS scores were different (p<0.05) between children with (3.41 ± 4.87; 45.09 ± 15.46, respectively) and without (0.63 ± 1.28; 29.53 ± 11.82, respectively) bruxism. Although an association between bruxism and OHRQoL (p=0.015) was observed, it was dropped (p=0.336; OR=1.77) in the logistic regression model. Trait anxiety was the variable responsible for the impact on the OHRQoL of children (p=0.012; OR=1.05).

CONCLUSION

Our results indicated anxiety as the main factor that interfered in the OHRQoL of children with sleep bruxism.

Self-reported temporomandibular joint disorder symptoms, oral health, and quality of life of children in kindergarten through grade 5: Do sex, race, and socioeconomic background matter?

BACKGROUND

The authors' objectives were to determine the percentage of children in kindergarten through grade 5 who reported symptoms of temporomandibular joint disorder (TMJD); to assess whether sex, race, and socioeconomic background mattered; and to explore the relationships between TMJD and children's oral health and oral health-related quality of life (OHRQoL).

METHODS

The research team conducted face-to-face interviews with 8,302 children in kindergarten through grade 5 (51% female, 49% male; 53% African American, 42% white). They conducted oral health screenings with 7,439 children.

RESULTS

Overall, 23.6% of the children reported pain when chewing tough food, and 18.8% reported pain when opening their mouth wide; 23.2% reported hearing a sound (clicking) when opening their mouth wide. Female students were more likely than male students and African American children were more likely than white children to report TMJD symptoms. The prevalence of TMJD symptoms did not correlate with whether the children had a need for oral health care services or whether they had an abscess or carious teeth with pulpal involvement. TMJD symptoms were associated significantly with children's OHRQoL.

CONCLUSIONS

Considerable percentages of 4- to 12-year-old children reported TMJD symptoms, with girls and African American children being more likely than their counterparts to be affected. Experiencing TMJD symptoms was associated significantly with poorer OHRQoL.

PRACTICAL IMPLICATIONS

Dental practitioners need to be aware that substantial percentages of kindergarten and elementary school-aged children experience TMJD symptoms. Taking a dental history and conducting an oral examination, therefore, should include assessments of the signs and symptoms of TMJD; treatment recommendations should be provided for affected children.

Avaliação dos ruídos da articulação temporomandibular em crianças com bruxismo

OBJETIVO: avaliar se há relação entre bruxismo e presença de ruídos articulares em crianças. MÉTODOS: participaram do estudo 48 crianças entre 6 e 9 anos atendidas na Clínica Infantil da Faculdade de Odontologia da Universidade Nove de Julho. Foram selecionadas 21 crianças com bruxismo e 27 crianças no grupo controle. Um único examinador previamente treinado e "cego" em relação aos grupos realizou exame de palpação manual e auscultação bilateral das Articulações Temporomandibulares com a utilização de estetoscópio, extra-auricular lateral e dorsal para a análise dos ruídos articulares, diferenciando-os em crepitação e estalidos. Foi realizado o número mínimo de 3 repetições nas mensurações dos ruídos para cada criança. Foram realizadas as análises descritivas de todas as variáveis e o teste qui-quadrado foi utilizado para avaliar a associação entre as variáveis, adotando-se um nível de significância de 5%. RESULTADOS: em relação à presença de ruído 37,5% (n=18) apresentaram algum tipo de ruído articular, sendo que 72,2% (n=13) apresentaram estalido e 27,8% (n=5) apresentaram crepitação. Das 18 crianças que apresentaram algum tipo de ruído, 66,7% (n=12) também eram bruxistas. Foi observada associação estatisticamente significante entre a presença de ruído e bruxismo. Ao analisar a associação entre ruído e as variáveis gênero e idade, o grupo estudado não houve associação entre ruído e gênero, porém em relação à idade, houve uma maior porcentagem de crianças sem a presença de ruído articular aos 6 anos de idade, sendo estatisticamente significante. CONCLUSÃO: os dados do presente estudo mostraram associação entre bruxismo e ruídos articulares em crianças.

Prevalence of sleep bruxism in children: a systematic review

INTRODUCTION

Prevalence of sleep bruxism (SB) in children is subject to discussions in the literature.

OBJECTIVE

This study is a systematic literature review aiming to critically assess the prevalence of SB in children.

METHODS

Survey using the following research databases: MEDLINE, Cochrane, EMBASE, PubMed, Lilacs and BBO, from January 2000 to February 2013, focusing on studies specifically assessing the prevalence of SB in children.

RESULTS

After applying the inclusion criteria, four studies were retrieved. Among the selected articles, the prevalence rates of SB ranged from 5.9% to 49.6%, and these variations showed possible associations with the diagnostic criteria used for SB.

CONCLUSION

There is a small number of studies with the primary objective of assessing SB in children. Additionally, there was a wide variation in the prevalence of SB in children. Thus, further, evidence-based studies with standardized and validated diagnostic criteria are necessary to assess the prevalence of SB in children more accurately.

Environmental factors, sleep duration, and sleep bruxism in Brazilian schoolchildren: a case-control study

OBJECTIVE

The purpose of our study was to evaluate the association between environmental factors, sleep duration, and sleep bruxism (SB) in schoolchildren.

METHODS

A case-control study was performed. Individuals participating in the study were randomly chosen from public and private schools in Belo Horizonte, Brazil. A total of 120 children with bruxism and 240 without bruxism (mean age, 8 years) participated in our study. A questionnaire for parents was used to collect data based on criteria taken from the American Academy of Sleep Medicine. Conditional binary logistic regression statistical tests and χ2 tests were used for analysis.

RESULTS

The final logistical model found that children with a median sleep time < or = 8 h per night (odds ratio [OR], 2.561 [95% confidence interval {CI}, 1.480-4.433]), who did not enjoy a good night's sleep (OR, 3.253 [95% CI, 1.600-6.615]), who slept with noise in the room (OR, 2.699 [95% CI, 1.645-4.429]), and who had the light on (OR, 2.370 [95% CI, 1.446-3.884]), were more likely to have SB.

CONCLUSION

Children who sleep for less than 8h a night are more likely to have SB. Light and noise in the room were two predisposing factors for the occurrence of SB.

Reproducibility of 6- and 4-category faces pain scale to the assessment of temporomandibular joint pain and muscle in school-age children

OBJECTIVE

The aim of this study was to compare the levels of reproducibility between two Faces Pain Scales (FPS) of 6 and 4 categories to the assessment of pain intensity on children with and without Temporomandibular joint and muscle pain.

MATERIAL AND METHODS

A total of 29 children were recruited: 13 symptomatic (9.79 ± 1.36 years old) and 16 asymptomatic (8.69 ± 0.87 years old). One previously-trained examiner applied manual palpation to evaluate orofacial structures, and FPS to assess pain intensity. All children were initial evaluated using 6-category FPS and after 3 days using 4-category FPS. The children were assessed after a seven day time interval from initial and second sessions. Weighted Kappa coefficient was used to verify reproducibility levels.

RESULTS

Similar levels of reproducibility (moderate and fair kappa values) have been verified with the application of the 6-category FPS on symptomatic and asymptomatic children. Similar results were verified using 4-category FPS on symptomatic and asymptomatic children (poor and fair kappa values).

CONCLUSION

Higher levels of reproducibility were verified with the application of the 6-category FPS in both groups and considering symptomatic and asymptomatic as single group. In this way, the 6-category FPS should be preferred over the 4-category FPS to assess pain intensity on children's orofacial structures.

Prevalence of sleep bruxism in children: a systematic review of the literature

The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.

Temporomandibular Disorders and Related Factors in a Group of Iranian Adolescents: A Cross-sectional Survey

Background and aims

Temporomandibular disorders (TMDs) are the most common condition affecting the tem-poromandibular joint and associated structures. The aim of this study was the epidemiologic evaluation of TMDs and re-lated factors in a group of Iranian adolescents.

Materials and methods

This descriptive cross-sectional survey included a sample of800 high school students (400 girls and 400 boys) aged 14 to18 years, in Mashhad, Iran, selected using cluster sampling. Examiners completed question-naires and performed the clinical examinations. Data were analyzed with the Chi-square and Fisher exact tests.

Results

The prevalence of TMDs in the studied sample was 34.7%. The most common signs of TMDs were clicking, muscle tenderness and TMJ tenderness. The most prevalent predisposing factors of TMDs were clenching, premature con-tact in protrusive movement and bruxism. A clear predominance was seen in girls (40.5%) compared with boys (29%) (P = 0.001).

Conclusion

Signs and symptoms of TMDs were prevalent in Iranian adolescents with a clear female predominance.

Relação de escolaridade, faixa etária e profissão de mães com a oferta de chupeta e mamadeira a seus filhos

OBJETIVO: avaliar a relação do grau de escolaridade, faixa etária e a profissão das mães com a oferta de chupeta e mamadeira a seus filhos MÉTODO: participaram deste estudo 190 mães de crianças entre 0 e 10 anos de idade, com idades de 20 a 45 anos que responderam a um questionário com questões fechadas a respeito de profissão, nível de escolaridade e uso de chupeta e mamadeira de seus filhos RESULTADOS: não foi observada diferença significante entre o grau de escolaridade quanto ao uso de chupeta (p= 0,915). O uso de mamadeira foi significantemente maior nos filhos de mães com ensino superior (p= 0,0124). Não houve diferença significante quanto à faixa etária das mães e a presença desses hábitos nos filhos (chupeta: p=0,427; mamadeira: p=0,427); e, entre mães que trabalham em casa e que trabalham fora de casa (chupeta: p=0,061; mamadeira: p=0,798). Não houve diferença entre mães que trabalham na área da saúde e em outras áreas (chupeta: p=0,339; mamadeira: p=0,455) CONCLUSÃO: as mães com nível superior de escolaridade oferecem significantemente mais mamadeira aos seus filhos, o que não ocorreu quanto ao uso de chupeta. Não foi observada diferença significante quanto ao uso de chupeta e mamadeira em relação à faixa etária e profissão de mães.

Deleterious sucking habits and atypical swallowing in children with otitis media with effusion

OBJECTIVE

The aim of this study was to investigate the possible correlation between otitis media with effusion, bad sucking habits and atypical swallowing in children affected by otitis media with effusion.

METHODS

65 children, aged from 7 to 12 years, observed in the ENT Department of the "La Sapienza" University of Rome, were enrolled in the study group (group A). All children were affected by otitis media with effusion for more than 3 months. As control group, 60 healthy children, aged from 7 to 12 years were identified (group B). All the children underwent medical history, with evaluation of the sucking habits, ENT examination, tympanometry, orthodontic examination and evaluation of swallowing. In the orthodontic examination the variables analyzed were: maximum mouth opening, right and left mandibular lateral movements and mandibular protrusion. Atypical swallowing was considered to occur when lip activity produced strong tension in the perioral musculature, and/or the tip of the tongue was placed or pushed against the anterior teeth during swallowing.

RESULTS

In the group A, atypical swallowing was found in 33/65 subjects out of the 65 children (50.7%). In the control group (group B) 16/60 children (26.6%) showed atypical swallowing. Compared with group B, deleterious sucking habits were significantly higher (p<0.05) in the study group (28/65 vs. 12/60). In both the study and control group, deleterious sucking habits were present in almost all children with atypical swallowing (28/33 in group A and 12/16 in group B).

CONCLUSIONS

Our data suggest a correlation between otitis media with effusion, deleterious sucking habits and prevalence of atypical swallowing.

Bruxism, oral parafunctions, anamnestic and clinical findings of temporomandibular disorders in children

The reported prevalence of temporomandibular disorders (TMD) present during childhood and adolescence ranges between 7% and 68%. The range of the reported prevalence of sleep bruxism in children is also wide. The purpose of the current study was threefold: (i) determine the prevalence of oral parafunctions, sleep bruxism and of anamnestic and clinical findings of TMD among Israeli children with primary or mixed dentition; (ii) to establish whether the parafunctional activities are associated with anamnestic and clinical findings of TMD in this population and (iii) to examine the possible impact of stressful life events on the prevalence of bruxism, oral parafunctions, and anamnestic and clinical findings of TMD in children. A total of 244 children (183 girls and 61 boys) aged 5-12 years were included in the study. Each participant underwent a full TMD examination. Parents, in collaboration with their children, completed a questionnaire on TMD symptoms, oral parafunctions and stressful life events in their children's life. Most participants (78·8%) reported at least one oral habit. Of these, only 'jaw play' was associated with TMD anamnestic and clinical findings. Stressful life events were associated only with the performance of multiple oral habits. These findings indicate that the performance of oral parafunctions is commonplace during childhood, with younger children exhibiting fewer oral parafunctions than adolescents. Stressful life events are related with an increase in the performance of multiple oral parafunctions in children but the later are not necessarily associated with anamnestic and clinical findings of TMD in the paediatric population.

Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder

BACKGROUND

Oral health-related quality of life (OHRQoL) in children and adolescents with signs and symptoms of temporomandibular disorder (TMD) has not yet been measured. This study aimed to evaluate the validity and reliability of OHRQoL measure for use in children and preadolescents with signs and symptoms of TMD.

METHODS

Five hundred and forty-seven students aged 8-14 years were recruited from public schools in Piracicaba, Brazil. Self-perceptions of QoL were measured using the Brazilian Portuguese versions of Child Perceptions Questionnaires (CPQ)8-10 (n = 247) and CPQ11-14 (n = 300). A single examiner, trained and calibrated for diagnosis according to the Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD), examined the participants. A self-report questionnaire assessed subjective symptoms of TMD. Intraexaminer reliability was assessed for the RDC/TMD clinical examinations using Cohen's Kappa (κ) and intraclass correlation coefficient (ICC). Criterion validity was calculated using the Spearman's correlation, construct validity using the Spearman's correlation and the Mann-Whitney test, and the magnitude of the difference between groups using effect size (ES). Reliability was determined using Cronbach's alpha, alpha if the item was deleted and corrected item-total correlation.

RESULTS

Intraexaminer reliability values ranged from regular (κ = 0.30) to excellent (κ = 0.96) for the categorical variables and from moderate (ICC = 0.49) to substantial (ICC = 0.74) for the continuous variables. Criterion validity was supported by significant associations between both CPQ scores and pain-related questions for the TMD groups. Mean CPQ8-10 scores were slightly higher for TMD children than control children (ES = 0.43). Preadolescents with TMD had moderately higher scores than the control ones (ES = 0.62; p < 0.0001). Significant correlation between the CPQ scores and global oral health, as well as overall well-being ratings (p < 0.001) occurred, supporting the construct validity. The Cronbach's alphas were 0.93 for CPQ8-10 and 0.94 for CPQ11-14. For the overall CPQ8-10 and CPQ11-14 scales, the corrected item-total correlation coefficients ranged from 0.39-0.76 and from 0.28-0.73, respectively. The alpha coefficients did not increase when any of the items were deleted in either CPQ samples.

CONCLUSIONS

The questionnaires are valid and reliable for use in children and preadolescents with signs and symptoms of temporomandibular disorder.

Prevalence of sleep bruxism in a group of Brazilian schoolchildren

AIM

This was to investigate the prevalence of sleep bruxism in Brazilian schoolchildren.

METHODS

A cross-sectional study was carried out examining 652 randomly selected children aged from 7 to 10 years of age from both public and private schools in Belo Horizonte, Brazil. Sleep bruxism among children was reported by parents by means of a pretested questionnaire based on the criteria of the American Academy of Sleep Disorders. The Social Vulnerability Index from Municipal database was used to determine social classification of families. A chi-square test was used with a significance level of 5%.

RESULTS

Sleep bruxism was present in 230 children, showing a prevalence of 35.3%. Among the 652 children, 340 (52.0%) were girls and 312 (48.0%) were boys, predominatly of 8-year-olds (84.2%). Sleep bruxism was present in 56.5% of the girls and 43.5% of the boys. The majority of the families were of a low social vulnerability (54.2%), whereas another 45.8% were of a high social vulnerability. More than half of the children without sleep bruxism (55.2%) were of low socio-economic background.

CONCLUSIONS

The high prevalence of 35.3% demonstrates the need for further research on this issue.

Effect of awareness through movement on the head posture of bruxist children

The aim of this study was to evaluate the effectiveness of physiotherapy to improve the head posture and reduce the signs of bruxism in a group of bruxist children. A single-blind randomized clinical trial was performed. All the subjects were 3- to 6-year old, had complete primary dentition, dental and skeletal class I occlusion and were classified as bruxist according to the minimal criteria of the ICSD for bruxism. For each child, a clinical, photographic and radiographic evaluation of the head and cervical posture were realized with standardized techniques. The children were randomized in an experimental (n = 13) and a control (n = 13) group. A physiotherapeutic intervention was applied to the children of the experimental group once a week, until 10 sessions were completed. Afterwards, the cephalogram and the clinical and photographic evaluation of the head posture were measured again. The data were analysed with the t-test and Mann-Whitney test. The subjects of the experimental group showed statistically significant improvement in the natural head posture. The physiotherapeutic intervention showed to be efficient to improve the head posture at the moment of measurement in the studied children. The relationship between bruxism and head posture, if exists, seems to be worthwhile to examine.

Prevalence of symptoms and signs indicative of temporomandibular disorders in children and adolescents. A cross-sectional epidemiological investigation covering two decades

AIMS

These were to 1) estimate the prevalence of subjective symptoms and clinical signs of temporomandibular disorders (TMD) in children and adolescents in the city of Jönköping, Sweden, 2) follow possible variations in TMD signs and symptoms over a 20-year period, and 3) study possible associations between TMD symptoms and signs and factors of interest.

DESIGN

About 100 individuals in the age groups of 3, 5, 10 and 15 years participated in cross-sectional stratified epidemiological investigations in 1983, 1993 and 2003.

METHODS

All participants were asked to fill in a questionnaire including questions on general and oral health, dental care habits and some socio-demographic issues. More specific questions recorded the presence or absence of subjective symptoms: tiredness in the jaws on awakening or during chewing; clicking sounds or crepitations from the temporomandibular joints (TMJs); locking/ catching of the mandible; luxation of the mandible; reduced jaw movement capacity; pain during jaw movements; other pain conditions in the jaws or in the TMJ regions. Subjects were examined clinically at each time period for; jaw mobility (maximum jaw opening including vertical overbite, maximum laterotrusion to the right and to the left, maximum protrusion); TMJ function (normal function, deflection on jaw opening of >2 mm, TMJ clicking or crepitations, TMJ locking, TMJ luxation); pain on jaw movement (no pain on movements, pain on one movement, pain on more than one movement); muscle pain (no muscle pain, pain on palpation in 1-3 sites, pain on palpation in >3 sites); TMJ pain (no joint pain, pain on lateral palpation of one or both joints, pain on posterior palpation of one or both joints). No functional examination of the masticatory system was performed in children aged 3 and 5 years.

RESULTS

TMD-related symptoms were very rare in 3- and 5-year-olds. In the age groups of 10- and 15-year olds, 5-9% of the participants reported more severe symptoms, up to 50% showed one or more TMD signs, while it was estimated that 1-2% were in need of TMD treatment. Several symptoms and signs increased with age. No gender differences, with the exception of recurrent headache, were noted. Oral parafunctions were reported by 11-47%. Apart from a few variables, no statistically significant changes in the prevalence of TMD symptoms and signs were observed over the 20-year period. Clenching/grinding of teeth and general health factors were found to be associated with TMD symptoms and signs.

CONCLUSIONS

The prevalence of more severe TMD symptoms and signs in children and adolescents was generally low in all three examinations and did not change significantly during the 20-year period. Increasing age, general health factors and oral parafunctions were associated with TMD symptoms and signs in 10- and 15-year-olds.

Oral parafunctions as risk factors for diagnostic TMD subgroups

The frequency of diurnal clenching and/or grinding and nail-biting habits was assessed in patients affected by temporomandibular disorders (TMDs) and in healthy controls in order to investigate the possible association between these oral parafunctions and different diagnostic subgroups of TMDs. The case group included 557 patients (127 men, mean age +/- SD = 34.5 +/- 15.4 years; 430 women, mean age +/- SD = 32.9 +/- 14.1 years) affected by myofascial pain or disc displacement or arthralgia/arthritis/arthrosis. The control group included 111 healthy subjects (55 men, mean age +/- SD = 37 +/- 15.2 years; 56 women, mean age +/- SD = 38.2 +/- 13.8 years). Multinomial logistic regression analysis was used to assess the association between oral parafunctions and TMDs, after adjusting for age and gender. Daytime clenching/grinding was a significant risk factor for myofascial pain (odds ratio (OR) = 4.9, 95% confidence interval (CI): 3.0-7.8) and for disc displacement (OR = 2.5, 95% CI: 1.4-4.3), nail biting was not associated to any of the subgroups investigated. Female gender was a significant risk factor for myofascial pain (OR = 3.8; 95% CI: 2.4-6.1), whereas the risk factor for developing disc displacement decreased with ageing. No association was found between gender, age and arthralgia/arthritis/arthrosis.

Changes in bite force, masticatory muscle thickness, and facial morphology between primary and mixed dentition in preschool children with normal occlusion

The study of stomatognathic system development can provide useful data for recognition of deviations from normality. Thus, a longitudinal examination of 14 children with normal occlusion from primary (stage I, mean age 59.21+/-8.40 months) to early mixed dentition (stage II, 77.57+/-5.92) was performed. Bite force was measured with a pressurized tube and correlated with ultrasonographic masseter and anterior portion of temporalis muscle thicknesses (at rest and maximal intercuspation), facial dimensions, age, and body mass index (BMI). Facial dimensions were assessed by standardized frontal photographs as follows: anterior facial height (AFH), lower face height (LFH), and bizygomatic width (BFW). Children with malocclusion, oral tissue/temporomandibular abnormalities, caries, or parafunctional habits were excluded. Results were submitted to the Shapiro-Wilk test, t-test/Wilcoxon's test, and backward stepwise multiple regression (alpha=0.05) for analysis. The results showed that muscle thickness did not differ significantly between the right and the left sides in either stage. Bite force, AFH/BFW ratio, and masseter thickness at rest increased significantly from stage I to II, although temporalis thickness, LFH/AFH ratio, and BMI did not change between the stages. The masseter thickness at rest and the stage of dentition were the most important factors contributing to bite force magnitude; the covariates age, BMI, and facial dimensions did not significantly influence bite force magnitude (power of the test: 96%). In the studied sample, the increase in bite force observed from primary to early mixed dentition was explained by the increase in masseter thickness and the stage of dentition.

[Prevalence and factors associated with non-nutritive sucking behavior. Cross sectional study among 5- to 6-year-old Senegalese children]

Sucking behaviours have been described in the literature under two facets i.e. nutritive and non nutritive. Nutritive sucking refers to breast feeding, bottle feeding or a combination of both. Non nutritive sucking habits are mentioned when children suck their thumb or another finger(s), a pacifier or any other object. Non nutritive sucking habits (NNSH) are suspected to potentially induce dentoalveolar anomalies and thus may constitute a public dental health problem. Anthropological and historical data suggest that non nutritive sucking habits are associated with modern pattern of life. The aim of this study is to investigate the prevalence and factors associated with NNSH in Senegalese children 5/6 years old. Data of this study were collected using a structured questionnaire administered by the investigators to mothers or caregivers of 443 children (231 boys and 212 girls) aged 5/6 years. Three types of data were collected: data on the social background of the children including place of residence (urban, suburban and rural) and the mother's occupation (workers, employee, executive, housewife), data regarding former and present sucking habits and information on the feeding pattern of the children when they were infants (breast feeding, bottle feeding or a combination of both). The results indicated a prevalence rate of 16.50% and 17.20% respectively for digit and pacifier sucking in this population. Also, a significant association was found between children's non nutritive sucking habits in one hand and the mothers' occupation and feeding pattern on the other hand. Breast fed children are less prone to develop a non nutritive sucking habit than bottle fed children. Longitudinal studies are necessary to verify the nature of these associations. The identification of factors associated with non nutritive sucking habits would permit to develop and target recommendations for the prevention of such habits.

Head posture and dental wear evaluation of bruxist children with primary teeth

The aim of the present study was to compare the head position and dental wear of bruxist and non-bruxist children with primary dentition.

METHODS

All the subjects had complete primary dentition, dental and skeletal class I occlusion and were classified as bruxist or non-bruxist according to their anxiety level, bruxism described by their parents and signs of temporomandibular disorders. The dental wear was drawn in dental casts and processed in digital format. Physiotherapeutic evaluation and a cephalometric radiograph with natural head position were also performed for each child to evaluate the cranio-cervical position for the bruxist group (n = 33) and the control group (n = 20). The variables of the two groups were compared, using the Student t-test and Mann-Whitney U-test.

RESULTS

A more anterior and downward head tilt was found in the bruxist group, with statistically significant differences compared with the controls. More significant dental wear was observed in the bruxist children.

CONCLUSIONS

Bruxism seems to be related to altered natural head posture and more intense dental wear. Further studies are necessary to explore bruxism mechanisms.

Temporomandibular disorders and bruxism in childhood and adolescence: review of the literature

OBJECTIVE

The aim of this article was to review the literature about temporomandibular disorders and bruxism and their relationships in children and adolescents.

METHODS

The literature was searched using Medline, ISI, Cochrane Library, Scielo and the Internet, from March 1970 to the end of June 2007. The inclusion criteria were: they evaluated a possible association between TMD and bruxism, and they dealt with child and/or adolescent samples. Furthermore, interim reports, related Internet sites and chapters in textbooks were considered. From 64 records found, 30 fulfilled the inclusion criteria.

RESULTS

The prevalence of temporomandibular disorders in children and adolescent varies widely in the literature. Temporomandibular disorders are often defined on the basis of signs and symptoms, of which the most common are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricular pain, facial pain, headaches and jaw tenderness on function, having mainly a mild character, fluctuation and progression to severe pain and dysfunction is rare. One of the possible causal factors suggested that temporomandibular disorders in children is a functional mandibular overload variable, mainly bruxism. Bruxism, defined as the habitual nonfunctional forceful contact between occlusal tooth surfaces, is involuntary, excessive grinding, clenching or rubbing of teeth during nonfunctional movements of the masticatory system. Its etiology is still controversial but the multifactorial cause has been attributed, including pathophysiologic, psychologic and morphologic factors. Moreover, in younger children, bruxism may be a consequence of the masticatory neuromuscular system immaturity. Complications include dental attrition, headaches, temporomandibular disorders and masticatory muscle soreness. Some studies have linked oral parafunctional habits to disturbances and diseases of the temporomandibular joint, mainly bruxism, suggesting its association with temporomandibular disorders in the primary and mixed dentition, whereas other authors did not observed respective relationship in primary dentition. The unreliability for the clinical assessment of bruxism also reduces confidence in conclusions about the relationship with temporomandibular disorders.

CONCLUSIONS

Taken all evidence together, the relationship between bruxism and temporomandibular disorders, if it exists, seems to be controversial and unclear.