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Sambale J, Koehler U, Conradt R, Kesper K, Cassel W, Degerli M, Viniol C, Korbmacher-Steiner HM. Is sleep bruxism in obstructive sleep apnea only an oral health related problem? BMC Oral Health 2024; 24:565. [PMID: 38745301 PMCID: PMC11094952 DOI: 10.1186/s12903-024-04351-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography. METHODS 106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated. RESULTS OSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea-hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk. CONCLUSION Increased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients. TRIAL REGISTRATION The study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22-2022) and registered at the "German Clinical Trial Register, DRKS" (DRKS0002959).
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Affiliation(s)
- J Sambale
- Department of Orthodontics, Clinic of Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35041, Marburg, Germany.
| | - U Koehler
- Departement of Pneumology, Philipps-University Marburg, Marburg, Germany
| | - R Conradt
- Faculty of Health Sciences at the University of Applied Sciences, Gießen, Germany
| | - K Kesper
- Departement of Pneumology, Philipps-University Marburg, Marburg, Germany
| | - W Cassel
- Departement of Pneumology, Philipps-University Marburg, Marburg, Germany
| | - M Degerli
- Departement of Pneumology, Philipps-University Marburg, Marburg, Germany
| | - C Viniol
- Departement of Pneumology, Philipps-University Marburg, Marburg, Germany
| | - H M Korbmacher-Steiner
- Department of Orthodontics, Clinic of Dentistry, Philipps-University Marburg, Georg-Voigt-Str. 3, 35041, Marburg, Germany
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Santiago V, Janal MN, Cook DB, Raphael KG. Examination of Conditioned Pain Modulation in Myofascial TMD With Consideration of Temporal Summation. THE JOURNAL OF PAIN 2024; 25:104430. [PMID: 37993032 PMCID: PMC11058037 DOI: 10.1016/j.jpain.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
Research on myofascial temporomandibular disorder (mTMD) has often focused on potential dysfunction in endogenous pain modulation. However, studies on the specific inhibitory and facilitatory components of endogenous pain modulation using conditioned pain modulation (CPM) and temporal summation of second pain (TSSP) have shown mixed results. This study aimed to 1) examine whether women with mTMD demonstrated efficient CPM compared to controls; 2) explore the association between independent measures of CPM and TSSP in women with mTMD relative to controls; and 3) determine whether resulting modulatory profiles differentially predicted pain intensity among cases. All participants were recruited from dental clinics. Cases were women who met the research diagnostic criteria for mTMD. Controls did not have facial pain on exam and were selected to be sociodemographically similar to cases. CPM and TSSP were assessed via independent psychophysical protocols. CPM was examined in linear mixed models predicting pain thresholds adjusted for age and stratified by TSSP. Mean CPM was estimated at a 2.2 (SD = 2.8) degree increase in pain thresholds (P ≤ .001), similar in cases and controls (P = .67). CPM was less efficient in cases with enhanced TSSP (P = .031), but not in controls. Although the double-pronociceptive profile of both low CPM and high TSSP trended higher among cases than controls, it did not predict higher levels of pain intensity among cases. This study does not support deficient inhibitory endogenous pain modulation in mTMD, but results suggest that inhibitory and facilitatory pain modulation should be examined concomitantly in the study of endogenous pain modulation. PERSPECTIVE: This manuscript presents a novel examination of inhibitory modulation by the level of facilitatory modulation in mTMD. The findings and approach may prove useful for mechanistic researchers studying endogenous pain modulation and clinical researchers seeking to jointly examine conditioned pain modulation and temporal summation in future research on chronic pain.
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Affiliation(s)
- Vivian Santiago
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison School of Education, Madison, WI, USA
| | - Karen G Raphael
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
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Maeda-Iino A, Osako Y, Nakagawa S, Takahashi K, Oga Y, Furukawa-Sainoki M, Harada M, Fukushima M, Miyawaki S. Relationship between masseter muscle activity during wakefulness and temporomandibular disorder-related symptoms. J Oral Rehabil 2024; 51:455-468. [PMID: 38030583 DOI: 10.1111/joor.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Masseter muscle activity during wakefulness may be associated with temporomandibular disorder (TMD)-related symptoms, psychosocial status and pain-related disability; however, this relationship is unclear. OBJECTIVES This study aimed to determine the relationship between masseter muscle electromyography (EMG) burst/duration during wakefulness and TMD-related symptoms, psychosocial status and pain-related disability. METHODS Sixty participants were assessed masseter muscle activity during wakefulness using a data-logger-type ultraminiature EMG system and TMD-related symptoms, psychosocial status and pain-related disability through Axis I and II of the diagnostic criteria for TMD (DC/TMD). EMG bursts lasting longer than 0.25 s but less than 2.0 s and those lasting longer than 2.0 s were classified as phasic and tonic bursts, respectively. RESULTS Participants with palpation-related pain in the temporalis and masseter muscles, as assessed through the DC/TMD examination form in Axis I, had more bursts (number/h) (p = .035 and p = .009, respectively) and longer duration (time/h) (p = .013 and p = .004, respectively) of tonic bursts of the masseter muscle during wakefulness. Participants with palpation-related pain in the masseter muscles had higher oral behaviour scores during wakefulness using Axis II (p = .001), which affected the number and duration of tonic bursts of the masseter muscle activity during wakefulness (p = .011 and p = .007, respectively). CONCLUSION As tonic bursts mainly reflect clenching, individuals with pain in the masseter muscles by palpation may have a high frequency and longer duration of clenching, as well as a high frequency of oral behaviours during wakefulness.
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Affiliation(s)
- Aya Maeda-Iino
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuki Osako
- Department of Orthodontics, Center of Developmental Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Shoko Nakagawa
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kotaro Takahashi
- Department of Orthodontics, Center of Developmental Dentistry, Kagoshima University Hospital, Kagoshima, Japan
| | - Yasuhiko Oga
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Minami Furukawa-Sainoki
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Marina Harada
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mika Fukushima
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shouichi Miyawaki
- Department of Orthodontics and Dentofacial Orthopedics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Bargellini A, Mannari E, Cugliari G, Deregibus A, Castroflorio T, Es Sebar L, Serino G, Roggia A, Scotti N. Short-Term Effects of 3D-Printed Occlusal Splints and Conventional Splints on Sleep Bruxism Activity: EMG-ECG Night Recordings of a Sample of Young Adults. J Clin Med 2024; 13:776. [PMID: 38337469 PMCID: PMC10856225 DOI: 10.3390/jcm13030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study aims to compare the effects of 3D-printed splints and conventional manufactured splints on sleep bruxism (SB) EMG activity. (2) Methods: Twenty-six patients (19 M, 7 F, 25.8 ± 2.6 years) were randomly allocated to a study group (3D splints) and a control group (conventional manufactured splints) and followed for a period of three months with night EMG-ECG recordings. Samples of the involved materials were analyzed for nanoindentation. The outcomes of interest considered were the overall SB index, the total amount of surface masseter muscle activity (sMMA), and general and SB-related phasic and tonic contractions. A statistical evaluation was performed with a confidence interval (CI) between 2.5% and 97.5%. (3) Results: Differences between groups with OAs were observed for general tonic contraction (p = 0.0009), while differences between recording times were observed for general phasic contractions (p = 0.002) and general tonic contractions (p = 0.00001). Differences between recording times were observed for the total amount of sMMA (p = 0.01), for general phasic contractions (p = 0.0001), and for general tonic contractions (p = 0.000009) during night recordings without OAs. (4) Conclusions: Three-dimensional splints seem to have a higher impact on SB-related electromyographic activity but not on the overall sleep bruxism index. The more regular surfaces offered by 3D splints could be related to phasic contraction stabilization.
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Affiliation(s)
- Andrea Bargellini
- Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, 10126 Torino, Italy; (A.B.); (A.D.); (T.C.)
- Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino, 10126 Torino, Italy
| | - Elena Mannari
- Department of Surgical Sciences, Dental School, University of Torino, 10126 Torino, Italy; (E.M.); (A.R.)
| | - Giovanni Cugliari
- Department of Medical Sciences, University of Torino, 10126 Torino, Italy;
| | - Andrea Deregibus
- Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, 10126 Torino, Italy; (A.B.); (A.D.); (T.C.)
- Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino, 10126 Torino, Italy
| | - Tommaso Castroflorio
- Department of Surgical Sciences, Specialization School of Orthodontics, Dental School, University of Torino, 10126 Torino, Italy; (A.B.); (A.D.); (T.C.)
- Department of Surgical Sciences, Gnathology Unit, Dental School, University of Torino, 10126 Torino, Italy
| | - Leila Es Sebar
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy;
| | - Gianpaolo Serino
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy;
- PolitoBioMedLab, Politecnico di Torino, 10129 Turin, Italy
| | - Andrea Roggia
- Department of Surgical Sciences, Dental School, University of Torino, 10126 Torino, Italy; (E.M.); (A.R.)
| | - Nicola Scotti
- Department of Surgical Sciences, Restorative Dentistry Unit, Dental School, University of Torino, 10126 Torino, Italy
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Asami K, Fujisawa M, Saito-Murakami K, Miura S, Fujita T, Imamura Y, Koyama S. Assessment of awake bruxism-Combinational analysis of ecological momentary assessment and electromyography. J Prosthodont Res 2024; 68:166-171. [PMID: 37286504 DOI: 10.2186/jpr.jpr_d_22_00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE No consensus exists regarding the examination methods and assessment criteria for awake bruxism (AB). In this study, masticatory muscle activity measured using electromyography (EMG) was recorded simultaneously with the ecological momentary assessment (EMA) of bruxism events. Data were collected to identify distinctive EMG parameters in AB. METHODS A total of 104 individuals were classified into the bruxism (BR) or control (CO) groups based on clinical findings. The participants recorded EMA on a tablet device under continuous EMG recording using a data log-type wireless EMG device. For EMA recording, a warning was randomly provided three times each hour for five hours. A receiver operating characteristic (ROC) curve was obtained based on EMA and EMG events. Maximum voluntary contraction (MVC) at the time of maximum bite force was set at 100%. The muscle activity was assessed as a relative value. RESULTS Based on discriminant analysis, analysis of participants who had four or more positive clenching EMA responses was appropriate. The assessed parameters for the EMG cutoff value determination procedure, which combined EMG and EMA, resulted in a cutoff value that enabled the distinction between the BR and CO groups. The area under the ROC curve was 0.77 and the cut-off value was 3.2 events/hour under the EMG of 20% MVC with a duration of ≥1 s. CONCLUSIONS This is the first study to report a combined analysis of the EMA and EMG. These results suggest its effectiveness as a cutoff value for AB screening.
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Affiliation(s)
- Kazuya Asami
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Masanori Fujisawa
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Konatsu Saito-Murakami
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Shoko Miura
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Takafumi Fujita
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Yoshiki Imamura
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Shiho Koyama
- Division of Fixed Prosthodontics, Department of Restorative and Biomaterials Sciences, Meikai University School of Dentistry, Sakado, Japan
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Ainoosah S, Farghal AE, Alzemei MS, Saini RS, Gurumurthy V, Quadri SA, Okshah A, Mosaddad SA, Heboyan A. Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review. BMC Oral Health 2024; 24:29. [PMID: 38182999 PMCID: PMC10770907 DOI: 10.1186/s12903-023-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sleep bruxism is a prevalent condition in dentistry practice, characterized by involuntary grinding or clenching of the teeth during sleep. Several therapies, including occlusal splints, have been used to manage sleep bruxism and temporomandibular disorders, including occlusal splints. This study aimed to compare the effectiveness of different occlusal splints in managing sleep bruxism. METHODS The PICO framework encompasses the characterization of the population, intervention, comparison, and pertinent outcomes. A comprehensive and systematic literature review was conducted on PubMed, Scopus, and Google Scholar to identify grey literature. The search specifically targeted scientific studies published before September 20, 2023. The Cochrane Collaboration Risk of Bias Tool assessed the accuracy of the included Randomized Control Trials (RCTs). The modified Newcastle-Ottawa Scale assessed non-randomized studies. Data were systematically extracted, synthesized, and reported thematically. RESULTS Out of the total of 808 articles that were evaluated, only 15 articles were found to meet the specified inclusion criteria. Adjustable splints, such as full-occlusion biofeedback splints, were more effective in reducing sleep bruxism episodes, improving patient-reported symptoms, and enhancing overall well-being. The impact of different occlusal sprints on electromyographic activity varies, and potential adverse effects should be considered individually. CONCLUSIONS This review provides valuable insights into the effectiveness of occlusal splints in managing sleep bruxism. The results of this study indicate that occlusal splint therapy is a viable treatment approach for sleep bruxism.
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Affiliation(s)
- Sultan Ainoosah
- Department of Substitute Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Ahmed E Farghal
- Department of Substitute Dental Science, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Marwa Saad Alzemei
- Department of Restorative Dental Sciences, College of Dentistry, Taibah University, Madinah, Saudi Arabia
| | - Ravinder S Saini
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | | | | | - Abdulmajeed Okshah
- Department of Dental Technology, COAMS, King Khalid University, Abha, Saudi Arabia
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Qasr-E-Dasht Street, Shiraz, Iran.
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
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Bracci A, Lobbezoo F, Colonna A, Bender S, Conti PCR, Emodi-Perlman A, Häggman-Henrikson B, Klasser GD, Michelotti A, Lavigne GJ, Svensson P, Ahlberg J, Manfredini D. Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies. J Oral Rehabil 2024; 51:150-161. [PMID: 37191494 DOI: 10.1111/joor.13514] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged. OBJECTIVE In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management. METHODS We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.
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Affiliation(s)
- Alessandro Bracci
- Department of Neuroscience, School of Dentistry, University of Padova, Padova, Italy
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anna Colonna
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Steven Bender
- Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, Texas, USA
| | - Paulo C R Conti
- Bauru School of Dentistry, University of Sao Paulo, São Paulo, Brazil
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Telaviv, Israel
| | | | - Gary D Klasser
- Department of Diagnostic Sciences, Louisiana State University School of Dentistry, New Orleans, Louisiana, USA
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Gilles J Lavigne
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, and Universite de Montreal, Montreal, Quebec, Canada
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Jari Ahlberg
- Department of Oral and Maxillofacial, Diseases, University of Helsinki, Helsinki, Finland
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
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Martynowicz H, Lavigne G, Kato T, Poreba R, Michalek-Zrabkowska M, Macek P, Gac P, Wojakowska A, Surowiak P, Mazur G, Wieckiewicz M. A case-control study on the effect of rhythmic masticatory muscle activity (RMMA) clusters on sleep fragmentation and severity of orofacial muscle pain in sleep bruxism. J Sleep Res 2023:e14072. [PMID: 37859534 DOI: 10.1111/jsr.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
Rhythmic masticatory muscle activity (RMMA) is a periodic muscle activity that characterises sleep bruxism (SB) events. These can occur as a single event, in pairs, or in clusters. Since RMMA episodes often occur in clusters and the relevance of this occurrence is unknown, we conducted a study to investigate the effect of RMMA clusters on sleep fragmentation and the severity of orofacial muscle pain. This study involved a secondary analysis using data from 184 adult subjects with orofacial muscle pain who underwent definitive polysomnography (PSG) for sleep bruxism diagnosis. Self-reported orofacial muscle pain (OFMP) was assessed using the numeric rating scale, and additional evaluation of side-to-side equivalence (symmetry) was described using a binary system. Among the 184 participants, 60.8% (n = 112) did not exhibit clusters and among the 72 participants with clusters, 36.1% (n = 26) and 63.9% (n = 46) were in the high and low RMMA frequency groups, respectively. The high SB group had significantly three times more phasic RMMA events than the noncluster group. A total of 89.67% (n = 165) of subjects reported orofacial muscle pain. While there was no difference in the severity of OFMP among groups, a significant decrease in symmetry between the severity of temporal muscle pain on the left and right sides was noted in the cluster group compared with the noncluster group. Clustering of RMMA events is associated with sleep fragmentation. The asymmetry of temporal muscle pain is related to the presence of RMMA clusters in sleep bruxism.
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Affiliation(s)
- Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Gilles Lavigne
- Faculty of Dental Medicine, Universite de Montreal, CIUSSS Nord Ile de Montreal and CHUM, Montreal, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Rafal Poreba
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Macek
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Gac
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Wojakowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Surowiak
- Department of Histology and Embryology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
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Yap AU, Tan MWY, Tan SHX, Chua AP. Sleep bruxism events: an epiphenomenon of severe obstructive sleep apnea? Clin Oral Investig 2023; 27:4633-4642. [PMID: 37256429 DOI: 10.1007/s00784-023-05089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study investigated the temporal relationships between apnea-hypopnea (AH) and sleep bruxism (SB) events and correlated SB to various respiratory/sleep indexes in adult patients with concomitant obstructive sleep apnea (OSA) and SB. MATERIALS AND METHODS Nocturnal PSG data of 147 consecutive OSA patients were examined for comorbid SB. Among the 49 subjects with coexisting OSA and SB, 26 were randomly selected for in-depth appraisal of temporal patterns which were classified as T1 (unrelated activities), T2 (AH events occur before SB events), T3 (SB events occur before AH events), and T4 (AH and SB events occur simultaneously). Data were analyzed using Mann-Whitney U tests and Spearman's correlation (α = 0.05). RESULTS The majority (84.5%) of AH events were unrelated to SB events. Of the 15.5% of related activities, T2 and T3 patterns occurred in 14.1% and 1.4%, respectively. SB events/index, the percentage of unrelated/related AH-SB events, and T2-T3 episodes were not associated with gender, age, body mass (BMI), and apnea-hypopnea (AHI) index. SB events were related to total sleep time (rs = 0.44), but no significant associations were discerned between SB and AH index. CONCLUSIONS As most AH events were unrelated to SB events, OSA and SB are probably epiphenomena in adult patients with concomitant conditions. Where AH-SB events were related, the T2 temporal pattern, where SB events were subsequent to AH events, featured predominantly alluding to a specific form of secondary SB triggered by sleep micro-arousals. CLINICAL RELEVANCE AH and SB events are probably epiphenomena in adult patients with coexisting OSA and SB. Even so, OSA patients should be routinely screened for SB and vice versa considering their frequent comorbidity.
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Affiliation(s)
- Adrian Ujin Yap
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Madeleine Wan Yong Tan
- Department of Dentistry, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Sharon Hui Xuan Tan
- Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ai Ping Chua
- Department of Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
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10
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Fulek M, Wieckiewicz M, Szymanska-Chabowska A, Michalek-Zrabkowska M, Fulek K, Lachowicz G, Poreba R, Mazur G, Martynowicz H. Systematic Review on the Link between Sleep Bruxism and Systemic Chronic Inflammation. Brain Sci 2023; 13:1104. [PMID: 37509035 PMCID: PMC10377141 DOI: 10.3390/brainsci13071104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Sleep bruxism (SB) is a sleep-related behavior characterized as rhythmic (phasic) or non-rhythmic (tonic) masticatory muscle activity. SB is a common sleep behavior with a predominantly central origin. The aim of this systematic review was to evaluate the relationship between inflammatory status and SB according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020). The research was registered at PROSPERO (CRD42023395985). We performed a systematic literature analysis using five different databases. Furthermore, the backward snowballing technique was applied to identify additional papers. Initially, 28 papers were screened from the database search, and 162 papers were revealed in the backward snowballing process. Eventually, five articles were included. Data concerning the inflammatory status of patients experiencing SB were investigated and summarized. Due to the heterogeneity of the compared studies, only a qualitative comparison and narrative summary were performed. The results suggest that SB could be associated with systemic inflammation. In fact, this systematic review revealed that there are no papers conclusively showing that the inflammatory status in bruxers is comparable to non-bruxers. However, each of the examined studies utilized different methods of assessing systemic inflammation, which makes the results dubious.
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Affiliation(s)
- Michal Fulek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland
| | - Anna Szymanska-Chabowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Katarzyna Fulek
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
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11
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Manfredini D, Thomas DC, Lobbezoo F. Temporomandibular Disorders Within the Context of Sleep Disorders. Dent Clin North Am 2023; 67:323-334. [PMID: 36965934 DOI: 10.1016/j.cden.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provided an overview of the knowledge on the relationship between temporomandibular disorders (TMDs) and the main sleep conditions and disorders of dental interest, namely, sleep bruxism (SB), sleep apnea, and gastroesophageal reflux disease (GERD). It emerged that although the topic of SB as a possible detrimental factor for the stomatognathic structures has been the most studied, evidence is growing that SB, obstructive sleep apnea, and GERD, all belong to a circle of mutually interacting sleep disorders and conditions that, in turn, may be associated with TMDs. The pathophysiology of the cause-and-effect relationships, if existing, has to be elucidated yet.
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Affiliation(s)
- Daniele Manfredini
- Facial Pain Unit, Department of Biomedical Technologies, School of Dentistry, University of Siena, Viale Bracci c/o Policlinico Le Scotte, Siena 53100, Italy.
| | - Davis C Thomas
- Rutgers School of Dental Medicine, 110 Bergen St, Newark, NJ 07103, USA; Eastman Institute of Oral Health, Rochester, NY, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
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12
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Electromyographic Assessment of Masseter Muscle Activity: A Proposal for a 24 h Recording Device with Preliminary Data. J Clin Med 2022; 12:jcm12010247. [PMID: 36615048 PMCID: PMC9821195 DOI: 10.3390/jcm12010247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The instrumental measurement of electromyographic (EMG) activity in the natural environment is the best strategy available to collect information on bruxism. The twofold aim of this study was to (1) introduce and discuss a novel EMG device for the assessment of awake (AB) and sleep bruxism (SB) in the home environment over 24 h and (2) present some preliminary data. METHODS Fifteen healthy volunteers (eight males and seven females; mean age: 48.2 ± 4.1 years) underwent 24 h EMG recording trials of their masseter muscle activity (MMA) with a miniaturized wireless device. This device allowed us to measure the durations of the different phases of the recordings (total duration, awake time, sleep time, and electrode dislodgement time) as well as the bruxism time index (BTI) and bruxism work index (BWI) for both the waking and sleeping hours. RESULTS For the healthy volunteers, on average, the bruxism work index (BWI) values were 0.4 ± 0.2 and 0.1 ± 0.1 for awake and sleep, respectively, while the mean bruxism time index (BTI) values were 0.9 ± 0.5 for awake and 0.3 ± 0.1 for sleep. CONCLUSIONS This investigation describes the technical features of a novel EMG recording device that permits the evaluation of masseter muscle activity in the home environment over 24 h. For the first time, a dedicated elaboration of the EMG signal allowed an assessment of muscle work and not just a count of purported SB/EMG events. CLINICAL SIGNIFICANCE Based on the multidisciplinary approach in the study of bruxism, such a methodology, thanks to its peculiar features, will allow researchers and clinicians to monitor the epidemiology of MMA and delve deeper into the awake and sleep bruxism correlates for tailored management in clinical settings.
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13
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Santiago V, Janal MN, Cook DB, Raphael KG. Temporal Summation and Aftersensations of Second Pain in Women with Myofascial Temporomandibular Disorder Differ by Presence of Temporomandibular Joint Pain. J Pain Res 2022; 15:3275-3286. [PMID: 36284523 PMCID: PMC9588293 DOI: 10.2147/jpr.s381640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/08/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Mechanisms underlying myofascial temporomandibular disorder (mTMD) are poorly understood. One theory is dysfunction in the central mediation of pain, specifically in enhanced facilitatory pain modulation. Because mechanisms leading to central sensitization may differ for joint and muscle pain, this study of mTMD addressed phenotypic heterogeneity by temporomandibular (TM) joint pain in the examination of quantitative sensory testing (QST). Patients and Methods The stimulus dependent increase in second pain (temporal summation (TS)) and associated aftersensations (AS) were examined across groups of women with mTMD with TM joint pain and without, and a demographically matched control group. Results TS was slightly more evident in mTMD without joint pain vs with (p = 0.035), but AS were most robustly persistent in the group with joint pain vs without (p < 0.002). Conclusion While both subgroups demonstrated evidence of central sensitization relative to controls on one of two measures, differences in QST results, if replicated, may point to possible differences in the mechanisms that yield central sensitization. Alternatively, it may represent methodological artifacts that need to be addressed. Therefore, greater consideration should be given to symptom-based phenotypes in studies examining TS and AS.
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Affiliation(s)
- Vivian Santiago
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA,Correspondence: Vivian Santiago, Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, 137th East 25th Street, Rm 731, New York, NY, 10010, USA, Tel +1 212 998-9419, Email
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA,Department of Kinesiology, University of Wisconsin-Madison School of Education, Madison, WI, USA
| | - Karen G Raphael
- Department of Oral & Maxillofacial Pathology, Radiology & Medicine, New York University College of Dentistry, New York, NY, USA
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14
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Nickel J, Gonzalez Y, Wu Y, Liu Y, Liu H, Iwasaki L. Chronic Pain-Related Jaw Muscle Motor Load and Sensory Processing. J Dent Res 2022; 101:1165-1171. [PMID: 35708459 PMCID: PMC9403723 DOI: 10.1177/00220345221099885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pain associated with temporomandibular disorders (TMDs) may reflect muscle mechanoreceptor afferent barrage and dysregulated sensory processing. This observational study tested for associations between Characteristic Pain Intensity (CPI), physical symptoms (Patient Health Questionnaire-15 [PHQ-15]), and cumulative jaw muscle motor load (mV*s). In accordance with institutional review board oversight and Strengthening the Reporting of Observational Studies in Epidemiology guidelines, adult subjects gave informed consent and were identified via Diagnostic Criteria for TMD (DC-TMD) examination and research protocols. Subjects were assigned to ±Pain groups using DC-TMD criteria for myalgia. CPI scores characterized pain intensity. PHQ-15 scores were surrogate measures of dysregulated sensory processing. Laboratory tests were performed to quantify masseter and temporalis muscle activities (mV) per bite force (N) for each subject. In their natural environments, subjects recorded day- and nighttime electromyography from which cumulative jaw muscle motor loads (mV*s) were determined for activities consistent with bite forces of >1 to ≤2 and >2 to ≤5 N. Data were assessed using univariate analysis of variance, simple effects tests, K-means cluster classification, and 3-dimensional regression analyses. Of 242 individuals screened, 144 enrolled, and 125 with complete data from study protocols, there were 35 females and 15 males for +Pain and 35 females and 40 males for -Pain. Subjects produced 324 daytime and 341 nighttime recordings of average duration 6.9 ± 1.7 and 7.6 ± 1.7 h, respectively. Overall, +Pain compared to -Pain subjects had significantly higher (all P ≤ 0.002) CPI and PHQ-15 scores. Cumulative jaw muscle motor loads showed significant between-subject effects for time, diagnostic group, and sex (all P < 0.003), where motor loads tended to be higher for daytime versus nighttime, +Pain versus -Pain groups, and males versus females. Two clusters were identified, and regression relations showed associations of low-magnitude daytime masseter motor load, PHQ-15, and CPI scores for cluster 1 (n = 105, R2 = 0.44) and cluster 2 (n = 18, R2 = 0.80). Furthermore, these regression relations showed thresholds of motor load and PHQ-15 scores, above which there were nonlinear increases in reported pain.
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Affiliation(s)
- J.C. Nickel
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y.M. Gonzalez
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y. Wu
- Department of Integrative Biomedical and Diagnostic Sciences, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Y. Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - H. Liu
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - L.R. Iwasaki
- Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
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15
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Customized Appliance Device for Force Detection in Bruxism Individuals: An Observational Study. Int J Dent 2022; 2022:2524327. [PMID: 35747202 PMCID: PMC9213119 DOI: 10.1155/2022/2524327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/01/2022] [Indexed: 12/13/2022] Open
Abstract
Objective This study aims to test a customised device for detecting contact-related sleep bruxism in adult patients and to show the efficacy of an established biofeedback method incorporated within the device. Methods Four volunteers, three of whom suffered from bruxism and one did not, underwent four tests to assess bruxism-related force detection during sleep with concurrent electromyographic recording and to compare SB activity with and without biofeedback stimuli. Results The device detected sleep bruxism in bruxer individuals, whilst no activity emerged in the control individual. A correlation between EMG and device signals for bruxism-related events emerged. Moreover, bruxism activity showed a significant decrease on the nights when the biofeedback treatment was applied. Conclusion The force-based device can detect appliance-contacting SB events as reliably as EMG recording. Finally, biofeedback stimuli allowed achieving a reduction in the severity and frequency of SB events.
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16
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Alessandri Bonetti A, Gallenzi P. Is there an association between EMG activity and temporomandibular disorders during orthotic mandibular advancement in sleep apnea patients undergoing DISE? Cranio 2022:1-6. [PMID: 35261324 DOI: 10.1080/08869634.2022.2047511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To detect whether myotatic reflex activation of masticatory muscles during drug-induced sleep endoscopy (DISE) can be an indirect marker for temporomandibular disorder (TMD) in patients suffering from obstructive sleep apnea (OSA). METHODS OSA patients were prospectively recruited and underwent a complete TMD examination prior to undergoing DISE with the addition of electrodes applied over masticatory muscles. A positive activation of myotatic reflex was considered in case of an increase in muscle tone of at least 50%. RESULTS Of the 41 patients included, 48.8% presented activation of myotatic reflex. Of these patients, 45% presented a TMD diagnosis, 40% presented pain at masticatory muscles palpation, and 15% did not report pain during clinical examination. CONCLUSION An increase in EMG activity during mandibular advancement is not associated with TMD presence, but it can be an indirect marker of pain in the orofacial area in OSA patients.
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Affiliation(s)
- Anna Alessandri Bonetti
- Institute of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Patrizia Gallenzi
- Institute of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Rome, Italy
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17
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Temporomandibular disorders cases with high-impact pain are more likely to experience short-term pain fluctuations. Sci Rep 2022; 12:1657. [PMID: 35102207 PMCID: PMC8803984 DOI: 10.1038/s41598-022-05598-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractTemporomandibular disorders (TMD) patients can present clinically significant jaw pain fluctuations which can be debilitating and lead to poor global health. The Graded Chronic Pain Scale evaluates pain-related disability and its dichotomous grading (high/low impact pain) can determine patient care pathways and in general high-impact pain patients have worse treatment outcomes. Individuals with low-impact TMD pain are thought to have better psychosocial functioning, more favorable disease course, and better ability to control pain, while individuals with high-impact pain can present with higher levels of physical and psychological symptoms. Thereby, there is reason to believe that individuals with low- and high-impact TMD pain could experience different pain trajectories over time. Our primary objective was to determine if short-term jaw pain fluctuations serve as a clinical marker for the impact status of TMD pain. To this end, we estimated the association between high/low impact pain status and jaw pain fluctuations over three visits (≤ 21-day-period) in 30 TMD cases. Secondarily, we measured the association between jaw pain intensity and pressure pain thresholds (PPT) over the face and hand, the latter measurements compared to matched pain-free controls (n = 17). Jaw pain fluctuations were more frequent among high-impact pain cases (n = 15) than low-impact pain cases (n = 15) (OR 5.5; 95% CI 1.2, 26.4; p value = 0.033). Jaw pain ratings were not associated with PPT ratings (p value > 0.220), suggesting different mechanisms for clinical versus experimental pain. Results from this proof-of-concept study suggest that targeted treatments to reduce short-term pain fluctuations in high-impact TMD pain is a potential strategy to achieve improved patient perception of clinical pain management outcomes.
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18
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Toyota R, Fukui KI, Kamimura M, Katagiri A, Sato H, Toyoda H, Rompré P, Ikebe K, Kato T. Sleep stage-dependent changes in tonic masseter and cortical activities in young subjects with primary sleep bruxism. Sleep 2021; 45:6349091. [PMID: 34383078 DOI: 10.1093/sleep/zsab207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The present study investigated the hypothesis that subjects with primary sleep bruxism (SB) exhibit masseter and cortical hyperactivities during quiet sleep periods that are associated with a high frequency of rhythmic masticatory muscle activity (RMMA). METHODS Fifteen SB and ten control participants underwent polysomnographic recordings. The frequencies of oromotor events and arousals and the percentage of arousals with oromotor events were assessed. Masseter muscle tone during sleep was quantified using a cluster analysis. Electroencephalography power and heart rate variability were quantified and then compared between the two groups and among sleep stages. RESULTS The frequency of RMMA and percentage of arousals with RMMA were significantly higher in SB subjects than in controls in all stages, while these variables for non-rhythmic oromotor events did not significantly differ between the groups. In SB subjects, the frequency of RMMA was the highest in stage N1 and the lowest in stages N3 and R, while the percentage of arousals with RMMA was higher in stage N3 than stages N1 and R. The cluster analysis classified masseter activity during sleep into two clusters for masseter tone and contractions. Masseter muscle tone showed typical stage-dependent changes in both groups, but did not significantly differ between the groups. Furthermore, no significant differences were observed in electroencephalography power or heart rate variability between the groups. CONCLUSION Young SB subjects exhibited sleep stage-dependent increases in the responsiveness of RMMA to transient arousals, but did not show masseter or cortical hyperactivity during sleep.
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Affiliation(s)
- Risa Toyota
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ken-Ichi Fukui
- SANKEN (The Institute of Scientific and Industrial Research), Osaka University, Osaka, Japan
| | - Mayo Kamimura
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hajime Sato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Division of Pharmacology, Meikai University School of Dentistry
| | - Hiroki Toyoda
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Pierre Rompré
- Faculty of Dentistry, Université de Montréal, Montreal
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan.,Sleep Medicine Center, Osaka University Hospital, Osaka, Japan
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Ettlin DA, Napimoga MH, Meira E Cruz M, Clemente-Napimoga JT. Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model. Neurosci Biobehav Rev 2021; 128:12-20. [PMID: 34118294 DOI: 10.1016/j.neubiorev.2021.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Dominik A Ettlin
- Clinic of Masticatory Disorders, Orofacial Pain Unit, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland.
| | - Marcelo Henrique Napimoga
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil
| | - Miguel Meira E Cruz
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil; Sleep Unit, Cardiovascular Center of University of Lisbon, Lisbon School of Medicine, Lisbon, Portugal
| | - Juliana Trindade Clemente-Napimoga
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro De Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil
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20
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Manfredini D, Lobbezoo F. Sleep bruxism and temporomandibular disorders: A scoping review of the literature. J Dent 2021; 111:103711. [PMID: 34090993 DOI: 10.1016/j.jdent.2021.103711] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To provide a scoping review of the literature by assessing all the English-language papers that investigated the relationship between sleep bruxism (SB) and temporomandibular disorders (TMDs). STUDY DATA AND SOURCES A search was performed in the National Library of Medicine (PubMed) and Scopus databases, in order to identify all the articles published assessing the relationship between SB and TMDs, by several different approaches. The selected articles were then structurally read and summarized in PICO tables. The articles were selected independently by the two authors. STUDY SELECTION Out of 185 references that were initially retrieved, 47 articles met the inclusion criteria and were thus included in the review. The studies were divided into four categories based on the type of SB assessment: 1. questionnaire/self-report (n = 26), 2. clinical examination (n = 7), 3. electromyography (EMG) (n = 5), and 4. polysomnography (PSG) (n = 9). CONCLUSIONS Studies based on questionnaire/self-report SB featured a low specificity for SB assessment, and in general they found a positive association with TMD pain. On the contrary, instrumental studies (i.e., electromyography, polysomnography) found a lower level of association or even a negative relationship between SB and TMD pain. Findings from this updated review confirmed the conclusions of a previous review by Manfredini & Lobbezoo, suggesting that literature findings on the relationship between SB and TMDs are dependent on the assessment strategies that are adopted for SB. Future studies should consider SB as a multifaceted motor behavior that must be evaluated in its continuum spectrum, rather than using a simplified dichotomous approach of presence/absence.
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Affiliation(s)
- Daniele Manfredini
- Professor, School of Dentistry, Department of Medical Biotechnologies, University of Siena, Italy.
| | - Frank Lobbezoo
- Professor and Chair, Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Greene CS, Manfredini D. Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis. J Oral Rehabil 2021; 48:1077-1088. [PMID: 33966303 PMCID: PMC8453911 DOI: 10.1111/joor.13180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Background Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated. Methods This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field. Results At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors. Conclusions The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.
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Affiliation(s)
- Charles S Greene
- Department of Orthodontics, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
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22
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Thymi M, Lobbezoo F, Aarab G, Ahlberg J, Baba K, Carra MC, Gallo LM, De Laat A, Manfredini D, Lavigne G, Svensson P. Signal acquisition and analysis of ambulatory electromyographic recordings for the assessment of sleep bruxism: A scoping review. J Oral Rehabil 2021; 48:846-871. [PMID: 33772835 PMCID: PMC9292505 DOI: 10.1111/joor.13170] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
Background Ambulatory electromyographic (EMG) devices are increasingly being used in sleep bruxism studies. EMG signal acquisition, analysis and scoring methods vary between studies. This may impact comparability of studies and the assessment of sleep bruxism in patients. Objectives (a) To provide an overview of EMG signal acquisition and analysis methods of recordings from limited‐channel ambulatory EMG devices for the assessment of sleep bruxism; and (b) to provide an overview of outcome measures used in sleep bruxism literature utilising such devices. Method A scoping review of the literature was performed. Online databases PubMed and Semantics Scholar were searched for studies published in English until 7 October 2020. Data on five categories were extracted: recording hardware, recording logistics, signal acquisition, signal analysis and sleep bruxism outcomes. Results Seventy‐eight studies were included, published between 1977 and 2020. Recording hardware was generally well described. Reports of participant instructions in device handling and of dealing with failed recordings were often lacking. Basic elements of signal acquisition, for example amplifications factors, impedance and bandpass settings, and signal analysis, for example rectification, signal processing and additional filtering, were underreported. Extensive variability was found for thresholds used to characterise sleep bruxism events. Sleep bruxism outcomes varied, but typically represented frequency, duration and/or intensity of masticatory muscle activity (MMA). Conclusion Adequate and standardised reporting of recording procedures is highly recommended. In future studies utilising ambulatory EMG devices, the focus may need to shift from the concept of scoring sleep bruxism events to that of scoring the whole spectrum of MMA.
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Affiliation(s)
- Magdalini Thymi
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Kazuyoshi Baba
- Department of Prosthodontics, Showa University School of Dentistry, Ohta-ku, Japan
| | - Maria Clotilde Carra
- UFR of Odontology Garanciere, Université de Paris and Service of Odontology, Rothschild Hospital (AP-HP), Paris, France
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Antoon De Laat
- Department of Oral Health Sciences, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentistry, University Hospital, Leuven, Belgium
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Gilles Lavigne
- Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada.,CIUSSS Nord Ile de Montreal, Center for Advance Research in Sleep Medicine & Stomatology, CHUM, Montreal, QC, Canada
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus Universitet Tandlageskolen, Aarhus, Denmark.,Faculty of Odontology, Malmø University, Malmø, Sweden
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23
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Laganà G, Osmanagiq V, Malara A, Venza N, Cozza P. Sleep Bruxism and SDB in Albanian Growing Subjects: A Cross-Sectional Study. Dent J (Basel) 2021; 9:dj9030025. [PMID: 33673649 PMCID: PMC7997344 DOI: 10.3390/dj9030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The aim of this study was to evaluate a possible correlation between sleep bruxism and risk factors of developing obstructive sleep apnea syndrome (OSAS) in a sample of growing subjects and to assess parental awareness about sleep bruxism in their children. Methods: The sample was composed of 310 subjects (173 females and 137 males), with a mean age of 8.9 years, attending "Ndre Mjeda" school of Tirana (Albania). All parents of the children participating in the study were asked to fill in a questionnaire manually or via a digital version. The questionnaire was composed of three sections: personal data, sleep quality data, and OSAS risk factors, and it was filled out by both parents. Results: Of our samples, 41.3% presented with bruxism, and 16.5% of the parents ground their teeth. Oral breathing was reported in 11.9% of the subjects, and among these, 40% of the subjects were affected by bruxism (p > 0.05). Of the subjects, 18.7% snore overnight. Comparing it with sleep bruxism, the two phenomena are often related (p = 0.00). Conclusions: Heredity, night-sweating, nycturia, oral breathing, and snoring seem to have a significant correlation with bruxism.
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Affiliation(s)
- Giuseppina Laganà
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (N.V.); (P.C.)
- Correspondence: ; +39-335-531-0894
| | | | - Arianna Malara
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (N.V.); (P.C.)
| | - Nicolò Venza
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (N.V.); (P.C.)
| | - Paola Cozza
- Department of Systems Medicine, University of Rome ‘Tor Vergata’, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (N.V.); (P.C.)
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24
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Riddle PC, Nickel JC, Liu Y, Gonzalez YM, Gallo LM, Conley RS, Dunford R, Liu H, Iwasaki LR. Mechanobehavior and mandibular ramus length in different facial phenotypes. Angle Orthod 2020; 90:866-872. [PMID: 33378519 DOI: 10.2319/032420-217.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To test the hypotheses that mechanobehavior scores (MBS) were correlated with mandibular ramus lengths (Co-Go) and differed between facial phenotypes. MATERIALS AND METHODS Subjects gave informed consent to participate. Co-Go (mm), mandibular plane angles (SN-GoGn, °), and three-dimensional anatomy were derived from cephalometric radiography or cone beam computed tomography. Temporomandibular joint (TMJ) energy densities (ED) (mJ/mm3) were measured using dynamic stereometry and duty factors (DF) (%) were measured from electromyography, to calculate MBS (= ED2 × DF,) for each TMJ. Polynomial regressions, K-means cluster analysis, and analysis of variance (ANOVA) with Tukey post-hoc tests were employed. RESULTS Fifty females and 23 males produced replete data. Polynomial regressions showed MBS were correlated with Co-Go (females, R2 = 0.57; males, R2 = 0.81). Cluster analysis identified three groups (P < .001). Dolichofacial subjects, with shorter normalized Co-Go, clustered into two subgroups with low and high MBS compared to brachyfacial subjects with longer Co-Go. SN-GoGn was significantly larger (P < .03) in the dolichofacial subgroups combined (33.0 ± 5.9°) compared to the brachyfacial group (29.8 ± 5.5°). CONCLUSIONS MBS correlated with Co-Go within sexes and differed significantly between brachyfacial and dolichofacial subjects.
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25
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Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo. Sleep Med 2020; 75:141-148. [DOI: 10.1016/j.sleep.2020.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
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26
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Svensson P, Lavigne G. Clinical bruxism semantics beyond academic debates: Normo‐ and patho‐bruxism as a new proposal. J Oral Rehabil 2020; 47:547-548. [DOI: 10.1111/joor.12967] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Peter Svensson
- Section of Orofacial Pain and Jaw Function School of Dentistry and Oral Health Aarhus Denmark
| | - Gilles Lavigne
- Faculty of Dentistry University of Montreal Montreal QC Canada
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27
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Abu Serdaneh S, AlHalabi M, Kowash M, Macefield V, Khamis AH, Salami A, Hussein I. Hall technique crowns and children's masseter muscle activity: A surface electromyography pilot study. Int J Paediatr Dent 2020; 30:303-313. [PMID: 31894621 DOI: 10.1111/ipd.12611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/10/2019] [Accepted: 12/29/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hall technique crowns (HTCs) alter the occlusion temporarily, potentially affecting jaw muscles, particularly the masseter - the primary jaw-closing muscle. AIM To assess masseter muscle activity (MMA) in children treated with a unilateral HTC. DESIGN In 12 children treated with a single HTC, bilateral MMA was recorded with surface electromyography (sEMG) for ten cycles of Rest Position (RP) and Maximum Voluntary Clenching (MVC) over 20 seconds immediately pre-HTC cementation (Pbase ), immediately post-HTC cementation (Pimmed ), at 2 weeks post-HTC cementation (P2w ) and at 6 weeks post-HTC cementation (P6w ). t test, ANOVA and post hoc statistics were used (P < .05). RESULTS As expected, MMA was low at rest and increased during maximal jaw clenching (P < .0001). MMA (mean ± SD) increased significantly (P < .001) between RP and MVC at: Pbase [from 1.60 μV·s (±0.96) to 5.40(±2.30)]; Pimmed [1.57(±1.15) to 3.75(±1.87)]; P2w [1.39(±0.54) to 5.54(±1.45)] and finally P6w [1.46(±0.56) to 6.45(±2.56)]. Rest MMA at Pbase , Pimmed , P2w and P6w remained unchanged (P = .18) whereas Pbase clench MMA reduced by a third at Pimmed (P < .001), returned to and exceeded baseline levels at P2w (P = .822) and P6w (P < .001), respectively. CONCLUSIONS This pilot study showed that Hall technique crowns may affect masseter muscle activity in children. Clench MMA was reduced immediately post-treatment but returned to and later exceeded baseline levels at 2 and 6 weeks, respectively. Rest MMA remained unchanged.
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Affiliation(s)
- Salsabeel Abu Serdaneh
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Manal AlHalabi
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mawlood Kowash
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Vaughan Macefield
- Department of Physiology, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic., Australia
| | - Ammar H Khamis
- Department of Biostatistics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Anas Salami
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iyad Hussein
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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28
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Correlations between Sleep Bruxism and Temporomandibular Disorders. J Clin Med 2020; 9:jcm9020611. [PMID: 32102466 PMCID: PMC7074179 DOI: 10.3390/jcm9020611] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to identify correlations between sleep bruxism (SB) and temporomandibular disorders (TMD) as diagnosed by means of the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Sleep bruxism was diagnosed on the basis of I) validated questionnaires, II) clinical symptoms, and III) electromyographic/electrocardiographic data. A total of 110 subjects were included in the study. Fifty-eight patients were identified as bruxers and 52 as nonbruxers. A psychosocial assessment was also performed. An RDC/TMD group-I diagnosis (myofascial pain) was made for 10 out of 58 bruxers, whereas none of the nonbruxers received a diagnosis of this type. No significant differences were found between bruxers and nonbruxers with regard to RDC/TMD group-II (disc displacement) and group-III (arthralgia, arthritis, arthrosis) diagnoses. Somatization was significantly more common among bruxers than nonbruxers. Multivariate logistic regression analysis revealed that somatization was the only factor significantly correlated with the diagnosis of myofascial pain. The results of this study indicate a correlation between myofascial pain, as diagnosed using the RDC/TMD, and somatization. It seems that somatization is a stronger predictor of an RDC/TMD diagnosis of myofascial pain than sleep bruxism is.
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29
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Manfredini D, Ahlberg J, Aarab G, Bracci A, Durham J, Ettlin D, Gallo LM, Koutris M, Wetselaar P, Svensson P, Lobbezoo F. Towards a Standardized Tool for the Assessment of Bruxism (STAB)—Overview and general remarks of a multidimensional bruxism evaluation system. J Oral Rehabil 2020; 47:549-556. [DOI: 10.1111/joor.12938] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/03/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Daniele Manfredini
- Department of Biomedical Technologies School of Dentistry University of Siena Siena Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland
| | - Ghizlane Aarab
- Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland
| | - Alessandro Bracci
- Department of Neuroscience School of Dentistry University of Padova Padova Italy
| | - Justin Durham
- Newcastle University’s School of Dental Sciences Newcastle UK
| | - Dominik Ettlin
- Clinic of Masticatory Disorders Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Luigi M. Gallo
- Clinic of Masticatory Disorders Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Michail Koutris
- Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Peter Wetselaar
- Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
| | - Frank Lobbezoo
- Department of Orofacial pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
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30
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Manfredini D, Colonna A, Bracci A, Lobbezoo F. Bruxism: a summary of current knowledge on aetiology, assessment and management. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ors.12454] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - A. Colonna
- Postgraduate School of Orthodontics University of Ferrara Ferrara Italy
| | - A. Bracci
- Department of Neuroscience School of Dentistry University of Padova Padova Italy
| | - F. Lobbezoo
- Department of Orofacial Pain and Dysfunction Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
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31
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He S, Wang S, Song F, Wu S, Chen J, Chen S. Effect of the use of stabilization splint on masticatory muscle activities in TMD patients with centric relation-maximum intercuspation discrepancy and absence of anterior/lateral guidance. Cranio 2019; 39:424-432. [PMID: 31429383 DOI: 10.1080/08869634.2019.1655861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shushu He
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Si Wang
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fang Song
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Shu Wu
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiangyue Chen
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Song Chen
- State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
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32
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Miettinen T, Myllymaa K, Muraja-Murro A, Westeren-Punnonen S, Hukkanen T, Töyräs J, Lappalainen R, Mervaala E, Sipilä K, Myllymaa S. Polysomnographic scoring of sleep bruxism events is accurate even in the absence of video recording but unreliable with EMG-only setups. Sleep Breath 2019; 24:893-904. [PMID: 31402440 PMCID: PMC7426313 DOI: 10.1007/s11325-019-01915-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the accuracy of scoring masticatory muscle activity (MMA) events in seven different polysomnography (PSG) setups. METHODS Nineteen volunteers (13 females, 6 males, age 31.1 ± 12.9 years, 12 self-proclaimed bruxers) attended one-night PSG recording, supplemented with audio, video, and a separate frontal electroencephalography electrode set (FES). The same examiner scored the MMA events with seven different setups, with varying number of channels available: (1) one, (2) two, and (3) four EMG channels, (4) PSG without audio or video (PSG-N), (5) home PSG with FES and audio (FES-A), (6) PSG with audio (PSG-A), and (7) PSG with audio and video (PSG-AV). A subset (n = 10) of recordings was scored twice to determine intra-scorer reliability. MMA indices and accuracy of scoring the events in different setups were compared against PSG-AV. RESULTS The intra-class correlation coefficient (ICC) between PSG-AV and PSG-A was high (0.940, p < 0.001) as well as for FES-A (0.927, p < 0.001), whereas for PSG-N, it was lower (0.835, p < 0.001); for setups with only EMG channels, coefficients were very low (ICC < 0.100 for all). Intra-examiner reliability was high (ICC > 0.939 for all setups), with the exception of PSG-N (ICC = 0.764, p = 0.002). When comparing against the MMA events scored in PSG-AV, the sensitivity of MMA event recognition for PSG-A was 78.5% and specificity 95.5%, which were substantially higher than sensitivity (52.0%) and specificity (87.2%) of PSG-N. CONCLUSIONS MMA event scoring accuracy with PSG-A or FES-A is almost comparable to PSG-AV. Since precise event recognition is essential for accurate MMA scoring, it is evident that one cannot rely exclusively on EMG.
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Affiliation(s)
- Tomi Miettinen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Katja Myllymaa
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Anu Muraja-Murro
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Susanna Westeren-Punnonen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Taina Hukkanen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Reijo Lappalainen
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| | - Esa Mervaala
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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33
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Exposto FG, Arima T, Svensson P. Sleep Disorders and Chronic Orofacial Pain. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00152-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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34
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Santiago V, Raphael K. Absence of joint pain identifies high levels of sleep masticatory muscle activity in myofascial temporomandibular disorder. J Oral Rehabil 2019; 46:1161-1169. [DOI: 10.1111/joor.12853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Karen Raphael
- New York University College of Dentistry New York New York
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35
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Manfredini D, Ahlberg J, Wetselaar P, Svensson P, Lobbezoo F. The bruxism construct: From cut‐off points to a continuum spectrum. J Oral Rehabil 2019; 46:991-997. [DOI: 10.1111/joor.12833] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 04/29/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry University of Siena Siena Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases University of Helsinki Helsinki Finland
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
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Thymi M, Shimada A, Lobbezoo F, Svensson P. Clinical jaw-muscle symptoms in a group of probable sleep bruxers. J Dent 2019; 85:81-87. [DOI: 10.1016/j.jdent.2019.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/30/2022] Open
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38
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Iwasaki LR, Gallo LM, Markova M, Erni S, Liu H, Nickel JC. Night‐time autonomic nervous system ultradian cycling and masticatory muscle activity. Orthod Craniofac Res 2019; 22 Suppl 1:107-112. [DOI: 10.1111/ocr.12267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Laura R. Iwasaki
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
| | - Luigi M. Gallo
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Michala Markova
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Stefan Erni
- Department of Masticatory DisordersSchool of DentistryUniversity of Zurich Zurich Switzerland
| | - Hongzeng Liu
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
| | - Jeff C. Nickel
- Department of OrthodonticsSchool of DentistryOregon Health & Science University Portland Oregon
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Effect of experimental temporomandibular disorder pain on sleep bruxism: a pilot study in males. Clin Oral Investig 2019; 24:103-111. [DOI: 10.1007/s00784-019-02889-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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40
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Smardz J, Martynowicz H, Michalek-Zrabkowska M, Wojakowska A, Mazur G, Winocur E, Wieckiewicz M. Sleep Bruxism and Occurrence of Temporomandibular Disorders-Related Pain: A Polysomnographic Study. Front Neurol 2019; 10:168. [PMID: 30915015 PMCID: PMC6421294 DOI: 10.3389/fneur.2019.00168] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: The diagnosis of sleep bruxism is challenging due to the difficulties involved. Sleep bruxism can lead to clinical consequences, including pain in masticatory muscles, limitation of jaw mobility, headache, and the spectrum of symptoms associated with damage to the teeth and oral mucosa. Currently, only video-polysomnography can definitely diagnose sleep bruxism. Due to the risk of painful temporomandibular disorders (TMD) in sleep bruxers, early diagnosis of pain in the temporomandibular region using questionnaires is recommended. Therefore, this study aimed to assess the relationship between the intensity of sleep bruxism and the occurrence of pain related to TMD. Materials and Methods: This study was conducted on the patients of the Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry at the Wroclaw Medical University. Based on a positive medical history, a thorough examination for the diagnosis of probable sleep bruxism was carried out in the enrolled patients. Eligible patients were then subjected to a video-polysomnographic study. Each patient was asked to complete the TMD Pain Screener questionnaire to assess the occurrence of pain in jaw and temple area. Results: The results of the study showed that increased bruxism episode index (BEI) was statistically significantly correlated with increase of all types of bruxism episodes—phasic, tonic, and mixed—in all the studied patients; a significant correlation was also found with respect to division of patients into studied and control groups. The study also showed that there was no statistically significant difference between BEI values and scores of TMD Pain Screener. In all the studied patients, a higher BEI was not found to be correlated with the occurrence of TMD-related pain assessed by TMD Pain Screener; similarly, no correlation was found with respect to division of patients into studied and control groups. Conclusions: The occurrence of TMD-related pain is not related to the intensity of sleep bruxism. TMD Pain Screener may be used as an auxiliary tool in the diagnosis or risk of occurrence of TMD-related pain, whereas in the case of sleep bruxism, it has only limited diagnostic value. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03083405
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Affiliation(s)
- Joanna Smardz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Efraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
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Sleep disturbances and sleep disorders in adults living with chronic pain: a meta-analysis. Sleep Med 2018; 52:198-210. [DOI: 10.1016/j.sleep.2018.05.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 11/23/2022]
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42
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Herrero Babiloni A, De Beaumont L, Lavigne GJ. Transcranial Magnetic Stimulation. Sleep Med Clin 2018; 13:571-582. [DOI: 10.1016/j.jsmc.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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43
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Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, Santiago V, Winocur E, De Laat A, De Leeuw R, Koyano K, Lavigne GJ, Svensson P, Manfredini D. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil 2018; 45:837-844. [PMID: 29926505 PMCID: PMC6287494 DOI: 10.1111/joor.12663] [Citation(s) in RCA: 568] [Impact Index Per Article: 94.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/23/2022]
Abstract
In 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re-examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non-rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non-instrumental approaches (notably self-report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut-off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism-related masticatory muscle activities should be assessed in the behaviour's continuum.
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Affiliation(s)
- F Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - K G Raphael
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, USA
| | - P Wetselaar
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A G Glaros
- School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - T Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Osaka, Japan
- Sleep Medicine Center, Osaka University Hospital, Osaka, Japan
| | - V Santiago
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, USA
| | - E Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A De Laat
- Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
- Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - R De Leeuw
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, Lexington, KY, USA
| | - K Koyano
- Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - G J Lavigne
- Centre d'étude du sommeil, Faculty of Dental Medicine, Université de Montréal and Hôpital du Sacré Coeur, Montréal, PQ, Canada
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Scandinavian Center for Orofacial Neurosciences
| | - D Manfredini
- School of Dentistry, University of Siena, Siena, Italy
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44
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Santiago V, Raphael K. Single-Item, Self-Rated Health is a Useful Indicator of Health in Myofascial Temporomandibular Disorders. J Oral Facial Pain Headache 2018; 33:260–268. [PMID: 30371685 PMCID: PMC8252675 DOI: 10.11607/ofph.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims: To (1) examine differences in self-rated health (SRH) between a group of women with myofascial temporomandibular disorders (mTMD) and controls; (2) determine the extent to which pain, mental health, and physical function mediate these differences; and (3) explore specific mTMD symptoms and impairments explaining SRH among mTMD cases. Methods: An existing dataset of a sample of women with mTMD (n = 125) and a group of demographically similar controls (n = 49) was used. SRH was measured via a single item with 5 answer options ranging from poor (SRH = 1) to excellent (SRH = 5). Bodily pain, mental health, and physical function were measured with the Short-Form Health Survey. Regression analyses with SRH as the outcome were conducted. Results: mTMD cases reported poorer SRH compared to controls, and bodily pain score fully mediated these lower scores. Physical function partially mediated the association between mTMD and SRH, while mental health did not explain much of the variance in SRH. This pattern held in case-only analyses. The association was not explained by mTMD-specific symptoms or by localized mTMD pain severity, although mTMD disability was independently associated with lower SRH. Conclusion: SRH is a simple and useful tool to consider in mTMD research, as it discriminates between cases and controls based on pain and physical function and is associated with mTMD disability.
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45
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Nickel JC, Iwasaki LR, Gonzalez YM, Gallo LM, Yao H. Mechanobehavior and Ontogenesis of the Temporomandibular Joint. J Dent Res 2018; 97:1185-1192. [PMID: 30004817 DOI: 10.1177/0022034518786469] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Craniofacial secondary cartilages of the mandibular condyle and temporomandibular joint (TMJ) eminence grow in response to the local mechanical environment. The intervening TMJ disc distributes normal loads over the cartilage surfaces and provides lubrication. A better understanding of the mechanical environment and its effects on growth, development, and degeneration of the TMJ may improve treatments aimed at modifying jaw growth and preventing or reversing degenerative joint disease (DJD). This review highlights data recorded in human subjects and from computer modeling that elucidate the role of mechanics in TMJ ontogeny. Presented data provide an approximation of the age-related changes in jaw-loading behaviors and TMJ contact mechanics. The cells of the mandibular condyle, eminence, and disc respond to the mechanical environment associated with behaviors and ultimately determine the TMJ components' mature morphologies and susceptibility to precocious development of DJD compared to postcranial joints. The TMJ disc may be especially prone to degenerative change due to its avascularity and steep oxygen and glucose gradients consequent to high cell density and rate of nutrient consumption, as well as low solute diffusivities. The combined effects of strain-related hypoxia and limited glucose concentrations dramatically affect synthesis of the extracellular matrix (ECM), which limit repair capabilities. Magnitude and frequency of jaw loading influence this localized in situ environment, including stem and fibrocartilage cell chemistry, as well as the rate of ECM mechanical fatigue. Key in vivo measurements to characterize the mechanical environment include the concentration of work input to articulating tissues, known as energy density, and the percentage of time that muscles are used to load the jaws out of a total recording time, known as duty factor. Combining these measurements into a mechanobehavioral score and linking these to results of computer models of strain-regulated biochemical events may elucidate the mechanisms responsible for growth, maintenance, and deterioration of TMJ tissues.
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Affiliation(s)
- J C Nickel
- 1 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.,2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L R Iwasaki
- 1 Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.,2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - Y M Gonzalez
- 2 Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - L M Gallo
- 3 Department of Masticatory Disorders, University of Zurich School of Dental Medicine, Zurich, Switzerland
| | - H Yao
- 4 Department of Bioengineering, Clemson University, Clemson, SC, USA.,5 Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
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46
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Mude AH, Kawakami S, Kato S, Minagi S. Properties of tonic episodes of masseter muscle activity during waking hours and sleep in subjects with and without history of orofacial pain. J Prosthodont Res 2018; 62:234-238. [DOI: 10.1016/j.jpor.2017.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/16/2022]
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47
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Muzalev K, Lobbezoo F, Janal MN, Raphael KG. Interepisode Sleep Bruxism Intervals and Myofascial Face Pain. Sleep 2017; 40:3800074. [PMID: 28482089 DOI: 10.1093/sleep/zsx078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Study Objectives Sleep bruxism (SB) is considered as a possible etiological factor for temporomandibular disorder (TMD) pain. However, polysomnographic (PSG) studies, which are current "gold standard" diagnostic approach to SB, failed to prove an association between SB and TMD. A possible explanation could be that PSG studies have considered only limited characteristics of SB activity: the number of SB events per hour and, sometimes, the total duration of SB per night. According to the sports sciences literature, lack of adequate rest time between muscle activities leads to muscle overloading and pain. Therefore, the aim of this study was to determine whether the intervals between bruxism events differ between patients with and without TMD pain. Methods Two groups of female volunteers were recruited: myofascial TMD pain group (n=124) and non-TMD control group (n=46). From these groups, we selected 86 (69%) case participants and 37 (80%) controls who had at least two SB episodes per night based on PSG recordings. A linear mixed model was used to compare case and control groups over the repeated observations of interepisode intervals. Results The duration of interepisode intervals was statistically similar in the case (mean [standard deviation {SD}] 1137.7 [1975.8] seconds)] and control (mean [SD] 1192.0 [1972.0] seconds) groups. There were also a similar number of SB episodes per hour and a total duration of SB episodes in both groups. Conclusions The current data fail to support the idea that TMD pain can be explained by increasing number of SB episodes per hour of sleep or decreasing the time between SB events.
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Affiliation(s)
- Konstantin Muzalev
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY
| | - Karen G Raphael
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY
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48
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Iwasaki L, Gonzalez Y, Liu Y, Liu H, Markova M, Gallo L, Nickel J. Mechanobehavioral Scores in Women with and without TMJ Disc Displacement. J Dent Res 2017; 96:895-901. [PMID: 28414608 PMCID: PMC5502957 DOI: 10.1177/0022034517704375] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cartilage fatigue may be a factor in the precocious development of degenerative changes in the temporomandibular joint (TMJ). This cross-sectional study estimated potential for cartilage fatigue via TMJ energy densities (ED) and jaw muscle duty factors (DF), which were combined to calculate mechanobehavioral scores (MBS) in women with (+) and without (-) bilateral TMJ disc displacement (DD). All subjects gave informed consent to participate and were examined using Diagnostic Criteria (DC) for Temporomandibular Disorders (TMD) and magnetic resonance (MR) and computed tomography (CT) images. Forty-seven subjects were categorized into +DD ( n = 29) and -DD ( n = 18) groups. Dynamic stereometry (MR images combined with jaw-tracking data) characterized individual-specific data of TMJ stress-field mechanics to determine ED (ED = W/ Q mJ/mm3, where W = work done, Q = volume of cartilage) during 10 symmetrical jaw-closing cycles with a 20-N mandibular right canine load. Subjects were trained to record masseter and temporalis electromyography over 3 days and 3 nights. Root mean square electromyography/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20-N bite-force (T20 N, µV), which defined thresholds. Muscle DF (DF = % duration of muscle activity/total recording time) were determined for a range of thresholds, and MBS (ED2 × DF) were calculated. Intergroup differences in ED, DF, and MBS were assessed via analyses of variance with Bonferroni and Tukey honest significant difference post hoc tests. Average ED for contralateral TMJs was significantly larger ( P = 0.012) by 1.4-fold in +DD compared to -DD subjects. Average DF were significantly larger (all P < 0.01) for +DD compared to -DD subjects by 1.7-, 2.5-, and 1.9-fold for day, night, and overall, respectively. Daytime MBS were significantly larger (all P < 0.04) by up to 8.5-fold in +DD compared to -DD subjects. Significantly larger ED, DF, and MBS were shown in women with compared to women without bilateral TMJ DD.
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Affiliation(s)
- L.R. Iwasaki
- School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Y.M. Gonzalez
- School of Dental Medicine, Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, USA
| | - Y. Liu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - H. Liu
- School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, University of Missouri–Kansas City, Kansas City, MO, USA
| | - M. Markova
- Department of Masticatory Disorders, University of Zurich School of Dental Medicine, Zurich, Switzerland
| | - L.M. Gallo
- Department of Masticatory Disorders, University of Zurich School of Dental Medicine, Zurich, Switzerland
| | - J.C. Nickel
- School of Dentistry, Departments of Orthodontics & Dentofacial Orthopedics and Oral & Craniofacial Sciences, University of Missouri–Kansas City, Kansas City, MO, USA
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49
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Wei F, Van Horn MH, Coombs MC, She X, Gonzales TS, Gonzalez YM, Scott JM, Iwasaki LR, Nickel JC, Yao H. A pilot study of nocturnal temporalis muscle activity in TMD diagnostic groups of women. J Oral Rehabil 2017; 44:517-525. [PMID: 28449265 DOI: 10.1111/joor.12517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 01/28/2023]
Abstract
Temporomandibular disorder (TMD) incidences are believed to be related to parafunctional behaviours like teeth clenching. This pilot study aimed to (i) develop an automated clench-detection algorithm, and (ii) apply the algorithm to test for differences in nocturnal clenching in women with and without TMD. Subjects gave informed consent to participate. Adult women were categorised using Diagnostic Criteria for TMD according to presence/absence (+/-) of both TM joint disc placement (DD) and chronic pain (P) into two groups (+DD+P, -DD-P) with 12 subjects each. Surface temporalis electromyography was recorded during oral tasks performed by subjects at two laboratory sessions. The data were used to characterise muscle activity per N of bite force (μV/N) for each subject, develop the clench-detection algorithm and test its accuracy. Ambulatory surface temporalis electromyography was self-recorded by each subject over three nights and analysed using the algorithm and bite force (N) versus muscle activity μV/N calibrations. Bonferroni-adjusted homoscedastic t-tests assessed for significant between-group differences in clenching (P < 0·05). Sensitivity, specificity and accuracy of algorithm-detected laboratory clenches were all ≥96%. During self-recordings 95% of clenches had durations of <4 s and peak forces of <10 N in both groups. Mean clench durations were significantly longer (P = 0·042) in +DD+P (1·9 ± 0·8 s) than -DD-P subjects (1·4 ± 0·4 s). Mean temporalis duty factors (%clench time/total recording time) were significantly larger (P = 0·041) in +DD+P (0·47 ± 0·34%) than -DD-P (0·26 ±0·22%) subjects. Nocturnal temporalis muscle activities detected by a validated algorithm were longer per clench and recording time in +DD+P compared to -DD-P women.
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Affiliation(s)
- F Wei
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - M H Van Horn
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - M C Coombs
- Department of Bioengineering, Clemson University, Clemson, SC, USA.,Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - X She
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - T S Gonzales
- Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Y M Gonzalez
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA
| | - J M Scott
- Department of Research and Graduate Programs, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - L R Iwasaki
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA.,Departments of Orthodontics and Dentofacial Orthopedics, and Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - J C Nickel
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA.,Departments of Orthodontics and Dentofacial Orthopedics, and Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - H Yao
- Department of Bioengineering, Clemson University, Clemson, SC, USA.,Department of Oral Health Sciences, College of Dental Medicine, Medical University of South Carolina, Charleston, SC, USA
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50
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Jiménez-Silva A, Peña-Durán C, Tobar-Reyes J, Frugone-Zambra R. Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014. Acta Odontol Scand 2017; 75:36-58. [PMID: 27796166 DOI: 10.1080/00016357.2016.1247465] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In order to establish a relationship between bruxism and temporomandibular disorders (TMDs), a systematic review was performed. MATERIALS AND METHODS A systematic research was performed based on PubMed, Cochrane Library, Medline, Embase, BIREME, Lilacs and Scielo data bases, between 2003 and 2014 including all languages. Descriptive clinical cases were identified. Two independent authors selected the articles. PICO format was used to analyse the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence. RESULTS Thirty-nine studies (n = 39) were analysed in this review. According to bruxism diagnosis, articles were grouped as follows: polysomnographic diagnosis (PSG) (n = 7), clinical diagnosis (n = 11) and survey/self-report (n = 21). Thirty-three articles (n = 33) established a positive relation between bruxism and TMD and six (n = 6) did not. Quality of evidence was low to moderate. In general, the most part of the studies showed shortcomings on their design with bias risk, and also had a low sensitivity on bruxism diagnosis. CONCLUSIONS The evidence based on PSG was not as conclusive as the studies that used surveys and clinical exam to diagnosis bruxism, when bruxism was related to TMD. Sleep bruxism could be associated with myofascial pain, arthralgia and joint pathology as disc displacement and joint noises. Although the evidence at present is inconclusive and does not provide information according to the type of bruxism (bruxism sleep and wakefulness), it is possible to suggest that bruxism would be associated with TMD.
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