Validity of the Oral Behaviours Checklist: correlations between OBC scores and intensity of facial pain

Analysis of risk factors and interactions for pain in temporomandibular disorder: A cross-sectional study

BACKGROUND

Risk factors for temporomandibular disorder (TMD) pain remain unclear.

OBJECTIVES

This study aimed to identify risk factors for TMD pain using a biopsychosocial model and to investigate interactions between potential risk factors-oral behaviours (OBs), psychological factors and sleep quality-and their direct and indirect effects on TMD pain.

METHODS

This was a cross-sectional study of 488 patients with TMDs (422 women; 30.8 ± 9.4 years). Pain was assessed using the Numerical Rating Scale. Demographic, behavioural, psychological and biomedical data were collected through clinical examination, face-to-face interviews and questionnaires. Multiple linear regression analysis was used to identify factors associated with TMD pain. Mediation and moderation analysis were used to evaluate interactions between variables. Significant mediation ('0' not included in the 95% confidence interval (CI)) and moderation (p < .05) effects on TMD pain were identified.

RESULTS

Marital status, diagnosis subgroup, previous medication use, depression and sleep quality were significant risk factors for TMD pain (p < .05). Significant mediation effects were observed as follows: depression and sleep quality mediated the association between OBs and pain; sleep quality mediated the association between somatization, depression, anxiety and pain; and depression mediated the association between sleep quality and pain (all 95% CI did not contain '0').

CONCLUSIONS

(1) Marital status, diagnosis subgroup, previous medication use, depression and sleep quality were associated with TMD pain. (2) OBs can exacerbate pain by promoting depression and reducing sleep quality. Psychological factors and sleep quality can interact to exacerbate pain.

Validity and reliability of the Turkish Version of the Oral Behaviors Checklist

OBJECTIVE

The aim of this study was to investigate the validity and reliability of the Turkish version of the Oral Behavior Checklist (OBC-TR).

MATERIALS AND METHODS

The study included 223 patients with temporomandibular disorders (TMDs) and 94 individuals without TMD. Face and content validity were analyzed. Structural (with confirmatory factor analysis [CFA]), convergent (with pain intensity, Fonseca Anamnestic Index [FAI], Hospital Anxiety and Depression Scale [HADS], and Oral Health Impact Profile [OHIP-14]), divergent (with active pain-free maximum mouth opening [MMO]), and discriminant validity were investigated to evaluate the construct validity. Cronbach's alpha for internal consistency and the intraclass correlation coefficient (ICC) for test-retest reliability were computed.

RESULTS

Face and content validity were satisfactory. The CFA has verified the structural validity of the OBC-TR. Strong associations between the OBC-TR score and pain intensity (r = 0.88), FAI (r = 0.90), HADS (r = 0.82-0.86), and OHIP-14 (r = 0.83) scores, and MMO (r = -0.85) verified the convergent and divergent validity of the OBC-TR. Concerning discriminant validity, the OBC-TR discriminated between patients with TMD and individuals without TMD (p < 0.05). Internal consistency (Cronbach's alpha = 0.89) and test-retest reliability (ICC = 0.91) were satisfactory.

CONCLUSION

The OBC-TR is a valid and reliable instrument to measure the frequency of oral parafunctional behaviors in Turkish-speaking patients with TMD.

Awake and Sleep Oral Behaviours in Patients With Painful Temporomandibular Disorders

OBJECTIVES

The aim of this research was to explore the oral behaviours exhibited by individuals with and without temporomandibular disorders (TMD) pain, and with various pain characteristics; and to determine which oral behaviour is correlated with painful TMD.

METHODS

328 patients with TMD who visited Orofacial Pain Clinic were included in this retrospective cross-sectional study. The patients were categorised into 2 groups-painful TMD and non-painful TMD-based on pain status; their other pain characteristics were recorded. To evaluate oral behaviours, researchers utilised the Oral Behaviors Checklist (OBC) and categorised into 3 levels based on the Diagnostic criteria for TMD scoring manual. To investigate the associations amongst demographic information, oral behaviour levels, and TMD pain status and characteristics, logistic regression was employed, whilst t tests were used to analyse OBC scores. Logistic regression was also used to examine individual oral behaviours in relation to specific pain characteristics.

RESULTS

Age and marital status were associated with TMD pain status. Significantly higher OBC scores were observed in chronic pain compared to acute pain group, but the scores were not significantly different for pain status and other pain characteristics. OBC score and level were associated solely with TMD pain chronicity. According to multivariate logistic regression, "clench or grind teeth when sleeping" was the strongest predictor of TMD pain and "place tongue forcibly against teeth" was the strongest predictor of chronic painful TMD.

CONCLUSIONS

High oral behaviour level and OBC scores were associated with chronic painful TMD. Sleep bruxism was the strongest predictor of TMD pain. Age and marital status were correlated with TMD pain status. In the treatment of TMD, there can be potential benefits in addressing and managing oral parafunctional behaviours.

Translation and cultural adaptation of the Standardized Tool for the Assessment of Bruxism (STAB) and the Bruxism Screener (BruxScreen): A 12-step guideline

BACKGROUND

Recently, the Standardized Tool for the Assessment of Bruxism (STAB) and the bruxism screener (BruxScreen) have been developed for use in research and clinical settings.

OBJECTIVE

As to ascertain high-quality use of both instruments worldwide, it was our aim to develop a guideline for the translation and cultural adaptation of the STAB and the BruxScreen.

METHODS AND RESULTS

This paper describes a 12-step guideline for the translation and cultural adaptation of the STAB and the BruxScreen. A format of a translation log is provided as well. Besides, a website has been created for the guidance of translation teams.

CONCLUSION

Following the 12 steps, new language versions of the STAB and the BruxScreen will be ready for further testing (reliability, validity, responsiveness and interpretability) and, ultimately, application in research and clinics around the world.

Smartphone application to report awake bruxism: Development and testing of the Swedish version and a pilot study to evaluate family history in young adults and their parents

BACKGROUND

Together with psychosocial and hereditary factors, bruxism is a possible risk factor for orofacial pain. Bruxism is defined as a masticatory muscle activity characterized by repetitive or sustained tooth contact, or by bracing or thrusting of the mandible. A smartphone application to report awake bruxism (AB) has been developed and translated into more than 25 languages.

OBJECTIVE(S)

To translate the application into Swedish, adapt it to Swedish culture and conduct a study to evaluate the usability of the application for studies on family history and associated risk factors.

METHODS

Translation and cultural adaption of the Swedish version of the application (BruxApp) was carried out in a four-step sequential process. Ten young adults (22-30 years) were recruited together with ten parents (42-67 years) and reported their AB with the application over two seven-day periods. Pain, stress and parafunctional behaviours were assessed by questionnaires.

RESULTS

The back translation check showed minimal discrepancies between the translation and the English version. Participants did not report any problems with the application. Response rates for both groups were 65%. A difference in frequency of AB was shown between young adults and parents (22.0% vs. 12.5%, p < .001). A positive moderate correlation was found between AB and stress (r = 0.54, p = .017).

CONCLUSION

The use of application strategies enables data collection on AB which can be used in both clinical and research settings. The results suggest that the Swedish version is ready for implementation and for studies on the relationships between AB, family history and psychosocial factors.

Psychological distress and the belief that oral behaviours put a strain on the masticatory system in relation to the self-report of awake bruxism: Four scenarios

BACKGROUND

It is assumed that other factors than masticatory muscle activity awareness could drive the self-report of awake bruxism.

OBJECTIVES

To investigate the extent to which the report of awake bruxism is associated with psychological distress, and with the belief that oral behaviours put a strain on the masticatory system among TMD-pain patients.

MATERIALS AND METHODS

The study sample consisted of 1830 adult patients with reported function-dependent TMD pain. Awake bruxism was assessed through six items of the Oral Behaviors Checklist. Psychological distress was assessed by means of somatic symptoms, depression and anxiety. Causal attribution belief was measured with the question 'Do you think these behaviours put a strain on your jaws, jaw muscles, and/or teeth?'

RESULTS

Mean age of all participants was 42.8 (±15.2) years, 78.2% being female. Controlled for sex, positive, yet weak, correlations were found between awake bruxism and somatic symptom severity (rs  = 0.258; p < .001), depression (rs  = 0.272; p < .001) and anxiety (rs  = 0.314; p < .001): patients with the highest scores reported approximately twice as much awake bruxism compared to those with minimal scores. Controlled for age and sex, a positive, moderate correlation was found between awake bruxism and causal attribution belief (rs  = 0.538; p < .001). Patients who believed that performing awake oral behaviours put 'very much' a strain on the masticatory system reported four times more awake bruxism than patients who did not believe that these behaviours are harmful.

CONCLUSIONS

Based on the results and relevant scientific literature, the theoretical background mechanisms of our findings are discussed in four scenarios that are either in favour of the use of self-report of awake bruxism being a representation of masticatory muscle activity awareness, or against it.

The association of self-reported awake bruxism and sleep bruxism with temporomandibular pain and dysfunction in adult patients with temporomandibular disorders

OBJECTIVE

To investigate the association of the severity of temporomandibular disorders (TMD) pain and dysfunction with the frequency of self-reported awake bruxism (AB), sleep bruxism (SB), and stress in an adult TMD-patient population.

MATERIALS AND METHODS

This cross-sectional study included 237 TMD patients based on the Diagnostic Criteria for TMD. Age, sex, frequency of self-reported AB and SB, and stress were included as independent variables. TMD pain and TMD dysfunction were included as dependent variables in regression analyses. Univariate and multivariable linear regression analyses were used to predict TMD pain and TMD dysfunction in two separate models. Finally, network analysis was performed to investigate the associations between all variables.

RESULTS

In the univariate analyses, TMD pain was significantly associated with self-reported AB-frequent (unstandardized coefficient (B) = 3.196, 95%CI 1.198-5.195, p = 0.002). TMD dysfunction was significantly associated with AB-frequent (B = 2.208, 95%CI 0.177-4.238, p = 0.033) and SB-sometimes (B = 1.698, 95%CI 0.001-3.394, p = 0.050). In the multivariable analyses, TMD pain was significantly associated with TMD dysfunction (B = 0.370, p < 0.001), stress (B=0.102, p < 0.001). TMD dysfunction was significantly associated with TMD pain (B = 0.410, p < 0.001) only. Network analysis showed that TMD pain is a bridge factor between AB, stress, and TMD dysfunction.

CONCLUSIONS

TMD pain is directly associated with AB, stress, and TMD dysfunction, while TMD dysfunction is only associated with TMD pain.

CLINICAL RELEVANCE

Reducing pain may improve pain-related dysfunction, and the management of AB and stress may improve TMD pain and dysfunction, and vice versa.

ASSOCIATIONS BETWEEN SCREENING FOR FUNCTIONAL JAW DISTURBANCES AND PATIENT REPORTED OUTCOMES ON JAW LIMITATIONS AND ORAL BEHAVIORS

OBJECTIVES

Temporomandibular disorders (TMDs) is a collective term for pain and functional disturbances related to the jaw muscles and the temporomandibular joint. In contrast to screening for orofacial pain, knowledge is limited on the association between patient-reported outcomes and screening for joint-related functional jaw disturbances. Therefore, our aim was to evaluate the association between a screening question for functional jaw disturbances, and disease-specific outcome measures for functional jaw limitations and oral behaviors.

METHODS

This study included 299 individuals (201 women; 20-69 years, median 37.0) in a general population sample from Västerbotten, Northern Sweden in 2014. A single screening question for functional jaw disturbances "Does your jaw lock or become stuck once a week or more?" was used to categorize individuals as cases or controls. Patient-reported outcomes on functional jaw disturbances were assessed with the 20-item jaw functional limitation scale (JFLS-20) and oral behaviors with the 21-item Oral Behaviors Checklist (OBC-21).

RESULTS

The strongest predictive probability to have a positive screening outcome was functional jaw limitations related to mobility (AUCboot=0.78, 95 CI:0.71-0.86, P < .001), followed by limitations related to communication (AUCboot = 0.74, 95 CI:0.63-0.80, P < .001) and mastication (AUCboot = 0.73, 95 CI:0.66-0.81, P < .001). The frequency of oral behaviors was not significantly associated with a positive screening outcome (AUCboot = 0.65, 95 CI:0.55-0.72, P = .223).

CONCLUSIONS

Self-reported functional limitations, but not oral behaviors, are strongly associated with a single screening question for frequent functional jaw disturbances. This finding provides support for incorporating a question on jaw catching/locking once a week or more in screening instruments for TMDs.

Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.

Prevalence of oral behaviours in general dental patients attending a university clinic in Italy

BACKGROUND

Oral behaviors represent a diverse array of habits beyond the physiological behaviors of the stomatognathic system.

OBJECTIVE

To describe the prevalence of different oral behaviors, as reported with the Oral Behavior Checklist (OBC-21), in a convenience sample of patients attending an Italian university clinic for routine dental cares.

METHODS

In this study, charts of adult patients presenting to the dental department of a regional hospital in Trieste, Italy, from January 2018 and January 2019 were reviewed. Patients with complete files were retrieved, and those with orofacial pain complaints were excluded. OBC-21 scores and grades (score of 0 corresponding to no risk, 1-24 to low risk, and higher than 24 to high risk) were analyzed and stratified according to age and sex.

RESULTS

Data from a total of 1424 patients were reported. The overall mean OBC score was 13.3 ± 9.9, with 6.7% no-risk grade, 79.6% low-risk grade, and 13.7% high-risk grade. In general, mean OBC scores decreased with increasing age. Females showed a higher frequency of high-risk grade than males. Most frequent prevalent habits included yawning (73.1%), eating between meals (66.9%) and chewing food on one side only (63.3%). Other behaviors were also highly prevalent, including pressing, touching, or holding teeth together other than while eating (52.7%) and awake clenching (47.5%).

CONCLUSION

A low-risk grade of oral behaviors has been found to be frequent in our sample. Future studies are warranted to confirm these findings in larger, representative general populations and to assess if any of these habits are linked to negative effects on the stomatognathic system.

Prevalence of painful temporomandibular disorders, awake bruxism and sleep bruxism among patients with severe post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with painful temporomandibular disorder (TMD) and may be part of the aetiology of awake bruxism (AB) and sleep bruxism (SB). Investigating the associations between PTSD symptoms on the one hand, and painful TMD, AB and SB on the other, can help tailoring treatment to the needs of this patient group.

OBJECTIVES

The aim of this study was to investigate the associations between PTSD symptoms and painful TMD, AB and SB among patients with PTSD, focusing on prevalence, symptom severity and the influence of trauma history on the presence of painful TMD, AB and SB.

METHODS

Individuals (N = 673) attending a specialised PTSD clinic were assessed (pre-treatment) for painful TMD (TMD pain screener), AB and SB (Oral Behaviours Checklist), PTSD symptoms (Clinician-Administered PTSD Scale) and type of traumatic events (Life Events Checklist).

RESULTS

Painful TMD, AB and SB were more prevalent among patients with PTSD (28.4%, 48.3% and 40.1%, respectively) than in the general population (8.0%, 31.0% and 15.3%, respectively; all p's < .001). PTSD symptom severity was found to be significantly, but poorly, associated with the severity of painful TMD (rs  = .126, p = .001), AB (rs  = .155, p < .001) and SB (rs  = .084, p = .029). Patients who had been exposed to sexual assault were more likely to report AB than patients who had not. Similarly, exposure to physical violence was associated with increased odds for SB.

CONCLUSION

Patients with severe PTSD are more likely to experience painful TMD, AB or SB, whereas type of traumatic event can be of influence. These findings can contribute to selecting appropriate treatment modalities when treating patients with painful TMD, AB and SB.

Probable awake bruxism - prevalence and associated factors: a cross-sectional study

Introduction:

Bruxism is defined as a repetitive activity of masticatory muscles, characterized by the clenching or grinding of the teeth, which can occur during wakefulness (awake bruxism) or during sleep (sleep bruxism).

Objectives:

The objectives of the present study were to determine the prevalence of awake bruxism and its associated factors.

Methods:

Sample was composed by 50 participants of both genders, aged between 18 and 60 years, submitted to a clinical examination - to observe the presence of tooth wear, marks on the mucosa, or masseter muscles hypertrophy - and self-applied questionnaires, which evaluated the presence of TMD signs and symptoms, oral behaviors, lifestyles, anxiety level and sleep quality.

Results:

The prevalence of awake bruxism was 48%. Its presence was statistically and significantly associated with the presence of signs and symptoms of TMD (p= 0.002), poor sleep quality (p = 0.032), buccal mucosa indentations (p < 0.001) and tongue (p = 0.011). Age, gender, social characteristics, habits (such as coffee ingestion, smoking, alcoholism and physical activity) and tooth wear were variables that had no significant association with awake bruxism.

Conclusions:

It was concluded that awake bruxism shows a high prevalence and a positive association with signs and symptoms of TMD and worst sleep quality. In addition, awake bruxism is more likely to occur in individuals who have buccal mucosa indentation and who present high rates of oral habits and oral behaviors.

Effects of patient education on the oral behavior of patients with temporomandibular degenerative joint disease: a prospective case series study

OBJECTIVE

To evaluate the effects of patient education and related factors on oral behaviors (OBs) in patients with temporomandibular joint degenerative diseases.

METHODS

Sixty-three patients were included. Temporomandibular joint specialists conducted clinical examinations, provided patient education, and administered the Oral Behavior Checklist (OBC) questionnaire at baseline. Patients were followed up at 6 months.

RESULTS

Eight OBs showed a high incidence among patients. At the 6-month follow-up, the incidence of 6 of the OBs decreased, all of which were high incidence OBs. The frequency of 9 OBs decreased, of which 8 were high incidence OBs. The average OBC score decreased from 22.97 ± 9.30 to 17.90 ± 9.28. Age, education level, and original OBC score had a significant effect on OB improvement.

CONCLUSION

Patient education and the corresponding treatment are conducive to OB improvement. The related factors affecting the improvement in patients' OBs were age, education level, and OB severity.

Lockdown impact on lifestyle and its association with oral parafunctional habits and bruxism in a Spanish adolescent population

AIM

To analyse the possible association between decreased physical and social activity and an increase in the use of mobile devices, internet, and social networks with increased anxiety and the appearance of oral parafunctions and bruxism for adolescents before and during COVID-19.

DESIGN

A total of 213 adolescents attended private clinics at two different times: before lockdown (T0) and after completion of total lockdown (T1). In T0 and T1, a clinical examination was carried out to assess dental wear (IA) and only in T1 were they given the self-report questionnaire which focuses on the periods before and during lockdown (self-reported bruxism, state anxiety, mobile phone and internet, social network use, physical and social activity, and questions on parafunctions).

RESULTS

There were a decrease in physical activity at T0-T1 and an increase in social media use, internet, state anxiety, and clinical and self-reported bruxism at T0-T1. There was a positive correlation between increased self-reported bruxism, increased social media use, mobile device use, and state anxiety.

CONCLUSIONS

There has been a change in adolescent lifestyle during lockdown with an increase in the prevalence of oral parafunctions and bruxism. In particular, the increase in the use of social networks at night and also in anxiety levels during lockdown were associated with of the increase in self-reported bruxism.

Polymorphic variants in genes related to stress coping are associated with the awake bruxism

BACKGROUND

Chronic stress is one of the leading predisposing factors in bruxism aetiology, but the influence of genetic factors is also suggested. We aimed to study whether sequence variants in genes involved in stress regulation pathways: NTRK2 and BDNF, may be associated with awake bruxism susceptibility, clinical presentation, and patients' perceived stress level.

METHODS

The study group included 104 patients with probable awake bruxism and 191 population controls. Patients underwent dental examination concerning the symptoms of bruxism and psychological testing. Genotyping was performed using HRMA and sequencing. Statistical analyses were conducted, and P values below 0.05 were considered statistically significant.

RESULTS

We observed a positive correlation of measured stress level and pathological teeth attrition in the anterior segment (r = 0.45, P < 0.001), enamel attritions (r = 0.44, P < 0.001), tongue impressions (r = 0.50, P < 0.001) and posterior teeth attrition (r = 0.27, P = 0.005). Moreover, the c.196A variant (p.66Met) of the BDNF gene and c.1397-31392G allele of the NTRK2 gene were present with elevated frequency, comparing to controls.

CONCLUSIONS

This study hence the thesis that perceived stress level is a substantial contributing factor to awake bruxism occurrence and its clinical manifestations. Moreover, sequence variants in genes related to stress coping may be correlated with awake bruxism's susceptibility via elevated perceived stress level.

Are oral overuse behaviours associated with painful temporomandibular disorders? A cross-sectional study in Portuguese university students

BACKGROUND

Many different types of oral overuse behaviours occur frequently in adult populations with painful temporomandibular disorders (TMDs). Less is known regarding these behaviours and their associations with TMDs in university students.

OBJECTIVES

Test the association between frequency of different oral overuse behaviours evaluated by the Oral Behaviour Checklist (OBC) and the severity of painful TMDs.

METHODS

In this cross-sectional study, 1381 students from 19 universities in the Oporto District, Portugal, completed the Research Diagnostic Criteria for TMD (RDC/TMD) Personal History Questionnaire and the OBC, and they received an RDC/TMD clinical examination. The OBC sum score (ranging from 0 to 84 points) was classified as normal (0 ≤ 16 points), low overuse (17 ≤ 24) or high overuse (≥25). Painful TMD subtypes (myalgia, arthralgia or combined) were identified. Associations were tested using multivariable binary logistic regression models (α = .05), adjusted for age and sex, and referencing the normal parafunction group.

RESULTS

University students with high overuse were more likely to have a painful TMD: myalgia (OR = 1.9, 95% CL: 1.3-3.0); arthralgia (OR = 2.2; 95% CL: 1.4-3.4), combined (OR = 5.0; 95% CL: 3.1-8.1). Students with low overuse were more likely to have only the combined painful TMD (OR = 2.4; 95% CL: 1.4-4.0) but not the individual painful disorders. Of the 21 different behaviours, 13 were reported at least 50% of the time.

CONCLUSIONS

In this university student sample, oral overuse behaviours are widespread, and their overall extent exhibited a dose-response relationship with respect to severity of painful TMDs based on pain and chronicity. Only some behaviours were independently associated with painful TMDs, suggesting the value of further OBC instrument development.

Association between waking-state oral behaviours, according to the oral behaviors checklist, and TMD subgroups

OBJECTIVES

To assess the association between waking-state oral behaviours and temporomandibular disorder (TMD) subgroups and to develop new scoring methods for the Oral Behavior Checklist (OBC).

METHODS

Patients with any TMD diagnosis, according to the diagnostic criteria for TMD (DC/TMD), were divided into subgroups: 'Dysfunctional-TMD' (n = 70), only mechanical dysfunction; 'Painful-TMD' (n = 204), only myalgia, arthralgia or both; and 'Painful-Dysfunctional TMD' (n = 95), combined pain and dysfunction. A group of individuals without TMD, 'Non-TMD' (n = 374), was used for testing associations. Participants completed the OBC. An exploratory factor analysis, followed by a confirmatory factor analysis of the OBC responses, identified 2 major factors, named non-functional activities (NFA) and functional activities (FA). Component total scores were computed. Differences among subgroups for OBC-MS (mean score) and NFA and FA factor scores were estimated using one-way ANOVA and Tukey post hoc tests. Significance was set at p < .05.

RESULTS

The OBC-MS in Non-TMD, Painful-TMD and Painful-Dysfunctional TMD subgroups was higher than in the Dysfunctional-TMD subgroup (p ≤ .001). NFA in Painful-TMD and Painful-Dysfunctional TMD subgroups were higher than in the Non-TMD group (p < .05); NFA in the Dysfunctional-TMD subgroup were lower than in the Painful-TMD subgroup (p = .034). In contrast, FA in Painful-TMD, Dysfunctional-TMD and Painful-Dysfunctional TMD subgroups were lower than in the Non-TMD group (p < .0001).

CONCLUSIONS

A new scoring method for the OBC results in item reduction and creation of meaningful subscales for functional and non-functional behaviours, which are differentially associated with painful and dysfunctional TMDs. This may help clinicians to better tailor treatment for the management of subtypes of TMD patients.

Prognostic factor analysis in patients with temporomandibular disorders after reversible treatment: study protocol for a prospective cohort study in China

INTRODUCTION

Temporomandibular disorders (TMDs) are complex multifactorial disorders. Reversible treatment has been suggested for the initial management of TMD; however, comparable therapeutic effects of different reversible intervention modalities remain controversial. Various biopsychosocial factors, which may be putative prognostic factors that influence the response to reversible treatment for TMD, have been reported to increase the risk of developing first-onset TMD. However, there is a paucity of research that aims to identify prognostic factors associated with the clinical outcomes of reversible treatment in people with TMD. The objective of this prospective cohort study is to identify prognostic factors that are associated with clinical outcomes of reversible treatment in patients with TMD and to analyse the risk factors that influence the development of chronic TMD.

METHODS AND ANALYSIS

We plan to recruit 834 patients with TMD who meet the inclusion criteria. Once informed consent is obtained, baseline data, including anamnestic data, physical assessments and self-report questionnaires, will be collected from participants at their first clinic visit; subsequently, they will receive 1-4 weeks of reversible treatment. The primary treatment outcome measures will be a change in the anterior maximum mouth opening, worsening of TMD pain scores assessed using a visual analogue scale (VAS) and a reduction in characteristic pain intensity. A good outcome will be defined as an anterior maximal opening ≥35 mm and at least a 30% reduction in VAS scores 3 months after baseline. The association between candidate prognostic factors and clinical outcomes of reversible TMD treatment will be analysed.

ETHICS AND DISSEMINATION

The protocol has been approved by the Ethics Committee of Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, based on the guidelines outlined in the Declaration of Helsinki (SH9H-2019-T316-4). The results of this study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. The authors intend to publish the results in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

ChiCTR2000033328.

Treatment responses in chronic temporomandibular patients depending on the treatment modalities and frequency of parafunctional behaviour

OBJECTIVES

(i) To evaluate the effect of three different interventions on treatment outcomes and (ii) to determine how the frequency of oral parafunction influences the effectiveness of the different therapeutic modalities.

METHODS

Forty-five participants were randomly assigned into three treatment groups [physical therapy (PT), stabilisation splint (SS) and control therapy (CT)]. According to Oral Behavior Checklist score, participants were divided into "high-frequency parafunction" (HFP) and low-frequency parafunction" (LFP) group. Primary (spontaneous pain and characteristic pain intensity) and secondary outcomes (range of mouth opening, anxiety symptoms, quality of life, perceived stress and global functional limitation) were evaluated during six-month treatment period.

RESULTS

Participants in PT group showed a significant reduction in characteristic pain intensity (p = .047, η²  = 0.243) when compared to SS and CT group, but significant improvement in spontaneous pain was found in all treatment groups. Patients treated with PT and SS exhibited significantly stronger improvement in pain-free mouth opening than patients in CT group (3rd month: p=.037, η2=0.258; 6th month: p = .005, η²  = 0.383). Within-group analyses showed significant decrease of perceived stress, anxiety symptoms and global functional limitation only in PT group over a six-month treatment period. Participants with HFP presented significantly greater levels of anxiety (3rd month: p = .009, η²  = 0.275; 6th month: p = .041, η²  = 0.176) than participants with LFP. Within-group analyses, however, showed significant improvement of anxiety, but also the decrease of perceived stress and improvement of global limitation for the HFP group but not for the LFP group.

CONCLUSION

Although no treatment can be marked as superior in terms of spontaneous pain relief, PT was more effective when observing relief of characteristic pain intensity. In HFP group the reduction of anxiety, stress and functional limitation was present regardless of the applied therapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04694274. Registered on 01/04/2021.

The Impact of Education and Physical Therapy on Oral Behaviour in Patients with Temporomandibular Disorder: A Preliminary Study

Patient education is important in the treatment of temporomandibular disorder (TMD), but little is known about its effect on oral behaviors. We aimed to determine the dominant oral behaviours in patients with TMD and assess the impact of education on such behaviours. Between July 2018 and April 2019, 54 patients diagnosed with TMD according to DC/TMD were recruited. They received physical therapy and were provided education on TMD and offered a list of recommendations for improving their oral behaviours. The patient education process usually lasted for 10–20 min. Of these patients, 48 were reexamined at the outpatient clinic, 3–9 months posttreatment. We recorded the Oral Behaviour Checklist (OBC) score, maximum painless mouth opening (mm), visual analogue scale (VAS) score for pain, and Jaw Functional Limitation Scale (JFLS) score pre- and posttreatment. Wilcoxon signed rank test and paired sample t-test were used for statistical analysis. Results showed that the most dominant oral behaviours included “putting pressure on the jaw” (59.3%); “chewing food on one side” (46.3%); “pressing, touching, or holding teeth together at times other than eating” (33.3%); and “eating between meals” (33.3%). Posttreatment, the patients reported a decrease in “chewing gum” (P = 0.002), “leaning with the hand on the jaw” (P = 0.013), “chewing food on one side” (P ≤ 0.001), and “eating between meals” (P = 0.007), but this change was not significant in subgroups with a follow-up interval of 9 months. We also observed a significant improvement in the maximum painless mouth opening (P ≤ 0.001), JFLS score (P ≤ 0.001), and VAS score (P ≤ 0.001) for pain, posttreatment. In conclusion, patient education can facilitate management of oral behaviours and should be targeted towards specific oral behaviours.

Evaluation of temporomandibular disorders, quality of life, and oral habits among dentistry students

Objective: To evaluate temporomandibular disorders (TMD), quality of life, and oral habits in dentistry students.Methods: The study was performed with 480 students (287 females, 193 males). The Fonseca Questionnaire, Oral Health Impact Profile-14 (OHIP-14), and Oral Behaviors Checklist (OBC) were used.Results: The mean scores of the fifth-year students from Fonseca TMD, OHIP-14, and OBC were statistically significantly higher than those of the students in other years of study. The mean Fonseca score of female students was higher than those of the males. There was a statistically significant difference regarding the OHIP-14 scores based on the Fonseca TMD scores. A statistically significant difference regarding OBC was present based on the Fonseca TMD scores.Conclusion: The prevalence of TMDs was higher among the senior dentistry students. Necessary measures should be taken in the dentistry educational system to raise students' quality of life, improve joint disorders, and eliminate current oral habits.

The association of self-reported awake bruxism with anxiety, depression, pain threshold at pressure, pain vigilance, and quality of life in patients undergoing orthodontic treatment

This study aimed to evaluate whether the presence of awake bruxism was associated with temporomandibular dysfunction symptoms, pain threshold at pressure, pain vigilance, oral health-related quality of life (OHRQoL), and anxiety and depression symptoms in patients undergoing orthodontic treatment.

Evaluation of temporomandibular disorder symptoms and oral health-related quality of life in adolescent orthodontic patients with different dental malocclusions

Objective: To estimate the prevalence of temporomandibular disorders in adolescent orthodontic patients with different dental malocclusions and to assess the relationship between oral health-related quality of life.Methods: This study was carried out on 648 randomly selected individuals 14-19 years of age. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), Fonseca Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) forms were used.Results: TheGCPS,TMDPain,Fonseca,OHIP-14, PHQ-9, GAD-7,OBC,andPHQ-15 mean scores of female participants were statistically significantly higher than males (p < 0.05).There was a significant difference among the malocclusion groups in terms of their mean scores in GCPS, Fonseca, and OHIP-14 (p < 0.05).The age values and JFLS, TMD Pain, Fonseca, OHIP-14, PHQ-9, GAD-7, and PHQ-15 were statistically significant correlations in the positive direction.Conclusion: The DC/TMD form allows both a physical assessment of Axis I and II that examines psychosocial status and pain-related disorders and a more comprehensive assessment. The mean OHIP-14 and Fonseca questionnaire scores of Class III groups were found to be significantly higher.

Osteovox self-management concept study. Part 1: Focus on the population

Objective: To analyze the prevalence of parafunctional behaviors in patients suffering from painful temporomandibular disorders (TMD) during the selection process of the study.Methods: This multidisciplinary study was based on seven selection criteria, of which the two main ones were parafunctions and symptomatology. The main clinical outcomes were (1) the type of TMD, (2) psychological symptoms, and (3) otological symptoms. From 409 consecutive examinations for TMD, 107 subjects met all criteria.Results: During the selection process, among the 409 subjects, 81.9% were diagnosed with parafunctions. After the selection process, among the 107 parafunctional subjects, pain (71%) was more disabling than functional limitations (29%). Most patients (74%) exceeded the thresholds of psychometric scales. Otological symptoms were observed in 52% of the subjects.Discussion: The study highlighted the importance of parafunctions and psychological factors in patients with painful TMD. Treatment should include all factors identified in this study (see Part 2).

Osteovox self-management concept study. Part 2: focus on the therapy

Objective: To evaluate the effect of a self-management program on a population with both painful temporomandibular disorder (TMD) and parafunctional behaviors. Methods: One hundred-seven participants enrolled in a program called Osteovox Self-Management Concept (OSMC). The primary outcome measure was the overall relief (OR) based on four pain and three functional limitation parameters. The secondary outcome measures concerned parafunctional behaviors, compliance with treatment, and several psychological and otological symptoms. Results: The mean OR was 47% (standard deviation (SD): 28%) after 1 month, 72% (SD: 26%) after 3 months, and 77% (SD: 23%) after 6 months. Significant OR (i.e., 60%-100%) was observed in 80.11% of the patients. OR was strongly correlated with compliance. The OSMC efficiently reduced parafunctional behaviors and otological symptoms. Discussion: This study demonstrated that OSMC is an effective, simple, short, and inexpensive therapy. This type of treatment follows the international recommendations of using reversible treatment for TMD.

Are vocalists prone to temporomandibular disorders?

Background

As vocalists demand high physical strains of the masticatory system, singing is frequently mentioned as a risk factor for temporomandibular disorders (TMDs).

Objectives

This study investigated whether vocalists report a higher prevalence of two types of TMDs (viz., TMD pain and temporomandibular joint sounds) compared with instrumentalists who do not load their masticatory system while performing. In addition, we examined which risk indicators are associated with the presence of these TMDs among musicians.

Methods

A total of 1470 musicians from 50 different music ensembles completed a questionnaire. Of these musicians, 306 were vocalists (mean age ± SD 37.5 ± 17.7 years; 63.9% female) and 209 musicians enrolled the control group (mean age ± SD 42.7 ± 18.0 years; 40.7% female).

Results

The prevalence of self‐reported TMD pain among vocalists was 21.9%, as compared to 12.0% in the control group. 20.0% of the vocalists reported TMJ sounds versus 15.1% of the controls. The multiple regression models indicated that being a vocalist was not a risk indicator for the presence of self‐reported TMD pain nor for self‐reported TMJ sounds. Instead, it appeared that the report of TMD pain among musicians was positively associated with female gender, next to the level of physical workload, depicted as frequency of oral behaviours and the hours of daily practice. Musicians’ report of TMJ sounds was associated with oral behaviours.

Conclusion

This study shows that singing is not associated with the reports of TMD pain and TMJ sounds, after adjusting for potentially confounding variables included in the models.

Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians

The study aims to investigate signs and symptoms of temporomandibular disorders (TMD) among physicians in a tertiary health-care center. It has estimated the level of symptomatology, determined the association with demographic data, and identified the related occupational risk factors. A cross-sectional survey was used, and physicians of genders, all age groups, and nationalities from King Abdulaziz Medical City in Riyadh, Saudi Arabia, were recruited. Subjects who had rheumatic arthritis, osteoarthritis, trigeminal neuralgia, or temporomandibular joint (TMJ) trauma were excluded. The data were collected through a self-administered questionnaire that measured TMD severity and oral parafunctional behaviors. Fonseca's anamnestic index (FAI) and an oral validated behavior checklist were used to assess the signs and symptoms of TMD. A total of 282 physicians participated in the study, and the prevalence of TMD signs among physicians was 37% (106); among them, 88 (83%) were within the light dysfunction category. Female physicians reported significantly higher FAI than males for side-to-side mandibular movement (12% vs. 5%, P = 0.04), reporting ear pain (18% vs. 10%, P = 0.04), and noticing clicking when chewing or opening the mouth (35% vs. 20%, P = 0.006). Younger practitioners (28-31 years old) who reported clicking while chewing or opening the mouth tended to have reported higher TMD dysfunction (35%) than those aged 40 and above (13%; P = 0.007). Self-reported signs of TMD were 37% among our population. Information collected from FAI is useful in early diagnosis and prevention of TMD.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

The Role of Stress in the Etiology of Oral Parafunction and Myofascial Pain

Oral parafunction during waking comprises possible behaviors that can be measured with a comprehensive checklist or behavioral monitoring. Multiple studies lead to largely consistent findings: stressful states can trigger parafunctional episodes that contribute to myofascial pain. However, this simple causal pathway coexists with at least 3 other pathways: anxiety and stress are potent direct contributors to pain, pain results in maladaptive behaviors such as parafunction, and parafunction may be a coping response to potential threat coupled with hypervigilance and somatosensory amplification. Awake parafunction remains an important risk factor for myofascial pain onset and overuse models alone of causation are insufficient.

Associations between sleep bruxism and (peri-) implant complications: a prospective cohort study

Objectives/Aims:

To describe the protocol of a prospective cohort study designed to answer the question: ‘Is sleep bruxism a risk factor for (peri-)implant complications?’.

Materials and Methods:

Our study is a single-centre, double-blind, prospective cohort study with a follow-up time of 2 years. Ninety-eight participants fulfilling inclusion criteria (planned treatment with implant-supported fixed suprastructure(s) and age 18 years or older) will be included. Sleep bruxism will be monitored at several time points as masticatory muscle activity during sleep by means of a portable single-channel electromyographic device. Our main outcomes are biological complications (i.e., related to peri-implant bleeding, probing depth, marginal bone height, quality of submucosal biofilm and loss of osseointegration) and technical complications (i.e., suprastructure, abutment, implant body or other).

Results:

The study is currently ongoing, and data are being gathered.

Discussion:

The results of this prospective cohort study will provide important information for clinicians treating bruxing patients with dental implants. Furthermore, it will contribute to the body of evidence related to the behaviour of dental implants and their complications under conditions of high mechanical loadings that result from sleep bruxism activity.

Conclusion:

The protocol of a prospective cohort study designed to investigate possible associations between sleep bruxism and (peri-) implant complications was presented.

Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network

BACKGROUND

Cracked teeth are ubiquitous in the adult dentition. The objective of this study was to determine which patient traits and behaviors and external tooth and crack characteristics correlate with cracked teeth being symptomatic.

METHODS

Dentists in The National Dental Practice-Based Research Network enrolled a convenience sample of patients each with a single, vital posterior tooth with at least 1 observable external crack in this observational study; they enrolled 2,975 cracked teeth from 209 practitioners. The authors collected data at the patient level, tooth level, and crack level. They used generalized estimating equations to obtain significant (P < .05) independent odds ratios (OR) associated with teeth that were symptomatic for a crack.

RESULTS

Characteristics positively associated with cracked tooth symptoms, after adjusting for demographics, included patients who clenched, ground, or pressed their teeth together (OR, 1.30; 95% confidence interval [CI], 1.12-1.50), molars (OR, 1.58; 95% CI, 1.30-1.92), teeth with a wear facet through enamel (OR, 1.22; 95% CI, 1.01-1.40), carious lesions (OR, 1.31; 95% CI, 1.07-1.60), cracks that were on the distal surface of the tooth (OR, 1.31; 95% CI, 1.13-1.52), and cracks that blocked transilluminated light (OR, 1.31, 95% CI, 1.09-1.57). Teeth with stained cracks were negatively associated with having cracked tooth symptoms (OR, 0.68; 95% CI, 0.55-0.84).

CONCLUSIONS

The greatest likelihood of a cracked tooth being symptomatic was found when patients reported clenching or grinding their teeth and had a molar with a distal crack that blocked transilluminated light.

PRACTICAL IMPLICATIONS

This information can help inform dentists in the decision-making process regarding the prognosis for a cracked tooth.

Association between waking-state oral parafunctional behaviours and bio-psychosocial characteristics

The term 'oral parafunctional behaviours' encompasses behaviours that are different from those required for, or associated with, physiological functional needs such as mastication, communication, swallowing or breathing. Previous reports have associated waking-state oral parafunctional behaviours with biopsychosocial characteristics such as female gender, presence of psychological symptoms, intensity of pain and pain-related temporomandibular disorders (TMD) diagnosis. However, the findings have been inconsistent, possibly due to methodological limitations and differences. In the present investigation, we aim to determine whether any association is present between waking-state oral parafunctional behaviours and biopsychosocial characteristics. All participants were investigated using a set of standardised and validated self-reporting questionnaires and diagnostic criteria for temporomandibular disorders (DC/TMD) examination protocol for clinical characterisation. Univariate analysis found that self-reported waking-state oral parafunctional behaviours were statistically significantly associated with presence of anxiety, depression and physical symptoms, pain intensity and TMD diagnosis. However, forward model multiple linear regression analysis indicated that only self-reported presence of physical and depression symptoms could explain statistically significant portions of the variance in self-reported waking-state oral parafunctional behaviours.