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Yanez-Regonesi F, Sangalli L, Robinson C, de Leeuw R. The relationship between possible, probable, or definite sleep bruxism and sleep quality: A systematic review. J Sleep Res 2024; 33:e14114. [PMID: 38053442 DOI: 10.1111/jsr.14114] [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: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
It has been suggested that sleep bruxism may interrupt sleep continuity, hence potentially influencing sleep quality. The aim of this study was to systematically review the relationship between possible, probable, and definite sleep bruxism and sleep quality in otherwise healthy individuals. A systematic search on sleep bruxism and sleep quality was performed in seven databases until 19 December 2022. Eligible articles were screened, and quality assessment was performed via the Joanna Briggs Institute Scale. Of 3681 articles screened, 13 were included in this study. Of these, six evaluated the relationship between sleep quality and possible sleep bruxism, three with probable sleep bruxism, and four with definite sleep bruxism. An association between poor sleep quality and sleep bruxism was found among those individuals diagnosed with possible and probable sleep bruxism. However, the studies conducted in individuals with definite sleep bruxism failed to demonstrate any association. With more reliable measures to evaluate sleep bruxism, a relationship between sleep bruxism and sleep quality was not evident.
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Affiliation(s)
- Fernanda Yanez-Regonesi
- Department of Oral Health Science, Orofacial Pain Clinic, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Linda Sangalli
- College of Dental Medicine - Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Cayla Robinson
- Libraries, Medical Center Library, University of Kentucky, Lexington, Kentucky, USA
| | - Reny de Leeuw
- Department of Oral Health Science, Orofacial Pain Clinic, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
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Zieliński G, Pająk A, Wójcicki M. Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4259. [PMID: 39064299 PMCID: PMC11278015 DOI: 10.3390/jcm13144259] [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: 07/03/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: The purpose of this systematic review was to assess the global prevalence of sleep bruxism and awake bruxism in pediatric and adult populations. Methods: This systematic review was conducted by analyzing studies published from 2003 to 2023. The following keyword combination was utilized: prevalence, epidemiology, population, and bruxism. The PubMed database was analyzed, supplemented by manual searches using the Google search. Additionally, the snowballing procedure method was applied. A double assessment of the quality of publications was carried out to preserve the highest possible quality of evidence (e.g., Joanna Briggs Institute critical appraisal checklist). Analyses were conducted using the R statistical language. Results: The global bruxism (sleep and awake) prevalence is 22.22%. The global sleep bruxism prevalence is 21% and awake prevalence is 23%. The occurrence of sleep bruxism, based on polysomnography, was estimated at 43%. The highest prevalence of sleep bruxism was observed in North America at 31%, followed by South America at 23%, Europe at 21%, and Asia at 19%. The prevalence of awake bruxism was highest in South America at 30%, followed by Asia at 25% and Europe at 18%. Conclusions: One in four individuals may experience awake bruxism. Bruxism is a significant factor among women. It was observed that age is a significant factor for the occurrence of sleep bruxism in women. Among the limitations of the study is the lack of analysis of the prevalence of bruxism in Africa and Australia due to not collecting an adequate sample for analysis. The study was registered in the Open Science Framework (10.17605/OSF.IO/ZE786).
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Affiliation(s)
- Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Agnieszka Pająk
- Clinic of Anaesthesiology and Paediatric Intensive Care, Medical University of Lublin, Gebali Str. 6, 20-093 Lublin, Poland
| | - Marcin Wójcicki
- Independent Unit of Functional Masticatory Disorder, Medical University of Lublin, 20-093 Lublin, Poland
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Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, De Beaumont L, Lavigne GJ, Martel MO. The Contribution of Sleep Quality and Psychological Factors to the Experience of Within-Day Pain Fluctuations Among Individuals With Temporomandibular Disorders. THE JOURNAL OF PAIN 2024:104576. [PMID: 38796127 DOI: 10.1016/j.jpain.2024.104576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
We assessed the impact of day-to-day sleep quality and psychological variables (catastrophizing, negative affect, and positive affect) to within-day pain fluctuations in 42 females with painful temporomandibular disorders (TMD) using electronic diaries. More specifically, we examined the contribution of these variables to the likelihood of experiencing pain exacerbations defined as 1) an increase of 20 points (or more) in pain intensity on a 0 to 100 visual analog scale from morning to evening, and/or 2) a transition from mild-to-moderate pain over the course of the day; and pain decreases defined as 3) a decrease of 20 points (or more) in pain intensity (visual analog scale) from morning to evening, and/or 4) a reduction from moderate-to-mild pain over the day. The results indicated significantly main effects of sleep on both pain exacerbation outcomes (both P's < .05), indicating that nights with better sleep quality were less likely to be followed by clinically meaningful pain exacerbations on the next day. The results also indicated that days characterized by higher levels of catastrophizing were associated with a greater likelihood of pain exacerbations on the same day (both P's < .05). Daily catastrophizing was the only variable significantly associated with within-day pain decrease indices (both P's < .05). None of the other variables were associated with these outcomes (all P's > .05). These results underscore the importance of addressing patients' sleep quality and psychological states in the management of painful TMD. PERSPECTIVES: These findings highlight the significance of sleep quality and pain catastrophizing in the experience of within-day pain fluctuations among individuals with TMD. Addressing these components through tailored interventions may help to alleviate the impact of pain fluctuations and enhance the overall well-being of TMD patients.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada.
| | - Catherine Provost
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Lee YH, Chung JW. Climate temperature and seasonal influences on the prevalence of temporomandibular disorders in South Korea. Sci Rep 2024; 14:10974. [PMID: 38744911 PMCID: PMC11094084 DOI: 10.1038/s41598-024-61829-2] [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: 12/29/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
This study aimed to explore seasonal variations in temporomandibular disorder (TMD) prevalence in South Korea, utilizing nationwide population-based big data. Data corresponding to the Korean Standard Classification of Diseases code of K07.6, which identifies TMD, were extracted from the Health Insurance Review and Assessment Service online platform for the period from 2010 to 2022. Additionally, we integrated these data with climate temperature records from the Korean Meteorological Administration. We subsequently conducted a statistical analysis of TMD patient data on a monthly and seasonal basis over the past 13 years to assess prevalence. Over the past 13 years, the number of TMD patients in Korea has steadily increased. The prevalence of TMD rose from 0.48% (224,708 out of a total population of 50,515,666) in 2010 to 0.94% (482,241 out of a total population of 51,439,038) in 2022, marking a 1.96-fold increase. Among children under 10 years of age, no significant differences were observed in TMD prevalence between boys and girls. However, a distinct female predominance emerged after the age of 10, with an average female-to-male ratio of 1.51:1. The peak prevalence of TMD occurred in individuals in their 20 s, followed by adolescents in their late 10 s. The majority of TMD patients were concentrated in Seoul and Gyeonggi province, with metropolitan areas accounting for 50% of the total patient count. Seasonally, TMD patient numbers showed no significant increase in winter compared with spring or summer. The temperature difference, defined as the absolute difference between the highest and lowest temperatures for each month, showed a positive correlation with TMD patient counts. A greater temperature difference was associated with higher patient counts. The strongest correlation between temperature differences and TMD patient numbers was observed in winter (r = 0.480, p < 0.01), followed by summer (r = 0.443, p < 0.01), and spring (r = 0.366, p < 0.05). Temperature differences demonstrated a significantly stronger correlation with the increase in the number of TMD patients than absolute climate temperatures. This aspect should be a key consideration when examining seasonal trends in TMD prevalence in South Korea.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, College of Dentistry, Kyung Hee University Dental Hospital, Kyung Hee University, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Jin-Woo Chung
- Department of Oral Medicine and Oral Diagnosis, Seoul National University School of Dentistry, #101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Abstract
Temporomandibular disorders (TMDs) and headache disorders are highly prevalent in the population. TMDs can present headache symptoms as a secondary headache and, in addition, be comorbid with primary headache disorders. This overlap has significant clinical implications for which it is essential for the physician to be aware, and they should screen for the potential presence of TMDs in a headache patient. Bruxism is a parafunctional behavior also prevalent in the population which has a role in TMDs and may influence headache symptomatology, but it is still necessary to clarify this relationship.
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Affiliation(s)
- Marcela Romero-Reyes
- Brotman Facial Pain Clinic, University of Maryland, School of Dentistry; Department of Neural and Pain Sciences, University of Maryland, Baltimore, School of Dentistry, 650 West Baltimore Street, Room 8253, Baltimore, MD 21201, USA.
| | - Jennifer P Bassiur
- Center for Oral, Facial & Head Pain, College of Dental Medicine, Columbia University Medical Center; Division of Oral & Maxillofacial Surgery, 620 West 168th Street, P & S Box 20, New York, NY 10032, USA
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Lito MFP, Knorst JK, Noronha TG, Pohl MB, Brondani B, de Araújo G, Ardenghi TM, Tomazoni F. Impact of the COVID-19 pandemic on sleep bruxism among adolescents in Brazil: A longitudinal study. Oral Dis 2024; 30:2678-2684. [PMID: 37759359 DOI: 10.1111/odi.14714] [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: 02/23/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/29/2023]
Abstract
AIM To evaluate the immediate and late impact of the COVID-19 pandemic on the occurrence of possible sleep bruxism (SB) among adolescents in Brazil. DESIGN This is a longitudinal study performed with adolescents (11-15 years old) from Southern Brazil. Baseline data were collected before the Brazilian COVID-19 outbreak (T1). Posteriorly, data were collected after 3 (T2) and 15 months under the Brazilian COVID-19 outbreak. The possible SB was evaluated by the question: 'Do you grind your teeth during your sleep?'. Sociodemographic, psychosocial and clinical variables were also collected. Changes in SB were evaluated by multilevel logistic regression models for repeated measures. RESULTS Of the 290 adolescents assessed at T1, 182 were reassessed at both follow-ups. The prevalence of possible SB was 13% at T1, 11% at T2 and 22% at T3. There were no immediate effects of the COVID-19 pandemic on the occurrence of possible SB (T2). Adolescents had odds 2.77 times greater of presented possible SB after 15 months (T3) of COVID-19 pandemic scenarios when compared to T1. CONCLUSION There was a considerable and late increase in the possible SB in adolescents in Brazil during the COVID-19 pandemic.
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Affiliation(s)
| | - Jessica Klöckner Knorst
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thaís Gioda Noronha
- Post Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Marina Blanco Pohl
- Post Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Bruna Brondani
- Post Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Gabriela de Araújo
- Post Graduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fernanda Tomazoni
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
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Herrero Babiloni A, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, Martel MO, De Beaumont L. One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders. J Oral Rehabil 2024; 51:827-839. [PMID: 38225806 DOI: 10.1111/joor.13655] [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: 06/29/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) are characterised by chronic pain and dysfunction in the jaw joint and masticatory muscles. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-invasive treatment for chronic pain; however, its effectiveness in individuals with TMD has not been thoroughly investigated. This study aimed to evaluate the immediate and sustained (over seven consecutive days) effects of a single session of active rTMS compared to sham stimulation on pain intensity and pain unpleasantness in individuals with TMD. METHODS A randomised, double-blind, sham-controlled trial enrolled 41 female participants with chronic TMD. Pain intensity and pain unpleasantness were assessed immediately pre- and post-intervention, as well as twice daily for 21 days using electronic diaries. Secondary outcomes included pain interference, sleep quality, positive and negative affect and pain catastrophizing. Adverse effects were monitored. Repeated measures ANOVA and multilevel modelling regression analyses were employed for data analysis. RESULT Active rTMS demonstrated a significant immediate mild reduction in pain intensity and pain unpleasantness compared to sham stimulation. However, these effects were not sustained over the 7-day post-intervention period. No significant differences were observed between interventions for pain interference, sleep quality and negative affect. A minority of participants reported minor and transient side effects, including headaches and fatigue. CONCLUSION A single session of active rTMS was safe and led to immediate mild analgesic effects in individuals with TMD compared to sham stimulation. However, no significant differences were observed between interventions over the 7-day post-intervention period. Based on this study, rTMS stimulation appears to be a promising safe approach to be tested in TMD patients with longer stimulation protocols.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Thomas DC, Manfredini D, Patel J, George A, Chanamolu B, Pitchumani PK, Sangalli L. Sleep bruxism: The past, the present, and the future-evolution of a concept. J Am Dent Assoc 2024; 155:329-343. [PMID: 38363252 DOI: 10.1016/j.adaj.2023.12.004] [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: 09/09/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded. TYPES OF STUDIES REVIEWED The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles. RESULTS There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB. CONCLUSIONS AND PRACTICAL IMPLICATIONS The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.
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Di Francesco F, Minervini G, Siurkel Y, Cicciù M, Lanza A. Efficacy of acupuncture and laser acupuncture in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. BMC Oral Health 2024; 24:174. [PMID: 38308258 PMCID: PMC10837950 DOI: 10.1186/s12903-023-03806-1] [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: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture and laser acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). The aim of this article was to assess the clinical evidence for acupuncture and laser acupuncture therapies as treatment for temporomandibular joint disorder (TMD). MATERIALS AND METHODS This systematic review includes randomized clinical trials (RCTs) of acupuncture and laser acupuncture as a treatment for TMD compared to other treatments. Systematic searches were conducted in 3 electronic databases up to July 2023; PubMed, EMBASE, and SCOPUS databases. All RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. The Cochrane risk of bias tool (RoB 2) tool was employed to analyze randomized controlled trials. A Meta-analysis was performed in order to investigate a quantitative analysis comparing acupuncture and laser acupuncture to placebo. RESULTS A total of 11 RCTs met our inclusion criteria. The findings show that acupuncture is short-term helpful for reducing the severity of TMD pain with muscle origin. Meta-analysis revealed that the Acupuncture group and Laser Acupuncture group had a higher efficacy rate than the Placebo control group, showing a high efficacy of Acupuncture and Laser Acupuncture group in the treatment of temporomandibular. CONCLUSIONS In conclusion, our systematic review demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication. However high efficacy of Laser Acupuncture in the treatment of temporomandibular disorders was reported.
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Affiliation(s)
- Fabrizio Di Francesco
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Campania University Luigi Vanvitelli, Naples, Italy.
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Campania University Luigi Vanvitelli, Naples, Italy.
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
| | - Yuliia Siurkel
- International European University School of Medicine, Akademika Hlushkova Ave, 42В, Kyiv, 03187, Ukraine.
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, Catania, 95124, Italy
| | - Alessandro Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Campania University Luigi Vanvitelli, Naples, Italy
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Minervini G, Di Blasio M, Franco R, Marrapodi MM, Vaienti B, Cicciù M, Ronsivalle V. Prevalence of temporomandibular disorders diagnosis in patients treated with Herbst appliance: a systematic review and meta-analysis. BMC Oral Health 2024; 24:137. [PMID: 38281907 PMCID: PMC10822183 DOI: 10.1186/s12903-023-03738-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: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The Herbst appliance is an excellent therapy for treating class II malocclusions with increased overjet. Its mechanics involve propelling the mandibular bone using two pistons the patient cannot remove. The so-called bite-jumping keeps the mandible in a more anterior position for a variable period, usually at least 6 months. This appliance does not inhibit joint functions and movements, although there are scientific papers in the literature investigating whether this appliance can lead to temporomandibular disorders. This systematic review aims to evaluate whether Herbst's device can cause temporomandibular diseases by assessing the presence of TMD in patients before and after treatment. METHODS A literature search up to 3 May 2023 was carried out on three online databases: PubMed, Scopus and Web of Science. Only studies that evaluated patients with Helkimo scores and Manual functional analysis were considered, as studies that assessed the difference in TMD before and after Herbst therapy. Review Manager version 5.2.8 (Cochrane Collaboration) was used for the pooled analysis. We measured the odds ratio (OR) between the two groups (pre and post-Herbst). RESULTS The included papers in this review were 60. Fifty-seven were excluded. In addition, a manual search was performed. After the search phase, four articles were considered in the study, one of which was found through a manual search. The overall effect showed that there was no difference in TMD prevalence between pre-Herbst and post-Herbst therapy (OR 0.74; 95% CI: 0.33-1.68). CONCLUSION Herbst appliance seems not to lead to an increase in the incidence of TMD in treated patients; on the contrary, it appears to decrease it. Further studies are needed to assess the possible influence of Herbst on TMDs.
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Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Caserta, 81100, Italy.
| | - Marco Di Blasio
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00100, Rome, Italy.
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy.
| | - Benedetta Vaienti
- Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
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11
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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: 8] [Impact Index Per Article: 8.0] [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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12
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Manfredini D, Ahlberg J, Aarab G, Bracci A, Durham J, Emodi-Perlman A, Ettlin D, Gallo LM, Häggman-Henrikson B, Koutris M, Peroz I, Svensson P, Wetselaar P, Lobbezoo F. The development of the Standardised Tool for the Assessment of Bruxism (STAB): An international road map. J Oral Rehabil 2024; 51:15-28. [PMID: 36261916 DOI: 10.1111/joor.13380] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.
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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 Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Justin Durham
- Newcastle University's School of Dental Sciences, Newcastle, UK
| | - Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dominik Ettlin
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Berne, Berne, Switzerland
| | - Luigi M Gallo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Birgitta Häggman-Henrikson
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
- Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingrid Peroz
- Department for Prosthodontics, Charité-University Medicine of Berlin, Charité Centre for Dentistry, Gerodontology and Craniomandibular Disorders, Berlin, Germany
| | - Peter Svensson
- Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - 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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13
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Herrero Babiloni A, Jodoin M, Provost C, Charlebois-Plante C, De Koninck BP, Apinis-Deshaies A, Lavigne GJ, De Beaumont L. Females with painful temporomandibular disorders present higher intracortical facilitation relative to pain-free controls. Clin Oral Investig 2023; 28:12. [PMID: 38129743 DOI: 10.1007/s00784-023-05412-5] [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: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to investigate cortical excitability differences in the primary motor cortex (M1) hand representation between individuals with temporomandibular disorders (TMD) and healthy controls. We assessed resting motor thresholds, motor-evoked potentials (MEPs), intracortical inhibition, and intracortical facilitation and explored potential associations with clinical and psychosocial characteristics in the TMD group. MATERIALS AND METHODS We recruited 36 female participants with TMD and 17 pain-free controls. Transcranial magnetic stimulation (TMS) was used to assess M1 cortical excitability. Correlations between clinical and psychosocial factors and cortical excitability measures were also evaluated. RESULTS Patients with TMD showed significantly higher intracortical facilitation at 12 ms (z = 1.98, p = 0.048) and 15 ms (z = 2.65, p = 0.008) when compared to controls. Correlations revealed associations between intracortical facilitation and pain interference, sleep quality, depressive symptoms, and pain catastrophizing in the TMD group. CONCLUSIONS Females with TMD exhibit heightened motor cortex intracortical facilitation in the hand representation, potentially indicating altered cortical excitability beyond the motor face area. This suggests a role for cortical excitability in TMD pathophysiology, influenced by psychosocial factors. CLINICAL RELEVANCE Understanding cortical excitability in TMD may inform targeted interventions. Psychosocial variables may play a role in cortical excitability, emphasizing the multidimensional nature of TMD-related pain. Further research is needed to confirm and expand upon these findings, with potential implications for the management of TMD and related pain conditions.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada.
| | - Marianne Jodoin
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Provost
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Camille Charlebois-Plante
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Beatrice P De Koninck
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Amelie Apinis-Deshaies
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Sacre-Coeur Hospital, CIUSSS NIM Research Center, CEAMS, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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14
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Chattrattrai T, Janal MN, Lobbezoo F, Raphael KG. The association between sleep bruxism and awake bruxism: Polysomnographic and electromyographic recordings in women with and without myofascial pain. J Oral Rehabil 2023; 50:822-829. [PMID: 37073471 PMCID: PMC10524115 DOI: 10.1111/joor.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/07/2023] [Accepted: 04/13/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Sleep bruxism (SB) and awake bruxism (AB) are masticatory muscle activities that are rarely assessed in the same individuals and are thought to be associated with different behaviours. OBJECTIVES To investigate whether individuals engaging in SB also engage in AB, that occurs during rest and during stress-related activity, and to investigate whether SB and AB are associated with different characteristics. METHODS Females with myofascial pain (N = 122) and non-myofascial pain controls (N = 46) were evaluated for SB events and for AB events at rest and AB during stress-related activity, using electromyographic (EMG) recordings and a standardised scoring of bruxism events. The joint distributions between SB and AB events and EMG activity were evaluated, and the characteristic qualities of SB and AB were assessed. RESULTS Neither SB event rates nor the EMG activity associated with those events was associated with AB events rates or EMG activity, either at rest or during stress-related activity. On the contrary, event rates and EMG activity when awake and at rest were positively associated with events and activity during stress-related activity. SB was characterised mainly by grinding, while AB was characterised mainly by clenching. CONCLUSION Sleep bruxism and awake bruxism do not tend to occur in the same individuals.
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Affiliation(s)
- Thiprawee Chattrattrai
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Masticatory Science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Oral & Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA
| | - Karen G. Raphael
- Department of Oral & Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA
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15
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Kreibig SD, Ten Brink M, Mehta A, Talmon A, Zhang JX, Brown AS, Lucas-Griffin SS, Axelrod AK, Manber R, Lavigne GJ, Gross JJ. The Role of Emotion Regulation, Affect, and Sleep in Individuals With Sleep Bruxism and Those Without: Protocol for a Remote Longitudinal Observational Study. JMIR Res Protoc 2023; 12:e41719. [PMID: 37616042 PMCID: PMC10485716 DOI: 10.2196/41719] [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: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Sleep bruxism (SB) is an oral behavior characterized by high levels of repetitive jaw muscle activity during sleep, leading to teeth grinding and clenching, and may develop into a disorder. Despite its prevalence and negative outcomes on oral health and quality of life, there is currently no cure for SB. The etiology of SB remains poorly understood, but recent research suggests a potential role of negative emotions and maladaptive emotion regulation (ER). OBJECTIVE This study's primary aim investigates whether ER is impaired in individuals with SB, while controlling for affective and sleep disturbances. The secondary aim tests for the presence of cross-sectional and longitudinal mediation pathways in the bidirectional relationships among SB, ER, affect, and sleep. METHODS The study used a nonrandomized repeated-measures observational design and was conducted remotely. Participants aged 18-49 years underwent a 14-day ambulatory assessment. Data collection was carried out using electronic platforms. We assessed trait and state SB and ER alongside affect and sleep variables. We measured SB using self-reported trait questionnaires, ecological momentary assessment (EMA) for real-time reports of SB behavior, and portable electromyography for multinight assessment of rhythmic masticatory muscle activity. We assessed ER through self-reported trait questionnaires, EMA for real-time reports of ER strategies, and heart rate variability derived from an electrocardiography wireless physiological sensor as an objective physiological measure. Participants' trait affect and real-time emotional experiences were obtained using self-reported trait questionnaires and EMA. Sleep patterns and quality were evaluated using self-reported trait questionnaires and sleep diaries, as well as actigraphy as a physiological measure. For the primary objective, analyses will test for maladaptive ER in terms of strategy use frequency and effectiveness as a function of SB using targeted contrasts in the general linear model. Control analyses will be conducted to examine the persistence of the SB-ER relationship after adjusting for affective and sleep measures, as well as demographic variables. For the secondary objective, cross-sectional and longitudinal mediation analyses will test various competing models of directional effects among self-reported and physiological measures of SB, ER, affect, and sleep. RESULTS This research received funding in April 2017. Data collection took place from August 2020 to March 2022. In all, 237 participants were eligible and completed the study. Data analysis has not yet started. CONCLUSIONS We hope that the effort to thoroughly measure SB and ER using gold standard methods and cutting-edge technology will advance the knowledge of SB. The findings of this study may contribute to a better understanding of the relationship among SB, ER, affect, and sleep disturbances. By identifying the role of ER in SB, the results may pave the way for the development of targeted interventions for SB management to alleviate the pain and distress of those affected. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41719.
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Affiliation(s)
- Sylvia D Kreibig
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Maia Ten Brink
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Ashish Mehta
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Anat Talmon
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Jin-Xiao Zhang
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Alan S Brown
- Department of Psychology, Stanford University, Stanford, CA, United States
| | | | - Ariel K Axelrod
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Gilles J Lavigne
- Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, United States
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16
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Kuang B, Aarab G, Wei Y, Blanken TF, Lobbezoo F, Someren EJWV, Ramautar JR, Wassing R. Associations between signs of sleep bruxism and insomnia: A polysomnographic study. J Sleep Res 2023; 32:e13827. [PMID: 36703561 PMCID: PMC10909425 DOI: 10.1111/jsr.13827] [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: 09/08/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Sleep bruxism has been linked with insomnia symptoms. Moreover, it has been suggested that there is a positive association between distress and the occurrence of sleep bruxism. However, the occurrence of sleep bruxism and its association with distress have not been studied in patients with insomnia. Therefore, we hypothesised that: (1) the occurrence of sleep bruxism is higher in patients with insomnia than in healthy controls; and (2) the occurrence of sleep bruxism in insomnia patients with moderate to high distress (IMHD) is higher than that in insomnia patients with slight distress (ISD). A total of 44 controls (34 females, 10 males, mean ± SD age = 46.8 ± 14.4 years) and 42 participants with insomnia (35 females, 7 males, mean ± SD age = 51.3 ± 12.1 years) were enrolled in this study. Among 42 participants with insomnia, 20 participants were subtyped as IMHD, 17 participants as ISD. Another five participants were not subtyped due to insufficient information. Group differences in rhythmic masticatory muscle activity (RMMA), a biomarker of sleep bruxism, were evaluated with Mann-Whitney U tests. The medians and interquartile ranges of the RMMA indices were 0.8|1.8|3.3 in controls, 1.1|1.6|2.3 in IMHD and 1.2|1.9|2.9 in ISD. There was no significant difference in the RMMA index, neither between participants with insomnia and controls (P = 0.514) nor between IMHD versus ISD (P = 0.270). The occurrence of RMMA indicators of possible sleep bruxism is not significantly different between individuals with insomnia and controls, nor between IMHD versus ISD.
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Affiliation(s)
- Boyuan Kuang
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Taikang Bybo DentalBeijingChina
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Yishul Wei
- Department of Sleep and CognitionNetherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
| | - Tessa F. Blanken
- Department of Sleep and CognitionNetherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
- Department of Psychological MethodsUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eus J. W. Van Someren
- Department of Sleep and CognitionNetherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
- Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jennifer R. Ramautar
- Department of Sleep and CognitionNetherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
- N=You Neurodevelopmental Precision Center, Amsterdam NeuroscienceAmsterdam Reproduction and Development, Amsterdam UMCAmsterdamThe Netherlands
- Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Rick Wassing
- Department of Sleep and CognitionNetherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and SciencesAmsterdamThe Netherlands
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical ResearchThe University of SydneySydneyNew South WalesAustralia
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17
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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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18
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Yanez-Regonesi F, Eisa E, Judge S, Carlson C, Okeson J, Moreno-Hay I. Diagnostic accuracy of a portable device (Bruxoff®) to measure sleep bruxism. J Oral Rehabil 2023; 50:258-266. [PMID: 36648354 DOI: 10.1111/joor.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 10/05/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diagnosis of sleep bruxism (SB) challenges clinicians every day due to multiple forms of assessment tools available, including self-reported questionnaires, clinical examinations, portable devices and laboratory polysomnography (PSG). PSG has become the gold standard for evaluating SB, but it can be limited due to cost and restricted accessibility which often is characterised by long waiting times. Hence, there is a need for the development of a reliable method that can assess SB in a simple and portable manner, which would offer acceptable sensitivity and specificity to evaluate SB. OBJECTIVE The objective of this study was to investigate reliability and validity of the Bruxoff® device for the diagnosis of SB compared to the PSG. METHODS Forty-nine subjects underwent one night of polysomnographic study with simultaneous recording with the Bruxoff® device. Rhythmic masticatory muscle activity (RMMA) index was scored according to published criteria. Pearson correlation, Bland-Altman plot and receiver operating characteristic (ROC) curve outcomes were used to quantify the agreement between both methods. RESULTS Receiver operating characteristic analysis showed an acceptable accuracy for the Bruxoff® with sensitivity of 83.3% and specificity of 72% when the cut-off was set at two events per hour. Pearson correlation analysis showed a nearly significant correlation between PSG and Bruxoff® for RMMA index (r = .282 p = .071) and for total SB episodes per night (r = .295 p = .058). Additionally, the Bland-Altman plot revealed a consistent and systematic difference in the measurement of events between devices. CONCLUSION The Bruxoff® device appears to be a promising diagnostic method for clinical use, but further study is needed.
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Affiliation(s)
- Fernanda Yanez-Regonesi
- Division of Orofacial Pain, Department of Oral Health Science, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Elfatih Eisa
- Division of Orofacial Pain, Department of Oral Health Science, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Stephanie Judge
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Charles Carlson
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffrey Okeson
- Division of Orofacial Pain, Department of Oral Health Science, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
| | - Isabel Moreno-Hay
- Division of Orofacial Pain, Department of Oral Health Science, University of Kentucky, College of Dentistry, Lexington, Kentucky, USA
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19
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Bracci A, Lobbezoo F, Häggman-Henrikson B, Colonna A, Nykänen L, Pollis M, Ahlberg J, Manfredini D. Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations. J Clin Med 2022; 11:jcm11175083. [PMID: 36079013 PMCID: PMC9457508 DOI: 10.3390/jcm11175083] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.
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Affiliation(s)
- Alessandro Bracci
- Department of Neurosciences, School of Dentistry, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Birgitta Häggman-Henrikson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, 20506 Malmö, Sweden
| | - Anna Colonna
- Department of Biomedical Technologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Laura Nykänen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00100 Helsinki, Finland
| | - Matteo Pollis
- Department of Biomedical Technologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00100 Helsinki, Finland
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, 53100 Siena, Italy
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20
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Associations between Bruxism, Stress, and Manifestations of Temporomandibular Disorder in Young Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095415. [PMID: 35564810 PMCID: PMC9102407 DOI: 10.3390/ijerph19095415] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Bruxism is a repetitive activity of the masticatory muscles, which determine teeth grinding or clenching, associated with rigidity, bracing, or thrusting of the mandibula. The aim of this study was to determine the prevalence of possible bruxism in 328 students attending the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, and its associations with stress and other manifestations of the temporo-mandibular disorder. This was a questionnaire-based study to collect information on self-evaluation of bruxism presence, frequency of specific episodes, stress, anxiety, and other manifestations of temporo-mandibular disorder. Self-evaluated bruxism was identified in 39.33% from the entire study group, allowing us to define two subgroups for further analysis. Sleep bruxism was present in 16.28% of participants; awake bruxism was present in 68.99%, while 14.73% of participants presented a combined form. The main manifestation of bruxism was reported as teeth grinding. Fatigue was identified as a common clinical sign of bruxism and temporo-mandibular disorder. Group distribution analysis (Chi-Square) indicated significant associations between bruxism and stress, panic, restlessness, or increased stress during the COVID-19 pandemic (p < 0.05). Bruxism, and especially awake bruxism, has increased in prevalence among young students, and it has been associated with increased levels of stress.
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Ohlmann B, Rathmann F, Bömicke W, Behnisch R, Rammelsberg P, Schmitter M. Validity of patient self‐reports and clinical signs in the assessment of sleep bruxism based on home‐recorded electromyographic/electrocardiographic data. J Oral Rehabil 2022; 49:720-728. [DOI: 10.1111/joor.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/21/2022] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Brigitte Ohlmann
- Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg Germany
| | - Friederike Rathmann
- Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg Germany
| | - Wolfgang Bömicke
- Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics (IMBI) University of Heidelberg Im Neuenheimer Feld 130.3 69120 Heidelberg Germany
| | - Peter Rammelsberg
- Department of Prosthodontics University of Heidelberg Im Neuenheimer Feld 400 69120 Heidelberg Germany
| | - Marc Schmitter
- Department of Prosthodontics University of Würzburg Pleicherwall 2 97070 Würzburg Germany
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22
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Chattrattrai T, Blanken TF, Lobbezoo F, Su N, Aarab G, Van Someren EJW. A network analysis of self-reported sleep bruxism in the Netherlands Sleep Registry: its associations with insomnia and several demographic, psychological, and life-style factors. Sleep Med 2022; 93:63-70. [DOI: 10.1016/j.sleep.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/13/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Accuracy of Surface Electromyography in the Diagnosis of Pain-Related Temporomandibular Disorders in Children with Awake Bruxism. J Clin Med 2022; 11:jcm11051323. [PMID: 35268414 PMCID: PMC8911396 DOI: 10.3390/jcm11051323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 12/27/2022] Open
Abstract
The study assessed masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related temporomandibular disorders (TMD-P) and awake bruxism (AB) and in children without TMD, as well as the diagnostic value of surface electromyography (sEMG) in diagnosing TMD-P in subjects with AB. After evaluation based on the Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 30 children diagnosed with myofascial pain were included in the myofascial pain group and 30 children without TMD diagnosis comprised the control group (mean age of 9.49 ± 1.34 years). The activity of the anterior temporal (TA) and masseter (MM) muscle was assessed bilaterally using a DAB-Bluetooth device (zebris Medical GmBH, Germany) at rest and during maximum voluntary clenching (MVC). The receiver operating characteristic (ROC) curve was used to determine the accuracy, sensitivity, and specificity of the normalized sEMG data. Statistically significant intergroup differences were observed in TA and MM muscle EMG activity at rest and during MVC. Moderate degree of sEMG accuracy in discriminating between TMD-P and non-TMD children was observed for TAmean, left MM, and MMmean EMG muscle activity at rest. sEMG can be a useful tool in assessing myofascial TMD pain in patients with AB.
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A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay. Case Rep Dent 2022; 2022:5288515. [PMID: 35070457 PMCID: PMC8776475 DOI: 10.1155/2022/5288515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.
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Association between Self-Reported Bruxism, Peripartum Depression and Myogenous Temporomandibular Disorders among Postpartum Women in Turkey. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Summary
Background/Aim: It is possible to find studies in the literature evaluating the relationship among self-reported bruxism, psychological factors, and myogenous temporomandibular disorder. In addition, the relationship between these issues has not yet been clarified. The objective of this study was to evaluate the association between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorders among postpartum women in Turkey.
Material and Methods: This study included 220 women, whom were asked about their bruxism behaviour during day and during sleep. Besides, all of them assessed with Short-Form Fonseca’s Anamnestic Index for myogenous temporomandibular disorder and the Edinburgh postnatal depression scale for peripartum depression.
Results: The results showed that, self-reported bruxism was observed at a statistically significantly higher rate (94.3%) in peripartum depression group. 86.5% of the patients with self-reported bruxism had myogenous temporomandibular disorder (p<0.001). As a result, 80.0% of the patients with peripartum depression had myogenous temporomandibular disorder (p<0.001).
Conclusions: In conclusion, a significant relationship has been found between peripartum depression and self-reported bruxism, self-reported bruxism and myogenous temporomandibular disorder, and peripartum depression and myogenous temporomandibular disorder. The present study is the first to evaluate the relationship between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorder so it could be considered as a pilot attempt, and further studies using more representative samples are encouraged.
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Bulanda S, Ilczuk-Rypuła D, Nitecka-Buchta A, Nowak Z, Baron S, Postek-Stefańska L. Sleep Bruxism in Children: Etiology, Diagnosis, and Treatment-A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189544. [PMID: 34574467 PMCID: PMC8471284 DOI: 10.3390/ijerph18189544] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed.
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Affiliation(s)
- Sylwia Bulanda
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (D.I.-R.); (L.P.-S.)
- Correspondence: (S.B.); (A.N.-B.)
| | - Danuta Ilczuk-Rypuła
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (D.I.-R.); (L.P.-S.)
| | - Aleksandra Nitecka-Buchta
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (Z.N.); (S.B.)
- Correspondence: (S.B.); (A.N.-B.)
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (Z.N.); (S.B.)
| | - Stefan Baron
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (Z.N.); (S.B.)
| | - Lidia Postek-Stefańska
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (D.I.-R.); (L.P.-S.)
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Janal MN, Lobbezoo F, Quigley KS, Raphael KG. Stress-evoked muscle activity in women with and without chronic myofascial face pain. J Oral Rehabil 2021; 48:1089-1098. [PMID: 34370315 DOI: 10.1111/joor.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Amplified muscle activity in reaction to daily life stressors might explain chronic pain in temporomandibular disorder (TMD). OBJECTIVES To assess whether patients with myofascial TMD pain (MFP) react to standardised stressors with greater masticatory muscle activity than demographically matched controls. METHODS A total of 124 female MFP patients and 46 demographically matched and pain-free controls rated distress while performing a series of standardised stress-reactivity tasks (viz., cold pressor test, mental arithmetic test, speech stressor test and reaction time/startle response test) as well as a vanilla baseline control task. Blood pressure was measured before and after each task, and electromyographic (EMG) activity was continuously recorded over the jaw-closing muscles and several non-masticatory muscles during each task. Linear mixed model analyses were used to test the hypothesis that case status, stress-reactivity task and muscle recording site influenced EMG activity. RESULTS Stress induction was successful, as evidenced by distress ratings and blood pressure measurements that were significantly elevated during performance of the stress tasks. Participants reported that some of the tasks were stressful in a way that resembled stressors experienced in their daily lives. Elevated muscle activity could be confirmed only for the reaction time/startle response task, where mean EMG activity was elevated more in cases than in controls, specifically in the jaw-closing muscles. CONCLUSION These data could not provide clear support for the theory that psychological stressors produce a differential increase in masticatory muscle activity in MFP patients than pain-free controls.
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Affiliation(s)
- Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - Frank Lobbezoo
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral & Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA
| | - Karen S Quigley
- Department of Psychology, Northeastern University, Boston, MA, USA.,Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Karen G Raphael
- Department of Oral & Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA
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Temporomandibular disorders in patients with polysomnographic diagnosis of sleep bruxism: a case-control study. Sleep Breath 2021; 26:941-948. [PMID: 34365593 DOI: 10.1007/s11325-021-02449-2] [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: 03/23/2021] [Revised: 06/20/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) is a collective term that refers to complaints of temporomandibular joint (TMJ) pain, fatigue and/or pain of the craniocervical muscles, limitation of movement of the mandible, and TMJ noises. Sleep bruxism (SB) is a disorder involving rhythmic (phasic) or non-rhythmic (tonic) masticatory muscle activity during sleep and is not a movement disorder or a sleep disorder in otherwise healthy individuals. The present study aimed to support or reject the null hypothesis that there is no association between SB and TMD. METHODS The study population was recruited from patients who visited the Artmedica Clinic, Mossoro city, Rio Grande do Norte, Brazil. Patients who underwent polysomnography received information about the research and were invited to participate following the inclusion and exclusion criteria. The study sample consisted of 40 individuals with age ranging from 19 to 76 years. The subjects were administered the questionnaire of the European Academy of Craniomandibular Disorders (AEDC). Those who answered affirmatively to at least one question of the questionnaire were recommended to visit the primary researcher's dental clinic for examination; those who met the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were evaluated, and their condition was classified into one or more subtypes of TMD. The subjects were divided into 4 groups according to the polysomnographic findings and the responses to the AEDC questionnaire. Of the 40 individuals who answered the AEDC questionnaire and underwent polysomnography, 28 presented with TMD symptoms. The data were expressed as simple frequency and percentage values using statistical software. Values of p < 0.05 were considered to be significant. RESULTS The results showed that the frequency of TMD in individuals diagnosed to have SB was 46.4%. According to the DC/TMD of the 28 individuals, the most prevalent TMD subtype was local myalgia (85.7%). Of the total subjects, 32.5% had TMD and SB, 36.4% were males, and in the age range of 31 to 40 years (40%). CONCLUSION In this study sample, there was no association between SB as currently defined and TMD, thus confirming previous findings on this topic.
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29
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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: 45] [Impact Index Per Article: 15.0] [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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30
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Rosar JV, Marquezin MCS, Pizzolato AS, Kobayashi FY, Bussadori SK, Pereira LJ, Castelo PM. Identifying predictive factors for sleep bruxism severity using clinical and polysomnographic parameters: a principal component analysis. J Clin Sleep Med 2021; 17:949-956. [PMID: 33432920 DOI: 10.5664/jcsm.9078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES The aim was to identify predictive factors for sleep bruxism (SB) severity among polysomnographic parameters, salivary cortisol levels, temporomandibular disorders, age, and sex. METHODS Young adults (19-30 years) were screened for self-/roommate reports of teeth grinding/clenching during sleep associated with clinical signs of tooth wear. Individuals positive for both conditions were administered a polysomnographic exam to provide a definite diagnosis of SB (n = 28). Healthy participants without SB signs/symptoms were also included (n = 15). The Research Diagnostic Criteria for Temporomandibular Disorders was applied to determine functional, muscular, and articular domains of the Temporomandibular Index. Cortisol awakening levels were measured in saliva. Principal component analysis was used to extract the latent components emerging from polysomnographic results, and 2 regression models were adjusted to predict the number and duration of bruxism episodes. RESULTS Principal component analysis resulted in 4 components-C1: %N1, total sleep time, sleep efficiency, arousals/microarousals; C2: %N2, %N3; C3: periodic limb movements and apneas; C4: %REM and REM latency. The number of SB episodes/h was predicted by increasing muscular scores and C2 (decrease in %N2 and increase in %N3) (adjusted R² = 45%; P =.001). The total time of SB episodes was predicted by decreased articular and increased functional scores, age, and female sex (adjusted R² = 36%; P = 0.010). Salivary cortisol levels were not associated with SB severity and did not differ between groups. CONCLUSIONS The findings showed that SB severity was predicted by muscular and functional scores, female sex, and distinct polysomnographic patterns, contributing to the deeper knowledge of the underlying pathophysiology of SB severity; additionally, the findings can help to formulate health approaches that are specific to the patient and will better assist in treating this condition.
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Affiliation(s)
| | | | - Aianne Souto Pizzolato
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | | | | | | | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
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31
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Emodi-Perlman A, Manfredini D, Shalev T, Yevdayev I, Frideman-Rubin P, Bracci A, Arnias-Winocur O, Eli I. Awake Bruxism-Single-Point Self-Report versus Ecological Momentary Assessment. J Clin Med 2021; 10:jcm10081699. [PMID: 33920877 PMCID: PMC8071231 DOI: 10.3390/jcm10081699] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 12/22/2022] Open
Abstract
Assessment of awake bruxism (AB) is problematic due to the inability to use continuous recordings during daytime activities. Recently, a new semi-instrumental approach was suggested, namely, ecological momentary assessment (EMA), via the use of a smartphone application. With the application, subjects are requested to report, at least 12 times per day, the status of their masticatory muscle activity (relaxed muscles, muscle bracing without tooth contact, teeth contact, teeth clenching, or teeth grinding). The aim of the present study was to test the association between a single observation point self-report and EMA assessment of AB. The most frequent condition recorded by the EMA was relaxed muscles (ca. 60%) and the least frequent was teeth grinding (less than 1%). The relaxed muscle condition also showed the lowest coefficient of variance over a seven-day period of report. Additionally, only the relaxed muscles and the muscle bracing conditions presented an acceptable ability to assess AB-positive and AB-negative subjects, as defined by single-point self-report questions. The combination between self-report and EMA may have the potential to promote our ability to assess AB. We suggest to re-consider the conditions of teeth contact and teeth grinding while using EMA to evaluate AB.
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Affiliation(s)
- Alona Emodi-Perlman
- Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (T.S.); (I.Y.); (P.F.-R.); (I.E.)
- Correspondence:
| | | | - Tamar Shalev
- Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (T.S.); (I.Y.); (P.F.-R.); (I.E.)
| | - Ilanit Yevdayev
- Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (T.S.); (I.Y.); (P.F.-R.); (I.E.)
| | - Pessia Frideman-Rubin
- Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (T.S.); (I.Y.); (P.F.-R.); (I.E.)
| | | | - Orit Arnias-Winocur
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, The Maurice and Gabriela Goldshleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel;
| | - Ilana Eli
- Department of Oral Rehabilitation, The Maurice and Gabriella School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (T.S.); (I.Y.); (P.F.-R.); (I.E.)
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32
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Ekman A, Rousu J, Näpänkangas R, Kuoppala R, Raustia A, Sipilä K. Association of self-reported bruxism with temporomandibular disorders - Northern Finland Birth Cohort (NFBC) 1966 study. Cranio 2020; 41:212-217. [PMID: 33267744 DOI: 10.1080/08869634.2020.1853306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To investigate the prevalence of self-reported bruxism and its association with temporomandibular disorders (TMD). The hypothesis of the study was that self-reported bruxism is associated with TMD.Methods: The data were gathered from 1962 subjects who participated in a field study in 2012-2013, including a questionnaire concerning bruxism and TMD symptoms as well as clinical sub-diagnoses of TMD using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Statistical method was chi-square test. Bonferroni correction was made, and a p-value of <0.003 was considered as significant.Results: The prevalence of self-reported bruxism was 39.6%: 34.0% in men and 44.5% in women. Those who reported sleep bruxism (SB) or awake bruxism (AB) had significantly more pain-related TMD symptoms and signs compared to those not reporting bruxism.Conclusion: The prevalence of self-reported bruxism is high among middle-aged adults and is associated with TMD pain-related symptoms and signs, as well as TMD diagnoses.
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Affiliation(s)
- Anne Ekman
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Julia Rousu
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ritva Näpänkangas
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ritva Kuoppala
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aune Raustia
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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33
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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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34
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de Siqueira SRDT, de Siqueira JTT, Teixeira MJ. Association between craniofacial pain complaints, somatoform symptoms and chronic diseases. Arch Oral Biol 2020; 122:104892. [PMID: 33352360 DOI: 10.1016/j.archoralbio.2020.104892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/06/2020] [Accepted: 08/21/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This case-control study aimed to investigate associations between craniofacial pain complaints, somatoform symptoms and chronic diseases. DESIGN 306 subjects were included in this study (174 patients and 132 healthy subjects). The evaluation consisted of demographic data, number of functional and nonfunctional chronic diseases, medications, somatoform symptoms (xerostomia, dry mucosa, numbness, gastrointestinal complaints), and pain complaints with associated characteristics (number of pain areas, sensation of tired face, bruxism, sleep disturbances, masticatory musculoskeletal evaluation). Statistical analysis included descriptive data, tested with chi-square, Fisher's exact, nonparametric Kolmogorov-Smirnoff, Student's t-test, Pearson's coefficient, two-steps cluster classification, multivariate linear and LASSO regressions. RESULTS Functional disorders were prevalent in 111 (63.8 %) patients with facial pain. They were taking more medication (p < 0.001) and had more sleep disturbances (p < 0.001), higher xerostomia scores (p < 0.001) and more gastrointestinal complaints (p < 0.001) than controls. There was a positive correlation between the functional score and the number of cranial areas with headache (R2 = 0.266, <0.001). The regression models for facial pain (R2 = 0.632), craniofacial pain (R2 = 0.623) and headache (R2 = 0.252) showed significant dependency of functional disorders (p < 0.001). CONCLUSION craniofacial pain was associated with functional diseases and somatoform symptoms. This association needs further investigation to understand the role of those disorders in craniofacial pain, considering that pain complaints are common somatoform and functional symptoms.
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Souto-Souza D, Mourão PS, Barroso HH, Douglas-de-Oliveira DW, Ramos-Jorge ML, Falci SGM, Galvão EL. Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta-analysis. Sleep Med Rev 2020; 53:101330. [PMID: 32554210 DOI: 10.1016/j.smrv.2020.101330] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/17/2022]
Abstract
Aim of the present systematic review was to evaluate whether children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at greater chance of developing bruxism compared to individuals without this disorder. Observational studies that evaluated the occurrence of bruxism in children and adolescents with ADHD were included. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation criteria. Thirty-two studies involving a total of 2629 children/adolescents with ADHD and 1739 with bruxism (1629 with sleep bruxism and 110 with awake bruxism) were included. The prevalence of bruxism, irrespective of type, in the children/adolescents was 31% (95% CI: 0.22-0.41, I2 = 93%). ADHD was associated with an increased chance of bruxism (OR: 2.94, 95% CI: 2.12-4.07, I2 = 61%), independently of the type [sleep bruxism (OR: 2.77, 95% CI: 1.90-4.03, I2 = 66%) or awake bruxism (OR: 10.64, 95% CI: 2.41-47.03, I2 = 65%)]. The presence of signs of ADHD without a diagnostic confirmation was not associated with an increased chance of bruxism (OR: 3.26, 95% CI: 0.76-14.04, I2 = 61%). Children and adolescents with a definitive diagnosis of ADHD are at greater chance of developing sleep and awake bruxism than those without this disorder.
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Affiliation(s)
- Debora Souto-Souza
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil.
| | - Priscila S Mourão
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Heloisa H Barroso
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Dhelfeson W Douglas-de-Oliveira
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Maria L Ramos-Jorge
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Saulo G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
| | - Endi L Galvão
- Post-Graduate Program in Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 39100-000, Diamantina, Minas Gerais, Brazil
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36
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Wieckiewicz M, Smardz J, Martynowicz H, Wojakowska A, Mazur G, Winocur E. Distribution of temporomandibular disorders among sleep bruxers and non‐bruxers—A polysomnographic study. J Oral Rehabil 2020; 47:820-826. [DOI: 10.1111/joor.12955] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mieszko Wieckiewicz
- Department of Experimental Dentistry Wroclaw Medical University Wroclaw Poland
| | - 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
| | - 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 Sackler Faculty of Medicine School of Dental Medicine Tel Aviv University Tel Aviv Israel
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Abstract
Data sourcesPubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases were searched from 1980 to March 2016. Literature reviews were explored in order to retrieve any other relevant papers.Study selectionRandomised controlled studies (RCTs), prospective and before and after studies that applied botulinum toxin (BoNT-A) to the masseter and/or temporalis muscles assessing objective and subjective parameters of bruxism published in English were included.Data extraction and synthesisThree reviewers independently assessed for eligibility. Disagreement was solved by discussion and when reaching consensus between at least two. Standard data items were extracted. Quality assessment was assessed using the Cochrane Collaboration's risk of bias tool and the Critical Appraisal Skills Program (CASP) tool. Before-After Study Checklist was used for the nonrandomised studies. Results were presented as a narrative review.ResultsFive studies were included in the review, of those three were RCTs and two before and after. A total of 188 subjects were included. Regimen was unique in each study and the follow-up ranged from two to 24 weeks. The risk of bias of the RCTs was assessed as low to unclear, while the before and after studies were assessed as of moderate risk of bias.ConclusionsThe authors concluded that botulinum toxin represents a possible option for the management of sleep bruxism (SB), minimising symptoms and reducing the intensity of contractions rather than for SB itself.
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Affiliation(s)
- Arthi Kumar
- New York University College of Dentistry, New York, USA
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38
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Maeda-Iino A, Fukushima M, Sakoguchi Y, Omure H, Oishi A, Oga Y, Furukawa-Sainoki M, Kanmura S, Ido A, Miyawaki S. Effects of intra-oesophageal acid infusion and a stress task on masseter muscle activity and autonomic nervous activity in wakefulness. J Oral Rehabil 2020; 47:567-576. [PMID: 32064657 DOI: 10.1111/joor.12947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/27/2020] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease may be an important risk factor for awake bruxism. Additionally, it has been known that a psychological stress task affects masseter muscle activity, and autonomic nervous system (ANS) activity modulation induces masseter muscle activity. OBJECTIVES This study aimed to investigate whether task-induced stress and experimental oesophageal acid infusion increase masseter muscle activity and alter ANS activity, compared to rest task and oesophageal saline infusion, respectively. METHODS Polygraphic monitoring, consisting of electromyography of the masseter muscle and electrocardiography, was performed in 12 healthy adult men during 30-min interventions with intra-oesophageal saline or acid infusion, while reading a book quietly, as rest, and while performing calculation, as a stress task. RESULTS At rest, masseter muscle activity and parasympathetic nervous system (PNS) activity during acid infusion were significantly higher (P = .019) and lower (P = .021) than during saline infusion, respectively. During saline infusion, both masseter muscle activity and sympathetic nervous system (SNS) activity or PNS activity while performing the calculation task were higher (P = .022 and .012, respectively) or lower (P = .007) than those during the reading task, respectively. In two-way repeated-measures ANOVA, intra-oesophageal infusion (saline or acid) significantly affected masseter muscle activity (P = .008) and PNS activity (P = .021). However, performing tasks (reading or calculation) significantly affected only PNS activity (P = .028). CONCLUSION Intra-oesophageal acid infusion significantly increased masseter muscle activity and decreased PNS activity. In contrast, stress task not only significantly decreased PNS activity, but only modestly increased masseter muscle activity and SNS activity.
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Affiliation(s)
- Aya Maeda-Iino
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mika Fukushima
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoko Sakoguchi
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Sakoguchi Dental Clinic, Kagoshima, Japan
| | - Haruhito Omure
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Omure Orthodontic Clinic, Matsuyama, Japan
| | - Akihito Oishi
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhiko Oga
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Minami Furukawa-Sainoki
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shuji Kanmura
- Department of Endoscopy, Kagoshima University Hospital, Kagoshima, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shouichi Miyawaki
- Field of Developmental Medicine, Health Research Course, Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.,Faculty of Dental Medicine, Airlangga University, Surabaya, Indonesia
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39
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Robin O, Claude A, Gehin C, Massot B, McAdams E. Recording of bruxism events in sleeping humans at home with a smart instrumented splint. Cranio 2020; 40:14-22. [PMID: 31914871 DOI: 10.1080/08869634.2019.1708608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this paper is to report quantitative and qualitative characteristics of bruxism events recorded in sleeping humans with a new smart ambulatory system specifically designed to measure dental clenching and grinding forces. The device is wireless and rechargeable, which enables its use over extended periods.Methods: Thirty recordings were obtained from volunteer subjects who wore the device at home during 10 consecutive nights (Clinicaltrials.gov N° NCT03363204).Results: The recordings showed that the system was able to successfully monitor bruxism during 10 consecutive nights, allowing a quantitative (number, duration, intensity, distribution during the night), as well as a qualitative characterization of the bruxism events (clenching vs. grinding).Discussion: This system could offer new perspectives in the field of bruxism, either as a research tool for clinical studies or as a medical device for the ambulatory home-based monitoring of bruxism.
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Affiliation(s)
- Olivier Robin
- Department of Orofacial Pain and Dysfunctions, Lyon Dental University Hospital, Lyon, France.,Nanotechnology Institute of Lyon, Biomedical sensors team, UMR CNRS, INSA, Lyon, France
| | - Arthur Claude
- Nanotechnology Institute of Lyon, Biomedical sensors team, UMR CNRS, INSA, Lyon, France.,Piwio SAS, Villeurbanne, France
| | - Claudine Gehin
- Nanotechnology Institute of Lyon, Biomedical sensors team, UMR CNRS, INSA, Lyon, France
| | - Bertrand Massot
- Nanotechnology Institute of Lyon, Biomedical sensors team, UMR CNRS, INSA, Lyon, France
| | - Eric McAdams
- Nanotechnology Institute of Lyon, Biomedical sensors team, UMR CNRS, INSA, Lyon, France
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40
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Saito T, Yamaguchi T, Mikami S, Saito M, Nakajima T, Yachida W, Maeda M, Sakuma T, Nakamura H. Minimum measurement time of masseteric electromyogram required for assessment of awake bruxism during the daytime. Cranio 2019; 40:144-151. [DOI: 10.1080/08869634.2019.1704982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Taishi Saito
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Taihiko Yamaguchi
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Saki Mikami
- Department of Temporomandibular Disorders, Center for Advanced Oral Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Miku Saito
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshinori Nakajima
- Department of Crown and Bridge Prosthodontics, Hokkaido University Hospital, Sapporo, Japan
| | - Wataru Yachida
- Department of Crown and Bridge Prosthodontics, Hokkaido University Hospital, Sapporo, Japan
| | - Masana Maeda
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshimitsu Sakuma
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hironobu Nakamura
- Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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41
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Cahlin BJ, Lindberg C, Dahlström L. Cerebral palsy and bruxism: Effects of botulinum toxin injections-A randomized controlled trial. Clin Exp Dent Res 2019; 5:460-468. [PMID: 31687178 PMCID: PMC6820579 DOI: 10.1002/cre2.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 01/20/2023] Open
Abstract
Objective Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX‐A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX‐A injections in subjects with CP and bruxism. Methods A prospective, parallel, randomized, placebo‐controlled, and double‐blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX‐A or corresponding placebo injections. Matched, healthy references were also evaluated. Results The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX‐A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX‐A was requested by the majority of the patients. Conclusion The evidence is unable to support the use of BTX‐A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.
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Affiliation(s)
- Birgitta Johansson Cahlin
- Department of Orofacial Pain and Jaw Function and Mun-H-Center, National Orofacial Resource Center for Rare Diseases, Public Dental Service Region Västra Götaland, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Christopher Lindberg
- Department of Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Lars Dahlström
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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42
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Skármeta NP, Hormazabal Navarrete F. Questions on the clinical applicability on the international consensus on the assessment of bruxism. J Oral Rehabil 2019; 47:255-257. [PMID: 31562643 DOI: 10.1111/joor.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/20/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolás Patricio Skármeta
- Faculty of Health Sciences, School of Dental Medicine, Orofacial Pain and Dental Occlusion, Universidad San Sebastián, Santiago, Chile.,Orofacial Pain and TMD, Hospital del Salvador, SMMO, Santiago, Chile.,Orofacial Pain and TMD, OPHdental, Santiago, Chile
| | - Fernando Hormazabal Navarrete
- School of Dentistry, Pontificia Universidad Católica de Chile, Santiago, Chile.,Orofacial Pain, Pain Unit, Hospital Clínico Mutual de Seguridad de la Cámara Chilena de la Construcción, Santiago, Chile
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43
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Duarte J, Souza JFD, Cavalcante-Leão B, Todero SRB, Ferreira FM, Fraiz FC. Association of possible sleep bruxism with daytime oral habits and sleep behavior in schoolchildren. Cranio 2019; 39:372-378. [DOI: 10.1080/08869634.2019.1661113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Joyce Duarte
- Department of Stomatology, School of Dentistry, Federal University of Paraná, Curitiba, Brazil
| | | | - Bianca Cavalcante-Leão
- Department of Stomatology, School of Dentistry, Federal University of Paraná, Curitiba, Brazil
| | | | - Fernanda Morais Ferreira
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fabian Calixto Fraiz
- Department of Stomatology, School of Dentistry, Federal University of Paraná, Curitiba, Brazil
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44
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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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45
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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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46
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Do family functioning and mothers’ and children’s stress increase the odds of probable sleep bruxism among schoolchildren? A case control study. Clin Oral Investig 2019; 24:1025-1033. [DOI: 10.1007/s00784-019-02997-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
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47
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Baad‐Hansen L, Thymi M, Lobbezoo F, Svensson P. To what extent is bruxism associated with musculoskeletal signs and symptoms? A systematic review. J Oral Rehabil 2019; 46:845-861. [DOI: 10.1111/joor.12821] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Lene Baad‐Hansen
- Section of Oro‐facial Pain and Jaw Function, Department of Dentistry Aarhus University Aarhus Denmark
- Scandinavian Center for Oro‐facial Neurosciences (SCON)
| | - Magdalini Thymi
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam Amsterdam The Netherlands
- Vrije Uiversiteit Amsterdam Amsterdam The Netherlands
| | - Frank Lobbezoo
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam Amsterdam The Netherlands
- Vrije Uiversiteit Amsterdam Amsterdam The Netherlands
| | - Peter Svensson
- Section of Oro‐facial Pain and Jaw Function, Department of Dentistry Aarhus University Aarhus Denmark
- Scandinavian Center for Oro‐facial Neurosciences (SCON)
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
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48
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Iodice G, Cimino R, Vollaro S, Lobbezoo F, Michelotti A. Prevalence of temporomandibular disorder pain, jaw noises and oral behaviours in an adult Italian population sample. J Oral Rehabil 2019; 46:691-698. [PMID: 30993737 DOI: 10.1111/joor.12803] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 02/11/2019] [Accepted: 04/10/2019] [Indexed: 12/11/2022]
Abstract
To evaluate the prevalence of temporomandibular disorder pain (TMD-pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self-reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD-pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD-pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD-pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD-pain and TMJ sounds. In a general Italian adult population sample, TMD-pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.
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Affiliation(s)
- Giorgio Iodice
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Division of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Roberta Cimino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Division of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Stefano Vollaro
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Division of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Division of Orthodontics, University of Naples "Federico II", Naples, Italy
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49
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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: 575] [Impact Index Per Article: 95.8] [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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50
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Miettinen T, Myllymaa K, Hukkanen T, Töyräs J, Sipilä K, Myllymaa S. Home Polysomnography Reveals a First-Night Effect in Patients With Low Sleep Bruxism Activity. J Clin Sleep Med 2018; 14:1377-1386. [PMID: 30092900 PMCID: PMC6086957 DOI: 10.5664/jcsm.7278] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/20/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the presence of a first-night effect (FNE) and the level of internight variability in sleep bruxism (SB) activity when a self-applicable electrode set is used in home polysomnography (PSG) in a sample of subjects with possible SB. METHODS Fourteen females and two males aged 38.3 ± 9.1 years (mean ± standard deviation) with self-reported SB underwent home-PSG on three consecutive nights. The subjects applied PSG sensors themselves, including self-applicable electrode sets used to record sleep and masseter muscle activity. Repeated-measures analysis of variance was used to compare SB and sleep variables between the nights. RESULTS Surprisingly, there were statistically significant elevations in the rhythmic masticatory muscle activity (RMMA) episode index (P = .009), burst index (P = .016), and bruxism time index (P = .049) throughout the course of 3 nights. More bruxers were diagnosed on the second (6 bruxers, ≥ 2 episodes/h) and third night (7 bruxers) compared to the first night (2 bruxers). Most subjects (14/16) had their highest RMMA index on the second or third night. The mean coefficient of variation for RMMA episode index was 50.7%. No statistically significant differences were detected in other sleep variables. CONCLUSIONS The results indicate that a FNE may be present in SB activity, possibly lasting several nights in some subjects. Furthermore, FNE appears to be combined with high internight variability of SB activity without indications of internight changes in sleep macrostructure. To confirm the level of ongoing SB activity, several nights of PSG may be required, especially in subjects with low first-night SB activity. COMMENTARY A commentary on this article appears in this issue on page 1281.
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Affiliation(s)
- Tomi Miettinen
- Department of Applied Physics, University of Eastern Finland, 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, Kuopio, Finland
- 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, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, 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, 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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