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

Comparison Between Ecological Momentary Assessment and Self-Report of Awake Bruxism Behaviours in a Group of Healthy Young Adults

OBJECTIVE

The aim of this investigation was to compare the self-reported frequency of awake bruxism (AB) behaviours by means of a validated single-observation point questionnaire (i.e., Oral Behaviour Checklist [OBC]) with the frequency reported in real-time with an Ecological Momentary Assessment (EMA) over 1 week.

MATERIALS AND METHODS

One hundred healthy young adults took part in the study. The frequency of some activities belonging to the spectrum of AB behaviours (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using the EMA approach with smartphone technology support over 1 week. The OBC questionnaire was used to evaluate the self-reported frequency of the same AB behaviours. Spearman's rank correlation coefficient was adopted to test the correlation between the average score of each OBC question considered (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) and the average frequency of the corresponding EMA item.

RESULTS

Statistical analysis showed a weak-to-moderate level of correlation between the two different AB assessment methods. Mandible bracing showed the highest level of correlation, while teeth grinding had the lowest one.

CONCLUSIONS

While the OBC represents a valid and easy-to-administer screening tool for evaluating bruxism behaviours, the EMA approach provides a more detailed real-time report on AB behaviours.

Stratification of orthognathic surgery patients for painful TMD and associated factors

OBJECTIVE

To identify clusters of patients with DFD based on variables related to TMD, psychological aspects, somatization, oral habits, and sleep.

METHOD

Ninety-two patients with DFD were evaluated before orthognathic surgery according to demographic data, facial profile, presence of painful TMD (DC/TMD), psychological aspects, oral habits, comorbidities, substance use, and sleep quality.

RESULTS

Eighty-six individuals comprised the final sample. The K-means cluster analysis identified two distinct but internally similar groups. One called "Vulnerable" with a higher prevalence of muscular TMD and associated factors with 43 (50%) participants, and another with 43 (50%) participants, called "Adaptive" with a lower prevalence of these variables (P<.01). The determining variables were signs and symptoms of anxiety and somatization, awake bruxism and self-reported sleep quality. The presence of arthralgia, comorbidities, or smoking did not influence the formation of the groups. The clusters were tested with gender, age, facial profile, maxillary excess, and deficiency. Only females were associated with the vulnerable group (P=.015). These results highlight the importance of multidimensional assessment of patients with DFD. The stratification of these individuals can help with personalized treatment, targeting specific strategies for each group, such as behavioral interventions and referrals to a multidisciplinary team.

Relationship Between Cigarette Smoking and Awake Bruxism: Does Smoking Increase the Frequency of Masticatory Muscle Activities?

BACKGROUND

Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness.

OBJECTIVE

The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits.

METHODS

Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four-item patient health questionnaire for anxiety and depression (PHQ-4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA).

RESULTS

A total of 100 participants (university employees, dentists, undergraduate and post-graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non-smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ-4 scores. Specifically, for every 1% increase in PHQ-4 score, the mean frequency of the AB behaviours increases 5-fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes (p > 0.05). Mandible bracing significantly correlated with the number of years of smoking (B = 1.58, p = 0.002).

CONCLUSIONS

According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.

Awake Bruxism Is Unrelated to Smoking, Despite the Different Psychological Status: A Pilot Study

OBJECTIVE

The aim of the present study is to get deeper into the complex interplay that might exist between awake bruxism (AB), tobacco smoking, and anxiety and/or depression symptoms in a group of healthy young adults.

MATERIALS AND METHODS

The study participants were recruited by advertising the investigation at the University of Siena, Siena, Italy. The inclusion criteria were being in good general health, without systemic diseases or oral diseases. People with ongoing medical or dental treatment and those with a history of systemic disease or temporomandibular disorders were excluded. The participants who were included in the study received a questionnaire containing three sections for the assessment of AB behaviors, anxiety and depression symptoms, and the number of cigarettes smoked.

RESULTS

A total of 141 healthy young adults met the inclusion criteria. Different awake masticatory muscle activities showed different strengths of association with anxiety and depression symptoms. However, no relationship was found between the number of smoked cigarettes and the frequency of the various masticatory muscle activities considered.

CONCLUSIONS

The result of the present study shows no clear-cut association between the frequency of self-reported AB behaviors and smoking in healthy individuals.

Musculoskeletal differences in the craniomandibular region of children and adolescents with and without bruxism: A comparative study

OBJECTIVE

To analyse the relationship between bruxism and musculoskeletal parameters of the cervical and mandibular regions in children and adolescents.

METHODS

A comparative cross-sectional study was performed with subjects from 6 to 16 years. Subjects were divided into bruxism (any type) and control groups. Descriptive data, jaw opening, upper cervical spine mobility, myofascial trigger points (MTPs) and muscular tension of the jaw and neck muscles, the activation pattern of neck flexors and activation of Deep Neck Flexors (DNF) were registered and compared between groups.

RESULTS

121 subjects participated in the study. Children and adolescents reporting bruxism showed a significant reduction in the contraction of DNF (p = .034) and the activation ratio (p = .035) compared to controls. Besides, MTPs of both masseters were significantly more frequent in subjects reporting bruxism (p = .001-0.002). No differences were found in other measurements.

CONCLUSION

Bruxism is related to a weaker contraction of DNF, a lower activation ratio, and a higher number of MTPs in masseters.

Effect of Screen Time and Sugar Consumption Reduction on Sleep Bruxism in Children: A Randomised Clinical Trial

OBJECTIVE

Sleep bruxism (SB) is associated with alterations in dopamine and serotonin, which are related to increased consumption of added sugar and overuse of screens. The aim of this study was to compare the effect of the interventions 'Food, Fun and Family' (FFF) and Counselling and Education (CE) on the frequency of SB in children.

METHODS

A randomised clinical trial was conducted. Forty-eight participants aged between 4 and 8 years, attending the paediatric clinics of Universidad CES (Colombia) and Hospital Elina de la Serna (Argentina) participated in the study. Subjects were randomised into the FFF (experimental) and CE (regular intervention) groups. The frequency of SB was reported with the Children's Sleep Habits Questionnaire (CSHQ), the consumption of added sugar from items with the HBSC-FFQ and the time of use of screens through a diary in baseline (before starting the intervention), at Week 6 and Week 12. Data were analysed with Kruskal-Wallis test followed by Dunn's post hoc, Mann-Whitney test, a linear mixed model and logistic ordinal regression analyses.

RESULTS

The FFF group had a more significant reduction in consumption of added sugar and screen time compared to the CE group (p < 0.05), especially from Week 6 to baseline. Regression analysis showed that reducing TV watching and consumption of added sugar were associated with a decrease in SB frequency, especially in the FFF group (OR < 1, p < 0.05), and the results were consistent across different study environments.

CONCLUSION

The FFF intervention was more effective in reducing the screen time and sugar consumption and thus decreased the frequency of SB, when compared with the CE intervention.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05310162.

Effect of occlusal appliances on the sleep of individuals with bruxism: A systematic review and meta-analyses

OBJECTIVE

This systematic review determined whether occlusal appliance use influences the sleep of individuals with sleep bruxism.

MATERIAL AND METHODS

Six databases and the gray literature were searched to identify randomized and non-randomized clinical trials comparing slow wave sleep and sleep quality of sleep bruxers before and after occlusal appliance use. The Risk of Bias was assessed using Cochrane tools and Meta-analyses were performed to compare data. The Certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Two randomized and eight non-randomized studies were included. Meta-analyses indicated that soft and hard appliances influenced the slow-wave sleep and sleep quality of sleep bruxers, as determined by polysomnography (Z = 5.58; p < .001), the Pittsburgh Sleep Quality Index (Z = 3.45; p < .001), and the Sleep Assessment Questionnaire (Z = 48.1; p < .001).

CONCLUSION

Occlusal appliance use significantly impacts slow-wave sleep and sleep quality in sleep bruxism individuals, regardless of appliance design or material.

Sleep bruxism and GERD correlation in a general population convenience sample

OBJECTIVE

To investigate the relationship between sleep bruxism(SB) and gastroesophageal reflux disease (GERD) with the use of validated questionnaires in a general population convenience sample.

METHODS

SB behaviour was evaluated in accordance with the Subject-Based Assessment strategy recommended in the Standardized Tool for the Assessment of Bruxism (STAB). .To evaluate GERD-related symptoms, the GERD-Q questionnaire was adopted. To study the correlation between current SB and GERD, Spearman test was performed. Mann-Whitney-U test was adopted to compare GERD-related symptoms in two distinct group comparisons based on the presence of current SB and a history of SB, respectively.

RESULTS

A significant but weak positive correlation between current SB and GERD was found (r = .112; p = .044). No significant differences in GERD-related symptoms between groups emerged.

CONCLUSIONS

This investigation showed a positive but weak correlation between current SB and GERD-related symptoms. Larger scale studies in representative samples are needed to further explore this correlation.

Effects of Manual Therapy and Home Exercise Treatment on Pain, Stress, Sleep, and Life Quality in Patients with Bruxism: A Randomized Clinical Trial

Background and Objectives: This study aimed to examine the effects of manual therapy (MT) and home exercise (HE) treatments on pain, sleep quality, stress level, and quality of life in patients with bruxism. Materials and Methods: The study included 30 bruxism patients ages 18-25 years who were randomly divided into the manual therapy group (MTG) and home exercise group (HEG). Before treatment (T1), all patients were asked to fill out the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Fonseca Anamnestic Index (FAI), and Quality of Life Scale/Short Form-36 (SF-36), and additionally, the number of trigger points (NTP) and pain levels were determined. MT and HE were applied for 8 weeks, and all tests were repeated at the end of treatment (T2). A paired-samples t test was used for intra-group comparisons at T1 and T2, and an independent t test was used for inter-group comparisons. The statistical significance level was accepted as p < 0.05. Results: When the results obtained with MT and HE were examined after 8 weeks of treatment, a significant difference was found for all parameters (FAI, PSQI, PSS, SF-36, NTP, activity pain, and night pain levels, p < 0.05) except rest pain in HEG. According to the inter-group comparison, a significant difference was found in PSQI, FAI, and NTP (p < 0.05). However, it was determined that both groups showed statistically similar effects in terms of pain, perceived stress, and quality of life (p > 0.05). Conclusions: MT and HE reduce perceived stress and pain intensity and also improve quality of life and sleep in patients with bruxism. HE is as effective as MT in terms of pain, stress quality of life. MT is more effective than HE in improving sleep quality and TMD symptoms. Both manual therapy and home exercise applications can be applied as alternative treatment methods in the treatment of bruxism.

The Role of Occlusal Appliances in Reducing Masseter Electromyographic Activity in Bruxism

Background/Objectives: Bruxism is a masticatory muscle activity, phasic or tonic, with/without teeth contact, that appears in sleep or an awake state. An instrumental technique used to measure the surface electromyographic (sEMG) activity of the masseter muscle is used to diagnose bruxism activity during sleep and while awake. The objective of this study was to compare the variation in bruxism (sleep and awake) indices and masseter activity indices in low sleep bruxism and moderate sleep bruxism before and after wearing an occlusal appliance (OA) for 3 months each night. Methods: A clinical interventional study was designed in which subjects diagnosed with sleep bruxism were randomly selected to be included in the study. After the first sEMG recording, two groups were formed: a low sleep-bruxism group (number of sleep-bruxism events/h between 2 and 4) and a moderate sleep-bruxism group (number of sleep-bruxism events/h equal or higher than 4). All subjects received treatment with a 3D-printed occlusal appliance and wore it each night for 3 months, at which point the second sEMG recording was performed. For each participant of this study, a chart was created that included anamnestic data, clinical data, and sEMG data. The data were statistically analyzed with SPSS, using the Mann-Whitney U and Wilcoxon signed-rank tests. Results: A total of 21 participants were included in the final analysis, 18 women and 3 men, with a mean age of 24.5 ± 2.7 years. The OA lowered all bruxism indices in the whole group, but clusters analysis showed a significant reduction in sleep-bruxism indices in the moderate sleep-bruxism group, while in the low-bruxism group, the sleep and awake indices varied insignificantly, and the number of sleep-bruxism events/h remained constant. Conclusions: The 3D-printed occlusal appliances significantly lowered the sleep-bruxism indices and sleep masseter activity indices recorded with a portable sEMG device in the moderate sleep-bruxism group. The OA lowered the awake-bruxism indices and awake masseter activity indices in the moderate sleep-bruxism group.

Reliability, reference values and factors related to maximum bite force measured by the Innobyte system in healthy adults with natural dentitions

OBJECTIVES

We aimed to determine the predictors of maximum bite force (MBF), as measured with the Innobyte system, and to assess the reliability and reference values for MBF in young adults with natural dentitions.

METHODS

This cross-sectional test-retest study included 101 dental students with natural dentitions. Participants had their dental occlusion examined and completed three questionnaires: the Temporomandibular disorders Pain Screener, Oral Behavior Checklist, and Jaw Functional Limitation Scale. Body mass index and muscle mass percentage were determined, and handgrip strength was measured with a dynamometer. The MBF was measured with Innobyte, with reliability assessed by the intraclass correlation coefficient, expressing reference values as MBF percentiles. Bivariate tests and multiple linear regression models were used for statistical analysis.

RESULTS

The intraclass correlation coefficient for the MBF was 0.90, with 10th to 90th percentiles of 487-876 N for females and 529-1003 N for males. A positive relationship existed between the MBF and male sex, muscle mass percentage, overbite, handgrip strength, and possible sleep/awake bruxism. Stepwise regression showed that overbite, handgrip strength, and possible sleep/awake bruxism had the greatest effect on the MBF, explaining 27% of the variation.

CONCLUSIONS

This study provides reference values for MBF when using the Innobyte system and shows excellent reliability. Overbite, general strength, and self-reported bruxism appear to be important predictors of MBF.

CLINICAL RELEVANCE

Innobyte is a reliable device that can be used to measure MBF bilaterally. Self-reported bruxism is associated with an 8%-10% increase in MBF.

Understanding the clinical management of co‐occurring sleep‐related bruxism and obstructive sleep apnea in adults: A narrative and critical review

Sleep‐related bruxism (SRB) is a motor oral behavior characterized by tooth grinding and jaw clenching activity, reported by 8%–12% of the adult general population and 3% of older individuals. The frequency of one of its biomarkers, rhythmic masticatory muscle activity (RMMA), remains elevated across ages. Obstructive sleep apnea (OSA) is associated with the brief and repetitive pause of breathing (apnea) and with transient reduction in oxygen (hypoxia). OSA is observed at all ages and in about 50% of older individuals with a male preponderance. SRB clinical assessment is based on self‐reporting of tooth grinding sound, awareness of clenching, jaw pain or headache, and clinical observation of tooth damage. OSA clinical assessment is based on sleepiness and fatigue, snoring, sleep quality, and awareness of breathing cessation, plus clinical examination of anatomical factors (e.g., obesity, retrognathia, large tonsil, macroglossia), age, gender, and body mass. Although the literature does not support association or causality between these two conditions, the co‐occurrence is reported in about 30%–50% of adults. To confirm a diagnosis of co‐occurring SRB and OSA, home sleep testing (HST) may be indicated. A sleep test is performed using electromyography (EMG) of jaw muscle (masseter or temporalis) and cardio‐respiratory variables (e.g., air flow, respiratory effort, oxygen level, heart rate). The management of co‐occurring SRB and OSA for individuals with prosthodontic needs is challenging to prevent compromising the oro‐pharyngeal space and breathing efficiency. OSA treatment in the presence of SRB includes continuous positive airway pressure (CPAP) use alone or with an occlusal splint or mandibular advancement device (MAD). In addition, the following may be considered: supine sleep correction device, myofuncional therapy, medications, and surgeries. All have limitations and risks. Individual variability suggests that phenotyping is mandatory to select the most efficient and personalized treatment.

Effects of orthodontic aligners on the ecological report of awake bruxism

BACKGROUND

The demand for orthodontic treatment with aligners has recently increased, but their effects on awake bruxism (AB) behaviours have to be evaluated yet.

OBJECTIVES

This investigation assessed if aligners can affect oral behaviours (i.e. tooth contact, teeth clenching, teeth grinding and mandible bracing) that are related with the AB spectrum.

METHODS

The investigation was performed in a sample of 32 consecutively recruited healthy adult patients who required orthodontic treatment. The study protocol involved three different sessions of 1-week monitoring without aligners, with passive aligners and with active aligners, respectively. All patients underwent an orthodontic treatment with aligners and used a smartphone-based application for a real-time report (i.e. ecological momentary assessment [EMA]) of their AB behaviours. Recording time was set from 8.00 to 12.30 and from 14.30 to 22.00. Analysis of variance (ANOVA) was used to compare the average reported frequency for each activity within and between the different sessions. The coefficient of variation (CV) was assessed to evaluate daily fluctuations within the 7 days monitoring periods.

RESULTS

The average reported frequency of the relaxed condition was 64.9%, 63.0% and 60.0% during the sessions without aligners, with passive aligners and with active aligners, respectively. ANOVA showed no significant differences in any of the AB behaviours within (i.e. between 7 days of evaluation) and between the monitoring sessions (i.e. before orthodontic treatment, with passive aligners, with active aligners). No sex differences were detected, except for the 'tooth contact' report that showed a higher frequency in females.

CONCLUSION

The impact of our results in the orthodontic field is not negligible; clinicians can find support for the hypothesis that from a global point of view, wearing or not wearing aligners (passive and/or active) does not influence the frequency of AB behaviours at the short term.

What has a year of social isolation due to the COVID-19 pandemic influenced oral parafunctional habits and temporomandibular disorders? A case-control study

OBJECTIVE

Few studies investigated the influence of oral parafunctional habits during the COVID-19 pandemic. Since some studies have demonstrated that signs and symptoms of temporomandibular disorder (TMD), as well as psychological alterations, increased during the COVID-19 pandemic lockdown, the aim of this study was to investigate whether social isolation is a situation that increases the prevalence of oral parafunctional habits.

METHODS

This was an observational case-control study. An online survey with questions about TMD symptoms (Diagnostic Criteria Symptom Questionnaire) and oral parafunctional habits (Oral Behaviours Checklist [OBC]) was administered to Brazilian residents at two different times (2020 and 2021). The participants were divided according to social isolation practices into study groups (GI: 2020, n = 507; GIII: 2021, n = 282) and control groups (GII: 2020, n = 98; GIV: 2021, n = 202).

RESULT

In each group, we evaluated the association of the frequency of oral parafunctional habits with the symptoms of TMD, and we observed that individuals with a greater presence of painful TMD present a greater number of oral parafunctional habits. Despite the literature showing that individuals who practiced social isolation developed more oral parafunctional habits, when analysing the association of the OBC questions in Groups GI × GII and GIII × GIV, only 'sustained talking' (p = .0022) and 'hold telephone between your hand and shoulders' (p = .0124) showed a significant difference in GI × GII. Kendall's coefficient of concordance revealed that there was a very strong concordance (GI × GII 0.9515 (p = .0087) and GIII × GIV 0.9655 (p = .0074)) between the ranks of the analysed oral parafunctional habits in all groups.

CONCLUSION

We can state that Individuals who practiced social isolation did not present more oral parafunctional habits than individuals who did not.

Genetics and sleep bruxism: a systematic review and meta-analysis of studies with twins

OBJECTIVE

To systematically review the literature regarding the concordance of sleep bruxism (SB) between monozygotic (MZ) and dizygotic (DZ) twins.

METHODS

The registration for this systematic review was accomplished in the International Prospective Register of Systematic Reviews (PROSPERO, No. CRD42021251751). As of July 2022, four databases were searched, including PubMed, Scopus, Embase, and Web of Science, as well as the grey literature in Google Scholar and OpenGrey. Observational studies evaluating SB in MZ and DZ twins of any age and sex were included. For the evaluation of the risk of bias, the Joanna Briggs checklist was utilized. The certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Pooled and subgroup meta-analyses were performed to estimate concordance of SB ​​between twins (p < 0.05).

RESULTS

In total, 3,155 records were identified. In the qualitative analysis, eleven studies were included; of these, seven were included in the meta-analysis. The majority of the articles exhibited a low risk of bias (63.6%). Greater SB concordance was observed between MZ twins than between DZ twins in the analysis of general concordance (OR = 1.47; 95% CI = 1.07-2.02) and also positive concordance (OR = 1.53; 95% CI = 1.29-1.81). Within the subgroup analyses, the significance of the findings remained only for the reported/self-reported SB regarding general concordance (OR = 1.44; 95% CI = 1.07-1.95) and positive concordance (OR = 1.55; 95% CI = 1.28-1.88). Low certainty of the evidence was observed for the general concordance analysis, while moderate certainty was observed for the positive concordance.

CONCLUSION

There was a higher concordance of SB in MZ twins compared to DZ twins, indicating a possible genetic influence on the condition's occurrence.

Relationship between sleep bruxism and obstructive sleep apnoea: A population-based survey

OBJECTIVE

Sleep bruxism (SB) and obstructive sleep apnoea (OSA) seem to be mutually associated. This study investigates the relationship between current SB and OSA-related symptoms and the difference in OSA-related symptoms between groups based on a history of SB.

METHODS

An online survey was drafted to report the presence of SB and OSA in sample of 243 individuals (M = 129;F = 114;mean(SD)age = 42.4 ± 14.4 years). The Subject-Based Assessment strategy recommended in the 'Standardized Tool for the Assessment of Bruxism' (STAB) was adopted to assess SB. To evaluate OSA-related symptoms, Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaires were adopted. Correlations between current SB and OSA-related symptoms were evaluated by Spearman test. ESS and STOP-BANG scores were compared by Mann-Whitney U test in individuals with and a without positive SB history.

RESULTS

Current SB and SB history were reported by 45.7% and 39.1% of the sample, respectively. 73.7%, 21% and 5.3% of the responders showed a low, intermediate and high risk of OSA, respectively. Neither significant correlations between current SB and OSA nor significant differences between SB groups emerged.

CONCLUSIONS

This study did neither find any significant correlation between self-report of current SB and OSA nor significant differences in ESS and STOP-BANG scores between groups based on SB history.

Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study

BACKGROUND

Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated.

OBJECTIVE

The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months.

METHODS

Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment.

RESULTS

The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment.

CONCLUSION

The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

A Two-Sample Mendelian Randomization Study of Neuroticism and Sleep Bruxism

Sleep bruxism (SB) affects a considerable part of the population and is associated with neuroticism, stress, and anxiety in various studies. However, the causal mechanisms between neuroticism and SB have not been examined. Understanding the reasons for SB is important as understanding bruxism may allow improved comprehensive management of the disorders and comorbidities related to it. Previous studies on the association of risk factors to SB have provided important symptomatic insight but were mainly questionnaire based or limited in sample size and could not adequately assess causal relationships. The aim of this study was to elaborate the possible causal relationship of neuroticism as a risk factor for SB through a Mendelian randomization (MR) approach by combining questionnaires, registry data, and genetic information in large scale. We performed a two-sample MR study using instrumental genetic variants of neuroticism, including neuroticism subcategories, in the UK Biobank (n = 380,506) and outcome data of probable SB using FinnGen (n [cases/controls] = 12,297/364,980). We discovered a causal effect from neuroticism to SB (odds ratio [OR] = 1.38 [1.10-1.74], P = 0.0057). A phenotype sensitive to stress and adversity had the strongest effect (OR = 1.59 [1.17-2.15], P = 0.0028). Sensitivity analyses across MR methods supported a causal relationship, and we did not observe pleiotropy between neuroticism and SB (MR-Egger intercept, P = 0.87). Our findings are in line with earlier observational studies that connect stress and SB. Furthermore, our results provide evidence that neurotic traits increase the risk of probable SB.

Probable sleep and awake bruxism in adolescents: A path analysis

BACKGROUND

Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes.

AIM

To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents.

DESIGN

A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis.

RESULTS

PSB and PAB are related to each other, with moderate and positive correlation (β = .390). Poor sleep quality and higher household income had a direct effect on both PSB (β = -.138; β = .123, respectively) and PAB (β = -.155; β = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (β = -.102). Adolescents that drool on the pillow (β = .184) and/or have agitated sleep (β = .104) tend to have PSB.

CONCLUSION

Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

Risk of Dental Implant Failures May Be Higher in Bruxers Than Nonbruxers

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Häggman-Henrikson B, Ali D, Aljamal M, Chrcanovic BR. Bruxism and dental implants: A systematic review and meta-analysis. J Oral Rehabil. 2024 Jan;51(1):202-217. 10.1111/joor.13567. Epub 2023 Aug 17. PMID: 37589382.

SOURCE OF FUNDING

None.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Sleep bruxism: The past, the present, and the future-evolution of a concept

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.

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

BACKGROUND

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

OBJECTIVE(S)

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

METHODS

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

RESULTS

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

CONCLUSION

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

Bruxism and dental implants: A systematic review and meta-analysis

BACKGROUND

Overload from bruxism may affect survival of dental implants.

OBJECTIVES

To evaluate implant failure and marginal bone loss (MBL) in patients presenting with probable bruxism compared to non-bruxers. The study was registered in PROSPERO (CRD42021238397).

METHODS

An electronic search September 2022 in PubMed/Medline, Web of Science and Science Direct was combined with a hand search. Two independent reviewers carried out abstract screening, full-text assessment, quality assessment (National Institutes of Health tool) and data extraction. Only studies that provided information on self-report and clinical examination needed for the diagnosis of at least 'probable' bruxism were included. A pairwise random-effect meta-analysis was carried out.

RESULTS

In total 1338 studies were identified, and after screening and full-text assessment 27 studies that presented data on 2105 implants in probable bruxers and 10 264 implants in non-bruxers were included, with 138 and 352 implant failures in respective groups. the meta-analysis showed that implants placed in probable bruxers had a higher risk of failure than in non-bruxers (OR 2.189; 95% CI 1.337, 3.583, p = .002). A meta-regression showed that follow-up time did not affect this OR. Eighteen studies provided general data on MBL but did not report results separated between bruxers and non-bruxers. Therefore, an analysis of MBL was not possible.

CONCLUSION

The results of the present systematic review show that implants placed in probable bruxers present a significantly higher risk of failure than implants placed in non-bruxers. This should be considered in treatment planning and management of implant patients.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management

BACKGROUND

Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear.

OBJECTIVES

The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic.

METHODS

The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment.

RESULTS

Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations.

CONCLUSION

Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

Standardised Tool for the Assessment of Bruxism

OBJECTIVE

This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences.

METHODS

The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications.

RESULTS

The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration.

CONCLUSIONS

The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies

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.

Assessment of awake bruxism by a novel bruxism screener and ecological momentary assessment among patients with masticatory muscle myalgia and healthy controls

BACKGROUND

Bruxism is a masticatory muscle activity occurring during sleep or wakefulness, involving grinding and clenching of teeth and/or jaw bracing. As yet, the aetiology, epidemiology and consequences of awake bruxism (AB) are largely unknown.

OBJECTIVES

The aims of the study were to AB behaviours using a novel bruxism screener (BruxScreen) questionnaire part and Ecological Momentary Assessment (EMA; BruxApp©) on AB behaviours, and to investigate AB's prevalence among masticatory muscle myalgia patients and non-patients.

METHODS

Altogether, 115 participants (masticatory myalgia patients referred to a specialist clinic (n = 67) and non-patients (n = 46)) filled in a bruxism screener questionnaire to report bruxism behaviours and jaw symptoms. A selection of both groups did a week-long EMA (patients n = 12, non-patients n = 11) to report AB behaviours. The chi-squared test was used to determine group differences in categorical variables. A logistic regression model was fitted to study the probability of AB.

RESULTS

According to BruxScreen, bruxism behaviours and jaw symptoms were more frequent in patients than in non-patients (p < .001). Based on EMA, 14.6% of the behaviour in patients was tooth clenching; for non-patients, this was 0.5% (p < .000). Relaxed muscles were reported by patients and non-patients at 20.6% and 56.4%, respectively (p < .021). Logistic regression, adjusted by age and sex, revealed that patients reported AB 5 times more often than non-patients (OR 4.8, 95% CI 2.1-11.2).

CONCLUSION

Awake bruxism behaviours are significantly more frequent in masticatory muscle myalgia patients than non-patients and associate with frequent bruxism-related symptoms. Self-reported teeth clenching seems to be the most significant sign of AB behaviour.

A worldwide bibliometric analysis of the research trends and hotspots of bruxism in adults during 1991-2021

BACKGROUND AND OBJECTIVES

With the increasing attention to bruxism, the research on bruxism is increasing rapidly. However, there is still a lack of systematic bibliometric analysis in the field of bruxism in adults. This study aimed to comprehensively explore and visualize the global trends and research hotspots in the field of bruxism in adults during 1991-2021.

METHODS

The study searched the literature published during 1991-2021 in the Web of Science Core Collection database without language restrictions. VOSviewer, CiteSpace and Microsoft Excel were applied to analyse the authors, institutions, journals, countries, cited references, keywords and other information of the included publications, and construct visualized cooperation networks.

RESULTS

A total of 878 articles were finally included. The top two most productive authors in the past 30 years were Lobbezoo F and Manfredini D. ACTA-Amsterdam, Univ Sao Paulo, Univ Helsinki, Univ Padua, Univ Montreal, et al. were prominent institutions in this field. Journal of Oral Rehabilitation made outstanding contributions in this field. The United States produced the most documents in this field, followed by Brazil. Both countries and authors cooperated closely around the world. The two most cited articles focused on the definition, assessment and classification of bruxism. In recent years, diagnostic criteria and stress have begun to receive a lot of attention.

CONCLUSION

From 1991 to 2021, the attention to bruxism in adults continued to increase. Diagnostic criteria and stress may be potential research hotspots in this field. This study references relevant scholars on development trends and research hotspots.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2022 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertise in their subject areas that include (in order of the appearance in this report): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence the daily dental treatment decisions of the reader with an emphasis on innovations, new materials and processes, and future trends in dentistry. With the tremendous volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope that readers find this work helpful in managing patients.

Relationship between bruxism and mandibular bone modifications based on medical imaging: a scoping review

OBJECTIVES

This scoping review aimed to assess the current state of knowledge regarding the relationship between bruxism and changes in density or volume of mandibular bone, based on medical imaging.

METHODS

Literature review was conducted following the PRISMA-ScR protocol. PubMed, Web of Science and Cochrane library databases were searched for peer-reviewed articles by two blinded reviewers. Studies based on the evaluation of mandibular bone density and/or bone volume with imaging examination in adult patients were examined. The selected articles were summarized in PICOS tables and assessed for methodological quality.

RESULTS

Nine articles were included, according to the inclusion criteria. They showed that bruxer patients had more bony exostoses of the mandibular angle, smaller condyles, and morphological changes for cancellous and cortical mandibular bone compared to non-bruxer patients.

CONCLUSION

Bruxism seems to induce morphological and anatomical changes in the different regions of the mandibular bone (condyles, mandibular angle, mandible body). Given the heterogeneity of the included studies, these results should be interpreted with caution. Further studies are needed to support these results, in particular via the analysis of three-dimensional imaging to overcome the limitations of panoramic radiograph.

Aspects of Dental Occlusion Assessed with the T-Scan System among a Group of Romanian Dental Students in a Cross-Sectional Study

This study evaluated the occlusal relationships in students with bruxism, using the T-Scan III system, and their correlation with the activity of the masticatory muscles assessed through surface electromyography (sEMG). The study group was divided into two subgroups (based on self-reporting): 20 participants with possible bruxism and 20 participants without possible bruxism; all participants underwent the following evaluations: sEMG recordings using the dia-BRUXO device for masticatory muscles assessment, as well as static and dynamic occlusion using the T-SCAN III system. The analysis of the maximum intercuspidal (MI) position revealed a positive moderate association between the values of the occlusal forces in MI distributed along the two hemiarches, and the number of grinding events during daytime, which was statistically significant (p < 0.05). The analysis of protrusion movements reflected statistically significant differences between the non-working interferences and sEMG parameters specific to bruxism (p < 0.05). The analysis of laterotrusion movements indicated that participants with anterolateral guidance presented higher values of awake bruxism indexes and higher values of clenching events during nighttime. For all three mandibular movements, their duration was higher for the study group compared to the control group. Therefore, this study confirmed the utility of sEMG recordings in the bruxism diagnosis process, as well as the association between dental occlusion and bruxism.