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Ma Y, Zhao W, Zhang S, Jin X, Xu J, Fu B, Shi Y. Treatment decisions of patients with Class II Division 2 malocclusion and severe tooth wear: a systematic review. BDJ Open 2024; 10:65. [PMID: 39138157 PMCID: PMC11322639 DOI: 10.1038/s41405-024-00248-x] [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: 05/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The treatment strategy for patients with severe tooth wear associated with Class II Division 2 malocclusion remains a major challenge for dental practitioners. OBJECTIVES To systematically review and summarize the literature on treatment strategies, restoration procedures and clinical outcomes for Class II Division 2 malocclusion patients with severe tooth wear. METHODS A literature review was conducted using Pubmed, Embase, the Cochrane Library, and Web of Science to identify eligible articles. Publications until October 16th, 2023 were searched independently and cross-checked by two researchers. RESULTS Of 1513 articles screened, 10 reports detailed treatment processes, including six males and four females aged 34-68 years old. Four articles recorded pre-treatment freeway space (FWS) values ranging from 5 to 9 mm. All ten cases had significant occlusal vertical dimension (OVD) loss and the increase in OVD after treatment ranged from 1 to 7 mm. Pre-prosthetic orthodontic treatment was performed in two cases, in one of which only the maxillary region was orthodontically treated. The most common restorations provided were full coverage restorations. In most cases, temporary restorations were applied before the permanent restorations for eight weeks to six months. Four different sequences of final restoration were proposed. Follow-up ranged from four months to six years and included seven patients, one of them showed symptoms of temporomandibular disorder (TMD). CONCLUSIONS A multidisciplinary team (MDT) approach to treatment is recommended. Consideration of pre-prosthetic orthodontic treatment is essential. Commonly used cephalometric measurements for anterior teeth include the interincisal angle and collum angle. The increases in OVD ranging from 1 to 7 mm can be effectively accommodated. Temporary restorations are recommended to accommodate the OVD, and the transition periods of 8 weeks to 6 months help the patients adapted well. Four different sequences for final rehabilitation have demonstrated positive clinical outcomes. Full crown restorations have emerged as the preferred choice for the ultimate restoration of these patients.
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Affiliation(s)
- Yuhan Ma
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Weijia Zhao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Sisi Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoting Jin
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianhao Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China.
| | - Ying Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Provincial Engineering Research Center for Oral Biomaterials and Devices, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, Zhejiang, China.
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Bronkhorst H, Kalaykova S, Huysmans MC, Loomans B, Pereira-Cenci T. Tooth wear and bruxism: A scoping review. J Dent 2024; 145:104983. [PMID: 38574847 DOI: 10.1016/j.jdent.2024.104983] [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: 02/15/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE This study presents a scoping review to determine the association between tooth wear and bruxism. DATA A protocol was developed a priori (Open Science Framework (DOI 10.17605/OSF.IO/CS7JX)). Established scoping review methods were used for screening, data extraction, and synthesis. Risk of bias was assessed using JBI tools. Direct associations between tooth wear and bruxism were assessed. SOURCES Embase, SCOPUS, Web of Science, Cochrane, and PubMed were searched. STUDY SELECTION Any clinical study containing tooth wear and bruxism assessment done on humans in any language was included. Animal, in-vitro studies and case reports were excluded. CONCLUSIONS Thirty publications reporting on the association between tooth wear and bruxism were included. The majority of publications were cross-sectional studies (90%) while only three were longitudinal (10%). Eleven papers assessed definitive bruxism for analysis (instrumental tools), one paper assessed probable bruxism (clinical inspection with self-report) and eighteen assessed possible bruxism (self-report). Of the eleven papers assessing definitive bruxism, eight also reported outcomes of non-instrumental tools. Tooth wear was mostly scored using indexes. Most studies reported no or weak associations between tooth wear and bruxism, except for the studies done on cervical tooth wear. When bruxism assessment was done through self-report, more often an association was found. Studies using multivariate analyses did not find an association between tooth wear and bruxism, except the cervical wear studies. Evidence shows inconclusive results as to whether bruxism and tooth wear are related or not. Therefore, well-designed longitudinal trials are needed to address this gap in the literature. CLINICAL SIGNIFICANCE Based on the evidence, dental clinicians should not infer bruxism activity solely on the presence of tooth wear.
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Affiliation(s)
- Hilde Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands.
| | - Stanimira Kalaykova
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands
| | - Marie-Charlotte Huysmans
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands
| | - Bas Loomans
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands
| | - Tatiana Pereira-Cenci
- Department of Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands
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Couto MCHD, Canhetti de Oliveira CM, Merlo S, Briley PM, Pinato L. Risk of sleep problems in a clinical sample of children who stutter. JOURNAL OF FLUENCY DISORDERS 2024; 79:106036. [PMID: 38241960 DOI: 10.1016/j.jfludis.2023.106036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE Previous studies have shown increased prevalence of sleep problems among people who stutter. However, there is a lack of knowledge about what these sleep problems may specifically be. METHOD Fifty children who stutter (CWS) from 6;0 to 12;9 years of age and 50 age- and gender-matched controls participated in this study. Parents did not report coexisting conditions, excepting stuttering and/or sleep problems. Sleep problems were investigated using a standardized questionnaire answered by parents. The questionnaire shows cut-off scores to identify the risk of sleep problems as a whole and on each one of the six subscales (i.e., disorders of initiating and maintaining sleep; sleep breathing disorders; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis). Scores above the cut-off are suggestive of sleep problems. RESULTS Twenty-one CWS scored higher than the cut-off on the sleep questionnaire compared to only two controls (p < 0.00001). Specifically, CWS scored higher than controls in disorders of initiating and maintaining sleep, sleep-wake transition disorders (especially jerking, sleep talking, and bruxism), and disorders of excessive somnolence (p < 0.0083, corrected for multiple comparisons). DISCUSSION Compared to controls, CWS are at greater risk for sleep problems, which are not consequences of coexisting disorders. Present findings confirm and expand current knowledge about sleep problems in CWS. Directionality possibilities and clinical implications are discussed.
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Affiliation(s)
- Maria Clara Helena do Couto
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
| | | | - Sandra Merlo
- Brazilian Fluency Institute, Av. Brg. Faria Lima, 1811, conj 822, São Paulo, SP 01452-001, Brazil.
| | - Patrick M Briley
- Department of Communication Sciences and Disorders, East Carolina University, 3310AC Health Sciences Building, MS 668, Greenville, NC 27834, United States.
| | - Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
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Pecori A, Luppieri V, Santin A, Spedicati B, Zampieri S, Cadenaro M, Girotto G, Concas MP. Clenching the Strings of Bruxism Etiopathogenesis: Association Analyses on Genetics and Environmental Risk Factors in a Deeply Characterized Italian Cohort. Biomedicines 2024; 12:304. [PMID: 38397906 PMCID: PMC10887134 DOI: 10.3390/biomedicines12020304] [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: 01/05/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Bruxism is a worldwide oral health problem. Although there is a consensus about its multifactorial nature, its precise etiopathogenetic mechanisms are unclear. This study, taking advantage of a deeply characterized cohort of 769 individuals (aged 6-89 years) coming from Northern Italy's genetically isolated populations, aims to epidemiologically describe environmental risk factors for bruxism development and identify genes potentially involved through a Genome-Wide Association Study (GWAS) approach. Logistic mixed models adjusted for age and sex were performed to evaluate associations between bruxism and possible risk factors, e.g., anxiety, smoking, and alcohol and caffeine intake. A case-control GWAS (135 cases, 523 controls), adjusted for age, sex, and anxiety, was conducted to identify new candidate genes. The GTEx data analysis was performed to evaluate the identified gene expression in human body tissues. Statistical analyses determined anxiety as a bruxism risk factor (OR = 2.54; 95% CI: 1.20-5.38; p-value = 0.015), and GWAS highlighted three novel genes potentially associated with bruxism: NLGN1 (topSNP = rs2046718; p-value = 2.63 × 10-7), RIMBP2 (topSNP = rs571497947; p-value = 4.68 × 10-7), and LHFP (topSNP = rs2324342; p-value = 7.47 × 10-6). The GTEx data analysis showed their expression in brain tissues. Overall, this work provided a deeper understanding of bruxism etiopathogenesis with the long-term perspective of developing personalized therapeutic approaches for improving affected individuals' quality of life.
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Affiliation(s)
- Alessandro Pecori
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
| | - Valentina Luppieri
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Aurora Santin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Beatrice Spedicati
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Stefania Zampieri
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
| | - Milena Cadenaro
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Giorgia Girotto
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Maria Pina Concas
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65, 34137 Trieste, Italy; (A.P.); (V.L.); (B.S.); (S.Z.); (M.C.); (G.G.); (M.P.C.)
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Andrisani G, Andrisani G. Sleep apnea pathophysiology. Sleep Breath 2023; 27:2111-2122. [PMID: 36976413 PMCID: PMC10656321 DOI: 10.1007/s11325-023-02783-7] [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: 05/25/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE The purpose of this study is to examine the pathophysiology underlying sleep apnea (SA). BACKGROUND We consider several critical features of SA including the roles played by the ascending reticular activating system (ARAS) that controls vegetative functions and electroencephalographic findings associated with both SA and normal sleep. We evaluate this knowledge together with our current understanding of the anatomy, histology, and physiology of the mesencephalic trigeminal nucleus (MTN) and mechanisms that contribute directly to normal and disordered sleep. MTN neurons express γ-aminobutyric acid (GABA) receptors which activate them (make chlorine come out of the cells) and that can be activated by GABA released from the hypothalamic preoptic area. METHOD We reviewed the published literature focused on sleep apnea (SA) reported in Google Scholar, Scopus, and PubMed databases. RESULTS The MTN neurons respond to the hypothalamic GABA release by releasing glutamate that activates neurons in the ARAS. Based on these findings, we conclude that a dysfunctional MTN may be incapable of activating neurons in the ARAS, notably those in the parabrachial nucleus, and that this will ultimately lead to SA. Despite its name, obstructive sleep apnea (OSA) is not caused by an airway obstruction that prevents breathing. CONCLUSIONS While obstruction may contribute to the overall pathology, the primary factor involved in this scenario is the lack of neurotransmitters.
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Affiliation(s)
- Giovanni Andrisani
- Matera Via Della Croce 47, 75100, Matera, Italy.
- Università Degli Studi Di Bari, Aldo Moro, Bari, Italy.
| | - Giorgia Andrisani
- Ezelsveldlaan 2, 2611 rv, Delft, Netherlands
- Universidad Alfonso X, El Sabio Villanueva de La Canada, Madrid, Spain
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Casazza E, Ballester B, Siaud B, Philip-Alliez C, Raskin A. Relationship between bruxism and mandibular bone modifications based on medical imaging: a scoping review. BMC Oral Health 2023; 23:483. [PMID: 37452323 PMCID: PMC10347727 DOI: 10.1186/s12903-023-03209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
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.
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Affiliation(s)
- Estelle Casazza
- Aix Marseille University, APHM, CNRS, EFS, ADES, 27 boulevard Jean Moulin – 13 385, Marseille, France
| | - Benoit Ballester
- Aix Marseille University, APHM, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | | | | | - Anne Raskin
- Aix Marseille University, APHM, CNRS, EFS, ADES, 27 boulevard Jean Moulin – 13 385, Marseille, France
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Lei Q, Lin D, Liu Y, Lin K, Huang W, Wu D. Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism. BMC Oral Health 2023; 23:325. [PMID: 37231466 DOI: 10.1186/s12903-023-03044-5] [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] [Received: 04/14/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Occlusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion. METHODS Sixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter. RESULTS At teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05). CONCLUSION Modified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.
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Affiliation(s)
- Qun Lei
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China.
| | - Dong Lin
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Yuyu Liu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Kaijin Lin
- Fujian Medical University, Fuzhou, China
| | - Wenxiu Huang
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Laboratory of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
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Vlăduțu DE, Ionescu M, Noveri L, Manolea HO, Scrieciu M, Popescu SM, Turcu AA, Ştefârță A, Lăzărescu G, Mercuț V. Aspects of Dental Occlusion Assessed with the T-Scan System among a Group of Romanian Dental Students in a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4877. [PMID: 36981784 PMCID: PMC10049240 DOI: 10.3390/ijerph20064877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Diana Elena Vlăduțu
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Horia Octavian Manolea
- Department of Dental Materials, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Monica Scrieciu
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sanda Mihaela Popescu
- Department of Oral Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Andreea Turcu
- Department of Orodental Prevention, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alexandru Ştefârță
- Department of Dental Materials, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Grigore Lăzărescu
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Veronica Mercuț
- Department of Prosthetic Dentistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Ågren M, Nanchaipruek Y, Phumariyapong P, Apinuntham C, Rakchart S, Pettersson M, Wanitphakdeedecha R. Duration of bite force reduction following a single injection of botulinum toxin in the masseter muscle bilaterally: A one-year non-randomized trial. J Oral Rehabil 2023; 50:343-350. [PMID: 36810787 DOI: 10.1111/joor.13434] [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: 03/14/2022] [Revised: 11/07/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Previous studies concerning the effect of botulinum toxin in masseter muscle have mainly reported effects observed through inspection of facial features or differences in pain levels. One systematic review of studies utilizing objective measurements reported that long-term muscular effect of botulinum neurotoxin injections into masseter muscle was inconclusive. OBJECTIVE To evaluate the duration of reduced maximal voluntary bite force (MVBF) after botulinum toxin intervention. METHODS The intervention group was comprised of individuals seeking aesthetic treatment for masseter reduction (n = 20), the reference group (n = 12) comprised of individuals with no intervention. Intervention through 25 units of Xeomin® (Merz Pharma GmbH & Co KGaA, Frankfurt am Main, Germany) botulinum neurotoxin type A injected into the masseter muscles bilaterally (totalling 50 units). A reference group did not receive any intervention. MVBF was measured in Newtons using a strain gauge meter at the incisors and first molars. MVBF was measured at baseline, at 4 weeks, 3 months, 6 months, and after 1 year. RESULTS Both groups were similar in terms of bite force, sex and age at baseline. MVBF remained similar compared to baseline in the reference group. At 3 months, a significant reduction at all measurement points was observed in the intervention group; at 6 months, this reduction was no longer significant. CONCLUSION A single intervention of 50 units of botulinum neurotoxin results in a reversible MVBF reduction of at least 3 months, although a visually discernable reduction may be more long-lasting.
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Affiliation(s)
- Martin Ågren
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden.,Prosthodontic Specialist Clinic, Region Västerbotten, Umeå, Sweden
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermkwan Apinuntham
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Mattias Pettersson
- Department of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
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Evaluation of mandibular bone density in bruxers: the value of panoramic radiographs. Oral Radiol 2023; 39:117-124. [PMID: 35438407 DOI: 10.1007/s11282-022-00612-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/03/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to establish a difference in mandibular bone density between bruxer and non-bruxer patients, based on panoramic radiographs. METHODS Panoramic radiographs of bruxer and non-bruxer patients were analyzed with ImageJ®. Several radiological determinants were studied on the patients' panoramic radiographs: gray values of cancellous bone and cortical bone, and bony exostoses at the mandibular angle. RESULTS Thirty-seven bruxers and forty-seven non-bruxers were included in the study. A statistically significant difference (p < 0.05) was noted in the cancellous to cortical bone ratios of bruxers and non-bruxers: the density of cancellous bone was greater in bruxers than in non-bruxers. The number of bony exostoses at the mandibular angle was significantly higher in bruxers (p < 0.05). CONCLUSIONS This study obtained radiological determinants of bruxism from panoramic radiographs. Further studies are needed to supplement this preliminary approach, especially via the analysis of three-dimensional imaging to overcome the limitations of panoramic radiography.
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Frosztega W, Wieckiewicz M, Nowacki D, Michalek-Zrabkowska M, Poreba R, Wojakowska A, Kanclerska J, Mazur G, Martynowicz H. Polysomnographic Assessment of Effects of Tobacco Smoking and Alcohol Consumption on Sleep Bruxism Intensity. J Clin Med 2022; 11:jcm11247453. [PMID: 36556069 PMCID: PMC9785944 DOI: 10.3390/jcm11247453] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Sleep bruxism (SB) is a common sleep-related movement behavior with a complex etiology. A recent hypothesis suggests psychoactive substance usage, tobacco smoking, and alcohol intake are risk factors for SB. This study aimed to evaluate SB intensity in tobacco smokers and alcohol drinkers. Methods: A total of 133 adults underwent full-night audio- and video-polysomnography, and the polysomnograms were evaluated using the American Academy of Sleep Medicine guidelines. The study group was divided into smoker and nonsmoker groups as well as drinker and non-drinker groups. Results: The results of the polysomnographic analysis confirmed that tobacco smoking has a significant effects on SB. Tobacco smokers showed increased bruxism intensity (5.50 ± 4.71 vs. 3.83 ± 3.26, p < 0.05), especially the mixed phenotype (0.93 ± 1.00 vs. 0.59 ± 0.59, p < 0.05), in the N1 sleep stage (22.84 ± 20.45 vs. 15.66 ± 13.60, p < 0.05) and the nonsupine position (4.93 ± 5.56 vs. 2.50 ± 2.31, p < 0.05). They also showed a higher number of bruxism episodes with arousal compared with nonsmokers (2.91 ± 2.83 vs. 1.61 ± 1.49, p < 0.05), indicating increased sleep fragmentation. However, no significant effect of alcohol on SB intensity was observed, and the bruxism episode index was similar in alcohol drinkers and nondrinkers. In addition, electrolyte disturbances and lipid disorders were evaluated. Compared with nonsmokers, tobacco smokers showed a higher concentration of plasma triglycerides (177.67 ± 106.9 vs. 129.18 ± 65.61) and lower levels of iron and magnesium (96.68 ± 43.58 vs. 123.83 ± 52.36 and 1.85 ± 0.22 vs. 1.96 ± 0.21, respectively). Conclusions: In summary, this study showed that tobacco smoking, but not alcohol consumption, is related to bruxism intensity and lipid and electrolyte disturbances in individuals with sleep disorders.
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Affiliation(s)
- Weronika Frosztega
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50-425 Wroclaw, Poland
| | - Dorian Nowacki
- Department of Human Nutrition, Wroclaw University of Environmental and Life Sciences, 37 Chelmonskiego St., 51-630 Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Justyna Kanclerska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska St., 50-556 Wroclaw, Poland
- Correspondence:
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2022; 128:248-330. [PMID: 36096911 DOI: 10.1016/j.prosdent.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; 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 daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.
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Rapp L, Madden S, Rode AV, Walsh LJ, Spallek H, Nguyen Q, Dau V, Woodfield P, Dao D, Zuaiter O, Habeb A, Hirst TR. Anesthetic-, irrigation- and pain-free dentistry? The case for a femtosecond laser enabled intraoral robotic device. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.976097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
By leveraging ultrashort pulse laser and micro-electromechanical systems (MEMS) technologies, we are developing a miniaturized intraoral dental robotic device that clamps onto teeth, is remotely controlled, and equipped with a focusing and scanning system to perform efficient, fast, and ultra-precise laser treatments of teeth and dental restorative materials. The device will be supported by a real-time monitoring system for visualization and diagnostic analysis with appropriate digital controls. It will liberate dentists from repetitive manual operations, physical strain and proximity to the patient's oro-pharyngal area that potentially contains infectious agents. The technology will provide patients with high-accuracy, minimally invasive and pain-free treatment. Unlike conventional lasers, femtosecond lasers can ablate all materials without generating heat, thus negating the need for water irrigation, allowing for a clear field of view, and lowering cross-infection hazards. Additionally, dentists can check, analyze, and perform precise cutting of tooth structure with automatic correction, reducing human error. Performing early-stage diagnosis and intervention remotely will be possible through units installed at schools, rural health centers and aged care facilities. Not only can the combination of femtosecond lasers, robotics and MEMS provide practical solutions to dentistry's enduring issues by allowing more precise, efficient, and predictable treatment, but it will also lead to improving the overall access to oral healthcare for communities at large.
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Kolak V, Pavlovic M, Aleksic E, Biocanin V, Gajic M, Nikitovic A, Lalovic M, Melih I, Pesic D. Probable Bruxism and Psychological Issues among Dental Students in Serbia during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137729. [PMID: 35805387 PMCID: PMC9266173 DOI: 10.3390/ijerph19137729] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has drastically changed the routine way of life, having consequences in many segments of life, including dental practice and education. The aim of this study was to evaluate the frequency of probable bruxism in a sample of dental students in Serbia and to estimate the potential association between psychological factors related to the COVID-19 pandemic and the presence of bruxism. A cross-sectional study included 178 dental students in Serbia, who were interviewed using a specially-designed self-administered online questionnaire, which consisted of three sections, and after that, a clinical examination for the presence of bruxism symptoms in the oral cavity. Psychological status was evaluated using the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S). Saliva samples were taken to analyze salivary cortisol levels. The prevalence of probable bruxism was 34.8%. Respondents with probable bruxism had significantly higher DASS-21 and FCV-19S scores and mean values of salivary cortisol compared to non-bruxers. A history of COVID-19 infection, high stress, and fear of COVID-19 scores were associated with the presence of probable bruxism. The findings suggest that the COVID-19 pandemic has had a great psychological impact and impact on the presence and worsening of bruxism symptoms in a sample of dental students in Serbia.
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Rahman F, Femiano F, Louis PJ, Kau CH. An Evaluation of Jaw Tracking Movements in Patients with Total Joint Replacements versus a Control Group. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060738. [PMID: 35744001 PMCID: PMC9228249 DOI: 10.3390/medicina58060738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: One form of treatment for degenerative temporomandibular joint diseases such as osteoarthritis, rheumatic arthritis, TMJ ankylosis, and condylar resorption is total joint replacement. The aim of this study was to examine the function of the temporomandibular joint after prosthetic joint replacement. Materials and methods: Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via a SICAT JMT+ device. This non-invasive system measures 3D position and linear movements in all degrees of freedom and allows undisturbed functional mandibular movements to provide a quantitative evaluation. In addition, a TMJ questionnaire consisting of the subjective symptoms was also obtained. To date, no similar studies have been cited in the literature. Results: Mandibular movements after prosthetic joint replacement were recorded during opening, closing, protrusion, and lateral excursive movements and were all significantly decreased compared to those of controls. In the treatment group, the maximum incisal opening was 33.46 ± 5.47 mm, left lateral movement was 1.91 ± 2.7 mm, right lateral movement was 1.74 ± 1.74 mm, and protrusive movement was 2.83 ± 2.05 mm. The p-value comparison study and control group indicated significant difference (p < 0.0001) between the two groups. The study group stated a high level of satisfaction with the total joint replacement. Conclusion: Within the limitations of the study, the following conclusions can be drawn: (1) TMJ replacement patients showed significantly limited jaw movements compared to the control group; (2) a small percentage of TMJ replacement patients still present low levels of pain but improved chewing ability and quality of life.
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Affiliation(s)
- Farhana Rahman
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
| | - Felice Femiano
- Dipartimento Multidiscilinare di Specialita Medico-Chirurgiche e Odontoiatriche, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
| | - Chung How Kau
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA;
- Correspondence:
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Rehabilitation of the Completely Edentulous Mandible by All-on-Four Treatment Concept: A Retrospective Cohort Study with Up to 10 Years Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2021; 58:medicina58010010. [PMID: 35056317 PMCID: PMC8779431 DOI: 10.3390/medicina58010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 02/01/2023]
Abstract
(1) Background and Objectives. Currently, there are no definitive long-term data about clinically significant difference in the failure of prosthesis and implant or marginal bone loss related to the rehabilitation of the completely edentulous mandible by all-on-four treatment concept. The main aim of present investigation was to report the long-term outcomes (10-years follow-up) of complete-arch mandibular rehabilitations based on the all-on-four concept. (2) Materials and Methods. Patients in need of extractions of teeth due to the occurrence of caries and/or severe periodontal disease and patients presented with edentulous mandibles were enrolled to the study. A total of 96 participants (mean follow-up period after intervention of 3185.2 days) were enrolled in the study. Participants were evaluated at the first visit, 10 days after intervention and every year after the intervention. Implant and prosthesis survival, bone loss and both local biological and mechanical complications were evaluated during the follow-up period. (3) Results. An implants’ survival rate of 97.9% was observed at the end of the follow-up period. Biological complications were reported in 19.8% of patients, whereas mechanical complications were reported in 27.1% of cases. The average marginal bone level at baseline was −0.03 mm. A significant marginal bone loss was observed after 10-years follow-up (2.5 mm). Binary logistic regression analysis showed significant association between smoke and both marginal bone loss and local biological complications. Lastly, a significant association was observed between bruxism and mechanical complications. (4) Conclusions. The high implant and prosthesis survival rate and the moderate incidence of biological and mechanical complications observed in present investigation can be associated to several factors such as high implant primary stability, prosthetic design, and control of the occlusal forces.
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Goldstein GR. Evidence-Based Dentistry: Causation. J Prosthodont 2021; 30:737-741. [PMID: 34582600 DOI: 10.1111/jopr.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Gary R Goldstein
- Professor Emeritus, Department of Prosthodontics, College of Dentistry, New York University, New York, NY
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Boscato N, Nascimento GG, Leite FRM, Horta BL, Svensson P, Demarco FF. Role of occlusal factors on probable bruxism and orofacial pain: Data from the 1982 Pelotas birth cohort study. J Dent 2021; 113:103788. [PMID: 34425171 DOI: 10.1016/j.jdent.2021.103788] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES This study aimed to explore the association between occlusal features and temporomandibular disorder (TMD) pain complaints and probable awake or sleep bruxism METHODS: Path analysis was used to estimate direct, indirect and total effects of occlusal features on probable bruxism and pain-related TMD in adults aged 31 years from the 1982 Pelotas Birth Cohort. A total of 539 cohort members had an oral examination in 2013. Occlusal features were assessed through the Dental Aesthetic Index (DAI), orofacial pain complaints through the TMD pain screener and probable bruxism based on self-reports in combination with clinical findings. RESULTS Malocclusions were found in 28.8% of the participants, while awake bruxism was reported in 35.2%, sleep bruxism in 15.2%, and pain-related TMD in 52.5% of the sample. Occlusion had no direct effect on either awake bruxism [standardized coefficient (SC) -0.002; p = 0.995] or pain-related TMD (SC -0.06; p = 0.115). Conversely, probable awake bruxism was associated with pain-related TMD (SC 0.35; p < 0.001). Similar results were found when sleep bruxism was set as the mediator of interest, as malocclusion did not directly affect sleep bruxism (SC 0.05; p= 0.220) nor pain-related TMD (SC -0.06; p = 0.167). A direct effect of sleep bruxism on pain-related TMD was observed with an SC of 0.16 (p < 0.001). CONCLUSION Our findings suggested that malocclusion during adulthood did not directly influence probable awake or sleep bruxism nor TMD pain complaints. Instead, probable awake and sleep bruxism was associated with TMD pain complaints. CLINICAL SIGNIFICANCE Malocclusion did not impact the presence of bruxism nor TMD complaints in adulthood, but awake and sleep bruxism were associated with TMD pain complaints. The significance of malocclusion should be reconsidered in contemporary dentistry and oral rehabilitation.
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Affiliation(s)
- Noéli Boscato
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
| | - Fabio R M Leite
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
| | - Bernardo L Horta
- Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark; Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Flavio F Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.
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