Adaptive Stress Coping in Awake Bruxism

Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers

To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.

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.

The prevalence of bruxism and oral parafunction activities among Israeli juveniles with autism spectrum disorder: A preliminary study during the COVID-19 pandemic

OBJECTIVE

To evaluate the prevalence of oral habits, bruxism, and Temporomandibular Disorders (TMD) injuvenileswithautisticspectrumdisorder(ASD).

METHODS

Data included 165 juveniles diagnosed with ASD, allocated to younger group aged 6 21 (n=86) and older group aged 13-21 (n=79).

RESULTS

Sleep bruxism was reported by 26.7% in the younger group and by 5% in the older group. Awake bruxism was reported by 22% and 17.7%, respectively. Oral habits were reported by 43% of all participants, with similar rate in both groups. TMD related p ain was low in both groups (6.3% and 7% respectively). The influence of the COVID 19 pandemic on oral parafunction was moderate in the younger group (17.4%) and mild in the older group (8.6%), influence on bruxism was mild in both groups (5.8% and 2.5%, respectively).

CONCLUSION

The prevalence of bruxism and oral parafunctions was similar to the reported in the literature for the general population.

The continuous adverse impact of COVID-19 on temporomandibular disorders and bruxism: comparison of pre- during- and post-pandemic time periods

INTRODUCTION

Some of the conditions affected by the COVID-19 pandemic were Temporomandibular Disorders (TMD) and bruxism. The present study compares the effect of the pandemic on TMD and bruxism (sleep and awake) in three time periods: before the pandemic (pre-COV), during the pandemic (during-COV) and after the pandemic subsided (post-COVR).

MATERIAL AND METHODS

A total of 587 adult patients (108 in the pre-COV group, 180 in the during-COV group and 252 in the post-COVR group) who arrived for a routine dental treatment between October 2018 and January 2023 were evaluated according to Axis I diagnosis of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Each patient received a DC/TMD Axis I diagnosis as follows: (i) Painful TMD (defined by the presence of at least one of the following - local myalgia, myofascial pain with referral, arthralgia or headache attributed to TMD); (ii) Non painful TMD (defined by the presence of disc displacement with/without reduction, degenerative joint disorders and/or dislocation), (iii) Possible sleep bruxism (SB) and/or (iv) Possible awake bruxism (AB).

STATISTICAL METHODS

Logistic regression analyses were conducted to establish the impact of time and gender on the prospects of painful TMD, non-painful TMD, SB and AB.

RESULTS

The odds of subjects to be diagnosed with painful TMD at the post-COVR era were 3.3 times higher compared to the pre-pandemic time period (pre-COV, 95% C.I. 1.438-7.585). The odds of subjects to be diagnosed with non-painful TMD during-COV were 4 times higher compared to the pre-COV era (95% C.I. 1.332-12.542). The odds of subjects to present possible SB at post-COVR were 2.7 times higher compared to pre-pandemic (pre-COV, 95% C.I. 1.258-5.889, p < 0.05) and the odds to present possible AB after the pandemic subsided (post-COVR) were 3.2 times compared to the pre-pandemic period (95% C.I. 1.496-6.949). The odds of female subjects to be diagnosed with either painful or non-painful TMD were 3.7-4.4 times higher, compared to males.

CONCLUSIONS

Results indicate that with regard to TMD and bruxism the pandemic adverse effects persist also after COVID-19 subsides and the restrictions caused by it are abolished. Apparently, during the pandemic females were affected more seriously by painful and non-painful TMD than males.

Personality, psychosocial and oral behavioural risk factors for temporomandibular disorder symptoms in Asian young adults

BACKGROUND

The relation between personality, psychosocial factors, somatisation, andoral behaviours as risk factors to temporomandibular disorder symptoms have notbeen well established.

OBJECTIVES

This study examined the association of temporomandibular disorder (TMD) symptoms with personality traits, psychological distress, somatisation and oral behaviours. The psychosocial and oral behavioural risk factors for TMD symptoms were also established in Asian young adults.

METHODS

Participants were recruited from a large private University. Based on the quintessential five TMD symptoms (5Ts) of the DC/TMD, the participants were stratified into those with no (NT), painful (PT), dysfunctional (DT) and mixed (MT) TMD symptoms. Personality traits, psychological distress, somatisation and oral behaviours were evaluated with the Big Five Inventory-10 (BFI-10), Depression, Anxiety, Stress Scales-21 (DASS-21), Patient Health Questionnaire-15 (PHQ-15) and Oral Behaviours Checklist (OBC) accordingly. Data were examined using Kruskal-Wallis/Mann-Whitney U and Chi-squared tests, as well as multivariate logistic regression analysis (α = .05).

RESULTS

Of the 420 young adults (mean age 22.7 ± 1.1 years) evaluated, 41.4% had no TMD symptoms, while 17.4%, 20.0% and 21.2% reported PT, DT and MT, respectively. Though personality traits did not vary notably, participants with MT and PT had significantly higher levels of negative affectivity, anxiety and stress than the NT group. Moreover, those with MT and PT presented significantly greater somatisation and more oral behaviours than the DT and NT groups. Multivariate regression analyses indicated that anxiety, somatisation, sleep-related and waking-state nonfunctional oral activities were associated with painful and/or dysfunctional TMD symptoms.

CONCLUSIONS

Except for sleep-related oral activity, psychosocial and oral behavioural risk factors differed for painful, dysfunctional and mixed TMD symptoms in Asian young adults.

The association between sleep bruxism and awake bruxism: Polysomnographic and electromyographic recordings in women with and without myofascial pain

BACKGROUND

Sleep bruxism (SB) and awake bruxism (AB) are masticatory muscle activities that are rarely assessed in the same individuals and are thought to be associated with different behaviours.

OBJECTIVES

To investigate whether individuals engaging in SB also engage in AB, that occurs during rest and during stress-related activity, and to investigate whether SB and AB are associated with different characteristics.

METHODS

Females with myofascial pain (N = 122) and non-myofascial pain controls (N = 46) were evaluated for SB events and for AB events at rest and AB during stress-related activity, using electromyographic (EMG) recordings and a standardised scoring of bruxism events. The joint distributions between SB and AB events and EMG activity were evaluated, and the characteristic qualities of SB and AB were assessed.

RESULTS

Neither SB event rates nor the EMG activity associated with those events was associated with AB events rates or EMG activity, either at rest or during stress-related activity. On the contrary, event rates and EMG activity when awake and at rest were positively associated with events and activity during stress-related activity. SB was characterised mainly by grinding, while AB was characterised mainly by clenching.

CONCLUSION

Sleep bruxism and awake bruxism do not tend to occur in the same individuals.

Oral behaviors in young adults: a multidimensional evaluation of the influence of personality, coping, and distress

OBJECTIVES

This study explored the relationship of oral parafunction to the psychological variables of personality, coping, and distress. Correlates of sleeping/waking-state oral activities with the different psychological factors were also examined, along with psychological predictors for high parafunction.

MATERIALS AND METHODS

Young adults from a large private university were enrolled. The frequency of oral behaviors was appraised with the oral behavior checklist (OBC), and participants were stratified into low and high parafunction (LP/HP) groups following the DC/TMD. Personality traits, coping styles, and psychological distress were assessed with the Big Five Personality Inventory-10 (BFI-10), brief-COPE Inventory (BCI), and Depression, Anxiety, Stress Scales-21 (DASS-21) correspondingly. Statistical evaluations were performed using the chi-square/Mann-Whitney U tests, Spearman's correlation, and logistic regression analyses (α = 0.05).

RESULTS

Among the 507 participants (mean age 22.2 ± 1.5 years), 84.6% and 15.4% had low and high parafunction respectively. While personality profiles did not vary substantially, the HP group exhibited significantly greater emotion-focused/dysfunctional coping, general distress, depression, anxiety, and stress scores than the LP group. Associations between OBC and the various psychological variables were weak when significant or insignificant. Neuroticism and dysfunctional coping were moderately correlated to general distress, depression, anxiety, and stress (rs = 0.44-0.60/0.45-0.51). Multivariate analyses indicated that high parafunction was predicted by dysfunctional coping style (OR = 2.55) and anxiety (OR = 1.33).

CONCLUSIONS

Dysfunctional coping was the main risk factor for high parafunction, increasing its odds by about 2.5 times.

CLINICAL RELEVANCE

Oral parafunction appears to be a dysfunctional coping response to psychological distress.

Increased vertical dimension of occlusion for varying periods differentially impairs learning and memory in guinea pigs

There is an increasing number of studies showing that occlusal dysfunction impairs learning and memory. We previously demonstrated that the brain has a mechanism to calibrate between the activities of spindle afferents and periodontal-mechanoreceptor afferents for controlling the chewing movement, and the accurate calibration can be done only at the proper vertical dimension of occlusion (VDO). Then, the chewing at an inappropriate VDO may induce a severe mental stress due to a mal-calibration. However, it is not clear how the impairment of learning/memory progresses over the period of stress induced by occlusal dysfunction. We investigated by passive avoidance test how the behavior and learning/memory are altered in guinea pigs in which the VDO was raised by 2-3 mm over the period up to 8 weeks. We found that the guinea pigs reared under the raised occlusal-condition (ROC) for 1 week showed a very high sensitivity to electrical stimulation whereas this did not cause the memory consolidation in the 1st-day retention trial, suggesting that such hypersensitivity rather hampered the fear learning. In the guinea pigs reared under the ROC for 2 and 8 weeks, the learning ability was not largely affected and memory consolidation occurred similarly whereas the memory retention deteriorated more severely in the latter guinea pigs than in the former ones. In the guinea pigs reared under the ROC for 3 and 4 weeks, learning was severely impaired, and memory consolidation did not occur. These results suggest that the occlusal dysfunction for varying periods differentially impairs learning and memory.

Awake and Sleep Bruxism Prevalence and Their Associated Psychological Factors in First-Year University Students: A Pre-Mid-Post COVID-19 Pandemic Comparison

There is a broad consensus accepting that psychological variables such as stress, anxiety, or depression play an important role in bruxism. The COVID-19 pandemic has led to an increase in stress, anxiety, and depression levels. The purpose of this study was to evaluate the impact of the COVID-19 pandemic on possible awake and sleep bruxism prevalence and on the psychological factors associated with bruxism, comparing pre-pandemic, pandemic/lockdown, and post-pandemic samples of first-year students. A total of 274 dentistry students from the Complutense University of Madrid participated in the study: 92 from 2018/2019 (pre-pandemic), 90 from 2020/2021 (pandemic), and 92 students from 2021/2022 (post-pandemic) academic years. The participants filled out a thorough battery of validated questionnaires evaluating bruxism and different psychological characteristics, such as anxiety, depression, somatization, personality, and stress coping styles. While sleep bruxism prevalence was significantly higher for the pandemic group, awake bruxism was smaller in comparison to pre-pandemic and post-pandemic groups. The post-pandemic group also presented higher levels of neuroticism and agreeableness personality traits, and positive reappraisal than the pre-pandemic group, with the pandemic group somewhere in between. Additionally, both the pandemic and post-pandemic group showed higher levels of depression and acceptance/resignation coping styles than the pre-pandemic group. Thus, among the three groups of students, the post-pandemic group was the one that showed a larger effect of the pandemic situation in their psychological variables, presenting higher levels of anxiety (state and trait), depression, acceptation/resignation coping style, higher neuroticism (emotional instability trait), and lower agreeableness trait. Nonetheless, the increase of positive reappraisal in the post-pandemic group (an adaptive coping stress style) might be also a sign of recovery. The higher sleep bruxism for the pandemic group might be related to the pandemic situation and lockdown, passively suffered, possibly promoting feelings of impotency, increased levels of depression and acceptance/resignation (normally considered a passive/maladaptive coping style), while acute stressful situations derived from daily personal social interactions might have increased anxiety levels and induced higher levels of awake bruxism observed in both the pre-pandemic and post-pandemic groups. However, further research, including larger and more representative samples, is needed to confirm this possible relationship.

Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles

BACKGROUND

Many studies have revealed high comorbidity and a clear association between temporomandibular disorders (TMD) and migraine. Furthermore, evidence points out that common psychological and behavioral factors might be related to the observed TMD and migraine association. However, this association and the underlying psychological factors are poorly understood.

OBJECTIVE

The main goal of this study was to describe the psychological and behavioral factors involved in TMD myalgia and migraine.

METHODS

A sample of 142 participants were recruited to form 4 groups: migraine patients (ICHD-III criteria), painful-TMD patients (Myalgia DC/TMD criteria), patients suffering from both pathologies according to the same criteria, and control patients. After a dental and neurological examination, the patients filled several psychological questionnaires validated for the Spanish population to assess anxiety (STAI), depression (DEP), stress coping (CRI), and somatic, anxiety, and depression symptoms (BSI-18).

RESULTS

The TMD myalgia patients, in general, showed a state of elevated anxiety, somatization, and reduced coping strategies, while the patients with migraine presented greater anxiety symptoms, depression (dysthymia trait and state), and somatization.

CONCLUSIONS

According to the data of the present study, situational anxiety (transient emotional state), together with the lack of coping strategies, could be more associated with TMD myalgia, while anxiety, as a more stable and long-lasting emotional state, together with depression, might be more related to migraine. Further longitudinal studies are needed to unravel whether these differentiated profiles are a consequence or possible risk factors for migraine and TMD.

Monitoring of awake bruxism by intelligent app

Background. Bruxism is a topic of much controversy and is continually debated in the field of dentistry due to the multifaceted clinical relationship that results in painful conditions and consequences to patients. The aim of this review was to determine the effectiveness of a smartphones app in monitoring awake bruxism. Methods. PROSPERO (registration number: CRD42021271190). The eligibility criteria were as followed: observational studies, case-control studies, studies that reported odds ratios, and studies on awake bruxism. The following keywords were searched: [smartphones apps] AND [apps] AND [awake bruxism], OR [sleep bruxism], OR [sleep hygiene], OR [parasomnias], AND [habits]. Results. All the included studies found that the use of the smartphone app allows controlled awake bruxism monitoring. The results also show that the slepp bruxism and awake bruxism  are interactive, having negative synergism and substantially increasing the risks of temporomandibular joint pain and temporomandibular disorders. Discussion. In the awake bruxims it was possible to identify 70% symptoms through the different frequencies of behavior provided by the App, within the present technological tools have become daily in young and adult population. The app is effective and easy to use by patients, effectively limiting biases the time of evaluation.

Relationship Analogy between Sleep Bruxism and Temporomandibular Disorders in Children: A Narrative Review

Sleep bruxism (SB) is a condition characterized by repetitive clenching or grinding teeth and/or by bracing or thrusting of the mandible during sleep. Although SB is not considered a disorder in children, SB can be a potential physical and psychological hazard or consequence, and this study examines whether SB is a risk factor for TMD as it is in adults. A narrative review on the topic of inferring the relationship between sleep bruxism and TMD in children was performed based on a search in the PubMed and Google Scholar databases for articles published between 1999 and 2022. A total of 76 articles were included in this review. SB is very common in children, may be related to psychological distress or sleep breathing disorder, with a prevalence of up to 49%, and mainly occurs in the non-rapid eye movement stage in the sleep structure. SB may be one cause of TMD. The prevalence of TMD in children is 16–33%. Compared to the female-dominant TMD prevalence in adults, the sex-differences in TMD prevalence in children are less pronounced. However, TMD-related pain is more prevalent in girls than in boys. Given the complex etiology of each of SB and TMD in children, it can be inferred that the explanation of the relationship between the two conditions is very challenging. Ultimately, their relationship should be understood in the individual biopsychosocial model in the process of special physical growth and mental development of children. Moreover, appropriate clinical guidelines for a definitive diagnosis of SB and TMD in children and more research with a high scientific evidence level, which is comprehensive, considering physical, psychological, genetic, and social cultural factors, are required.

Associations between Bruxism, Stress, and Manifestations of Temporomandibular Disorder in Young Students

Bruxism is a repetitive activity of the masticatory muscles, which determine teeth grinding or clenching, associated with rigidity, bracing, or thrusting of the mandibula. The aim of this study was to determine the prevalence of possible bruxism in 328 students attending the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, and its associations with stress and other manifestations of the temporo-mandibular disorder. This was a questionnaire-based study to collect information on self-evaluation of bruxism presence, frequency of specific episodes, stress, anxiety, and other manifestations of temporo-mandibular disorder. Self-evaluated bruxism was identified in 39.33% from the entire study group, allowing us to define two subgroups for further analysis. Sleep bruxism was present in 16.28% of participants; awake bruxism was present in 68.99%, while 14.73% of participants presented a combined form. The main manifestation of bruxism was reported as teeth grinding. Fatigue was identified as a common clinical sign of bruxism and temporo-mandibular disorder. Group distribution analysis (Chi-Square) indicated significant associations between bruxism and stress, panic, restlessness, or increased stress during the COVID-19 pandemic (p < 0.05). Bruxism, and especially awake bruxism, has increased in prevalence among young students, and it has been associated with increased levels of stress.

Temporomandibular Disorders, Bruxism, Perceived Stress, and Coping Strategies among Medical University Students in Times of Social Isolation during Outbreak of COVID-19 Pandemic

The COVID-19 pandemic caught universities along with their students off-guard, enforcing online education. Fear of the unknown, disinformation, and isolation resulted in an increased stress level in the entire population. Medical university students are particularly endangered with high stress levels and developing TMD. Temporomandibular disorders (TMD) are of multifactorial etiology, and manifest with jaw dysfunction, masticatory muscle tension or pain, as well as headache. Though bruxism can act as an exacerbating factor for TMD, stress can also play crucial role in the onset. The study aimed to measure occurrence of TMD and bruxism symptoms in the medical student population, asses the stress level, and evaluate adopted stress-coping strategies during the COVID-19 pandemic outbreak. A survey study was performed among 1018 students at Medical University of Lodz during April 2020. A self-designed questionnaire for screening TMD and bruxism symptoms, Perceived Stress Scale (PSS-10), and Brief-COPE questionnaires were applied. TMD and bruxism symptoms were observed in the majority of subjects during social isolation. The perceived stress levels were significantly higher in those experiencing TMD and bruxism symptoms. Mostly maladaptive, emotion-focused coping strategies were chosen by study subjects experiencing high levels of stress. Choosing Self-Blaming as a coping strategy is the strongest predictor of perceived stress.

Short-term Effects of a First-Line Treatment Including Counseling and Self-Management Strategies on Chronic TMD Muscle Pain and Awake Bruxism in Women

AIMS

To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment.

METHODS

FL-A was administered to 14 women with chronic mTMD (mean age ± SD = 33.8 ± 11.1 years; 8 with Graded Chronic Pain Scale [GCPS] grade I and 6 with grade II). Its effects on facial pain, masticatory muscle tenderness, and spontaneous awake bruxism episodes were evaluated using questionnaires, surface electromyography, and quantitative sensory testing. General linear models were used to test FL-A efficacy after 1 (T1) and 2 (T2) months.

RESULTS

FL-A reduced pain (from baseline [T0] to T2, P = .010), the frequency of awake bruxism episodes (T0 to T1, P = .024), and their intensity by about 30% (T0 to T1, P < .001). Pressure pain thresholds at the masticatory muscle locations increased significantly from T0 to T2 (P < .001). Patients' trait anxiety decreased significantly from T0 to T2 (P = .030). Trait anxiety measured at baseline was not correlated with relative changes in pain (T0 to T2, P = .248).

CONCLUSION

In the short term, FL-A reduces facial pain, masticatory muscle tenderness, and awake bruxism in women with chronic mTMD with low disability. A conservative management strategy should be prioritized for the initial management of these patients.

Altered electromyographic responses to emotional and pain information in awake bruxers: case-control study

OBJECTIVES

This study aims to investigate how emotional information and pain-related information affect the activity of the masticatory muscles in participants with awake bruxism and controls.

MATERIAL AND METHODS

Different videos and texts, with positive, negative, and neutral valence or related to pain, were presented to a sample of university students, while their electromyographic (EMG) activity around the masseter muscle and their skin conductance were recorded. Two groups were selected, with 24 subjects each: one group of subjects with definitive awake bruxism (confirmed by posterior EMG activity) who also suffered from moderate jaw discomfort, and another group of subjects without bruxism.

RESULTS

The results demonstrated that the subjects with definitive awake bruxism displayed greater muscular activity when presented videos and texts with negative valence, especially when related to pain, than the non-bruxist group.

CONCLUSIONS

This study supports the idea that persons with bruxism who also suffer moderate levels of jaw discomfort present greater bruxism activity when watching pain-related stimuli, and to a lesser extent when watching negative stimuli.

CLINICAL RELEVANCE

The increased muscular activity induced by negative and pain-related information might contribute to pain exacerbation and perpetuation in persons with bruxism who suffer from discomfort.

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients

Aim: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. Methods: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. Results: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). Conclusions: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD.

Psychosocial and Behavioral Factors in Awake Bruxism-Self-Report versus Ecological Momentary Assessment

The issue of psychosocial factors and concurrent conditions associated with AB is a relatively new approach in the study of Awake Bruxism (AB). In the present study a population of 84 dental students were assessed for probable AB with two modes of AB assessment: Single point self-report (SR) and ecological momentary assessment through a designated smartphone application (BA). The two assessment modes were compared with regard to their ability to phenotype subjects as far as the following psychosocial and behavioral variables are concerned: Gender; depression; somatization; oral behaviors; chronic pain and associated pain symptoms in the head, neck and scapula. Two-way ANOVA showed main effect of SR for the following variables: Chronic Pain Intensity score (F_(1,49) = 6.441, p < 0.02), migraine/headache (F_(1,81) = 7.396, p < 0.01), pain in neck (F_(1,81) = 6.726, p < 0.05), pain in scapula (F_(1,81) = 8.546, p < 0.005) and the oral behaviors of pushing the tongue forcefully against the teeth (F_(1,81) = 5.222, p < 0.05) and inserting the tongue between the upper and lower teeth (F_(1,81) = 5.344, p < 0.03). The effect of SR on the habit of chewing gum was borderline (F_(1,81) = 3.369, p = 0.07). Main effect of BA was found for depression (F_(1,81) = 6.049, p < 0.05), while the effect of BA on somatization was borderline (F_(1,81) = 3.657, p = 0.059). An interaction between SR and BA groups could be observed for the behavior of biting, chewing or playing with the tongue, cheeks or lips (F_(1,81) = 4.117, p < 0.05). The results suggest that a combination of a single-point self-report referring to the past 30 days, and an ecological momentary assessment supplying information about the actual timing of the report, can help us to better assess AB, as well as increase our ability to define the phenotype of subjects with AB as far as psychosocial and behavioral factors are concerned.