Sleep Bruxism: Validity of Clinical Research Diagnostic Criteria in a Controlled Polysomnographic Study

Faculté de médecine dentaire, Université de Montréal, Centre-Ville, Canada.
Journal of Dental Research (Impact Factor: 4.14). 02/1996; 75(1):546-52. DOI: 10.1177/00220345960750010601
Source: PubMed


The clinical validity of diagnostic criteria for sleep orofacial motor activity--more specifically, bruxism--has never been tested. Polysomnographic recordings from 18 bruxers and 18 asymptomatic subjects, selected according to American Sleep Disorders Association criteria, were analyzed (1) to discriminate sleep bruxism from other orofacial motor activities and (2) to calculate sensitivity, specificity, and predictive values of research criteria. Clinical observations and reports revealed that all 18 bruxers reported frequent tooth-grinding during sleep. Tooth wear was noted in 16 out of 18 bruxers and jaw discomfort reported by six of them. These findings were present in none of the controls. The analysis of polysomnographic data showed that the asymptomatic subjects presented a mean of 1.7 +/- 0.3 bruxism episodes per hour of sleep (sustained or repetitive bursting activity in jaw closer muscles), while bruxers had a significantly higher level of activity: 5.4 +/- 0.6. Controls exhibited 4.6 +/- 0.3 bruxism bursts per episode and 6.2 (from 0 to 23) bruxism bursts per hour of sleep, whereas bruxers showed, respectively, 7.0 +/- 0.7 and 36.1 (5.8 to 108). Bruxism-like episodes with at least two grinding sounds were noted in 14 of the 18 bruxers and in one control. The two groups exhibited no difference in any of the sleep parameters. Based on the present findings, the following polysomnographic diagnostic cut-off criteria are suggested: (1) more than 4 bruxism episodes per hour, (2) more than 6 bruxism bursts per episode and/or 25 bruxism bursts per hour of sleep, and (3) at least 2 episodes with grinding sounds. When the polysomnographic bruxism-related variables were combined under logistic regression, the clinical diagnosis was correctly predicted in 81.3% of the controls and 83.3% of the bruxers. The validity of these clinical research criteria needs now to be challenged in a larger population, over time, and in subjects presenting various levels of severity of sleep bruxism.

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Available from: Gilles J Lavigne, Jun 14, 2014
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    • "Electromyographic (EMG) events are classified as tonic (namely, sustained clenching), phasic (i.e., repeated tooth grinding events) or mixed (a combination of these two patterns) [2]. The precise diagnosis is established based on the association between clinical report, physical exam and polysomnography (PSG) [3] [4] [5] [6] [7]. Diagnoses based only on noise reports or on dental wear might overestimate or underestimate the SB [5] [8] [9]. "
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    ABSTRACT: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring.
    Sleep Science 08/2015; DOI:10.1016/j.slsci.2015.08.002
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    • "Recientemente, las investigaciones en fisiología del sueño han llamado la atención de los dentistas puesto que los desórdenes de sueño, tales como las alteraciones de la respiración durante el mismo, han demostrado tener una compleja interrelación con las cefaleas, síndrome de apnea e hipoapnea de sueño (SAHOS) y BS. Para esta revisión bibliográfica, se seleccionaron y analizaron artículos en Pubmed utilizando las palabras clave, considerando como primera referencia el artículo de Lavigne et al. (1996) donde se establecen los criterios de diagnóstico de BS, hasta los artículos publicados en marzo de 2015. El objetivo del trabajo es informar a la comunidad médica y odontológica sobre la prevalencia, etiología, comorbilidades asociadas y las opciones terapéuticas para el BS en niños y adolescentes entre 3 y 17 años. "

    • "The detected MMA not relating to functional behaviors such as eating was termed a nonfunctional MMA. Second, according to Lavigne's criteria (Lavigne et al., 1996), the detected nonfunctional MMA event was classified as phasic, tonic, and mixed type. The phasic type corresponds to at least three EMG bursts of 0.25–2.0 "
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    ABSTRACT: Continuous parafunctional masseter muscle activities (MMA) that are associated with daytime bruxism have been suspected to be one of the main pathoetiology for orofacial pain. The purpose of this study was to examine the long-term stability and reliability of daytime EMG measurement of MMA using a portable device (Actiwave; CamNtech Ltd). Daytime masseter muscle EMG of five subjects were recorded for four days in their normal living environment. There was no significant time dependent effect on EMG amplitude during recording period. A total of 4923 MMA events were detected in all analysis periods (129.4h) and classified into phasic type (1209 events, 24.6%), tonic type (1759 events, 37.0%), and mixed type (1377 events, 28.0%). There was no significant difference in the number of occurrence among three MMA types. With respect to the duration and peak MMA, there were significant differences among three MMA types. The result of this study indicated that Actiwave can be used to measure MMA events during daytime with high stability and reliability under the normal living environment and it was suspected that parafunctional habits may be associated with the occurrence patterns of MMA during daytime. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology 05/2015; 55(4). DOI:10.1016/j.jelekin.2015.04.012 · 1.65 Impact Factor
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