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

ABSTRACT 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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    • "The long-term impact of the stressor leads to a state of severe mental and physical tension [30] [31] that is relieved by movement reactions of parafunctions nature, such as bruxism [32] [33]. Parafunctional habits of masticatory system muscles, with and without associated chronic pain, long-term treatment requiring numerous visits to specialists, rehabilitation exercises, as well as changes of habits are the source of secondary stress for the patient [34] [35] [36] [37] [38]. "
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    ABSTRACT: Lack of educational projects in the available literature was an inspiration to develop a psychoeducational program. The objective was to provide patients with basic information on the contribution of stressors in the occurrence of temporomandibular joint dysfunction and educate on methods for coping with stress most commonly used in psychology. In the course of three meetings, patients are familiarised with the issue of experienced stress as a potential source of psychosomatic illnesses (in particular, temporomandibular joint dysfunction). Preliminary patients' opinions, expressed through self-report methods, indicate significant usefulness of the developed psychoeducational program for the process of treatment and the quality of patients' lives.
    08/2014; 2014:1-6. DOI:10.1155/2014/678169
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    • "Objective testing is uncommon outside research settings, but includes EMG recording of the activity of the masticatory muscles and PSG recording of the sleeping patient. While full audio-video PSG recording remains the gold standard for diagnosis of SB [1,14,15], standardized clinical diagnostic criteria have also been proposed [1,15,16]. There are no validated objective tests for the diagnosis of AB, which relies instead on direct questions and visual observation of patient behaviour [3]. "
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    ABSTRACT: Background Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition. The two clinical manifestations of the condition (sleep and awake bruxism) are thought to have unrelated aetiologies but are palliated using similar techniques. The lack of a definitive treatment has prompted renewed interest in biofeedback, a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs. This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism; to assess the efficacy and acceptability of biofeedback therapy in management of awake bruxism and, separately, sleep bruxism in adults; and to compare findings between the two variants. Methods A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults. We will search electronic databases and the grey literature using a predefined search strategy to identify randomised and non-randomised studies, technical reports and patents. Searches will not be restricted by language or date and will be expanded through contact with authors and experts, and by following up reference lists and citations. Two authors, working independently, will conduct screening of search results, study selection, data extraction and quality assessment and a third will resolve any disagreements. The primary outcomes of acceptability and effectiveness will be assessed using only randomised studies, segregated by bruxism subtype. A meta-analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met, otherwise the data will be summarized in narrative form. Data from non-randomised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues. PROSPERO registration number: CRD42013006880. Discussion Biofeedback is not new, but its place in the clinical management of bruxism remains unclear. New research, and the availability of miniaturized consumer-grade devices, makes a systematic review timely to guide treatment decisions and inform future research.
    Systematic Reviews 05/2014; 3(1):42. DOI:10.1186/2046-4053-3-42
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    • "Sleep bruxism events were assessed according to published criteria, and masseter events were identified as RMMA (American Academy of Sleep Medicine, 2005; Lavigne et al., 1996). The amplitude threshold was set at twice the baseline activity (Yamaguchi et al., 2012). "
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    ABSTRACT: There is some evidence suggesting that obstructive sleep apnea-hypopnea syndrome is concomitant with sleep bruxism. The aim of this study was to investigate the temporal association between sleep apnea-hypopnea events and sleep bruxism events. In an open observational study, data were gathered from 10 male subjects with confirmed obstructive sleep apnea-hypopnea syndrome and concomitant sleep bruxism. Polysomnography and audio-video recordings were performed for 1 night in a sleep laboratory. Breathing, brain, heart and masticatory muscle activity signals were analysed to quantify sleep and sleep stage duration, and number and temporal distribution of apnea-hypopnea events and sleep bruxism events. Apnea-hypopnea events were collected within a 5-min time window before and after sleep bruxism events, with the sleep bruxism events as the pivotal reference point. Two temporal patterns were analysed: (i) the interval between apnea-hypopnea events termination and sleep bruxism events onset, called T1; and (ii) the interval between sleep bruxism events termination and apnea-hypopnea events onset, called T2. Of the intervals between sleep bruxism events and the nearest apnea-hypopnea event, 80.5% were scored within 5 min. Most intervals were distributed within a period of <30 s, with peak at 0-10 s. The T1 interval had a mean length of 33.4 s and was significantly shorter than the T2 interval (64.0 s; P < 0.05). Significantly more sleep bruxism events were scored in association with the T1 than the T2 pattern (P < 0.05). Thus, in patients with concomitant obstructive sleep apnea-hypopnea syndrome and sleep bruxism, most sleep bruxism events occurred after sleep apnea-hypopnea events, suggesting that sleep bruxism events occurring close to sleep apnea-hypopnea events is a secondary form of sleep bruxism.
    Journal of Sleep Research 11/2013; 23(2). DOI:10.1111/jsr.12099 · 3.35 Impact Factor
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