Article

Risk Factors for Sleep Bruxism in the General Population*

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Abstract

Sleep bruxism can have a significant effect on the patient's quality of life. It may also be associated with a number of disorders. However, little is known about the epidemiology of sleep bruxism and its risk factors in the general population. Cross-sectional telephone survey using the Sleep-EVAL knowledge based system. Representative samples of three general populations (United Kingdom, Germany, and Italy) consisting of 158 million inhabitants. Thirteen thousand fifty-seven subjects aged > or = 15 years (United Kingdom, 4,972 subjects; Germany, 4,115 subjects; and Italy, 3,970 subjects). None. Clinical questionnaire on bruxism (using the International Classification of Sleep Disorders [ICSD] minimal set of criteria) with an investigation of associated pathologies (ie, sleep, breathing disorders, and psychiatric and neurologic pathologies). Grinding of teeth during sleep occurring at least weekly was reported by 8.2% of the subjects, and significant consequences from teeth grinding during sleep (ie, muscular discomfort on awakening, disturbing tooth grinding, or necessity of dental work) were found in half of these subjects. Moreover, 4.4% of the population fulfilled the criteria of ICSD sleep bruxism diagnosis. Finally, subjects with obstructive sleep apnea syndrome (odds ratio [OR], 1.8), loud snorers (OR, 1.4), subjects with moderate daytime sleepiness (OR, 1.3), heavy alcohol drinkers (OR, 1.8), caffeine drinkers (OR, 1.4), smokers (OR, 1.3), subjects with a highly stressful life (OR, 1.3), and those with anxiety (OR, 1.3) are at higher risk of reporting sleep bruxism. Sleep bruxism is common in the general population and represents the third most frequent parasomnia. It has numerous consequences, which are not limited to dental or muscular problems. Among the associated risk factors, patients with anxiety and sleep-disordered breathing have a higher number of risk factors for sleep bruxism, and this must raise concerns about the future of these individuals. An educational effort to raise the awareness of dentists and physicians about this pathology is necessary.

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... De etiologia multifatorial, pode estar relacionada à depressão, ansiedade, obesidade, apneia do sono, insônia, BS, dentre outros (Roberta et al., 2000;Newman et al., 2000;Ohayon;Li;Guilleminault, 2001). Sua presença pode ser avaliada por meio de instrumentos que avaliam a qualidade do sono como a Escala de Sonolência Epworth (ESE) (Johns, 1991). ...
... De etiologia multifatorial, pode estar relacionada à depressão, ansiedade, obesidade, apneia do sono, insônia, BS, dentre outros (Roberta et al., 2000;Newman et al., 2000;Ohayon;Li;Guilleminault, 2001). Sua presença pode ser avaliada por meio de instrumentos que avaliam a qualidade do sono como a Escala de Sonolência Epworth (ESE) (Johns, 1991). ...
... De etiologia multifatorial, pode estar relacionada à depressão, ansiedade, obesidade, apneia do sono, insônia, BS, dentre outros (Roberta et al., 2000;Newman et al., 2000;Ohayon;Li;Guilleminault, 2001). Sua presença pode ser avaliada por meio de instrumentos que avaliam a qualidade do sono como a Escala de Sonolência Epworth (ESE) (Johns, 1991). ...
Article
O objetivo do estudo foi investigar a associação entre o bruxismo do sono (BS) e a ocorrência de sonolência diurna (SD). Foi realizada uma revisão sistemática seguindo o Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol. O protocolo foi registrado no International Prospective Register of Systematic Reviews (No CRD42021246944). Foram consultadas 8 bases de dados eletrônicas, incluindo a literatura cinzenta, e busca manual. A População, Exposição, Comparação e Desfecho foi utilizada para definir os critérios de elegibilidade, sendo incluídos apenas estudos observacionais (transversais e caso-controle). A qualidade dos estudos foi investigada usando a Escala de Newcastle-Ottawa. Foram incluídos 8 artigos publicados entre 2001 e 2019, em inglês, sendo 3 caso-controles e 5 transversais. Com base na Escala Newcastle-Ottawa, 2 estudos apresentaram risco de viés alto (escore total=3); 5 estudos, risco de viés moderado (escore total variando de 4 a 6) e 2 estudos, risco de viés baixo (escores totais 6 e 7). Com base nos meios de diagnóstico utilizados, 6 estudos mostraram associação significativa do BS com SD, sendo que para 2 estudos, o BS foi fator sugestivo de explicação para SD e para 2 estudos, a SD foi sugestiva de explicação para o relato de BS. O BS foi associado à SD. Com base nos achados, sugere-se que a presença de bruxismo do sono pode levar à sonolência diurna excessiva assim como a sonolência diurna pode levar ao bruxismo.
... As the literature evolved, several factors were proposed as initiating and perpetuating bruxism. These included, but were not limited to, peripheral factors, 1,41-44 psychological factors, [45][46][47][48][49][50][51][52] exogenous factors (eg, illicit drugs and prescription medications), 53-56 genetic factors, 30,57-59 systemic comorbidities, 20,60 and cardiorespiratory-related sleep arousals. 61 We will discuss these concepts and the up-to-date literature. ...
... [81][82][83][84][85] Researchers seemed to have confirmed such an association when bruxism was self-reported. [45][46][47][48][49][50][51][52] Concepts such as stress sensitivity and their relation to SB have been examined in the literature. [86][87][88] In EMG-based studies, researchers have questioned the causal relationship between stress and SB. ...
... 24,92,93 The possible factors include, but are not limited to, day-to-day and diurnal variations in bruxism, presence or absence of pain, 86 variability of screening and diagnostic tools, 86,89 and variability of criteria for identifying, defining, and classifying what stress means to patients. 87,88 The stress-bruxism relationship may be supported mostly by studies in which bruxism is clinically diagnosed or self-reported, [45][46][47][48][49][50][51][52] and EMG studies have yielded conflicting findings. 86,89,90 Some of the literature has referred to psychological distress. ...
... 2 Sleep bruxism is considered a motor behavior with a multifactorial etiology, and research has focused on the associated factors that play a role in its pathophysiology. 1,3 Lifestyle habits, such as smoking, alcohol and coffee consumption, and psychological traits, such as anxiety, stress, depression, and sleep disorders, have been associated with increased SB. 4,5 University students may be subjected to considerable levels of stress, anxiety, and depression, which may be associated with several psychosocial stressors emerging from the academic environment. 6,7 Furthermore, sleep quality can be related to academic lifestyle. ...
... Few studies have investigated the mental outcomes associated with bruxer behavior in university students. Controversial cross-sectional findings regarding the correlation regarding stress levels 13,14 and depression 5,15 with bruxism have also been identified, which may be related to the small samples and specific characteristics of the populations included in these investigations. ...
... 20 In this instrument, respondents rate the frequency of their feelings and thoughts related to events and situations that occurred in the last month. In total, 6 items are negative (1, 2, 3, 6, 9, and 10), and 4 are positive (4,5,7,8). Each question is rated on a 5-point Likerttype scale (1 ¼ never; 5 ¼ very often) and produces a total score ranging from 0 to 40. ...
Article
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The aim of the present study was to examine the association regarding sleep bruxism (SB), depression, and stress in Brazilian university students. We conducted a cross-sectional study with a large-sample of university students (n = 2,089) in the city of Pelotas, Rio Grande do Sul, Southern Brazil. A self-administered questionnaire was sent to classrooms to evaluate socioeconomic and demographic characteristics. Possible SB was detected by self-report according to the International Consensus on The Assessment of Bruxism Criteria (2018). The Patient Health Questionnaire-9 and the Perceived Stress Scale were used to assess depression and stress symptoms respectively. Crude and adjusted Poisson regression analyses were performed. The prevalence of possible SB, high level of stress, and depressive symptoms in the sample were of 20.4%, 16.6%, and 16.6% respectively. Stress in female students was significantly associated with an increased prevalence of possible SB, but not in male students. Regarding depression, the prevalence of SB was 28% higher in students with depressive symptoms. Students with stress or depression had a 35% higher prevalence of SB than those without any symptoms. Conclusion The findings have shown that university students with stress and depressive symptoms were more likely to be detected with possible SB.
... Bruxism is a multifactorial condition potentially influenced by the central nervous system (CNS), oral motor performance, sleep-wake cycle, autonomic nervous system, and catecholaminergic, genetic, and psychological factors (22). Studies have associated occlusal interference (23), the rhythmic or tonic activity of the masseter and temporalis muscles (24), and abnormal anatomy of the TMJ (25) with the incidence of bruxism. They have also shown the relationship between bruxism and psychological factors, such as stress and anxiety (24,(26)(27)(28). ...
... Studies have associated occlusal interference (23), the rhythmic or tonic activity of the masseter and temporalis muscles (24), and abnormal anatomy of the TMJ (25) with the incidence of bruxism. They have also shown the relationship between bruxism and psychological factors, such as stress and anxiety (24,(26)(27)(28). Childhood bruxism might persist into adulthood. ...
... These results are consistent with the results of previous studies that have shown a link between bruxism and sleep-disordered breathing, such as obstructive sleep apnea, which is a known cause of respiratory problems. Ohayon et al. have also demonstrated a significant association between bruxism and sleep-disordered breathing (24). Furthermore, Sakaguchi et al. examined the relationship between mandibular position and obstructive sleep apnea, a type of respiratory disorder linked to bruxism, in previous studies. ...
Article
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Background: Bruxism is a parafunctional oral activity defined as excessive teeth grinding or jaw clenching. This disorder causes damage to the teeth and deforms them. Objectives: This is the first phase of the sleep bruxism and respiratory disorders assessment study in Kerman, Iran, which evaluated respiratory disorders and sleep bruxism in schoolchildren aged 8 - 11 years between 2018 - 2019. Methods: A total of 573 primary school students aged 8 - 11 years were recruited for this cross-sectional study in Kerman between 2018 - 2019. The subjects were chosen randomly from 20 schools located throughout the city. Following permission from officials, 30 students from each school were admitted to the study randomly. The parents were invited to fill out a checklist that included a history of respiratory and sleep problems and signs of bruxism or abnormal jaw movements. Additionally, an examination was performed, and the symptoms of bruxism, such as tooth wear and restoration fractures, were documented. Results: The parents of 573 children were recruited to the study. The prevalence of bruxism and respiratory diseases was observed to be 20.6% (n = 118) and 26.5% (n = 152), respectively. The children with sound production had 2.3 times higher odds of bruxism prevalence than those without sound production (P = 0.004). However, children with temporomandibular joint and paranasal sinus sensitivity had 4.5 (P = 0.001) and 3.8 (P = 0.001) times higher odds, respectively. Additionally, the odds of bruxism prevalence were 1.4 times higher in children with respiratory disorders than those without (P = 0.001). Conclusions: Bruxism was common in children who had a respiratory disorder. Given the potential impact of bruxism on children’s dental health, it is important to pay special attention to the health status of children with respiratory disorders.
... Another problem is generated by the fact that the psyche influences self-reporting, which is very subjective [20,59,60]. For this reason, the assessment of bruxism through self-reporting has limited value. ...
... The clinical evaluation should include an extraoral and an intraoral examination to identify signs and symptoms related to bruxism [13,57]. The extraoral examination should evaluate the masticatory muscles (masseter hypertrophy, for example), the presence of pain (muscle pain, TMJ pain, headaches), and other signs of TMD (temporomandibular dysfunction) [1,59]. The intraoral examination should include a detailed dental-periodontal examination to monitor the dental effects of bruxism (dental wear, enamel cracks and fractures, broken tooth syndrome, vertical or horizontal root fractures in vital and nonvital teeth, failure of prosthetic restorations, tooth mobility-occlusal trauma) and inspection of the mucous membranes of the cheeks to identify the linea alba, dental impressions on the tongue and traumatic lesions, e.g., of the tongue and cheeks, as well as the presence of intraoral pain (teeth soreness or hypersensitivity) [1,57]. ...
Article
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Background/Objectives: The study aimed to validate the diagnostic system proposed by the Standardized Tool for the Assessment of Bruxism (STAB) by correlating the results obtained based on questionnaire and non-instrumental and instrumental tools. Methods: The study had three stages (questionnaire, clinical examination, and electromyographic study). The subjects completed a questionnaire and clinical exam. Positive signs of bruxism included oral mucosal signs and the presence of dental wear according to the BEWE index. In stage three, sEMG was performed after allocating subjects into four groups according to the questionnaire and clinical exam results: sleep bruxism (SB), awake bruxism (AB), sleep and awake bruxism (SB AB), and no bruxism (no B). After the third stage, a new selection was made, and the subjects were divided into four groups, according to sEMG results. Diagnostic accuracy was computed for possible bruxism SB and grinding and clenching sound diagnosis, possible bruxism AB and AB acknowledgment, possible bruxism SB AB, and tooth wear index. Results: For SB, the sensitivity and specificity of the tools were the highest. The non-instrumental questionnaire and clinical assessment identified 67% of SB cases and 89% without SB. For AB, the specificity was higher (84%), while the sensitivity was lower (55%), as almost half of the subjects were not aware of the presence of AB. The tests showed a low sensitivity (15%) but a high specificity (83%) for tooth wear. The absence of tooth wear was frequently associated with the absence of bruxism, while the presence of tooth wear did not necessarily imply the existence of bruxism. Conclusions: Non-instrumental evaluation of bruxism through questionnaires and clinical exams is valuable, especially for SB. Instrumental evaluation through electromyography remains a gold standard for bruxism diagnosis.
... Night bruxism is an oral habit that occurs during sleep, characterized by movements of the temporomandibular muscles, which force the tooth surfaces to come into contact with each other. The consequences of this disorder include excessive tooth wear, tooth fractures, muscle pain, inflammation and recession of the gums, pain in the temporomandibular joint, increased risk of periodontal problems, overloaded implants, loss and tangling of teeth (OHAYON, LI andGUILLEMINAULT, 2001 andNAKATA et al, 2008). ...
... Night bruxism is an oral habit that occurs during sleep, characterized by movements of the temporomandibular muscles, which force the tooth surfaces to come into contact with each other. The consequences of this disorder include excessive tooth wear, tooth fractures, muscle pain, inflammation and recession of the gums, pain in the temporomandibular joint, increased risk of periodontal problems, overloaded implants, loss and tangling of teeth (OHAYON, LI andGUILLEMINAULT, 2001 andNAKATA et al, 2008). ...
Conference Paper
Bruxism has been shown to be a multifactorial disease that, in addition to chewing disorders, is related to everyday stress and anxiety. Bruxism is more common in environments with high levels of stress. For example, in the military we see an environment in which various factors contribute to psychological imbalance in the pre- and post-disaster period (SOARES, FERNANDES and SILVA, 2021).
... The comorbidity of sleep bruxism (SB) and obstructive sleep apnea (OSA) is an area of interest in research on sleep medicine and dentistry (2)(3)(4)(5). The prevalence of SB in the adult population was previously reported to be 5.5-8% (6)(7)(8). OSA is more prevalent than SB, occurring in approximately 30% of the population (9). The prevalence of both SB and OSA is high, and SB increases the risk of negative oral health consequences (e.g., temporomandibular joint pain, prosthodontic complications), OSA is known to be associated with hypertension and various vascular diseases. ...
... It is very important to investigate the factors and effects of the combination of these two conditions. Epidemiological studies suggested that OSA patients are more likely to have SB (8), and this is supported by the findings of polysomnographic (PSG) studies showing that between 9 and 70% of OSA patients also have SB (10)(11)(12)(13)(14) and the body position-related OSA phenotype has higher SB and severe SB incidence (15). Genetic predisposition to OSA-SB relationship was also proposed previously (16). ...
Article
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Purpose The present study investigated the relationship between sleep bruxism (SB) and obstructive sleep apnea (OSA) in relation to the sleep architecture. Methods We conducted a cross-sectional study. Polysomnographic recordings were performed on 36 patients. Sleep, respiratory, and oromotor variables, such as rhythmic masticatory muscle activity (RMMA) and non-specific masticatory muscle activity (NSMA), were compared between OSA patients with or without SB. A correlation analysis of the frequency of respiratory and oromotor events in NREM and REM sleep was performed. The frequency of oromotor events following respiratory events was also assessed. Results The proportion of REM sleep was higher in OSA patients with SB than in those without SB (p = 0.02). The apnea-hypopnea index (AHI) did not significantly differ between the two groups; however, AHI was approximately 8-fold lower during REM sleep in OSA patients with SB (p = 0.01) and the arousal threshold was also lower (p = 0.04). Although the RMMA index was higher in OSA patients with than in those without SB (p < 0.01), the NSMA index did not significantly differ. The percentage of RMMA following respiratory events was significantly higher in OSA patients with than in those without SB, whereas that of NSMA did not significantly differ. The frequency of oromotor events throughout the whole night positively correlated with AHI. However, regardless of the sleep state, AHI did not correlate with the RMMA index, but positively correlated with the NSMA index. Conclusion In consideration of the limitations of the present study, the results obtained indicate that OSA patients with SB have a unique phenotype of OSA and also emphasize the distinct relationship of respiratory events with RMMA and NSMA.
... Sleep bruxism also represents the third most frequent parasomnia [155]. People in a state of high mental tension and psychological stress may maintain an excited state of the occlusal muscles at night and experience nocturnal teeth-grinding symptoms [155][156][157][158]. Subjects with obstructive sleep apnea syndrome, loud snorers, subjects with moderate daytime sleepiness, heavy alcohol drinkers, caffeine drinkers, and smokers are at higher risk of reporting sleep bruxism [156]. ...
... Sleep bruxism also represents the third most frequent parasomnia [155]. People in a state of high mental tension and psychological stress may maintain an excited state of the occlusal muscles at night and experience nocturnal teeth-grinding symptoms [155][156][157][158]. Subjects with obstructive sleep apnea syndrome, loud snorers, subjects with moderate daytime sleepiness, heavy alcohol drinkers, caffeine drinkers, and smokers are at higher risk of reporting sleep bruxism [156]. In 2021, Lee et al. integrated sensors such as accelerometers and gyroscopes in a jaw advancement device used to improve sleep apnea to help monitor the occurrence of sleep apnea and teeth grinding and to improve the effectiveness of related treatment devices [159]. ...
Article
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Sleep is an essential physiological activity, accounting for about one-third of our lives, which significantly impacts our memory, mood, health, and children’s growth. Especially after the COVID-19 epidemic, sleep health issues have attracted more attention. In recent years, with the development of wearable electronic devices, there have been more and more studies, products, or solutions related to sleep monitoring. Many mature technologies, such as polysomnography, have been applied to clinical practice. However, it is urgent to develop wearable or non-contacting electronic devices suitable for household continuous sleep monitoring. This paper first introduces the basic knowledge of sleep and the significance of sleep monitoring. Then, according to the types of physiological signals monitored, this paper describes the research progress of bioelectrical signals, biomechanical signals, and biochemical signals used for sleep monitoring. However, it is not ideal to monitor the sleep quality for the whole night based on only one signal. Therefore, this paper reviews the research on multi-signal monitoring and introduces systematic sleep monitoring schemes. Finally, a conclusion and discussion of sleep monitoring are presented to propose potential future directions and prospects for sleep monitoring.
... Bruxism is considered a necessary physiological function that supports cardiac and respiratory activities and plays a role in awakening mechanisms (Andrisani & Andrisani, 2021). However, various factors, such as alcohol, drugs, diet, and certain medical conditions, can influence the intensity and frequency of bruxism (Frosztega et al., 2022;Montastruc, 2023;Ohayon et al., 2001;Toyama et al., 2023). Excessive bruxing forces can lead to significant tooth wear and other dental issues, such as non-carious cervical lesions (NCCL), abfractions, enamel chipping, crown failure, tooth sensitivity, and periodontal tissue damage, which may require clinical intervention (Benazzi et al., 2013;Bustos et al., 2020;Miranda et al., 2017). ...
Article
La masticación es considerada la función principal del sistema estomatognático y de los dientes. Estudios realizados en los años 70 y 80, revelaron que practicamente no hay contacto dentario durante la masticación, excepto durante la fase de máxima intercuspidación. Aunque la masticación se basa en un patrón muscular automatizado, es todavía una actividad consciente. El desgaste dental es mayoritariamente atribuido a la abrasión causada por los componentes más duros de la comida o por contaminación de ésta con materiales abrasivos como sílice o carbonatos. En cambio, el bruxismo del sueño es un movimiento excursivo, inconsciente, de los dientes inferiores, que utiliza toda la longitud de las guías oclusales con mayor fuerza muscular y sin la interposición del bolo alimenticio. Por esa razón, puede resultar en contactos dentales de mayor extensión, con el resultado de pérdida de material. Al considerar los humanos modernos que utilizan una dieta blanda y refinada, que generalmente no contribuye para el desgaste dentario, la posibilidad de que el bruxismo sea el mayor contribuyente para la pérdida de material dentario no puede ser descartada. Así, los patrones de desgaste dentario en sujetos modernos y en poblaciones antiguas deberían ser considerados con base en la experiencia clínica del análisis de las actividades de bruxismo y masticación en sujetos vivos. En este artículo se presenta la experiencia clínica en pacientes con bruxismo y con desgaste dental en sociedades industrializadas contemporáneas como una posible fuente de información que se debe integrar al análisis del desgaste encontrado en hallazgos arqueológicos.
... Bruxism is a sleep-related movement disorder that includes jaw clenching or teeth grinding, which can be associated with undesirable consequences, such as tooth wear and headaches. 60 The bruxism symptom relating to teeth grinding has been reported by approximately 8% of the general population, 61,62 and in approximately 40% of children 11 years of age and below. 63 ...
Article
There are more than 90 recognized sleep disorders, many of which impair sleep and daytime function and adversely impact heath, well-being, and chronic disease risk. Unfortunately, many sleep disorders are undiagnosed or not managed effectively. This review describes how to identify, evaluate, and treat common sleep disorders.
... SB can be divided into primary and secondary categories based on its cause [18,19]. Notably, several studies have considered OSA as a risk factor for SB [20][21][22]. In patients with OSA, masticatory muscle activity may occur after an apnea-hypopnea event [23,24]. ...
Article
Full-text available
Patient: A 67-year-old woman presented to our clinic with chief complaints of headache and mandibular heaviness. Physical examination revealed bilateral tenderness in the temporalis and masseter muscles, corresponding to the patient’s chief complaint. Thus, a diagnosis of temporomandibular disorders (TMDs)-related headache was made. However, sleep disorders were identified after further consultation. Hence, sleep apnea-related headache was suspected due to a snoring habit with a Mallampati classification of Class IV. Out-of-center sleep testing (OCST) revealed a respiratory event index (REI) of 10.1/h and a low peripheral oxygen saturation (SpO2) of 76%. Consequently, a diagnosis of obstructive sleep apnea (OSA) was made, and treatment using the mandibular advancement device (MAD) was recommended. Following MAD treatment, the patient’s sleep quality improved, and morning headaches ceased. Subsequent OCST performed while wearing the MAD showed a significant reduction in the REI to 1.6/h and an increase in the SpO2 to 86%, indicating the therapeutic efficacy of the MAD in treating OSA. Discussion: MAD treatment effectively alleviated the patient’s morning headaches, suggesting that sleep bruxism should not be considered the only cause of headaches. OSA should also be considered and addressed when investigating the potential causes of morning headaches in patients. Conclusions: In patients experiencing TMDs symptoms and morning headaches, TMDs should not be presumed as the sole cause. Dentists should discuss the likelihood of sleep disorders during consultations. If sleep disorders are suspected, the possibility of OSA should be considered, and sleep tests should be conducted when necessary.
... Bruxism is an activity of the masticatory muscle that occurs during sleep, in a rhythmic or nonrhythmic manner, or during awakening, with repetitive or prolonged contact between the teeth and/or a clenching action of the jaw [4]. It has been reported that the incidence TMDs is between 10% and 15%, while that of bruxism is about 8% [5,6]. The AAOP clinical classification of TMDs includes a heterogeneous group of joint and nonjoint conditions often associated with similar symptoms: masticatory muscle disorders such as myofascial pain, myositis, myospasm, localized myalgia (unclassifiable), contracture, and neoplasms; and joint disorders such as congenital or growth disorders, disc disorders, inflammatory disorders, osteoarthrosis, ankylosis, and fracture [7]. ...
Article
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Objectives The aim of this review was to analyze mechanical and biological properties of resin materials used with subtractive or additive techniques for oral appliances fabrication and compare them to those conventionally manufactured. Materials and methods The protocol was registered online at Open Science Framework (OSF) registries (https://osf.io/h5es3) and the study was based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). An electronic search was conducted on MEDLINE (via PubMed), Scopus, and Web of Science from 1 February 2022 to 1 May 2022. Inclusion criteria: in vitro and in vivo studies published in the last 10 years, with CAD-CAM or 3D printed resins for occlusal splints. Data considered homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05) with Stata17 statistical software. Since all variables were continuous, the Hedge g measure was calculated. A fixed-effects model was used for I² = 0%, while statistical analysis was conducted using a random-effects model with I² > 0%. Results 13 studies were included after full-text reading. The mechanical properties most studied were wear, flexural strength, surface hardness and surface roughness, while only 1 study investigated biological properties, performing the XTT viability assay. For the meta-analysis, only surface roughness, volume loss, and flexural strength were selected. Considering surface roughness, the subtractive specimen had a lower average value compared to traditional ones (Hedge’s g with 95% CI = -1.25[ -1.84, − 0.66]). No significant difference was detected in terms of volume loss (P > 0.05) between the groups (Hedge’s g with 95% CI = -0.01 [-2.71, − 2.68]). While flexural strength was higher in the control group (Hedge’s g with 95% CI = 2.32 [0.10–4.53]). Conclusion 3D printed materials showed properties comparable to conventional resins, while milled splint materials have not shown better mechanical performance compared with conventional heat-cured acrylic resin. Polyetheretherketone (PEEK) have great potential and needs to be further investigated. Biological tests on oral cell populations are needed to confirm the long-term biocompatibility of these materials. Clinical relevance The use of “mixed splints” combining different materials needs to be improved and evaluated in future research to take full advantage of different characteristics and properties.
... Psychosocial factors such as stress and anxiety are particularly associated with bruxism [7] In addition, environmental risk factors include smoking, alcohol, caffeine consumption, use of drugs, or certain medications (e.g., SSRIs) [8][9][10]. ...
... Solely two participants chose stress, sleep dysfunction, genetic factors, alcohol and coffee consumption, and particular medical conditions as being among the etiological factors of bruxism. Several authors have described each of these variables (1,11,12,13,14). Hence, the need for additional information among dentists on bruxism is emphasized. ...
Article
Background and Objectives: Bruxism is a parafunctional activity that can have several causes. Patients with bruxism need an interdisciplinary approach to treatment planning and individualized treatment options. The present study evaluates dentists' knowledge of the bruxism condition and their need for further education. Diagnosis and treatment methods used by practicians from different specialties are emphasized. Materials and Methods: A prospective cross-sectional, observational, and analytical cohort study was conducted. It employed a questionnaire based on information on etiology, diagnosis, and treatment methods and included data from 80 dental practitioners from Cluj County. Results: Most dentists (81.3%) recognized awake and sleep bruxism as separate entities. Most participants identified psychological status as the primary etiological factor (80%), followed by occlusal interferences (13.8%) and other factors (genetics). Anamnesis and clinical examination were performed for bruxism diagnosis (90%). Occlusal balance (%) and occlusal splints (%) were the most encountered treatment methods. Only 27.5% of the practitioners referred patients to other specialists. Physiotherapy and psychotherapy were the primary interdisciplinary approaches. Cognitive behavioral therapy was employed by 43.8%, whereas pharmaceutical therapy by 20% of the practitioners. Conclusions. There is a need for standardized training among dentists due to a lack of information on this topic. When combined with an interdisciplinary approach, complementary diagnostic methods such as polysomnography and BruxApp can yield accurate diagnosis.
... Any daytime stress would lead to nocturnal muscle tension/hyperactivity [37]. The existence of a genuine causal link between stress and bruxism [38] has been demonstrated by analyzing the influence of these neurotransmitters on manducatory muscle activity. Several central nervous system structures, such as the vegetative (sympathetic) nervous system [37], the brainstem [37,38,39] and the limbic system [40], are involved in generating rhythmic jaw movements and modulating muscle tone during sleep. ...
Article
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Sleep bruxism (SB) corresponds to physiologically based manducatory muscle reactions, with no identifiable neuropathic cause, in relation to anxiety disorders, respiratory disorders or behavioral "tocs". The aim of this study was to assess the relationship between SB and perceived stress by measuring salivary cortisol levels. The study included 61 consenting adult participants: 31 for the study group (bruxers) and 30 for the control group (no bruxers). The diagnosis of BS was made using a standard bruxism assessment questionnaire defined by the American Academy of Sleep Medicine (AASM). The preliminary diagnosis was confirmed by clinical assessment according to AASM criteria. The BRUXi index, a tool proposed by Orthlieb, was used to determine the intensity of bruxism. Perceived stress was measured using the Perceived Stress Scale questionnaire. Unstimulated whole saliva was collected and morning salivary cortisol levels were determined by ELISA. Non-parametric statistical methods were used to analyze the data. The bruxers (study group) had significantly high levels of mean salivary cortisol (12.3±4.2 ng/mL or 34.5±14.6 nmol/L) than the non-bruxers (control group) (5.3±1.2 ng/mL or 14.5±4.6 nmol/L) (p<0.001). The elevated salivary cortisol level was positively associated with perceived stress and SB (p<0.0001) in the study group. These results suggest that bruxing activity is associated with higher levels of perceived psychological stress and salivary cortisol. Despite the absence of polysomnographic recording for the diagnosis of SB, a positive correlation between SB and salivary cortisol levels was observed in bruxers.
... 44,49 Several studies have suggested that it is associated with factors including stress, sleep apnoea, anxiety, the consumption of caffeine or alcohol, gastroesophageal reflux, and potentially having a genetic component. 40,[42][43][44]50,51 Dysregulation of the autonomic nervous system and micro-arousal during sleep have also been proposed as possible risk factors. 40 It is worth noting that tooth clenching and grinding during sleep may serve other purposes as well, such as stimulating saliva production for oral lubrication and help maintain a patent airway. ...
... Most notable conditions associated with secondary SB include OSA, periodic limb movements of sleep, and insomnia. Among sleep disorders associated with secondary bruxism, OSA is one of the conditions strongly associated with SB [8][9][10]. Currently treatment of SB focuses on prevention of tooth damage such as the use of occlusal splint, behavioral strategy such as practicing good sleep hygiene, and the use of some medications [11][12][13]. ...
Article
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Background Sleep bruxism (SB) is often found to co-exist with obstructive sleep apnea (OSA). However, there are no data on prevalence and risk factors of SB in patients with OSA patients regarding the effect of optimal positive airway pressure (PAP). Objective This study aimed to study prevalence and risk factors of SB in OSA and to compare SB episodes during pre-treatment versus during optimal PAP therapy. Methods This investigation was a retrospective study including randomly selected patients with OSA who underwent split-night polysomnography. Data were collected from August 2021 to October 2022. Clinical demographic data and SB data were analyzed. The association between SB episodes and obstructive respiratory events were manually reviewed. If most of the SB episodes were observed within 5 s following obstructive respiratory events, SB was defined as SB associated with OSA. Comparison of SB index (SBI) was made between baseline portion of the study versus during optimal PAP. Results Among 100 patients enrolled, mean age was 50.8 ± 16.7 years and 73 subject (73%) were male. Mean respiratory disturbance index (RDI) and mean nadir oxygen saturation were 52.4 ± 33.4 and 79.3 ± 11.2% respectively. During the baseline portion of the study, 49 patients (49%) had SB and 31 patients (31%) had severe SB (SBI ≥ 4). Sleep bruxism associated with OSA was observed in 73.5% of all SB. The risk factor for SB was endorsement of nocturnal tooth grinding (odds ratio (OR) 5.69, 95%CI 1.74–18.58). Risk factors for severe bruxism were male sex (OR 4.01, 95%CI 1.02–15.88) and endorsement of nocturnal tooth grinding (OR 9.63, 95%CI 2.54–36.42). Risk factors for SB associated with OSA were non-supine RDI (OR 1.02, 95%CI 1.001–1.034) and endorsement of nocturnal tooth grinding (OR 5.4, 95%CI 1.22–23.93). In SB group, when comparison was made between baseline portion and during optimal PAP, significant reduction of SBI was observed (5.5 (3.2, 9.3) vs. 0 (0, 2.1), p < 0.001). Median difference of SBI between baseline portion and during optimal PAP was 4.4 (2.0, 8.3) (p < 0.001). Conclusions In this group of patients with OSA, almost half was observed to have SB in which the majority were associated with OSA. Optimal PAP resulted in a significant reduction in SB episodes. In addition to endorsement of nocturnal tooth grinding, non-supine RDI was observed to be a potential risk factor for SB associated with OSA.
... Approximately half of the patients presented other sleep complaints, like mild sleep apnea and bruxism, with the first being implicated in the differential diagnosis and as a potential aggravating factor, the second being associated with other factors, such as anxiety (Polmann et al., 2019), delayed chronotypes (Ribeiro et al., 2018) and psychological stress (Ohayon et al., 2001). ...
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Insufficient sleep syndrome possibly represents the worldwide leading cause of daytime sleepiness, but remains poorly recognised and studied. The aim of this case series is to comprehensively describe a cohort of patients with insufficient sleep syndrome. Eighty‐two patients were studied concerning demographic and socio‐economic features, medical, psychiatric and sleep comorbidities, substance use, sleep symptoms, actigraphy, video‐polysomnography, multiple sleep latency tests and treatment. The typical patient with insufficient sleep syndrome is a middle‐aged adult (with no difference of gender), employed, who has a family, often carrying psychiatric and neurological comorbidities, in particular headache, anxiety and depression. Other sleep disorders, especially mild sleep apnea and bruxism, were common as well. Actigraphy was a valuable tool in the characterisation of insufficient sleep syndrome, showing a sleep restriction during weekdays, associated with a recovery rebound of night sleep during weekends and a high amount of daytime sleep. An over‐ or underestimation of sleeping was common, concerning both the duration of night sleep and daytime napping. The average daily sleep considering both daytime and night‐time, weekdays and weekends corresponds to the recommended minimal normal duration, meaning that the burden of insufficient sleep syndrome could mainly depend on sleep fragmentation and low quality. Sleep efficiency was elevated both in actigraphy and video‐polysomnography. Multiple sleep latency tests evidenced a tendency toward sleep‐onset rapid eye movement periods. Our study offers a comprehensive characterisation of patients with insufficient sleep syndrome, and clarifies their sleeping pattern, opening avenues for management and treatment of the disorder. Current options seem not adapted, and in our opinion a cognitive‐behavioural psychotherapy protocol should be developed.
... Chronic stress can be one of the factors which can initiate or aggravate oral pathology [8]. Research has also demonstrated that psychological stress is a risk factor for bruxism, dental caries, and periodontal diseases [9,10]. It contributes to the modulation of oral diseases through immune system dysfunction, increased stress hormones, cariogenic bacterial counts, and poor oral health behaviors [10][11][12]. ...
Article
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Background Psychological stress is a known risk factor and modulator for several oral diseases. It is among the critical etiological factors of bruxism and several other disorders. The quantum of bite force is one of the prime determinants of wear resistance and the clinical performance of restorations. Thus, the present study aims to investigate the relationship between the maximum voluntary bite force (MVBF) and the amount of perceived stress experienced by an individual. Materials and methods Patients (n=111) fulfilling the exclusion and inclusion criteria were divided into high, medium, and low-stress groups based on their stress scores deduced from the Perceived Stress Scale questionnaire (PSS). Bite force measurement was recorded in Newtons (N) for each subject using a portable customized bite recording FlexiForce sensor (B 201). The data were analyzed using Kruskal-Wallis and independent samples t-test. Results Among the females, the bite force in the medium and high-stress groups was greater compared to the low-stress level group. On the other hand, there was no difference in bite force between any of the stress level groups among male participants. Conclusion The results show that higher MVBF is associated with higher perceived stress scores in adult females. Practical Implications Psychological counseling can be included in the dental treatment plan of individuals with a high-stress score to counteract their stress-related higher occlusal forces, parafunctional jaw movements, and risky oral health behaviors, thereby potentially reducing the incidence of adverse outcomes such as temporomandibular joint dysfunction and restoration failure by careful choice of restorative materials.
... 47 Prevalence of PS in SB ranges from 7.3% 30 to 32.7%. 48 A plausible temporality between PS and BS is still to be demonstrated. ...
Article
Introduction: Bruxism is defined as a repetitive masticatory muscle activity that can manifest it upon awakening (awake bruxism-AB) or during sleep (sleep bruxism-SB). Some forms of both, AB and SB can be associated to many other coexistent factors, considered of risk for the initiation and maintenance of the bruxism. Although controversial, the term 'secondary bruxism' has frequently been used to label these cases. The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques, however, are important factors to be considered when judging the literature findings. The use (and abuse) of drugs, caffeine, nicotine, alcohol and psychoactive substances, the presence of respiratory disorders during sleep, gastroesophageal reflux disorders and movement, neurological and psychiatric disorders are among these factors. The scarcity of controlled studies and the complexity and interactions among all aforementioned factors, unfortunately, does not allow to establish any causality or temporal association with SB and AB. The supposition that variables are related depends on different parameters, not clearly demonstrated in the available studies. Objectives: This narrative review aims at providing oral health care professionals with an update on the co-risk factors and disorders possibly associated with bruxism. In addition, the authors discuss the appropriateness of the term 'secondary bruxism' as a valid diagnostic category based on the available evidence. Conclusion: The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques found in many studies preclude any solid and convincing conclusion on the existence of the 'secondary' bruxism.
... By this time the fragile condyle, condylar neck, and joint disc may shift, finally leading to TMJ injury. Diatchenko [61] indicated that people with OSA have an increased stimulation of the sympathetic nervous system, that underlies an incremental risk of developing first-onset TMD [62]. ...
Article
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Objective: To evaluate the correlation between obstructive sleep apnea (OSA) and temporomandibular joint (TMJ) morphology, tooth wear condition, orofacial pain through a follow-up program. Materials and methods: Seventy one OSA patients were divided into three groups according to their (apnea hypopnea index) AHI: mild group (n = 23), moderate group (n = 24), and severe group (n = 24). All patients had OSA therapies around six months after confirm the diagnosis of OSA. The tooth wear score and orofacial pain condition of all patients were recorded via clinical examination. Cone beam computed tomography (CBCT) images were also taken when confirm the diagnosis of OSA (T0), 6 months after the diagnosis (T1), and 6 months after the OSA treatment (T2). Parameters indicating the condylar morphology and joint space were evaluated. The differences of clinical symptoms and TMJ conditions among T0, T1 and T2 time point were detected in the three groups respectively. The changes in T1-T0 and T2-T1 of all descriptions among three groups were also compared. The correlations between AHI and clinical symptoms were detected with Spearman correlation analysis. Results: In mild group, there was no difference in all clinical symptoms and TMJ morphology among the three time points. Both in moderate and severe group, the condylar volume, superficial area, wear score, visual analogue scales (VAS), and R value (indicating condyle position) displayed significant differences among the three time points (P < 0.05). From T0 to T1, mild group displayed fewer decreases in the condylar volume and superficial area and fewer increases in wear score than that in moderate and severe group (P < 0.05). From T1 to T2, there was a greatest reduction in severe group for R value, and significant difference in the description of VAS and R value were found among the three groups. AHI was negatively correlated condylar volume and condylar superficial area, and was positively correlated with tooth wear score and VAS (P < 0.05). Conclusion: Moderate to severe OSA will aggravate orofacial pain and tooth wear, affect TMJ volume and superficial area, even change the location of condyles. Appropriate OSA therapies may be effective ways to alleviate these adverse effects in long-term.
... The effect of therapy, according to Cohen, in the scope of this research was high 0.89, which proves that therapy was successful and had positive effect on the quality of life for patients with parafunctional activities. In this study, the total number of OHIP points after treatment was 19.41, higher compared to the results of other studies, most likely because persons with parafunctions are more prone to stress and self-criticism and oral health affects their quality of life to a greater extent [16,35,36,37,38,39]. It has been proven that oral disorders have a greater impact on young people, people with compromised general health, as well as people with a worse economic and social status [40,41]. ...
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The aim of this article was to evaluate properties of new polymer material, based on PEEK, for FPDs in patients with parafunctions. Methods: Prospective clinical study involved patients with diagnosed signs and symptoms of parafunctions, restored with 100 units, PEEK based FPDs, veneered with composite material. During one year observation period the following parameters were evaluated: color changes, periodontal indices, treatment success using FDI criteria, occlusal parameters, patient-reported outcome measures (OHIP-49) and occurrence of complications. Results: Spectrophotometry revealed that 63% of bridges experienced changes for L*, a*, b* color parameters, but it was not clinically significant for patients. Periodontal indices (PI, GI, BOP) revealed statistically significant higher values around restorations. According to FDI criteria, therapy was considered successful and 86.7% of FPDs were acceptable. Computerized occlusal analysis demonstrated no significant difference in the number of occlusal contacts and the intensity of relative forces between restoration and control side. Results of OHIP-49 questionnaire showed improved patient’s quality of life. Complications appeared in a limited number of cases. Conclusion: PEEK based FPDs could be indicated for successful prosthodontic rehabilitation in patients with parafunctional activities, but further material improvements and long-term clinical trials should be conducted to analyze performance of this material in challenging cases, for patients with CMD and in implant therapy.
... A multifactorial large scale population study on Sleep Bruxism revealed highly stressful life as a significant risk factor. [7] The results of a recent study [8] suggest that in these subgroups of Temporomandibular Disorder/bruxers, increased depression corresponds to increased hostility and provides support for previous investigations indicating that there is a relationship between hostility and bruxism (but only in the groups with moderate and severe bruxism). ...
Article
Bruxism is defined as parafunctional grinding of teeth or an oral habit consisting of involuntary rhythmic or spasmodic non functional gnashing, grinding or clenching of teeth in other than chewing movements of the mandible which may lead to occlusal trauma and temporomandibular joint disorders. The aim of the study is to assess the knowledge , attitude and practice on sequelae of bruxism in dentists in university hospital setting in chennai.
... Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB) 1 . The prevalence estimate for SB ranges from 6% to 8% and AB has a reported prevalence of 30% in large epidemiological studies mainly assessed by self reports in adult populations [2][3][4] . Even though SB and AB are considered different entities, a co-occurrence of up to 20% has been reported 5 pointing towards shared etiology. ...
Article
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Study Objectives Sleep bruxism (SB) can cause damage on teeth, headache and severe pain affecting both sleep and daily functioning. Yet despite the growing interest into bruxism, the underlying clinically relevant biological mechanisms remain unresolved. The aim of our study was to understand biological mechanisms and clinical correlates of SB including previously reported disease associations. Methods We used data from the FinnGen release R9 (N=377,277 individuals) that are linked with Finnish hospital and primary care registries. We identified 12,297 (3.26%) individuals with International Classification of Diseases (ICD)-10 codes used for SB. In addition, we used logistic regression to examine the association between probable SB and its clinically diagnosed risk factors and comorbidities using ICD-10 codes. Furthermore, we examined medication purchases using prescription registry. Finally, we performed the first genome-wide association analysis for probable SB and computed genetic correlations using questionnaire, lifestyle and clinical traits. Results The genome-wide association analysis revealed one significant association: rs10193179 intronic to Myosin IIIB (MYO3B) gene. In addition, we observed phenotypic associations and high genetic correlations with pain diagnoses, sleep apnea, reflux disease, upper respiratory diseases, psychiatric traits and also their related medications such as antidepressants and sleep medication (P<1e-4 for each trait). Conclusions Our study provides a large-scale genetic framework to understand risk factors for SB and suggests potential biological mechanisms. Furthermore, our work strengthens the important earlier work that highlights SB as a trait that is associated with multiple axes of health. As part of this study, we provide genome-wide summary statistics that we hope will be useful for the scientific community studying SB.
... 28 On üç bin elli yedi birey üzerinde gerçekleştirilen bir çalışmada, bruksizmin yüksek stresli bireylerde düşük stresli bireylere göre 1,3 kat daha fazla görüldüğü saptanmıştır. 30 Bruksizmin strese karşı davranışsal bir yanıt olduğu bildirilmektedir. 26 Stres oluşumunda birçok faktör rol oynamaktadır. ...
... Other background factors for bruxism include sociodemographic factors, such as age and socioeconomic status [21,22], as well as poor self-reported general health [23]. Furthermore, the use of psychoactive substances such as coffee, tobacco or alcohol is also recognized to be associated with bruxism [23][24][25][26]. ...
Article
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Objective: The study aimed to investigate the association of sleep bruxism (SB) and awake bruxism (AB) with health-related factors. Methods: Data on bruxism and diagnosed diseases, use of psychoactive substances and regular identified psychoactive drugs were collected from 1,962 subjects in the Northern Finland Birth Cohort 1966 through a questionnaire. The associations were analyzed using chi-square tests and binary regression models, adjusting for gender and education, and for anxiety/depression symptoms. Results: Migraine and gastric/duodenal disorders, use of serotonergic antidepressants and a high number of psychoactive drugs associated significantly with AB and SB. Gastrointestinal diseases associated with SB. Poor general health and hand eczema associated with AB. Based on the multivariate model, depression/anxiety symptoms seemed to mediate the associations of bruxism with depression, hand eczema, self-reported gastric/duodenal disorders and the number of identified drugs. Conclusion: Several diseases, depression/anxiety symptoms and psychoactive medications were associated with SB and AB, the associations being stronger with AB than SB.
Article
Aim of the study This systematic review aimed to centralize the information regarding the effect of the orthodontic treatment with clear aligners (CAT) on the masticatory muscles activity, functional or parafunctional, by objective recording means of surface electromyography (sEMG). Materials and methods : An electronic search was performed until June 2024 using the following search strategy :(((orthodontic OR clear OR removable) AND (aligner*)) OR Invisalign) AND (Bruxism OR (parafunctional masticatory forces) OR (masticatory muscle activity) OR clenching) AND (EMG OR Electromyography). Time restrictions for the search were established between 2000-2024. Results 640 studies were computed. Using the PRISMA method, 38 duplicates were found and removed to obtain 602 studies to be screened by title and abstract. 9 studies were eligible to be reviewed. Conclusions CAT does not influence muscle activity. Most of the data available is about the response of the masseter muscle but there is no clear evidence that this is the most affected muscle by bruxism.
Article
Aims Potocki–Lupski syndrome (PTLS), which is caused by the partial duplication of the short arm of autosome 17, is characterized by feeding difficulties associated with muscle hypotonia and dysphagia in infancy, followed by growth retardation and low body weight in later stages. Speech and motor developmental disorders are observed in childhood, accompanied by autism spectrum disorders in several cases. Other disorders include dental and skeletal abnormalities, and associated sleep apnea. Herein, we describe the first case of dental evaluation and treatment under intravenous sedation in a patient with PTLS. Methods A 13‐year‐old boy with PTLS and intellectual disability was referred for the treatment of dental caries. Routine intraoral examination and dental treatment were not feasible. As the patient had no muscle hypotonia, dysphagia, or severe growth delay, intraoral examination and dental treatment were successfully performed under intravenous sedation. No incidence of intraoral airway obstruction or aspiration was reported. The patient was followed‐up post‐operatively. Conclusion PTLS, a newly identified syndrome, is associated with cardiovascular abnormalities, dysphagia, failure to thrive, and sleep apnea, which are potential risk factors for sedation. This case report highlights the importance of facial and oral findings in determining the risks of difficulties in airway management.
Article
Study objectives: To determine the prevalence and risk factors of sleep bruxism (SB) in adults with primary snoring (PS). Methods: This study included 292 adults with PS (140 males, 152 females; mean age ± SD = 42.8 ±12.2 years; mean BMI ± SD = 26.7 ± 4.7 kg/m2) without previous treatment for snoring. SB was diagnosed based on the frequency of the biomarker of SB: rhythmic masticatory muscle activity (RMMA; SB when RMMA ≥ 2 episodes/hour). Logistic regression was performed, with SB as the dependent variable and with age, sex, BMI, and sleep- and respiratory-related polysomnographic parameters as the independent variables to identify the risk factors for SB. Results: The prevalence of SB was 44.6% in adults with PS. Younger age (OR = 0.965 [0.944, 0.987]) and shorter total sleep time (OR = 0.760 [0.609, 0.948]) significantly increased the risk of SB (P < 0.05). Conclusions: SB is highly prevalent in adults with PS. Younger age and shorter sleep time are significant risk factors for SB in adults with PS. Clinical trial registration: Registry: Netherlands Trial Register; Name: A Large Sample Polysomnographic Study on Sleep Bruxism; Identifier: NL8516.
Article
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Bruxism is defined as a repetitive muscular activity of the jaw, characterized by clenching, or grinding of the teeth due to dragging or thrusting of the jaw. It can manifest itself during sleep or wakefulness. The aim of this review is to establish the most important aspects of bruxism in adults, focusing on its etiology, diagnosis, and its repercussions in adults. The prevalence of sleep bruxism among adults ranges from 22% to 30% and between 1% to 15% for bruxism during wakefulness. Its etiology is associated with two groups of factors: central (psychological and pathophysiological) and peripheral (morphological). In diagnostic methods, it is found as possible (non-instrumental approach or self-report), probable (self-report and clinical examination) or definitive (self-report, clinical examination and polysomnography). The gold standard for the diagnosis of sleep bruxism is polysomnography. In terms of its repercussions, we can find different types of dental hard tissue lesions, mainly abfractions, attrition and mixed lesions. At the musculoskeletal level, the evidence is contradictory as it has been associated with muscle fatigue, sensitivity, and tension, but there is no linear cause-effect relationship. A direct and statistically significant relationship exists between sleep bruxism and morning headaches.
Article
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Abstract Objectives To estimate the statistical and epidemiological association between Sleep bruxism (SB) and Obstructive sleep apnea (OSA) based on OSA severity, and to describe sleep data findings within the analyzed population. Methods A case-control study (N = 37) was conducted on subjects with and without OSA. All subjects underwent a full-night polysomnographic recording at the Sleep Unit (Clinical Neurophysiology Department) of San Carlos University Hospital. The diagnosis and severity of OSA were determined using ICSD-3 and AASM-2.6 scoring. The definitive SB diagnosis was obtained through a self-report test, physical examination, and PSG recordings. Variables used to study the association between both conditions included the apnea and hypopnea episodes, the Apnea-hypopnea index (AHI), the number of SB episodes per night, and the bruxism index. Chi2, correlations, and ANOVA were calculated. The epidemiological association was calculated using the OR. Results SB showed an epidemiological association with OSA, with an OR of 0.15 (0.036-0.68), suggesting it could be considered a protective factor (p < 0.05). OSA patients presented fewer average SB episodes (6.8 ± 12.31) than non-OSA patients (25.08 ± 31.68). SB episodes correlated negatively (p < 0.05) with the AHI and the number of hypopneas (p < 0.05). The average number of SB episodes was significantly higher in patients with mild OSA compared to those with severe OSA. Conclusions In this sample of patients with subclinical and mild OSA, SB may act as a protective factor. However, confirmation of these results with a larger sample size is necessary.
Chapter
In sleep medicine, the multidisciplinary collaboration of those involved is of the utmost importance. The dentist is an important part of this team related to sleep disorders, and as such, it is his duty to train properly to be up to the task. Dental sleep medicine as such involves—among others—oral appliance therapy related to sleep-disordered breathing. Maxillofacial surgeons are also part of this multidisciplinary team, and their surgical collaboration is different from what our ENT colleagues also contribute.
Article
Bruxism is a common condition often seen in daily practice. Although interocclusal appliances are often used, there are no established treatments to eliminate bruxism. Here, we report two patients who complained of bruxism and insomnia. Based on the diagnosis of Kampo medicine, we thought that stress was involved in the background of both cases. Therefore, we prescribed them yokukansan, and their symptoms improved. These results suggest that yokukansan may be effective for sleep bruxism and insomnia.
Chapter
The split-screen, video polysomnogram (PSG) of a 23-year-old woman with a history notable for many stressors and frequent nightmares associated with screaming arousals showed significant bruxism (nocturnal tooth grinding) with rhythmic masticatory muscle activity (RMMA) recognized as a pattern of rhythmic muscle artifact throughout multiple channels of the study (Video 1) [1]. The conventional PSG sweep speed of 10 mm/s (or 30 s/page) relatively compressed the data making electroencephalographic (EEG) sleep staging impossible (Fig. 1a). By digitally expanding the EEG through utilization of the faster sweep speed of a conventional EEG study (30 mm/s, or10 seconds/page), we were able to correlate the muscle activity of bruxism with a specific sleep state (Fig. 1b).
Article
Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children. A search was conducted in May 2023 in PubMed Clinical Queries using the key terms “Bruxism” OR “Teeth grinding” AND “sleep”. The search strategy included all observational studies, clinical trials, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. According to the International classification of sleep disorders, the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism, “possible” sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; “probable” sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation); and “definite” sleep bruxism based on the history and clinical findings and confirmation by polysomnography, preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost, lengthy time involvement, and the need for high levels of technical competence, polysomnography is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history (e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy and/or tenderness of masseter muscles). In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures, oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.
Article
Objective: This article reviews common sleep-related movement disorders, including their clinical description, epidemiology, pathophysiology (if known), and evaluation and management strategies. This article will provide the reader with a good foundation for approaching concerns that are suggestive of sleep-related movement disorders to properly evaluate and manage these conditions. Latest developments: α2δ Ligands, such as gabapentin enacarbil, can be used for the initial treatment of restless legs syndrome (RLS) or in those who cannot tolerate, or have developed augmentation to, dopamine agonists. Another option is the rotigotine patch, which has a 24-hour treatment window and may be beneficial for those who have developed augmentation with short-acting dopamine agonists. IV iron can improve RLS symptoms even in those whose serum ferritin level is between 75 ng/mL and 100 ng/mL. At serum ferritin levels greater than 75 ng/mL, oral iron will likely have minimal absorption or little effect on the improvement of RLS. Research has found an association between RLS and cardiovascular disease, particularly in people who have periodic limb movements of sleep. Essential points: RLS is the most common sleep-related movement disorder. Its pathophysiology is likely a combination of central iron deficiency, dopamine overproduction, and possibly cortical excitation. Treatment includes oral or IV iron. Dopaminergic medications can be very effective but often lead to augmentation, which limits their long-term use. Other sleep-related movement disorders to be aware of are sleep-related rhythmic movement disorder, nocturnal muscle cramps, sleep-related propriospinal myoclonus, sleep bruxism, and benign myoclonus of infancy.
Article
Background: Sleep on the first night in a sleep laboratory is characterized by a lower sleep quality and frequency of rhythmic masticatory muscle activity (RMMA) than that on the second night in moderate to severe sleep bruxism (SB) patients. Objective: The aims of this study was to clarify the physiological factors contributing to the first night effect on oromotor activity during sleep and investigate whether physiological factors involved in the first night effect differed between rhythmic and non-rhythmic oromotor activities. Methods: Polysomnographic data collected on two consecutive nights from fifteen moderate to severe SB subjects (F 7: M 8; age: 23.2±1.3 [mean ± SD] years) were retrospectively analyzed. Sleep variables, RMMA, and non-specific masticatory muscle activity (NSMA) were scored in relation to episode types (i.e., phasic or tonic and cluster or isolated), sleep architecture, and transient arousals. The relationships between nightly differences in oromotor and sleep variables were assessed. The distribution of oromotor events, arousals, cortical electroencephalographic power, RR intervals, and heart rate variability were examined in relation to sleep cycle changes. These variables were compared between the first and second nights and between RMMA and NSMA. Results: Sleep variables showed a lower sleep quality on Night 1 than on Night 2. In comparisons with Night 1, the RMMA index increased by 18.8% (p <0.001, the Wilcoxon signed-rank test) on Night 2, while the NSMA index decreased by 17.9% (p = 0.041). Changes in the RMMA index did not correlate with those in sleep variables, while changes in the NSMA index correlated with those in arousal-related variables (P <0.001, Spearman's rank correlation). An increase in the RMMA index on Night 2 was found for the cluster type and stage N1 related to sleep cyclic fluctuations in cortical and cardiac activities. In contrast, the decrease in the NSMA index was associated with increases in the isolated type and the occurrence of stage N2 and wakefulness regardless of the sleep cycle. Conclusion: Discrepancies in first night effect on the occurrence of RMMA and NSMA represent unique sleep-related processes in the genesis of oromotor phenotypes in SB subjects.
Article
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This article will provide an overview of the diagnosis of common temporomandibular disorders (TMDs) and bruxism, along with their relevance in management of tooth wear. When assessing and managing a tooth wear case, the teeth should not be considered in isolation, but as part of the articulatory system, which has three inter-related elements: the teeth, the temporomandibular joints and the masticatory muscles. The presence/absence of bruxism and TMD are highly relevant, although there may not be a causal relationship between these. A consideration of TMD and bruxism, together with the potential impact these may have on the patient during and after any management of tooth wear, will form part of patient education and the informed consent process.
Article
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Despite apparent similar amounts of bruxism, two groups that had been evaluated polysomnographically differed dramatically in symptomatology. Patients with severe symptoms were referred to as the destructive bruxism group and were compared with (a) a group with sleep disturbance complaints who had bruxism and (b) a group of insomniac depressed patients chosen without regard to bruxism. It was hypothesized that not only the presence of bruxism during sleep but its pattern and sleep stage relationship were factors affecting clinical symptoms. The results indicated that the sleep stage relationship was an important factor. Patients with severe symptoms attributed to nocturnal bruxism were likely to have more bruxism in REM sleep than the other groups. These results if replicated prospectively would help explain some of the discrepancies in the literature concerning sleep stage relationship of bruxism, as well as help explain differences in symptomatology of bruxism patients.
Article
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Using a single-subject design, two methods of treating nocturnal bruxism were evaluated. Neither technique was successful; both resulted in a rebound effect when treatment was stopped. In addition, the role of anxiety in bruxing behavior was evaluated. Contrary to most theoretical beliefs, bruxing resulting from anxiety was not as important as "anticipatory" anxiety resulting in bruxing.
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A survey conducted through personal interviews was done in Canada to estimate the prevalence of subjective symptoms related to restless legs syndrome (RLS) and to sleep bruxism. Of the 2,019 respondents, all over 18 years of age, 15% reported leg restlessness at bedtime; 10% reported unpleasant leg muscle sensations associated with awakening during sleep and with the irresistible need to move or walk. Both these complaints are related to RLS. The prevalence of RLS-related symptoms increased linearly with age. Tooth grinding, a symptom related to sleep bruxism, was reported by 8% of the subjects; in contrast to RLS-related symptoms, the prevalence of tooth grinding decreased linearly with age. RLS-related symptoms were reported more frequently in Eastern provinces than in Ontario and Western Canada, and more frequently in Roman Catholic and French-speaking responders. This was not the case for sleep bruxism; between 14.5% and 17.3% of the subjects who reported subjective RLS-related symptoms also reported tooth grinding. Conversely, 9.6-10.9% of the tooth grinders reported RLS-related symptoms. These data suggest that both sleep movement disorders can be concomitant and that socio-geographic and age characteristics influence the prevalence of reports.
Article
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A 59-year-old man with temporomandibular joint pain/dysfunction syndrome presented with a long history of nocturnal bruxism. All-night polysomnographic recordings with video monitoring showed episodes of teeth grinding or clenching occurring exclusively during rapid eye movement (REM) sleep, which were often associated with movements of the hands and fingers and/or brief vocalization. Throughout REM sleep, there was excessive phasic chin electromyographic twitching, without increased tone, and also excessive phasic electromyographic twitching in multiple muscle sites. The patient maintained a normal nonrapid eye movement-REM cycle, but showed increased REM density. Polysomnographic characteristics suggested that there may be a common pathophysiology in a certain type of sleep bruxism and the REM sleep behavior disorder. Sleep bruxism seen in this case is concluded to be a manifestation of subclinical REM sleep behavior disorder.
Article
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An accurate description of the population prevalence of temporomandibular disorders (TMDs) would be of value to scientists, health-policy makers, and clinicians but, to date, various unreplicated epidemiologic methodologies have produced disparate prevalence figures. We report on a telephone survey that sought to describe the prevalence of six TMD-related symptoms among a random, non-clinic sample from the Kansas City metropolitan area. The prevalence figures for nocturnal bruxism, diurnal clenching, jaw soreness and joint sounds ranged from 10-19%. Some figures were higher than those from St. Louis, but generally the figures accord well with the results of other prevalence studies. Of the 534 people interviewed, 246 reported one or more of the six TMD-related symptoms. Symptoms were not more prevalent among women than men, but were higher among persons of age 45 and under. Pain was reported more commonly by persons with multiple symptoms. The level of concordance between data from Kansas City and St. Louis supports the validity of the telephone survey method for studying TMD prevalence in non-clinic samples.
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Bruxism in children has been reported to occur in association with certain parasomnias (i.e., sleep talking, bed wetting). Various dental, medical, neurological, and psychological risk factors also have been correlated with bruxism. A case-control study was therefore conducted to test the null hypothesis that there is no difference between bruxers and nonbruxers in the occurrence rate of other parasomnias and these reported risk factors. A 54-item survey questionnaire was developed and mailed to 342 pediatric patients, half of whom were avowed to be bruxers by their parents. These patients were selected randomly from a private pediatric practice in Northern California. One-hundred fifty-two subjects (77 bruxers and 75 controls) returned the questionnaire, and stepwise logistic regression analysis revealed that five of the 54 factors (nocturnal muscle cramps, bed wetting, colic, drooling while sleeping, and sleep talking) showed significant differences between bruxers and controls (odds ratios ranged from 3.11 to 1.95). These findings strongly suggest the possibility of a common sleep disturbance underlying these nonsleep-stage specific parasomnias.
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We studied 24 bruxers (23-67 years old). They often complained of orofacial and bodily pain and presented autonomic symptoms (sweating 23%, palpitations at night 62%, decreased libido 50%); 19% had increased blood pressure requiring treatment, and 65% reported frequent headaches in the morning. Deep sleep and rapid eye movement (REM) were delayed. An average of 167 orofacial episodes developed during the night. The mean number of masseter bursts strictly defined as bruxism was 79, the mean delay for the first occurrence after sleep onset 18 minutes. The majority of bruxism occurred in stage 2 sleep and REM sleep. The mean number of shifts of sleep stages was 70, one-third occurring within the first minute following a bruxing episode, and 15% of bruxing episodes developed after a shift in sleep stage. Electroencephalogram showed alpha-delta pattern in 15% of the subjects. Short-lasting alpha activity was often encountered during the 10 seconds preceding the development of a bruxing episode. Tachycardia developed at its onset, persisting for 10 seconds. We suggest that, as a minor alarm response to endogenous/exogenous stimuli, arousal develops and is often followed by motor activation, such as a burst of bruxing, with, as in any situation when motor activity suddenly increases, a secondary increase of heart activity.
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Our objective was to study the prevalence of different headache types, characterizations, and triggers of headache in Finnish children starting school. Questionnaires were sent to 1,132 families with 6-year-old children. Children with headache disturbing their daily activities (n=96) and an asymptomatic control group of children (n=96) participated in a clinical interview and examination. Children with headache had significantly more bruxism (odds ratio [OR], 1.9; 95% CI, 1.0 to 3.4), tenderness in the occipital muscle insertion areas (OR, 4.8; 95% CI, 1.8 to 12.7), and tenderness in the temporomandibular joint areas (OR, 2.8; 95% CI, 1.3 to 6.0). They also had more travel sickness (OR, 3.4; 95% CI, 1.7 to 6.7) than control children. Eating ice cream (OR, 5.3; 95% CI, 1.4 to 20.3), fear (OR, 3.7; 95% CI, 1.2 to 11.2), and anxiety (OR, 3.2; 95% CI, 1.0 to 10.8) triggered headache more often in migraineurs than in children with tension-type headache. Children with migraine also reported more frequently abdominal (OR, 5.6; 95% CI, 1.7 to 18.1) and other (OR, 3.5; 95% CI, 1.2 to 9.8) pain concurrently with headache, and they used medication for pain relief more often (OR, 3.1; 95% CI, 1.0 to 9.5). Headache classification in children may be improved by palpation of occipital muscle insertions and temporomandibular joint areas, and by discerning a history of triggering events and concurrent symptoms.
Article
Bmxism in children has been reported to occur in association with certain parasomnias (i.e., sleep talking, bed wetting). Various dental, medical, neurological, and psychological risk factors also have been correlated ivith bruxism. A case-control study ivas therefore conducted to test the null hypothesis that there is no difference between bruxers and nonbruxers in the occurrence rate of other parasomnias and these reported risk factors. A 54-item survey questionnaire iras developed and mailed to 342 pediatrie patients, half of whom were avowed to be bruxers by their parents. These patients were selected randomly from a private pediatrie practice in Northern California. One-hundred fifty-two subjects (77 bruxers and 75 controls) returned the questionnaire, and stepwise logistic regression analysis revealed that five of the 54 factors (nocturnal muscle cramps, bed welling, colic, drooling while sleeping, and sleep talking) showed significant differences between bruxers and controls (odds ratios ranged from 3.11 to 1.95). These findings strongly suggest the possibility of a common sleep disturbance underhtiny these nonsleev-stase specifie parasomnias.
Article
Epidemiological studies can provide information not only on specific diagnostic entities but also on their underlying symptomatic constellations. For this purpose, an expert system was developed for the assessment of sleep disorders and endowed with the fuzzy logic capabilities necessary to determine the degree to which a given symptom corresponds to a specific diagnosis. Uncertainty is inherent in fields such as sleep medicine and psychiatry, and becomes evident in clinical practice at the stages of data collection and diagnostic formulation, when the clinician must determine whether a symptom is present and must choose from several diagnostic possibilities. The process involves a considerable degree of subjectivity on the part of the patient in trying to describe his or her symptoms, and of the clinician whose final diagnosis will depend on his or her clinical experience and interpretation of what is normal and what is pathological. Inferential models of the probabilistic or fuzzy logic type take into account such uncertainty. The Sleep-Eval system has been used in epidemiological and clinical studies involving 34,044 interviews collected by close to 300 interviewers. The diagnostic potential of these models is illustrated using data collected in an epidemiological study of the noninstitutionalized general population of Italy and underlines the advantages and limits of the binary, bayesian, and fuzzy logic methods and analyses.
Article
There is evidence that sleep bruxism is an arousal-related phenomenon. In non-REM sleep, transient arousals recur at 20- to 40-second intervals and are organized according to a cyclic alternating pattern. Polysomnographic recordings from six subjects (two females and four males) affected by sleep bruxism (patients) and six healthy age-and gender-matched volunteers without complaints about sleep (controls) were analyzed to: (1) compare the sleep structure of bruxers with that of non-complaining subjects; and (2) investigate the relations between bruxism episodes and transient arousals. Patients and controls showed no significant differences in conventional sleep variables, but bruxers showed a significantly higher number of the transient arousals characterized by EEG desynchronization. Bruxism episodes were equally distributed between non-REM and REM sleep, but were more frequent in stages 1 and 2 (p < 0.0001) than in slow-wave sleep. The great majority of bruxism episodes detected in non-REM sleep (88%) were associated with the cyclic alternating pattern and always occurred during a transient arousal. Heart rate during the bruxism episodes (69.3+/-18.2) was significantly higher (p < 0.0001) than that during the pre-bruxing period (58.1+/-15.9). Almost 80% of all bruxism episodes were associated with jerks at the anterior tibial muscles. The framework of the cyclic alternating pattern offers a unified interpretation for sleep bruxism and arousal-related phenomena.
Article
Although the relative incidence of violent behavior during sleep (VBS) is presumed to be low, no epidemiologic data exist to evaluate the prevalence of the phenomenon or to begin to understand its precursors or subtypes. This study examined the frequency of violent or injurious behavior during sleep and associated psychiatric risk factors. A representative United Kingdom sample of 2078 men and 2894 women between the ages of 15 to 100 years (representing 79.6% of those contacted) participated in a telephone interview directed by the Sleep-EVAL expert system specially designed for conducting such diagnostic telephone surveys. Two percent (N = 106) of respondents reported currently experiencing VBS. The VBS group experienced more night terrors and daytime sleepiness than the non-VBS group. Sleep talking, bruxism, and hypnic jerks were more frequent within the VBS than the other group, as were hypnagogic hallucinations (especially the experience of being attacked), the incidence of smoking, and caffeine and bedtime alcohol intake. The VBS group also reported current features of anxiety and mood disorders significantly more frequently and reported being hospitalized more often during the previous 12 months than the non-VBS group. Subjects with mood or anxiety disorders that co-occurred with other nocturnal symptoms had a higher risk of reporting VBS than all other subjects. We have identified a number of sleep, mental disorder, and other general health factors that characterize those experiencing episodes of VBS. These findings suggest that specific factors, perhaps reflecting an interaction of lifestyle and hereditary contributions, may be responsible for the observed variability in this rare but potentially serious condition.
Article
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Article
Nocturnal bruxing events were recorded during a single night of sleep for 12 subjects with sleep-disordered breathing and 12 age- and sex-matched controls. The results suggest that bruxing events are very common in both groups and are closely associated with sleep arousals. There were few differences in the number, duration, or type of bruxing events between these two groups. Bruxing events were common during stage 1, stage 2, and REM sleep, while they rarely occurred during stage 3 and 4 sleep. The average duration of bruxing events ranged from 3.82 to 6.68 seconds. There was a trend toward more bruxing events occurring while sleeping on the back than on the side.
Article
We examined patients to find out whether they noticed the prevalence of metallic taste and set out to determine the association of metallic taste with demographic, medical, and dental factors. Data were collected as part of a Veterans Administration Cooperative Study investigating the suitability of alternative metal ceramic alloys as substitutes for alloys that contain gold. Crowns and fixed partial dentures were made from control and alternative alloys for accepted volunteer patients. A month after placement of the restorations and at regularly scheduled recall appointments, the patients were asked if they tasted a metallic flavor. Of the 2023 times the question was asked, 101 positive responses were given by 68 patients (46 reported metallic flavor once, and 22 reported it more than once). Results indicated that youth, sensitivity to heat and cold, bruxism, grinding, and an increasing number of restorative units were significantly related to metallic taste. For any given visit, about 5% of the patients reported tasting a metallic flavor regardless of the type of alloy that was used in the restoration. Metallic taste does not appear to be a problem with alternative alloys.
Article
Résumé A cause du comportement des indices polygraphiques et surtout du fait de provocation par des stimuli d'éveil, on conclut que le grincement des dents pendant le sommeil se manifeste comme une sorte de réaction d'éveil.
Article
Although it has been suggested that bruxism is a cause or a risk factor in myofascial pain of the masticatory muscles, the prevalence of pain in bruxers and its characteristics have not been assessed or compared to those of myofascial pain patients in general. In this study, self-reports of pain and quality of life were recorded on 100-mm visual analogue and five-point category scales from two research populations: (1) 19 nocturnal bruxers who participated in a polysomnographic study and (2) 61 patients with myofascial pain of the masticatory muscles with no evidence of bruxism who participated in a controlled clinical trial on the efficacy of oral splints. The data show that pain was more intense in those bruxers who reported pain than among the myofascial pain patients, even though pain was not the chief complaint of bruxers. Both conditions reduced the patient's quality of life, although pain patients (either bruxism or myofascial pain) appeared to be much more affected than bruxers who were pain-free. The fact that pain from bruxism was worst in the morning suggests that it is possibly a form of postexercise muscle soreness. Myofascial pain, which was worst late in the day, is likely to have a different etiology.
Article
A review of the literature on the relationship between oral parafunctions and craniomandibular dysfunction is presented. The interpretation of the results was performed by applying the epidemiologic approach of "necessary and sufficient" which implies that there must be a one-to-one relationship between the factor and the disease. In all studies but one bruxism was constantly correlated with signs and/or symptoms of craniomandibular dysfunction indicating that a one-to-one relationship exists between this parafunction and the dysfunction of the masticatory system. Also, the reported correlations were highly significant. The strength and consistency of correlations support causality. The causal relationship between the rest of the oral parafunctions and craniomandibular dysfunction needs further investigation. On the basis of the evidence provided by the reviewed studies, bruxism cannot be considered as necessary, but a sufficient cause of craniomandibular dysfunction for a certain group of individuals.
Article
An epidemiologic sample of 293 subjects in three age groups, now 17, 21, and 25 years of age, were followed longitudinally with respect to symptoms of craniomandibular dysfunction during a 10-year period. Reports of one or more such symptoms increased in all three age groups during the 10 years. At the follow-up, 1 in 3 individuals in all three groups had noticed such symptoms occasionally and 10% had them frequently. Reports of oral parafunctions such as bruxing and clenching also increased, while other parafunctions such as nail, lip, cheek, and tongue biting increased from the age of 7 to 11 but then decreased with age. Despite the high incidence of subjective symptoms of craniomandibular disorders, only a few subjects had had any kind of functional treatment performed during the 10-year period, and only 7 had an actual demand for treatment at present.
Article
Cigarette smoking has been associated with sleep disturbances. However, little is known about how smoking affects restless legs syndrome (RLS) and sleep bruxism, two movement disorders associated with sleep. From a nationwide survey of 2,019 Canadian adults, we estimated the prevalence of smoking to be 36%. Although there was no difference between smokers and nonsmokers for RLS prevalence, almost twice as many smokers (12%) as nonsmokers (7%) were aware of experiencing sleep bruxism. The estimated risk of a smoker suffering from RLS was nonsignificant. On the other hand, the risk of a smoker grinding his or her teeth was moderate (odds ratio = 1.9). Analysis of sleep laboratory findings revealed no differences in motor RLS and periodic leg movements in sleep (PLMS) indices between smoking and nonsmoking patients; after adjustment for age, there were no differences in sleep efficiency, latency, number of awakenings, or the arousal index for the RLS/PLMS patients. Among those suffering from bruxism, smokers had more tooth-grinding episodes than did nonsmokers (35.0 vs. 7.0; p = 0.056); none of the sleep variables differentiated sleep bruxism smokers from nonsmokers. It appears that cigarette smoking does not influence RLS/PLMS, whereas the risk that smoking and tooth grinding are concomitant is moderate. Smoking was not significantly associated with more motor activity in RLS/PLMS, but more grinding was noted in sleep bruxism.
Article
Signs and symptoms of craniomandibular dysfunction (CMD) and social medical history were reported in 29 subjects, aged 23-68 years, with longstanding (5 years or more) bruxing behaviour. The subjects were selected from answers to an advertisement in the local newspaper. The subjects presented many symptoms of a general character including somatic and psycho-social problems, sleep disorders (72%), and pain (86%). More than half of the subjects (55%) had symptoms every day. Frequent aches in the neck, back, throat or shoulders were reported by 69% and frequent headache by 48% of the subjects. The most common symptoms of CMD were pain in the face or jaws (48%), stiffness in the jaws in the morning (44%), temporomandibular joint (TMJ) sounds (34%) and fatigue in the jaws during chewing (38%) and the most common clinical signs were more than three muscles tender on palpation (76%), TMJ-sounds (55%) and tenderness of TMJ on lateral palpation (66%). There was a statistically significant correlation between frequent tooth clenching and headache, pain in the neck, back, throat or shoulders, sleep disorders and high scores of the clinical dysfunction index (Di). The frequent clenchers had higher score values than the 'non-clenchers' for pain in the face and the jaws; headache; pain in the neck, back, throat or shoulders and the clinical dysfunction index (Di). These findings indicate a causal relationship between frequent tooth clenching and signs and symptoms of CMD, including headache and pain in the neck, back, throat or shoulders and high pathogenicity for frequent clenching. However, the material in this study is small and some precaution must be taken prior to generalized conclusions. More studies are required, especially sleep laboratory investigations, which could perhaps give answers to some of the numerous questions in this unexplored field of odontology.
Article
This study compared the presence of headache and bruxing behavior among 133 craniomandibular disorder patients (CMD) referred to the The Center For the Study Of Craniomandibular Disorders and to the presence of headache and bruxing behavior occurring in 133 controls seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a three year period. The mean age of the CMD group was 38 years (range 28-42), and the mean age of the controls was 37 years (range 25-44). The information gathered included questionnaire and clinical examination. Different types of headaches, signs and symptoms of CMD, and bruxing behavior were assessed both in the CMD group and in the corresponding control group. Results of this study showed that bruxing behavior and headache pain were significantly more prevalent in the CMD group (57%, 76%) than in the corresponding control group (37%, 49%). Of the three types of headache observed, tension and combination headaches were more prevalent in the CMD group (n = 48 = 36% and n = 37 = 28%). Migraine headache was more prevalent in the CMD group (n = 16 = 12%) than in the control group (n = 3 = 2%). It was concluded that headache and bruxing behavior predominated in CMD patients. This data reinforces the need to assess headache pain and signs and symptoms of bruxing behavior in CMD patients, particularly in those suffering chronic facial pain and headache.
Article
The comparability among epidemiological surveys of sleep disorders has been encumbered because of the array of methodologies used from study to study. The present international initiative addresses this limitation. Many such studies using the exact same methodology are being completed in six European countries (France, the United Kingdom, Germany, Italy, Portugal, and Spain), two Canadian cities (metropolitan areas of Montreal and Toronto), New York State, and the city of San Francisco. These surveys have been undertaken with the aim of documenting the prevalence of sleep disorders in the general population according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and the International Classification of Sleep Disorders (ICSD-90). Data are gathered over the telephone by lay interviewers using the Sleep-EVAL expert system. This paper describes the methodology involved in the realization of these studies. Sample design and selection procedures are discussed.
Article
The relative roles of genetic and environmental factors in bruxism are not known. In 1990 a questionnaire sent to the Finnish Twin Cohort yielded responses from 1298 monozygotic and 2419 dizygotic twin pairs aged 33-60 years. We used structural equation modelling to estimate genetic and environmental components of variance in the liability to bruxism. There was a significant gender difference both in childhood (P = 0.001) and adult (P = 0.007) bruxism. Females compared to males reported childhood bruxism 'often' 5.2% vs 4.1% and 'sometimes' 17.4% vs 17.3%, and as adults 'weekly' 3.7% vs 3.8% and 'monthly' 3.9% vs 4.6%, respectively. Bruxism in childhood and adulthood is highly correlated (0.86 in males and 0.87 in females). The proportion of total phenotypic variance in liability to bruxism attributed to genetic influences in childhood bruxism was 49% (95% CI 37-60%) in males and 64% (55-71%) in females, and for adults 39% (27-50%) among males and 53% (44-62%) among females. The correlation between the genetic effects on childhood bruxism and the genetic effects on adult bruxism was estimated in a bivariate model to be 0.95 (95% CI 0.94-0.96) in males and 0.89 (0.88-0.90) in females. Bruxism appears to be quite a persistent trait. There are substantial genetic effects on bruxism both in childhood and as adults, which appear to be highly correlated.
Article
If masticatory load distribution is task-dependent, then the pattern of wear on an acrylic resin occlusal splint over time may affect clinical outcome. This pilot study quantitatively assessed posterior wear after 3 months on the occlusal surfaces of maxillary stabilization splints. Subjects with known history of nocturnal bruxism were given heat-cured full-arch acrylic resin occlusal stabilization splints to be worn nocturnally for 3 months. Splint occlusion was adjusted at appliance delivery and was refined at the baseline session 1 to 2 weeks later. No further adjustment of the splint surface was performed during the 3-month study period. Sequential impressions of the splint occlusal surface provided epoxy resin models that were digitized and analyzed through specialized software. Changes in the digitized splint surface from baseline to 3 months allowed comparison of wear facets between splint sides and among tooth locations. Splint wear was asymmetric between sides and uneven between dental locations. For full coverage occlusal splints, the appliance wear phenomenon can be site specific and, if left undisturbed, may yield two extremes of high wear and a zone of low wear in-between.
Article
Responses of 18 smokers and 165 nonsmokers to two items which assessed experience with symptoms of bruxism were compared. Smokers were about three times more likely to experience symptoms of bruxism but not over-all stressful experience.
Article
The objective of this study was to assess and compare the frequency of some joint disorders in 130 CMD + bruxing behavior patients, 66 CMD/nonbruxing behaviors patients referred for diagnosis and treatment to the Center for the Study of Craniomandibular Disorders and 130 control subjects seeking routine dental care. Both patients and controls were consecutive referrals to the clinic occurring over a five year period. The mean age of the CMD + bruxing behavior group was about 35.48 years (range 14-54, SD = 8.45), and 36.84 years (range 17-60, SD = 9.30) in the 66 CMD nonbruxing behavior group, and 34.34 years (range 14-62, SD = 9.92) in the control group of 130 subjects. Information gathered included a questionnaire, history of signs and symptoms, and a clinical examination. Different types of joint disorders, muscle signs and symptoms and bruxing behavior were assessed in the CMD groups and in the corresponding control group. The study concluded that capsulitis/synovitis, retrodiskal pain and disk-attachment pain predominated in CMD + bruxing behavior patients. The data reinforces the need to assess CMD + bruxing behavior patients to evaluate signs and symptoms of such disorders in order to obtain additional information about the true source of pain and the need for proper management.
Article
To validate the Sleep-EVAL expert system, a computerized tool designed for the assessment of sleep disorders, against polysomnographic data and clinical assessments by sleep specialists. Patients were interviewed twice, once by a physician using Sleep-EVAL and again by a sleep specialist. Polysomnographic data were also recorded to ascertain diagnoses. Agreement between diagnoses generated by Sleep-EVAL and those formulated by sleep specialists was determined via the kappa statistic. Sleep disorder centers at Stanford University (USA) and Regensburg University (Germany). 105 patients aged 18 years or over. NA. Sleep-EVAL made an average of 1.32 diagnoses per patient, compared with 0.93 for the sleep specialists. Overall agreement on any sleep-breathing disorder was 96.9% (Kappa .94). More than half of the patients were diagnosed with obstructive sleep apnea syndrome (OSAS); the agreement rate for this specific diagnosis was 96.7% (Kappa .93). The findings indicate that the Sleep-EVAL system is a valid instrument for the recognition of major sleep disorders, particularly insomnia and OSAS.
Principles and practice of sleep medicine
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