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

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


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

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    • "Moreover , they were accompanied by limb automatisms, and occurred during both sleep and awake seizures [3]. Other differences with idiopathic SB are the number of TG episodes per night (one episode vs repetitive TG episodes), the duration of the episode, which lasted much longer than in SB (50 seconds vs 9 seconds), and maybe the presence of eyes open during the motor event [2] [4]. In our patient, assessment of heart rate was not possible because of the movement artifact, so we have not been able to confirm the increased heart rate associated with TG that has been observed by other authors [3] [5] [6]. "
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    ABSTRACT: Teeth grinding (TG) is the main sign of sleep bruxism (SB) [1,2], although occasionally itmay be seen as a rhythmic motor event (automatism) during epileptic seizures [3]. We report a patient with drug-resistant right temporal lobe epilepsy with prominent TG during his seizures, which occurred mainly during sleep but occasionally also during wakefulness. After presurgical evaluation, the patient underwent right anterior mesial temporal resection, which has rendered him free of seizures and TG episodes, as shown by polysomnography (PSG). The case illustrates the unusual occurrence of TG associated with epileptic seizures.
    Full-text · Article · Sep 2015 · Sleep Medicine
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    • "Electromyographic (EMG) events are classified as tonic (namely, sustained clenching), phasic (i.e., repeated tooth grinding events) or mixed (a combination of these two patterns) [2]. The precise diagnosis is established based on the association between clinical report, physical exam and polysomnography (PSG) [3] [4] [5] [6] [7]. Diagnoses based only on noise reports or on dental wear might overestimate or underestimate the SB [5] [8] [9]. "
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    ABSTRACT: Introduction: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring. Methods: Fifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables "total duration of events (seconds), "shortest events", "longest events" and index in each phasic, tonic or mixed event. Results: The correlation was positive and significant relative to all the investigated variables, being T>0.54. Conclusion: It was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring.
    Full-text · Article · Aug 2015 · Sleep Science
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    • "Recientemente, las investigaciones en fisiología del sueño han llamado la atención de los dentistas puesto que los desórdenes de sueño, tales como las alteraciones de la respiración durante el mismo, han demostrado tener una compleja interrelación con las cefaleas, síndrome de apnea e hipoapnea de sueño (SAHOS) y BS. Para esta revisión bibliográfica, se seleccionaron y analizaron artículos en Pubmed utilizando las palabras clave, considerando como primera referencia el artículo de Lavigne et al. (1996) donde se establecen los criterios de diagnóstico de BS, hasta los artículos publicados en marzo de 2015. El objetivo del trabajo es informar a la comunidad médica y odontológica sobre la prevalencia, etiología, comorbilidades asociadas y las opciones terapéuticas para el BS en niños y adolescentes entre 3 y 17 años. "

    Preview · Article · Jul 2015
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