Relationship of self-reported sleep bruxism and awake bruxism with chronotype profiles in Italian dental students

Sleep bruxism: The past, the present, and the future-evolution of a concept

BACKGROUND

The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded.

TYPES OF STUDIES REVIEWED

The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles.

RESULTS

There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.

Probable sleep and awake bruxism in adolescents: A path analysis

BACKGROUND

Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes.

AIM

To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents.

DESIGN

A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis.

RESULTS

PSB and PAB are related to each other, with moderate and positive correlation (β = .390). Poor sleep quality and higher household income had a direct effect on both PSB (β = -.138; β = .123, respectively) and PAB (β = -.155; β = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (β = -.102). Adolescents that drool on the pillow (β = .184) and/or have agitated sleep (β = .104) tend to have PSB.

CONCLUSION

Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

Associations between self-reported bruxism, sleep quality, and psychological status among dental students in Turkey

OBJECTIVES

To assess sleep quality among dental students and to identify psychological factors associated with self-reported sleep bruxism (SB).

METHODS

A total of 212 dentistry students from the Usak University Faculty of Dentistry participated in this study. A self-report questionnaire was administered to identify possible SB. The Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was administered to evaluate psychological factors, and the Pittsburgh Sleep Questionnaire Index (PSQI) was used to evaluate sleep quality.

RESULTS

Possible SB was more frequently observed in females than in males. The mean DASS-21 score in those with possible SB was significantly higher than in those without SB (p< 0.001). The mean PSQI (total) score was also significantly higher in those with possible SB than in those without SB (5.0 ± 2.4) (p= 0.007).

CONCLUSION

The findings revealed that psychological factors and sleep quality significantly affected the prevalence of self-reported SB among dental students.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies

BACKGROUND

With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged.

OBJECTIVE

In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management.

METHODS

We summarised current strategies for AB assessment and proposed a research route for improving its metrics.

RESULTS

Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity.

CONCLUSIONS

Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.

The association of self-reported awake bruxism and sleep bruxism with temporomandibular pain and dysfunction in adult patients with temporomandibular disorders

OBJECTIVE

To investigate the association of the severity of temporomandibular disorders (TMD) pain and dysfunction with the frequency of self-reported awake bruxism (AB), sleep bruxism (SB), and stress in an adult TMD-patient population.

MATERIALS AND METHODS

This cross-sectional study included 237 TMD patients based on the Diagnostic Criteria for TMD. Age, sex, frequency of self-reported AB and SB, and stress were included as independent variables. TMD pain and TMD dysfunction were included as dependent variables in regression analyses. Univariate and multivariable linear regression analyses were used to predict TMD pain and TMD dysfunction in two separate models. Finally, network analysis was performed to investigate the associations between all variables.

RESULTS

In the univariate analyses, TMD pain was significantly associated with self-reported AB-frequent (unstandardized coefficient (B) = 3.196, 95%CI 1.198-5.195, p = 0.002). TMD dysfunction was significantly associated with AB-frequent (B = 2.208, 95%CI 0.177-4.238, p = 0.033) and SB-sometimes (B = 1.698, 95%CI 0.001-3.394, p = 0.050). In the multivariable analyses, TMD pain was significantly associated with TMD dysfunction (B = 0.370, p < 0.001), stress (B=0.102, p < 0.001). TMD dysfunction was significantly associated with TMD pain (B = 0.410, p < 0.001) only. Network analysis showed that TMD pain is a bridge factor between AB, stress, and TMD dysfunction.

CONCLUSIONS

TMD pain is directly associated with AB, stress, and TMD dysfunction, while TMD dysfunction is only associated with TMD pain.

CLINICAL RELEVANCE

Reducing pain may improve pain-related dysfunction, and the management of AB and stress may improve TMD pain and dysfunction, and vice versa.

Monitoring of awake bruxism by intelligent app

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

Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations

Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.

Factors associated with awake bruxism according to perceptions of parents/guardians and self-reports of children

BACKGROUND

Bruxism is a repetitive activity of the masticatory muscles that has been associated with orofacial disorders and psychosocial factors AIM: The aim of this study was to investigate associations between possible awake bruxism (PAB) and family functioning, bullying, and dental caries in children 8-10 years of age.

DESIGN

A school-based study was conducted with 739 pairs of parents/guardians and children. The parents/guardians answered the Family Adaptability and Cohesion Evaluation Scales for the establishment of family functioning. Information on bullying due to dental conditions was collected from the children. Dental caries in the children was evaluated using International Caries Detection and Assessment System criteria. A directed acyclic graph was used to define the theoretical model and select control factors. Descriptive analysis was performed, followed by multivariate logistic regression for complex samples.

RESULTS

Considering the parental reports, fewer years of mother's schooling, a low family income, very flexible family adaptability, and cavitated dental caries were associated with PAB. The female sex, bullying, and orofacial dysfunction were associated with self-reported PAB.

CONCLUSIONS

Therefore, the factors associated with PAB differ according to the reports of parents/guardians or self-reports of children. Healthcare providers should consider both reports for a more effective intervention addressing PAB.

Prevalence, awareness, and management of bruxism in Thai dental students: A cross-sectional study

OBJECTIVE

To determine the prevalence of self-reported bruxism, awareness of bruxism's adverse effects, and bruxism management among Thai undergraduate dental students.

METHODS

An online self-reported questionnaire was designed and tested for validity and reliability and then distributed to dental students at 12 universities in Thailand from September 2020 to January 2021.

RESULTS

There were 464 respondents (338 females and 126 males) with an average age of 21.42 ± 2.06 years. The prevalence of self-reported awake and sleep bruxism was 35.78% and 37.28%, respectively, and 19.40% had both awake and sleep bruxism. Awareness scores were higher for dentists than for patients (p< 0.001). Only 12.14% of sleep bruxers still wear an occlusal splint for bruxism management.

CONCLUSION

The prevalence of self-reported awake and sleep bruxism was high among Thai dental students. They are well aware of the adverse effects of bruxism with inappropriate management of the condition.

Circadian preference and its relationship with possible sleep and awake bruxism in adults assisted by the public health system

Modern lifestyle and social demands induce changes in sleep routines that may not meet individual circadian preferences (chronotype). Such changes may be associated with the development of unhealthy lifestyles and the emergence of diseases relevant to public health services, such as obesity, hypertension, and diabetes mellitus, as well as sleep bruxism (SB) and awake bruxism (AB). The present study aimed to assess the relationship between the evening, morning or intermediate chronotypes with the report of possible SB and AB in adult individuals assisted by the Family Health Strategy (FHS). The selection of participants was performed through probabilistic cluster analysis. The sample size (n = 384) was calculated to include a representative sample of the 52,628 adults registered in the FHS of a countryside city located in the Southeast Region of Brazil. The Morningness-Eveningness Questionnaire (MEQ) was used to determine the chronotype, and Questionnaire-Based Self-Reported Bruxism was used for identifying possible SB and AB. The following clinical and social-behavioral variables were also evaluated: age, sex, BMI, income, physical activity, schooling, alcohol consumption and smoking, chronic diseases and depression. Two logistic regression models were used: one for SB and one for AB. Possible SB was associated with female sex, lack of physical activity and income above 2 minimum wages. Regarding chronotype, a 19% reduction in the chance of possible SB was observed in morning individuals compared to evening individuals (p = .017). Possible AB was associated with younger individuals, smoking and depression. In conclusion, compared with the evening circadian preference, the morning circadian preference was associated with greater protection against possible SB in an adult population assisted by the FHS.

A world panorama of bruxism in children and adolescents with emphasis on associated sleep features: A bibliometric analysis

BACKGROUND AND OBJECTIVES

To present a world panorama of the published papers on bruxism in children and adolescents, emphasising the characteristics of studies related to the sleep features of these patients.

METHODS

Literature searches were conducted in six databases without language or date restrictions. Data on the titles, types of study, main subjects, countries of origin, keywords, years of publication, authors and their network collaborations, journals and sleep studies were extracted and analysed using VantagePoint™ software.

RESULTS

A total of 725 studies met the eligibility criteria. Most included only children (75.31%), with observational design (66.34%), and risk or aetiology (53.93%) as the main subject. Brazil (18.06%) and Brazilian authors (54.84%) had the largest number of studies, with a low amount of network collaboration. The Journal of Oral Rehabilitation published most of the studies (6.2%); publications in this field have grown considerably from 2000 to 2020. Of the studies, 123 (16.96%) included sleep studies; night sweating, restless sleep, sleep talking, mouth breathing, snoring, obstructive sleep apnoea syndrome, sleep-disordered breathing, nightmares, poor sleep quality and duration, and daytime naps were significantly associated with bruxism in most.

CONCLUSION

Studies on bruxism in children and adolescents have increased in the past 20 years, with most being observational, and risk or aetiology as the main subject. Brazil and the Journal of Oral Rehabilitation have published most in the field. Sleep studies have shown some features associated with bruxism, such as night sweating, restless sleep, somniloquy, snoring, breathing problems, nightmares, daytime naps, and poor sleep quality and duration.

Possible sleep and awake bruxism, chronotype profile and TMD symptoms among Turkish dental students

It was hypothesized that an individual's chronotype profile has an effect on the performance of work or study tasks. Dental students have to cope with both academic and clinical workloads, and the latter requires extra concentration. The first aim was to evaluate the association of sleep bruxism (SB) and awake bruxism (AB) with sleep related items, temporomandibular disorder (TMD) complaints, and chronotype profile; the second aim was to evaluate the association between complaints of TMD and chronotype profile among dental students. The present cross-sectional descriptive study involved 218 dental students whose ages ranged between 18 and 30 years. In order to gather data, students were required to respond to a questionnaire, which aimed to evaluate possible SB and possible AB occurrence and demographics, sleep-related items and complaints of TMD. For the assessment of the chronotype profile, the morningness-eveningness questionnaire (MEQ) was used. The chi-square test, the Mann-Whitney U test, and t-test analyses were performed to evaluate the factors associated with SB, AB and chronotype profile. The frequency of self-reported SB was 25.2% and AB was 28.9%. The prevalence in the eveningness profile who reported possible AB was 45.3%, while it was 24.2% in intermediate individuals and 18.8% in the morningness profile. An association was also found between possible AB and eveningness chronotype profile (p = .009). No association was found between other temporomandibular joint (TMJ) pain and noise and chronotype profiles (p > .05). An association was found between possible AB and eveningness chronotype profile but no association was found between possible SB and chronotype profile. Moreover, complaint of TMD (face, head, neck pain) was observed particularly in students with an eveningness profile.

Awake bruxism frequency and psychosocial factors in college preparatory students

OBJECTIVE

To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students.

METHODS

Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05).

RESULTS

The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001).

CONCLUSION

College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.

Predictors of behaviour change for unhealthy sleep patterns among Indian dental students

OBJECTIVE

The present study aimed at determining predictors of sleep behaviour change among dental students using the multi-theory model (MTM) of health behaviour change in India.

METHODS

This study was conducted among 535 students of a dental college in India. Predictors of sleep behaviour change were assessed using a validated 30-item questionnaire. Theoretical predictors of sleep behaviour were modelled using multiple linear regression.

RESULTS

The response rate was 95.10%. A total of 449 of 535 students filled in the form, out of which 127 (28.30%) were inadequate sleepers. Inadequate sleep behaviour showed a strong preponderance within the male population (81.9%). The percentage of inadequate sleepers was highest in second year undergraduates and those obtaining between 60 and 69.9% marks in previous exams. For the initiation model, the standardised regression coefficients (β) for the three constructs - participatory dialogue, behavioural confidence and change in physical environment were 0.050 [p = 0.579, 95% (confidence interval)CI: -0.039 to 0.070], 0.213 (p = 0.019, 95% CI: 0.029-0.320) and 0.062 (p = 0.496, 95% CI: -0.073 to 0.149), respectively. For the sustenance model, β for emotional transformation, practice for change and changes in social environment was 0.192 (p = 0.047, 95% CI: 0.002-0.250), 0.175 (p = 0.091, 95% CI: -0.024 to 0.318) and 0.046 (p = 0.623, 95% CI: -0.094 to 0.157), respectively.

CONCLUSION

Improving behavioural confidence and bringing about emotional transformation were significant predictors for a reduction in inadequate sleep behaviour in dental students. Working on these predictors may improve sleep behaviours in dental students.

The Bruxoff Device as a Screening Method for Sleep Bruxism in Dental Practice

Sleep bruxism (SB) is a masticatory muscle activity during sleep and a common phenomenon. Severe SB can have a serious impact on the success of dental treatment. Reliable methods of screening and diagnosing patients with SB are crucial. Therefore, in this study, a Bruxoff device as a potential screening and diagnostic method for sleep bruxism was evaluated. A total of 60 adults participated in this study: 35 patients with symptoms of bruxism (study group) and 25 asymptomatic patients (control group). Data were recorded using Bruxoff. All symptomatic patients participating in the study turned out to be bruxers, while not all asymptomatic patients turned out to be non-bruxers according to the Bruxoff device. Bruxoff is a simple screening device that can be safely used to evaluate masseter muscle activity during sleep. Since the device does not have a built-in microphone and/or video camera and, therefore, cannot record grinding sounds, the objective capabilities of Bruxoff as a single diagnostic device for sleep bruxism are limited.

Chronodentistry: the role & potential of molecular clocks in oral medicine

Molecular clocks help organisms to adapt important physiological functions to periodically changing conditions in the environment. These include the adaption of the 24 h sleep-wake rhythm to changes of day and night. The circadian clock is known to act as a key regulator in processes of health and disease in different organs. The knowledge on the circadian clock led to the development of chronopharmacology and chronotherapy. These fields aim to investigate how efficiency of medication and therapies can be improved based on circadian clock mechanisms. In this review we aim to highlight the role of the circadian clock in oral tissues and its potential in the different fields of dentistry including oral and maxillofacial surgery, restorative dentistry, endodontics, periodontics and orthodontics to trigger the evolving field of chronodentistry.