Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity

Understanding the clinical management of co-occurring sleep-related bruxism and obstructive sleep apnea in adults: A narrative and critical review

Sleep-related bruxism (SRB) is a motor oral behavior characterized by tooth grinding and jaw clenching activity, reported by 8%-12% of the adult general population and 3% of older individuals. The frequency of one of its biomarkers, rhythmic masticatory muscle activity (RMMA), remains elevated across ages. Obstructive sleep apnea (OSA) is associated with the brief and repetitive pause of breathing (apnea) and with transient reduction in oxygen (hypoxia). OSA is observed at all ages and in about 50% of older individuals with a male preponderance. SRB clinical assessment is based on self-reporting of tooth grinding sound, awareness of clenching, jaw pain or headache, and clinical observation of tooth damage. OSA clinical assessment is based on sleepiness and fatigue, snoring, sleep quality, and awareness of breathing cessation, plus clinical examination of anatomical factors (e.g., obesity, retrognathia, large tonsil, macroglossia), age, gender, and body mass. Although the literature does not support association or causality between these two conditions, the co-occurrence is reported in about 30%-50% of adults. To confirm a diagnosis of co-occurring SRB and OSA, home sleep testing (HST) may be indicated. A sleep test is performed using electromyography (EMG) of jaw muscle (masseter or temporalis) and cardio-respiratory variables (e.g., air flow, respiratory effort, oxygen level, heart rate). The management of co-occurring SRB and OSA for individuals with prosthodontic needs is challenging to prevent compromising the oro-pharyngeal space and breathing efficiency. OSA treatment in the presence of SRB includes continuous positive airway pressure (CPAP) use alone or with an occlusal splint or mandibular advancement device (MAD). In addition, the following may be considered: supine sleep correction device, myofuncional therapy, medications, and surgeries. All have limitations and risks. Individual variability suggests that phenotyping is mandatory to select the most efficient and personalized treatment.

Short-term effect of material type and thickness of occlusal splints on maximum bite force and sleep quality in patients with sleep bruxism: a randomized controlled clinical trial

OBJECTIVE

To evaluate the short-term effects of hard and soft splints of different thicknesses on maximum bite force (MBF) and sleep quality (SQ) in participants with sleep bruxism (SB).

METHODS

One-hundred-fifteen patients were randomly allocated to five groups: Groups H2(Hard splint-2 mm), H3(Hard splint-3 mm), S2(Soft splint-2 mm), S3(Soft splint-3 mm), and C (control). Outcomes were MBF (assessed with a digital gnathodynamometer) and SQ (assessed with the Pittsburgh Sleep Quality Index). Measurements were performed at T0 (before the splints), T1 (1-month follow-up), and T2 (2-months follow-up). Data were analyzed using one-way analysis of variance(ANOVA), Tukey's HSD, and chi-square tests (alpha = 0.05).

RESULTS

At T1, the highest MBF values were observed in group H3 (658.01 ± 22.6 N), while the lowest in group S2 (585.45 ± 8.68 N). For T2, the highest values were obtained in H3 group (676.85 ± 21.9 N), and the lowest in group S2 (565.65 ± 10.9 N) (p < 0.05).For SQ, groups S2 and S3 revealed the lowest PSQI values at T1 (9.1; 9.6) and T2 (9; 9.5) (p < 0.001).

CONCLUSIONS

The short-term use of both 2 and 3-mm thick soft splints resulted in a decrease in MBF. Improvement in SQ in patients using soft splints was observed in the 1st month and was maintained in the 2nd month.

CLINICAL RELEVANCE

This study provides insights on short-term clinical effects as regards to increased sleep quality and regulated maximum bite force as a function of splint material type and the thickness of the splint.

Effects on general pain perception and dental pulp sensibility in probable sleep bruxism subjects by experimentally induced pain in a pilot study

In this pilot study, the general pain perception and the dental pulp sensibility of probable sleep bruxism (SB) subjects were compared with that of non-SB subjects. The cold pressor test (CPT), electric pulp test (EPT), and thermal pulp test with CO₂ snow were executed by one trained dentist (blind to SB diagnosis). A one-factorial multivariate analysis of variance (MANOVA) with SB diagnosis as independent variable and standardized measures regarding pain perception and evaluation was performed. One-hundred-and-five participants (53 SB and 52 non-SB subjects) were included. The one-factorial MANOVA revealed a significant difference between SB and non-SB subjects (p = 0.01) concerning pain perception variables. Post-hoc univariate analyses of variance (ANOVA) showed statistically significant lower general pain tolerance (p = 0.02), higher general subjective sensibility of the teeth (p < 0.01), and a statistical trend for higher subjective dental pain intensity (p = 0.07) in SB subjects. In most of the standardized variables, probable SB subjects seem to react and feel similar to non-SB subjects. However, as probable SB subjects subjectively perceive their teeth to be more sensitive and tend to rate their subjective dental pain intensity more intensely after CO₂ testing, data might point to a somatosensory amplification.

Quality of information on Instagram about masseter botox injection for bruxism

STATEMENT OF PROBLEM

Nowadays, masseter botulinum toxin injections are frequently used to treat bruxism. People first search for social media resources for their health-related problems. However, the quality of the information on Instagram about masseter botox injection for bruxism is unknown.

PURPOSE

The aim of this study was to evaluate the quality ant content of the Instagram posts shared publicly about masseter botox. The hashtag #masseterbotox was searched on Instagram.

MATERIALS AND METHODS

A total of 1000 posts were scanned. Unrelated posts were excluded from the study. The video posts were evaluated by using Global Quality Scale (GQS) and reliability of information toolkits.

RESULTS

One-hundred seventy-nine photograph and 65 video posts that met the criteria were analyzed. Most of the posts were posted by doctors and healthcare professionals (151 posts), followed by clinics (87 posts) and patients (6 posts). The information reliability scores of Instagram video posts about #masseterbotox were found to be very low (1.34±1.28). Number of views, reliability of information and GQS scores were not statistically significant between groups according to the source of the video posts (p>.05). GQS scores were higher in experience videos than information and advertisement videos (p<.05).

CONCLUSIONS

Clinicians should warn their patients about the reliability of information on Instagram and should guide them to the right social media resources.

CLINICAL IMPLICATIONS

Dental professionals should direct their patients about masseter botox injections to the right resources on social media platforms.

Managements of sleep bruxism in adult: A systematic review

This systematic review aimed to update the management of sleep bruxism (SB) in adults, as diagnosed using polysomnography (PSG) and/or electromyography (EMG). Management methods covered were oral appliance therapy (OAT) with stabilization splints, cognitive-behavioral therapy (CBT), biofeedback therapy (BFT), and pharmacological therapy. A comprehensive search was conducted on MEDLINE, Cochrane Library, and Web of Science up to October 1st, 2021. Reference list searches and hand searches were also performed by an external organization. Two reviewers for each therapy independently performed article selection, data extraction, and risk of bias assessment. The reviewers resolved any disagreements concerning the assortment of the articles by discussion. Finally, 11, 3, 14, and 22 articles were selected for each therapy. The results suggested that OAT tended to reduce the number of SB events, although there was no significant difference compared to other types of splints, that the potential benefits of CBT were not well supported, and that BFT, rabeprazole, clonazepam, clonidine, and botulinum toxin type A injection showed significant reductions in specific SB parameters, although several side effects were reported. It can be concluded that more methodologically rigorous randomized large-sample long-term follow-up clinical trials are needed to clarify the efficacy and safety of management for SB.

Efficacy of botulinum toxin type a in the targeted treatment of sleep bruxism: a double-blind, randomised, placebo-controlled, cross-over study

Background

Intramuscular injections of botulinum toxin A (BTX-A) have been used in the treatment of sleep bruxism (SB) however controlled trials are limited and the optimal injection strategy and dose is not known.

Methods

This double-blind, randomised, placebo-controlled, cross-over study evaluated the efficacy and safety of BTX-A in participants with SB. Average bruxism events per hour of sleep (Bruxism Index, BI) was calculated using surface electromyography. Participants with BI >5 were included and randomised by order of injection (active or placebo with the opposite 20 weeks later) and into one of three differing treatment groups: bilateral masseter (60 units(U)), bilateral masseter and temporalis (90U) and bilateral masseter, temporalis and medial pterygoid muscles (120U). Change in BI and subjective measures of headache, pain, and bruxism at 4 and 12 weeks was calculated following intervention, and differences between treatment groups analysed.

Results

41 participants were recruited, 35 randomised and data from 22 participants (14 female) were analysed. BI was significantly lower at 4 weeks after active treatment when compared with placebo (mean=−1.66, p=0.003), not sustained at 12 weeks. The difference was greater with higher doses injected and among those with greater baseline BI. There was no difference in subjective measures at any time point. Five participants injected had mild, transient side effects.

Discussion

Targeted BTX-A injection is a safe and effective treatment for SB. A greater benefit may be achieved by administering BTX-A into more muscles and at higher total doses and among those with higher baseline BI.

Trial registration number

ACTRN12618001430224.

Psychological therapies for temporomandibular disorders (TMDs)

BACKGROUND

Temporomandibular disorders (TMDs) are a group of musculoskeletal disorders affecting the jaw. They are frequently associated with pain that can be difficult to manage and may become persistent (chronic). Psychological therapies aim to support people with TMDs to manage their pain, leading to reduced pain, disability and distress.

OBJECTIVES

To assess the effects of psychological therapies in people (aged 12 years and over) with painful TMD lasting 3 months or longer.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched six bibliographic databases up to 21 October 2021 and used additional search methods to identify published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of any psychological therapy (e.g. cognitive behaviour therapy (CBT), behaviour therapy (BT), acceptance and commitment therapy (ACT), mindfulness) for the management of painful TMD. We compared these against control or alternative treatment (e.g. oral appliance, medication, physiotherapy).

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We reported outcome data immediately after treatment and at the longest available follow-up. We used the Cochrane RoB 1 tool to assess the risk of bias in included studies. Two review authors independently assessed each included study for any risk of bias in sequence generation, allocation concealment, blinding of outcome assessors, incomplete outcome data, selective reporting of outcomes, and other issues. We judged the certainty of the evidence for each key comparison and outcome as high, moderate, low or very low according to GRADE criteria.

MAIN RESULTS

We identified 22 RCTs (2001 participants), carried out between 1967 and 2021. We were able to include 12 of these studies in meta-analyses. The risk of bias was high across studies, and we judged the certainty of the evidence to be low to very low overall; further research may change the findings. Our key outcomes of interest were: pain intensity, disability caused by pain, adverse events and psychological distress. Treatments varied in length, with the shortest being 4 weeks. The follow-up time ranged from 3 months to 12 months. Most studies evaluated CBT.   At treatment completion, there was no evidence of a benefit of CBT on pain intensity when measured against alternative treatment (standardised mean difference (SMD) 0.03, confidence interval (CI) -0.21 to 0.28; P = 0.79; 5 studies, 509 participants) or control (SMD -0.09, CI -0.30 to 0.12; P = 0.41; 6 studies, 577 participants). At follow-up, there was evidence of a small benefit of CBT for reducing pain intensity compared to alternative treatment (SMD -0.29, 95% CI -0.50 to -0.08; 5 studies, 475 participants) and control (SMD -0.30, CI -0.51 to -0.09; 6 studies, 639 participants). At treatment completion, there was no evidence of a difference in disability outcomes (interference in activities caused by pain) between CBT and alternative treatment (SMD 0.15, CI -0.40 to 0.10; P = 0.25; 3 studies, 245 participants), or between CBT and control/usual care (SMD 0.02, CI -0.21 to 0.24; P = 0.88; 3 studies, 315 participants). Nor was there evidence of a difference at follow-up (CBT versus alternative treatment: SMD -0.15, CI -0.42 to 0.12; 3 studies, 245 participants; CBT versus control: SMD 0.01 CI - 0.61 to 0.64; 2 studies, 240 participants). There were very few data on adverse events. From the data available, adverse effects associated with psychological treatment tended to be minor and to occur less often than in alternative treatment groups. There were, however, insufficient data available to draw firm conclusions. CBT showed a small benefit in terms of reducing psychological distress at treatment completion compared to alternative treatment (SMD -0.32, 95% CI -0.50 to -0.15; 6 studies, 553 participants), which was maintained at follow-up (SMD -0.32, 95% CI -0.51 to -0.13; 6 studies, 516 participants). For CBT versus control, only one study reported results for distress and did not find evidence of a difference between groups at treatment completion (mean difference (MD) 2.36, 95% CI -1.17 to 5.89; 101 participants) or follow-up (MD -1.02, 95% CI -4.02 to 1.98; 101 participants). We assessed the certainty of the evidence to be low or very low for all comparisons and outcomes. The data were insufficient to draw any reliable conclusions about psychological therapies other than CBT.

AUTHORS' CONCLUSIONS

We found mixed evidence for the effects of psychological therapies on painful temporomandibular disorders (TMDs). There is low-certainty evidence that CBT may reduce pain intensity more than alternative treatments or control when measured at longest follow-up,  but not at treatment completion. There is low-certainty evidence that CBT may be better than alternative treatments, but not control, for reducing psychological distress at treatment completion and follow-up. There is low-certainty evidence that CBT may not be better than other treatments or control for pain disability outcomes.  There is insufficient evidence to draw conclusions about alternative psychological therapeutic approaches, and there are insufficient data to be clear about adverse effects that may be associated with psychological therapies for painful TMD.  Overall, we found insufficient evidence on which to base a reliable judgement about the efficacy of psychological therapies for painful TMD. Further research is needed to determine whether or not psychological therapies are effective, the most effective type of therapy and delivery method, and how it can best be targeted. In particular, high-quality RCTs conducted in primary care and community settings are required, which evaluate a range of psychological approaches against alternative treatments or usual care, involve both adults and adolescents, and collect measures of pain intensity, pain disability and psychological distress until at least 12 months post-treatment.

Validation of a new diagnostic method for quantification of sleep bruxism activity

OBJECTIVES

To validate a new diagnostic method (DIABRUX) for quantifying sleep bruxism (SB) activity using the current gold standard, polysomnography (PSG), as a criterion in an adequate sample size investigation.

MATERIALS AND METHODS

For SB diagnosis, each participant received a two-night ambulatory PSG including audio-video recordings. The 0.5-mm-thick sheet is produced in a thermoforming process. After diagnosis via PSG, each subject wore the diagnostic sheet for five consecutive nights. The resulting total abrasion on the surface was automatically quantified in pixels by a software specially designed for this purpose.

RESULTS

Forty-five participants (10 SB and 35 non-SB subjects) were included. The difference of the mean pixel score between the SB (M = 1,306, SD = 913) and the non-SB group (M = 381, SD = 483; 3.4 times higher for SB) was statistically significant (p < 0.001). The receiver operator characteristic (ROC) analysis revealed a value of 507 pixels as the most appropriate cut-off criterion with a sensitivity of 1.0, a specificity to 0.8, and an area under the curve (AUC) of 0.88. The positive and negative predictive value accounted for 0.59 and 1.0.

CONCLUSIONS

The present data confirm that the new diagnostic method is valid and user-friendly that may be used for therapeutic evaluation, and for the acquisition of larger sample sizes within sophisticated study designs.

CLINICAL RELEVANCE

The verified properties of the new diagnostic method allow estimating SB activity before damages occur due to long-standing bruxism activity. Therefore, it might be utilized for preventive dentistry.

TRIAL REGISTRATION NUMBER

NC T03325920 (September 22, 2017).

The effect of continuous positive airway pressure and mandibular advancement device on sleep bruxism intensity in obstructive sleep apnea patients

We aimed to evaluate and compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) in reducing the intensity of sleep bruxism (SB) in patients with obstructive sleep apnea (OSA). Forty-eight adults with OSA were subjected to single-night full polysomnography (PSG) in the Sleep Laboratory of the Wroclaw Medical University. The respiratory events and bruxism episodes were scored according to the standards of the American Academy of Sleep Medicine. The patients were assigned to the CPAP treatment or the MAD treatment in accordance to apnea–hypopnea index (AHI). The second PSG examination was conducted during the MAD or CPAP treatment to assess the effect of treatment on bruxism episode index (BEI) and AHI. The mean AHI and mean BEI in the study material were estimated to be 30.05 ± 15.39 and 5.10 ± 5.31, respectively. The bruxism parameters were significantly decreased in both the CPAP and MAD groups. Compared to the MAD, the CPAP treatment was more effective in reducing AHI; however, there was no significant difference in effectiveness of CPAP and MAD treatment in BEI reduction. Both CPAP and MAD treatments were effective against SB coexisting with OSA. Due to the application of these treatment options, the risk of OSA should be estimated in patients with SB.

Cardiovascular Implications of Sleep Bruxism-A Systematic Review with Narrative Summary and Future Perspectives

Sleep bruxism is a common sleep-related behavior characterized as repetitive masticatory muscle activity. Genetic vulnerability to stress and anxiety is considered a basal component in the pathogenesis of bruxism events. Dysfunction of the autonomic nervous system related with an arousal during sleep is considered an underlying cause of the cardiovascular implications of sleep bruxism. Increased cardiovascular risk was previously linked with sleep conditions: for example, obstructive sleep apnea and insomnia, and sleep bruxism. The aim of present systematic review was to evaluate the current arguments on the relationship between sleep bruxism and cardiovascular diseases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We have reviewed the Embase, PubMed (Medline) and Scopus databases to identify applicable articles (1994-2021). A total of 127 records in English language were identified, then after screening and exclusion of nonrelevant records, 19 full-text articles were evaluated. Finally, we included 12 studies for synthesis. Due to the heterogeneity of the compared studies, only a qualitative comparison and narrative summary were performed. In the majority of studies, increased sympathetic activity was successfully established to escalate heart rate variability, the inflammatory process, oxidative stress, endothelial remodeling and hormonal disturbances, leading to hypertension and other cardiovascular complications.

The efficacy of occlusal splints in the treatment of bruxism: A systematic review

OBJECTIVES

Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities.

DATA

Data extraction was undertaken in conjunction with quality of evidence assessment.

SOURCES

A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group's Trials, The Cochrane Central Register of Controlled Trials and EMBASE.

STUDY SELECTION

Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions.

RESULTS

Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias.

CONCLUSIONS

There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality.

CLINICAL SIGNIFICANCE STATEMENT

This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.

Pain perception and functional/occlusal parameters in sleep bruxism subjects following a therapeutic intervention

Background

This study was conducted to assess the individual pain perception in sleep bruxism (SB) subjects. Moreover, the effects of a cognitive behavioural therapy (CBT) compared to an occlusal appliance (OA) on pain perception and a possible continuative impact on several functional parameters were investigated.

Methods

A total of 57 SB subjects participated in this investigation. The diagnosis of SB was based on the clinical criteria of the American Academy of Sleep Medicine (AASM). Twenty-eight SB subjects were randomly allocated to the CBT group and 29 to the OA group. The therapeutic intervention took place over a period of 12 weeks, whereby both groups were examined at baseline, immediately after termination of the intervention, and at a 6-month follow-up for pain perception and functional parameters. At each of the three measurement periods, participants completed the pain perception scale and ten functional/occlusal parameters were recorded.

Results

Of the 12 parameters recorded, statistically significant main effects were found for the affective pain perception (p < 0.05) and for the three functional variables. Interestingly, the values obtained for the affective pain perception were considerably below that of a reference group. Apart from the determined statistically significant results, the values recorded for all functional/occlusal variables as well as those obtained for the sensory pain perception were clearly located within normative ranges.

Conclusions

Within the limitations of this study, it might be concluded that the significantly reduced affective pain perception in SB subjects is the expression of an adaptation mechanism.

Lesões cervicais não-cariosas de abfração: prevalência e relação com bruxismo do sono

As lesões cervicais não cariosas (LCNCs) são caracterizadas pela perda da estrutura dentária localizada na região próxima a junção cemento-esmalte. O bruxismo do sono é uma parafunção caracterizada pelo contato não-funcional dos dentes durante o sono, manifestada pelo apertar ou ranger dos mesmos. Considerando que uma das possíveis etiologias das LCNCs é a sobrecarga oclusal, torna-se importante a compreensão da relação entre a prevalência destas lesões e os fatores de sobrecarga presentes no meio oral. Objetivo: Avaliar a prevalência de LCNCs do tipo abfração e sua relação com o diagnóstico positivo de bruxismo do sono em uma amostra de pacientes da IMED e CEOM. Metodologia: Este foi um estudo clínico do tipo transversal, onde foi realizada avaliação observacional em uma amostra de 25 pacientes de ambos os sexos, com idade entre 20 e 62 anos. O diagnóstico de bruxismo do sono foi realizado através de um questionário e exame clínico intra-oral. O diagnóstico de abfração foi realizado por meio de exame clínico intra-bucal com auxílio de sonda exploradora e milimetrada. Foram utilizados o teste exato de Fisher e Mann-Whitney para analise estatística (α=0,05). Resultados: a prevalência de lesões de abração na amostra total de dentes foi de 5,64%, sendo significativamente maior em pacientes bruxômas (8,83%) do que em pacientes sem bruxismo (1,38%) (p=0,017). A presença de bruxismo foi associada à presença de abfrações (p=0,012). Conclusão: o diagnóstico positivo do bruxismo do sono é um fator de risco, aumentando consideravelmente a chance de o paciente apresentar LCNCs do tipo abfração.

Symptoms in different severity degrees of bruxism: a cross-sectional study

ABSTRACT Objective: The aim of the present study was to evaluate symptoms of the muscle pain, sleep quality, oral health, anxiety, stress and depression in individuals with different severity degrees of bruxism. Methods: Seventy-two individuals with bruxism were enrolled in the study, classified into: moderate (n=25) and severe (n=47) bruxism. Pain intensity was assessed using the Visual Analogical Scale, pain threshold with algometer, sleep quality by the Pittsburgh Sleep Quality Index, oral health by the Oral Health Impact Profile, anxiety by the State-Trait Anxiety Inventory, stress by the Perceived Stress Scale and depression using the Beck Depression Inventory. The significance level considered was 5%. Results: The results showed that individuals with severe bruxism presented greater muscle pain intensity, sleep disorder, worse oral health, high anxiety level and dysphoria with statistically significant differences (p<0.05) than individuals with moderate bruxism, except in pain threshold and stress (p<0.05). Conclusion: Data suggest that individuals with severe bruxism have more intense symptoms. They present greater muscle pain, alterations in sleep quality and oral health, anxiety and depression than individuals with moderate bruxism. However, both present similarity in stress.

Sleep bruxism: Current knowledge and contemporary management

Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

To see bruxism: a functional MRI study

OBJECTIVE

Since the pathophysiology of bruxism is not clearly understood, there exists no possible treatment. The aim of this study is to investigate the cerebral activation differences between healthy subjects and patients with bruxism on behalf of possible aetiological factors.

METHODS

12 healthy subjects and 12 patients with bruxism, a total of 24 right-handed female subjects (aged 20-27 years) were examined using functional MRI during tooth-clenching and resting tasks. Imaging was performed with 3.0-T MRI scanner with a 32-channel head coil. Differences in regional brain activity between patients with bruxism and healthy subjects (control group) were observed with BrainVoyager QX 2.8 (Brain Innovation, Maastricht, Netherlands) statistical data analysis program. Activation maps were created using the general linear model: single study and multistudy multisubject for statistical group analysis. This protocol was approved by the ethics committee of medical faculty of Kirikkale University, Turkey (02/04), based on the guidelines set forth in the Declaration of Helsinki.

RESULTS

The group analysis revealed a statistically significant increase in blood oxygenation level-dependent signal of three clusters in the control group (p<0.005), which may indicate brain regions related with somatognosis, repetitive passive motion, proprioception and tactile perception. These areas coincide with Brodmann areas 7, 31, 39 and 40. It is conceivable that there are differences between healthy subjects and patients with bruxism.

CONCLUSIONS

Our findings indicate that there was a decrease of cortical activation pattern in patients with bruxism in clenching tasks. This indicates decreased blood flow and activation in regional neuronal activity. Bruxism, as an oral motor disorder concerns dentistry, neurology and psychiatry. These results might improve the understanding and physiological handling of sleep bruxism.

Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial

Background

Bruxism is a parafunctional habit characterized by grinding and/or clenching of the teeth. It may happen while awake (awake bruxism) or while sleeping (sleep bruxism). In adults, the prevalence is 20% for the awake bruxism and 8% for the sleep bruxism. Peripheral, central, and psychosocial factors influence the disorder, which may predispose to pain in the masticatory muscles and neck, headache, decreased pain thresholds in the masticatory and cervical muscles, limitation mandibular range of motion, sleep disorders, stress, anxiety, depression, and overall impairment of oral health. The aim of this study is to compare two distinct physical therapy interventions with dental treatment in pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism.

Methods/Design

Participants will be randomized into one of three groups: Group 1 (n = 24) intervention will consist of massage and stretching exercises; Group 2 (n = 24) will consist of relaxation and imagination therapies; and Group 3 (n = 24) will receive dental treatment. The evaluations will be performed at baseline, immediately after treatment, and at 2-month follow-up. Pain intensity will be assessed using the visual analogical scale, while pain thresholds will be determined using dolorimetry. Mandibular range of motion will be assessed using digital pachymeter. Sleep quality will be assessed by the Pittsburgh Sleep Quality Index, anxiety by the State-Trait Anxiety Inventory, stress by the Perceived Stress Scale-10, depression by the Beck Depression Inventory, and oral health will be assessed using the Oral Health Impact Profile - 14. Significance level will be determined at the 5% level.

Discussion

This project describes the randomization method that will be used to compare two physical therapy interventions with dental treatment in the management of pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. The study will support the practice of evidence-based physical therapy for individuals with bruxism. Data will be published after study is completed.

Trial registration

ClinicalTrials.gov, NCT01778881

Efficacy of three hygienic protocols in reducing biofilm adherence to removable thermoplastic appliance

OBJECTIVES

To examine the ability of a removable thermoplastic appliance (RTA) to adsorb hygienic solutions and inhibit bacterial growth and to examine the efficacy of three hygiene protocols in reducing bacterial biofilm adherence to RTA.

MATERIALS AND METHODS

Solution adsorption and bacterial growth inhibition were examined in vitro using paper vs RTA discs. Subsequently, 11 patients treated with RTA (mean age, 29.1 ± 4.7 years) were assigned into a sequence of three hygiene protocols: regular RTA brushing (baseline), immersion RTAs in chlorhexidine mouthwash (CHX), and using a vibrating bath with cleaning solution (VBC). For each patient, 12 upper RTAs were examined (2 baseline RTAs, 5 CHX RTAs, and 5 VBC RTAs), for a total of 132 RTAs. All RTAs were stained with gentian violet, and biofilm presence was measured using a photodensitometer.

RESULTS

The RTA discs did not adsorb CHX or cleaning solution. The later agent did not show antibacterial features. Baseline RTAs showed significant biofilm adherence (P < .001) on the posterior palatal side of the aligner and on the anterior incisal edge. CHX and VBC hygienic protocols significantly (P < .001) reduced baseline biofilm adherence by 16% and 50%, respectively. Hygienic improvement was maintained over 140 days when CHX and VBC were used. However, VBC was three times more efficient than CHX.

CONCLUSIONS

This study highly recommends the use of a VBC protocol. Biofilm deposits on the RTA, especially on incisal edges and attachment dimples, could lead to inadequate tooth/RTA and attachment/RTA overlap and consequently impair tooth alignment.

Is there a first night effect on sleep bruxism? A sleep laboratory study

STUDY OBJECTIVES

Sleep bruxism (SB) is reported to vary in frequency over time. The aim of this study was to assess the first night effect on SB.

METHODS

A retrospective polysomnographic (PSG) analysis was performed of data from a sample of SB patients (12 females, 4 males; age range: 17-39 years) recorded in a sleep laboratory over 2 consecutive nights. Sleep parameters and jaw muscle activity variables (i.e., rhythmic masticatory muscle activity [RMMA]) for SB were quantified and compared between the 2 nights. Subjects were classified into groups according to severity of RMMA frequency, such as low frequency (2-4 episodes/h and/or < 25 bursts/h) and moderate-high frequency (≥ 4 episodes/h and ≥ 25 bursts/h).

RESULTS

Overall, no first night effects were found for most sleep variables. However, total sleep time, sleep efficiency, and stage transitions showed significant time and group interactions (repeated measures ANOVAs, p ≤ 0.05). The RMMA episode index did not differ between the 2 nights, whereas the second night showed significantly higher burst index, bruxism time index, and mean burst duration (repeated measure ANOVAs, p ≤ 0.05). Five patients of 8 in the low frequency group were classified into the moderate-high frequency group on the second night, whereas only one patient in the moderate-high frequency group moved to the low frequency group.

CONCLUSIONS

The results showed no overall first night effect on severity of RMMA frequency in young and healthy patients with SB. In clinical practice, one-night sleep recording may be sufficient for moderate-high frequency SB patients. However, low RMMA frequency in the first night could be confirmed by a second night based on the patient's medical and dental history.

Effects of sleep bruxism on functional and occlusal parameters: a prospective controlled investigation

This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm (s.d., 0.69 mm) in the sleep bruxism group and a mean slide of 0.4 mm (s.d., 0.57 mm) in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects (Mann–Whitney U-test; P=0.008). However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive capacity of the stomatognathic system into future investigations.

Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine

Sleep bruxism (SB) is a common sleep-related motor disorder characterized by tooth grinding and clenching. SB diagnosis is made on history of tooth grinding and confirmed by polysomnographic recording of electromyographic (EMG) episodes in the masseter and temporalis muscles. The typical EMG activity pattern in patients with SB is known as rhythmic masticatory muscle activity (RMMA). The authors observed that most RMMA episodes occur in association with sleep arousal and are preceded by physiologic activation of the central nervous and sympathetic cardiac systems. This article provides a comprehensive review of the cause, pathophysiology, assessment, and management of SB.

Tooth surface loss: tools and tips for management

Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive 'full-mouth' indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these.

CLINICAL RELEVANCE

Treatment options and guidance for managing patients who present with tooth surface loss.

Bruxismo do sono: possibilidades terapêuticas baseadas em evidências

INTRODUÇÃO: o bruxismo do sono (BS) é uma desordem de movimentos estereotipados e periódicos, associados ao ranger e/ou apertar de dentes durante o sono, decorrentes da contração rítmica dos músculos mastigatórios. Essa condição não é uma doença, porém quando exacerbada pode ocasionar desequilíbrio e alteração das estruturas orofaciais. Dessa forma, surge a necessidade de se obter terapêuticas efetivas e seguras para o controle e o manejo do paciente bruxômano. As alternativas de tratamento variam desde terapêuticas orodentais e farmacológicas até técnicas comportamentais-cognitivas. OBJETIVOS: através de uma revisão sistemática da literatura, tendo como bases de pesquisa a Medline, Cochrane, Embase, Pubmed, Lilacs e BBO, no período compreendido entre 1990 e 2008, e com enfoque em estudos clínicos randomizados e quasi-randomizados, revisões sistemáticas e meta-análises, esse trabalho teve como objetivo analisar e discutir métodos de tratamento para o BS. RESULTADOS: pela análise da literatura verifica-se que existe uma grande quantidade de opções terapêuticas para o BS, porém muitas das terapias não têm suporte científico que as sustente. Assim, a escolha terapêutica deve ser pautada em evidências científicas e no bom senso clínico, objetivando uma melhora na qualidade de vida do paciente bruxômano.

Bruxism in children with nasal obstruction

INTRODUCTION

Bruxism is characterized by repeated tooth grinding or clenching. The condition can occur in all age ranges and in both genders, being related or not to other oral habits.

OBJECTIVE

The objective of the present study was to investigate the occurrence of bruxism in children with nasal obstruction and to determine its association with other factors.

METHODS

Sixty children with nasal obstruction seen at the Otorhinolaryngology Outpatient Clinic of the University Hospital of Ribeirão Preto participated in the study. The data were obtained using a pre-established questionnaire applied to the person responsible and by orofacial evaluation of the patient. The participants were divided into two groups: group with bruxism (GB) as reported by the relatives and with the presence of tooth wear detected by clinical evaluation, and group without bruxism (GWB), consisting of children with none of the two symptoms of bruxism mentioned above.

RESULTS

The presence of bruxism exceeded its absence in the sample studied (65.22%). There was no significant difference (P<0.05) between groups regarding gender, phase of dentition, presence of hearing diseases, degree of malocclusion, or child behavior.

CONCLUSION

Bruxism and deleterious oral habits such as biting behavior (objects, lips and nails) were significantly present, together with the absence of suction habits, in the children with nasal obstruction.

Occlusal splints for treating sleep bruxism (tooth grinding)

BACKGROUND

Sleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental.

OBJECTIVES

To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo or no treatment.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertation, Theses and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.

SELECTION CRITERIA

We selected randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism.

DATA COLLECTION AND ANALYSIS

Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary.

MAIN RESULTS

Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to: palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses.

AUTHORS' CONCLUSIONS

There is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. The study design must be parallel, in order to eliminate the bias provided by studies of cross-over type. A standardisation of the outcomes of the treatment of sleep bruxism should be established in the RCTs.