Periodontal status and bruxism. A comparative study of patients with periodontal disease and occlusal parafunctions

Association between clinical manifestations of occlusal trauma and magnetic resonance imaging findings of periodontal ligament space

OBJECTIVES

The purpose of this study was to evaluate the association between clinical manifestations of occlusal trauma of the teeth and maximum signal intensity of periodontal ligament space on MRI.

METHODS

20 subjects (males: 9, females: 11, mean age: 35.9 ± 14.0 years, range: 22-65 years) participated in this study. Subjective symptoms of bruxism, tooth mobility, fremitus, occlusal contact area, occlusal force, widening of the periodontal ligament space, and thickening of the lamina dura were defined as clinical manifestations of occlusal trauma. The total number of clinical manifestations was used to evaluate the degree of clinical occlusal trauma, with a score of 7 indicating the highest degree of occlusal trauma. The maximum signal intensity in the periodontal ligament space was evaluated by a specific T2 weighted MRI sequence: IDEAL image.

RESULTS

Spearman's rank correlation between the total clinical occlusal trauma score and maximum signal intensity in the periodontal ligament space was 0.529 for all teeth, 0.517 for anterior teeth, and 0.396 for molar teeth (p < 0.001 for all).

CONCLUSIONS

A significant correlation between the degree of occlusal trauma and the signal intensity of the periodontal ligament space suggests a new potential MRI-based method for objectively determining occlusal trauma.

Bruxism

Bruxism is a parafunctional activity of the masticatory system, which is characterized by clenching or scraping of teeth. This condition is often accompanied by a change in the shape and size of the teeth, as well as the function of the stomatognathic system. Bruxism can occur during sleep and in the waking state. The etiology is multifactorial and all causes can be divided into peripheral and central. The clinical signs and symptoms of bruxism are primarily characterized by temporomandibular disorders, the appearance of bruxofacets and changes in the hard dental tissues, supporting apparatus of the teeth and masticatory muscles, as well as headaches. The diagnosis of bruxism is made on the basis of anamnesis and clinical signs and symptoms, while electromyography and polysomnographic analysis are used in scientific researches. Therapy is aimed at controlling etiological factors and reducing symptoms. Occlusal splints are the most commonly used in the treatment of bruxism. Medications are used in situations when other methods, including psychotherapy, do not give positive results. Given the multifactorial etiology, the therapeutic approach must be multidisciplinary. The approach to the patient must be individual in order to treat as effectively as possible.

Knowledgeability, attitude, and practice behaviors of primary care providers toward managing patients' oral health care in medical practice: Wisconsin statewide survey

BACKGROUND

In this study, the authors sought to explore the receptivity, preparedness, and rates of adoption of integrated medical-dental models of care (MOCs) in the practice setting among primary care providers (PCPs) treating patients with diabetes mellitus (DM).

METHODS

The authors conducted an anonymous statewide survey targeting PCPs across a range of Wisconsin-based practice settings to evaluate knowledgeability, attitude, practice behaviors, and perceived barriers to oral health screening in a medical setting. Qualitative analytical approaches included thematic analyses applied to evaluate the status of and barriers to integrated medical-dental MOC adoption.

RESULTS

The integrated medical-dental MOC adoption rate was 34%. Top perceived barriers to integrated medical-dental MOC adoption included insurance coverage (71%) and care access (70%). A total of 39% indicated competency for educating patients about the association between DM and periodontitis. Although 72% of PCPs indicated optimal periodicity for oral health assessment as frequent, 39% reported frequently conducting such assessments.

CONCLUSIONS

Although PCPs indicate receptivity to integrated medical-dental MOCs, PCPs identify suboptimal education, lack of adequate training in oral-systemic disease assessment, and barriers to oral health care access as barriers to integrated medical-dental MOC adoption.

PRACTICAL IMPLICATIONS

Integrated medical-dental MOC adoption in care delivery to patients with DM remains below average. Interdisciplinary efforts and education are needed to address identified barriers to care integration.

Bruxism-Related Signs and Periodontal Disease: A Preliminary Study

Background:

The effect of awake and sleep bruxism on periodontal disease has not been evaluated separately to date. Furthermore, there are few studies that have focused on awake bruxism with light force.

Objective:

The study aimed to investigate the frequency of sleep and awake bruxism in patients with periodontal disease.

Methods:

The subjects were 57 patients with periodontal disease who visited the Department of Periodontics of the Dental Hospital affiliated with Tokyo Medical and Dental University. Subjects were asked to fill out a questionnaire consisting of three items on bruxism (sleep and awake bruxism), and the maximum community periodontal index was investigated.

Results:

The proportions of individuals with high sleep bruxism-related signs and high awake bruxism-related signs were 6.0% and 44.0%, respectively. No significant difference was found in the comparison of maximum community periodontal index proportions between individuals with high sleep bruxism-related signs and high awake bruxism-related signs.

Conclusion:

The results of this survey of patients with periodontal disease showed that the proportion of subjects with high awake bruxism-related signs subjects was higher than those of the subjects with high sleep bruxism-related signs. Sleep bruxism has attracted attention as a factor influencing periodontal disease, and our data suggest that patients with periodontal disease demonstrate more bruxism while being awake than during sleep.

Predictors of long-term outcomes in patients undergoing periodontal maintenance

AIM

This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables.

MATERIAL AND METHODS

A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed.

RESULTS

Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD.

CONCLUSIONS

Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.

Bruxism is unlikely to cause damage to the periodontium: findings from a systematic literature assessment

BACKGROUND

This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se?

METHODS

Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis.

RESULTS

The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions.

CONCLUSIONS

Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue.

The effect of oral splint devices on sleep bruxism: a 6-week observation with an ambulatory electromyographic recording device

This study investigated the effect of stabilization splint (SS) and palatal splint (PS), which had the same design as SS except for the elimination of the occlusal coverage, on sleep bruxism (SB) using a portable electromyographic (EMG) recording system. Sixteen bruxers participated in this study. The EMG activities of the right masseter muscle during sleep were recorded for three nights each in the following five recording periods: before, immediately after, and 2, 4 and 6 weeks after the insertion of the splint. The crossover design, in which each splint was applied to each subject for 6 weeks with an interval of 2 months for a washout period, was employed in this randomized-controlled study. The number of SB events, duration and total activities of SB were analysed. The number of SB events before the insertion of splints (baseline) was 2.98 +/- 1.61 times h(-1). Both splints significantly reduced SB immediately after the insertion of devices (P < 0.05, one-way repeated-measures anova followed by Dunnett); however, no reduction was observed in 2, 4 or 6 weeks (P > 0.05). There was no statistical difference in the effect on SB between the SS and PS (P > 0.05, two-way repeated-measures anova). Both splints reduced the masseter EMG activities associated with SB; however, the effect was transient.

A clinical study of specific signs and symptoms of CMD in bruxers classified by the degree of severity

Two hundred and seventy-six CMD patients referred consecutively for diagnosis and treatment over a period of four years were assessed. Two hundred and eleven were classified as bruxers according to the use of a questionnaire and clinical examination. One hundred (47.39%) presented clinical characteristics of mild bruxers, 66 (31.27%) presented moderate bruxism and 45 (21.32%) demonstrated severe bruxism. Severe bruxers presented the lowest degree of jaw opening (39.21 mm) and highest prevalence of capsulitis (97.77%), retrodiskal pain (84.44%) and disk-attachment pain (48.88%). As compared to the mild and moderate groups, severe bruxers also demonstrated significantly higher prevalence of protective splinting and transient locking or recent history of intermittent locking, masticatory pain, reciprocal clicking and signs and symptoms of Myofascial Pain Dysfunction Syndrome (MPDS). Because higher prevalence of specific muscle and joint disorders were observed in bruxers and such prevalence was progressive from the mild to the moderate and severe group, it may be concluded that bruxing behavior is a significant factor in the etiology and progression of muscle and joint disorders. Based on the review of the literature, the analysis of our data in comparison to other studies allowed us to conclude that severe bruxers are more impaired by muscular and joint disorders as compared to mild and moderate bruxers.

Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders

This study was designed to investigate the short-term effects of stabilization appliances on parafunctional oral motor behaviour (bruxing and clenching) during sleep in patients with and without signs of temporomandibular disorders (TMD). Results revealed that stabilization appliances do not stop nocturnal parafunctional activities in both groups of patients. Active wear facets on the guide ramps of appliances were created by bilateral mandibular excursions. The extension of these facets indicate that the mandible moves laterally far beyond the edge-to-edge contact relationship of the canines during eccentric bruxism. Results also indicate that, with the exception of temporomandibular joint (TMJ) clicks, stabilization appliance therapy is effective in eliminating the signs of TMD evaluated.

Occlusal trauma: a case in perspective

The decision to initiate occlusal therapy as part of periodontal treatment is often controversial. This case report illustrates an indication for providing such therapy and suggests an appropriate sequence to follow for achieving a desirable outcome.

Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis

The purpose of the present study was to determine the reliability of several selected signs of trauma from occlusion and their relations with severity of periodontitis. 32 moderate to advanced chronic periodontitis patients participated in the study. All teeth present were evaluated for various abnormal occlusal contacts, signs of trauma from occlusion, and the severity of periodontitis. Standardized periapical radiographs were also taken for each tooth. The results demonstrated that: (1) no significant difference occurred in probing pocket depth (PD), clinical attachment loss (AL), or percentage of alveolar bone height (BH) between teeth with and without various abnormal occlusal contacts, i.e., premature contacts in centric relation occlusion, non-working contacts in lateral excursions, premature contacts of anterior teeth or posterior protrusive tooth contacts; (2) teeth with either significant mobility, functional mobility, or radiographically widened periodontal ligament space (PDLS) had deeper PD, more AL and lower BH than teeth without these signs, while teeth with pronounced wear or radiographically thickened lamina dura had less AL than teeth without these findings; (3) 2 combined indices, i.e., the trauma from occlusion index (TOI) and the adaptability index (AI), were proposed for the identification of occlusal trauma and the response of periodontium to excessive biting forces in heavy function, respectively; TOI-positive teeth exhibit deeper PD, more AL and less osseous support than TOI-negative teeth; however, AI-positive teeth had less AL and more osseous support than AI-negative teeth; (4) with identical attachment level, TOI-positive teeth had less osseous support than TOI-negative teeth while the magnitude of difference became greater with an increase of attachment loss.