Frequency of daytime tooth clenching episodes in individuals affected by masticatory muscle pain and pain-free controls during standardized ability tasks

Tooth clenching has been suggested to be related to temporomandibular pain. However, the electromyographic characteristics of daytime clenching episodes have been minimally investigated. This study aimed to analyze the frequency, amplitude, and duration of daytime clenching episodes in patients with masticatory muscle pain and pain-free individuals

Self-reported bruxism mirrors anxiety and stress in adults

Objectives: The aims were to analyze whether the levels of self-reported bruxism and anxiety associate among otherwise healthy subjects, and to investigate the independent effects of anxiety and stress experience on the probability of self-reported bruxism. Study Design: As part of a study on irregular shift work, a questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (number of subjects: n=750) and to an equal number of randomly selected employees in the same company with regular eight-hour daytime work. Results: The response rates were 82.3% (56.6 % men) and 34.3 % (46.7 % men), respectively. Among the 874 respondents, those aware of more frequent bruxism reported significantly more severe anxiety (p<0.001). Adjusted by age and gender, frequent bruxers were more than two times more likely to report severe stress (odds ratio 2.5; 95% confidence interval 1.5-4.2) and anxiety (odds ratio 2.2; 95% confidence interval 1.3-3.6) than non-or-mild bruxers. Conclusions: Present findings suggest that self-reported bruxism and psychological states such as anxiety or stress may be related in working age subjects

STAB-A response to the commentary "Questions on the clinical applicability on the international consensus on the assessment of bruxism" by Skarmeta and Hormazabal Navarrete

Peer reviewe

Comprehension of pictograms for pain quality and pain affect in adults with Down syndrome

Background Adults with Down syndrome (DS) are at risk for age-related painful physical conditions, but also for under-reporting pain. Pictograms may facilitate self-report of pain, because they seem suitable for the global visual processing in DS and for iconic representation of abstract concepts. Method Participants (N = 39, M age = 41.2) assigned pain qualities to pictograms, rated pain affect levels in facial scales (pictograms vs. drawn faces), and performed cognitive tests. Results Recognition of all intended pain qualities was above chance level. Pain affect levels of both facial scales were ordered equally well. Both facial scales were preferred equally we

Why using 'harmless behaviour', 'risk factor' and 'protective factor' as terms describing the various possible consequences of bruxism is still the best option

Non peer reviewe

Ecological Momentary Assessment and Intervention Principles for the Study of Awake Bruxism Behaviors, Part 1 : General Principles and Preliminary Data on Healthy Young Italian Adults

Background: Awake bruxism (AB) is an oral condition that has some uncertainties concerning the epidemiology, also due to the different diagnostic strategies that have been adopted to address it in the research setting. The recent new definition of AB suggests that an ecological momentary assessment (EMA), which enables real-time reporting of the condition under study, can implement knowledge on the topic. Objectives: This article will discuss the general principles of EMA and EMI (Ecological Momentary Intervention) and comment on a preliminary dataset gathered with a smartphone application in a population of Italian young adults. Materials and Methods: A dedicated smartphone application has been used (BruxApp (R)) on a sample of 30 University students (mean age 24 +/- 3.5 years) to record real time report on five specific oral conditions (relaxed jaw muscles, tooth contact, teeth clenching, teeth grinding, mandible bracing) that are related with the spectrum of AB activities. Data were recorded over a 7-day period for two times, with a 1-month interval between the two observation periods. The purpose of collecting data over a second week, 1-month later, was to monitor AB behaviors over time, and test for potential "EMI" effects. Results: Over the first 7 days (T1), the average frequency of relaxed jaw muscles reports at the population level was 62%. Teeth contact (20%) and mandible bracing (14%) were the most frequent AB behaviors. No significant gender differences were detected. One month later, during the second week of data collection (T2), the frequency of the conditions was as follows: relaxed jaw muscles 74%, teeth contact 11% and mandible bracing 13%. Conclusions: These data recorded do not allow any generalization due the unrepresentativeness of the study population. On the other hand, they can be used as templates for future comparisons to get deeper into the study of natural fluctuations of AB behaviors as well as into the potential biofeedback effect of an ecological momentary assessment/intervention. It is important to recognize that the use of smartphone technology may help to set range of values for AB frequency in otherwise healthy individuals, in order to stand as comparisons for selected populations with risk or associated factors.Peer reviewe

Psychological Distress: A Mediating Factor in the Relationship Between Sleep Bruxism and Tobacco Smoking

Background: Sleep bruxism (SB) is defined as a masticatory muscle activity during sleep characterised by a multifactorial aetiology. Tobacco smoking and psychological status are considered predisposing factors for SB, but their mutual interaction remains unclear. Objective: To investigate the relationship between self-report SB, tobacco smoking, and psychological status, adopting a multiple-variable model in a sample of healthy young adults. Methods: A sample of 150 individuals (Female = 62%; mean age (±SD) = 23.3 (±3.4) years) completed a questionnaire to assess self-reported SB, tobacco smoking, and psychological distress. Self-reported SB was assessed according to the Subject-Based Assessment strategy recommended in the ‘Standardized Tool for the Assessment of Bruxism’ (STAB). Psychological distress was evaluated using the four-item Patient Health Questionnaire-4 (PHQ-4) for anxiety and depression. Tobacco smoking was assessed by four questions included in the Global Adult Tobacco Smoking (GATS) questionnaire. Spearman's rank correlation, ordinal regression, and mediation analysis were used to examine the relationship between SB, psychological distress, and smoking-related variables. Results: Significant positive correlations between SB and psychological distress (r = 0.350, p &lt; 0.001) and between SB and n° cigarettes/day (r = 0.196 p &lt; 0.05) emerged. Psychological distress positively mediated this relationship between tobacco smoking and SB, with an indirect effect of 0.065 (C.I. = 0.108–0.313; p value &lt; 0.05). Psychological distress showed a positive predictive effect for SB (OR = 1.23, C.I. = 0.071–0.345, p &lt; 0.05), while no significant associations with smoking variables were found. Conclusions: Within the limitation of this study, tobacco smoking does not seem to be directly correlated with sleep bruxism. Psychological distress could play the role as a mediating factor in this relationship

Weight gain may affect mandibular advancement device therapy in patients with obstructive sleep apnea : a retrospective study

Purpose The aim was to analyze whether or not weight gain influences the treatment outcome of patients with obstructive sleep apnea (OSA) treated with mandibular advancement devices (MAD). Methods As a part of a follow-up study among OSA patients treated with MAD in primary oral health care, a group of 28 patients reporting worsening of daytime or nighttime symptoms of OSA was given closer examination. Altogether, 21 subjects had a complete set of recordings and were enrolled into the study. Results Only three subjects had lost weight during the study period. The mean weight gain of 3.6kg7.1kg was significant (p=0.035). According to linear regression, weight gain was independently significantly associated with lower mean peripheral oxygen saturation 92.4 (SD 1.8 (% per hour) (p=0.019)) and lowest oxygen saturation 80.1 (SD 7.2 (%) (p=0.024)) scores. Conclusions Weight gain is detrimentally associated with MAD treatment in patients with OSA. These findings suggest that regular follow-up by an experienced dentist is advisable to assess for possible worsening of OSA. Patient support to encourage weight control may be an important adjunct to MAD treatment for OSA.Peer reviewe

Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea : A randomized, placebo-controlled trial on temporomandibular side-effects

Purpose To assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment. Methods This study concerns a secondary analysis of a randomized placebo-controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra-oral placebo appliance in a parallel design. Sixty-four mild to severe OSA patients (52.0 +/- 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire. Results Clinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401-.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359). Conclusions A low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.Peer reviewe

Oral health-related quality of life in patients with Parkinson’s disease

Background: Parkinson's disease (PD) is a neurodegenerative condition affecting the quality of life. Due to a worsening of oral health in PD patients with the progression of the disease, oral health-related quality of life (OHRQoL) could be impaired as well. Objectives: To assess whether PD patients in The Netherlands experience worse OHRQoL than historical controls, and to investigate which factors are associated with OHRQoL in PD patients. Materials & Methods: In total, 341 PD patients (65.5 ± 8.4 years) and 411 historical controls (62.6 ± 5.3 years) participated. Both groups completed a questionnaire. The PD patients were asked questions regarding demographics, PD, oral health, and OHRQoL. The historical controls filled in demographic information and questions regarding OHRQoL. The latter construct was assessed using the Dutch 14-item version of the Oral Health Impact Profile (OHIP-14). Data were analysed using independent samples t-tests and univariate and multivariate linear regression analysis. Results: The mean OHIP-14 score was higher in PD patients (19.1 ± 6.7) than in historical controls (16.5 ± 4.4) (t(239) = 6.5; p <.001). OHRQoL in PD patients was statistically significant associated with motor aspects of experiences of daily living (B = 0.31; t(315) = 7.03; p <.001), worsening of the oral environment during disease course (B = 3.39; t(315) = 4.21; p <.001), being dentate (B = −5.60; t(315) = −4.5; p <.001), tooth wear (B = 2.25; t(315) = 3.29; p =.001), and possible burning mouth syndrome (B = 5.87; t(315) = 2.87; p =.004). Conclusion: PD patients had a lower OHRQoL than historical controls. Besides, PD-related variables and oral health-related variables were associated with OHRQoL