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Special Issue "(Generalized) Bruxism: Current Challenges and Innovative Treatment"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Stomatology".

Deadline for manuscript submissions: 2 August 2023 | Viewed by 10872

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Dr. Alessandro Bracci

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Guest Editor

Department of Neuroscience, School of Dentistry, UNIPD, University of Padova, Padova, Italy
Interests: bruxism; awake bruxism; sleep bruxism; ecological momentary assessment

Prof. Dr. Daniele Manfredini

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Guest Editor

Department of Neuroscience, School of Dentistry, UNIPD, University of Padova, Padova, Italy
Interests: bruxism; temporomandibular disorders; orofacial pain
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Dear Colleagues,

Bruxism is a hot topic in medicine, because of the many medical conditions that may be associated with it and require multidisciplinary involvement of different professionals (e.g., dentists, neurologists, psychologists, sleep doctors).

The current evidence suggests that bruxism is a muscle behavior not suitable for evaluation in terms of the simple dichotomy “present vs absent”. The different motor activities belonging to the bruxism spectrum need to be potentially discriminated between each other, and an impression of their phenotype in terms of duration and intensity is also needed.

Knowledge on bruxism is rapidly evolving, especially with regard to the concept of bruxism itself, which is now viewed as an umbrella term for different sleep- and wake-time jaw muscle activities that are not necessarily related with specific sleep correlates or with teeth contact. This means that future development in the approaches to evaluate bruxism must reflect the ongoing paradigm change in its definition.

The final goal is to understand when bruxism is just a harmless behavior or is associated with negative (e.g., tooth wear, orofacial pain, TMD) and/or positive health outcomes (e.g., restore of airway latency in patients with sleep apnea, oral moistening).

Practitioners frequently examine patients who engage in frequent bruxism activities. Nonetheless, it is important that treatment is directed to those patients with pain and/or other negative consequences on teeth, restorations, and implants. Concurrently, overtreatment of patients with neutral or positive effects of bruxism should be avoided as well as a proper referral strategy to other specialists for any underlying disorder must be adopted.

Thus, investigating bruxism epidemiology by the use of standardised tools is a recommended strategy that may have an important social impact to integrate dental and medical knowledge.

Dr. Alessandro Bracci
Prof. Dr. Daniele Manfredini
Guest Editors

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Keywords

bruxism
awake bruxism
sleep bruxism
ecological momentary assessment
temporomandibular disorders
teeth grinding
teeth clenching
mandibular bracing

Published Papers (10 papers)

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Research

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Open AccessArticle

Sleep Bruxism and Orofacial Pain in Patients with Sleep Disorders: A Controlled Cohort Study

Maria Lavinia Bartolucci

Serena Incerti Parenti

Francesco Bortolotti

Veronica Della Godenza

Stefano Vandi

Fabio Pizza

Giuseppe Plazzi

and

Giulio Alessandri-Bonetti

J. Clin. Med. 2023, 12(8), 2997; https://doi.org/10.3390/jcm12082997 - 20 Apr 2023

Viewed by 652

Abstract

Background: The gold standard for the diagnosis of sleep bruxism (SB) is laboratory polysomnography (L-PSG) recording. However, many clinicians still define SB using patients’ self-assessment and/or clinical tooth wear (TW). The purpose of this cross-sectional controlled study was to compare the prevalence of TW, head-neck muscles sensitivity and Temporomandibular Disorders (TMD) between SB and non-SB patients diagnosed with L-PSG in a cohort of patient with sleep disorders (SD). Methods: 102 adult subjects with suspected SD underwent L-PSG recording to assess the presence of sleep disorder and SB. TW was clinically analyzed using TWES 2.0. The pressure pain threshold (PPT) of masticatory muscles were assessed using a Fisher algometer. Diagnostic criteria for TMD (DC/TMD) were used to evaluate the presence of TMD. SB self-assessment questionnaires were administered. TWES score, PPT, TMD prevalence and questionnaire results were compared between SB and non-SB patients. Results: 22 SB patients and 66 non-SB patients with SD were included. No significant differences emerged between groups in regards to TW, the PPT values, or SB’s self-assessment questionnaires as well the prevalence of TMD. Conclusion: in a SD population, TW is not pathognomonic of active SB and SB self-assessment is not reliable. There seems to be no correlation between SB, TMD and head/neck muscle sensitivity. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Open AccessArticle

Nutrients Associated with Sleep Bruxism

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J. Clin. Med. 2023, 12(7), 2623; https://doi.org/10.3390/jcm12072623 - 31 Mar 2023

Viewed by 1444

Abstract

Background: The purpose of the present research was to identify nutrients related to sleep bruxism and to establish a hypothesis regarding the relationship between sleep bruxism and nutrients. Methods: We recruited 143 Japanese university students in 2021 and assigned them to sleep bruxism (n = 58) and non-sleep bruxism groups (n = 85), using an identical single-channel wearable electromyography device. To investigate nutrient intakes, participants answered a food frequency questionnaire based on food groups. We assessed differences in nutrient intakes between the sleep bruxism and non-sleep bruxism groups. Results: Logistic regression modeling showed that sleep bruxism tended to be associated with dietary fiber (odds ratio, 0.91; 95% confidence interval, 0.83–1.00; p = 0.059). In addition, a subgroup analysis selecting students in the top and bottom quartiles of dietary fiber intake showed that students with sleep bruxism had a significantly lower dietary fiber intake (10.4 ± 4.6 g) than those without sleep bruxism (13.4 ± 6.1 g; p = 0.022). Conclusion: The present research showed that dietary fiber intake may be related to sleep bruxism. Therefore, we hypothesized that dietary fiber would improve sleep bruxism in young adults. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Open AccessArticle

Sleep Bruxism in Children—What Can Be Learned from Anamnestic Information

Alona Emodi-Perlman

Yarden Shreiber-Fridman

Shani Kaminsky-Kurtz

Ilana Eli

and

Sigalit Blumer

J. Clin. Med. 2023, 12(7), 2564; https://doi.org/10.3390/jcm12072564 - 29 Mar 2023

Viewed by 701

Abstract

Sleep bruxism (SB) is a masticatory muscle activity during sleep, and its clinical manifestation in young children is still unclear. The aim of the present study was to evaluate the role of anamnestic information in predicting possible SB in children aged 4–12 years. In a cross-sectional retrospective exploratory study, the dental files of 521 children were examined with regard to the following anamnestic information: gender, age, medical conditions associated with ear, nose, and throat (ENT), respiratory disorders, use of methylphenidate (Ritalin), oral habits, and bruxing during sleep. A child was defined as presenting possible SB when a positive report was received from parents regarding such behavior (SB positive, No. = 84). There were no age- and/or gender-wise differences between SB-positive children and children whose parents did not report SB behavior (SB negative). SB-positive children suffered more from ENT and respiratory disorders than children without SB. Additionally, the use of pacifiers/finger sucking, as well as snoring, were more common among SB-positive children as compared to their SB-negative counterparts (Chi-square). The variables which were found to significantly increase the odds of possible SB in children were mouth breathing, ENT problems, and use of a pacifier or finger sucking (forward stepwise logistic regression). Clinicians should look for clinical signs of possible SB in children whose anamnesis reveals one or more of these anamnestic signals. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

Open AccessArticle

Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders

Mariana Barbosa Câmara-Souza

Alessandro Bracci

Anna Colonna

Marco Ferrari

Renata Cunha Matheus Rodrigues Garcia

and

Daniele Manfredini

J. Clin. Med. 2023, 12(2), 501; https://doi.org/10.3390/jcm12020501 - 07 Jan 2023

Cited by 1 | Viewed by 994

Abstract

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

Open AccessArticle

Electromyographic Assessment of Masseter Muscle Activity: A Proposal for a 24 h Recording Device with Preliminary Data

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J. Clin. Med. 2023, 12(1), 247; https://doi.org/10.3390/jcm12010247 - 29 Dec 2022

Cited by 5 | Viewed by 1782

Abstract

Objective: The instrumental measurement of electromyographic (EMG) activity in the natural environment is the best strategy available to collect information on bruxism. The twofold aim of this study was to (1) introduce and discuss a novel EMG device for the assessment of awake (AB) and sleep bruxism (SB) in the home environment over 24 h and (2) present some preliminary data. Methods: Fifteen healthy volunteers (eight males and seven females; mean age: 48.2 ± 4.1 years) underwent 24 h EMG recording trials of their masseter muscle activity (MMA) with a miniaturized wireless device. This device allowed us to measure the durations of the different phases of the recordings (total duration, awake time, sleep time, and electrode dislodgement time) as well as the bruxism time index (BTI) and bruxism work index (BWI) for both the waking and sleeping hours. Results: For the healthy volunteers, on average, the bruxism work index (BWI) values were 0.4 ± 0.2 and 0.1 ± 0.1 for awake and sleep, respectively, while the mean bruxism time index (BTI) values were 0.9 ± 0.5 for awake and 0.3 ± 0.1 for sleep. Conclusions: This investigation describes the technical features of a novel EMG recording device that permits the evaluation of masseter muscle activity in the home environment over 24 h. For the first time, a dedicated elaboration of the EMG signal allowed an assessment of muscle work and not just a count of purported SB/EMG events. Clinical significance: Based on the multidisciplinary approach in the study of bruxism, such a methodology, thanks to its peculiar features, will allow researchers and clinicians to monitor the epidemiology of MMA and delve deeper into the awake and sleep bruxism correlates for tailored management in clinical settings. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Open AccessArticle

Impact of Confinement by COVID-19 in Awake and Sleep Bruxism Reported by Portuguese Dental Students

Júnia Maria Serra-Negra

and

Daniele Manfredini

J. Clin. Med. 2022, 11(20), 6147; https://doi.org/10.3390/jcm11206147 - 18 Oct 2022

Viewed by 828

Abstract

Confinement by COVID-19 was a stressful period that could potentially trigger awake bruxism (AB) and/or sleep bruxism (SB) behaviors. This study aims to characterize the AB and SB behaviors reported by Portuguese dental students before the pandemic and during the first period of mandatory confinement by COVID-19. Dental students were included in this longitudinal study. They answered the Portuguese validated version of the Oral Behavior Checklist (OBC) before the COVID-19 pandemic emerged (T1) and one month after mandatory confinement started in Portugal (T2). Descriptive statistics and the linear-by-linear association test were performed to assess changes over time (p ≤ 0.05). Sixty-four dental students (mean age 22.5 ± 2.8 years; 81.5% females) completed the study protocol. Considering AB, there was a general increase of the behavior from T1 to T2. The percentage of participants who reported to “grind their teeth when waking up” just few times decreased (p < 0.001) and the percentage of participants who reported “feeling discomfort/tension in the facial muscles when waking up just few times” increased (p = 0.019). Considering SB, there was a significant decrease of the behavior in all samples. The number of “None” report to grinding teeth during sleep or when waking up increased (p = 0.012). An increase in the self-reporting of feeling discomfort in masticatory muscles when awake or sleeping was observed (p = 0.028). The percentage of participants who did “not remember” any AB or SB activity decreased (p < 0.050). The confinement due to COVID-19 resulted in a forced change in dental students’ lifestyles that resulted in an increase of reported AB and a decrease of reported SB. Clinical Significance: In case of confinement periods, students should be encouraged to try normalizing their daily life by creating healthy routines and, by doing so, reducing the possible predisposition to bruxism and its consequences. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

Open AccessArticle

Comparison between Ecological Momentary Assessment and Questionnaire for Assessing the Frequency of Waking-Time Non-Functional Oral Behaviours

and

J. Clin. Med. 2022, 11(19), 5880; https://doi.org/10.3390/jcm11195880 - 05 Oct 2022

Cited by 4 | Viewed by 781

Abstract

Over the years, several tools have been proposed to measure oral behaviours (OB). Recently, a smartphone-based application for ecological momentary assessment (EMA) has been introduced to collect real-time data on waking-time OB. The aim of this study was to compare the self-reported frequency of OB by means of a standardised questionnaire with that recorded with a smartphone-based application for EMA. A total of 151 participants, recruited from the general population, were invited to fill in the Oral Behaviour Checklist (OBC). Scores for four questions concerning grinding, clenching, tooth contact, and mandible bracing were computed. Afterwards, participants were provided with a smartphone application for prolonged real-time reporting of OB. One-way analysis of variance (ANOVA) and a general linear mixed model (GLMM) were used to compare the responses to each OBC question with the frequencies of the same condition recorded with the EMA. Results showed significant association between OBC responses and the EMA recordings. In particular, increased frequencies of clenching, grinding, and teeth contact were recorded by individuals who provided higher OBC scores. On the other hand, a nonlinear association was observed for “mandible bracing”, pointing out difficulties in the comprehension of this condition. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Open AccessArticle

Influence of MAD Application on Episodes of Obstructive Apnea and Bruxism during Sleep—A Prospective Study

Monika Wojda

and

Jolanta Kostrzewa-Janicka

J. Clin. Med. 2022, 11(19), 5809; https://doi.org/10.3390/jcm11195809 - 30 Sep 2022

Viewed by 845

Abstract

The condition of sleep bruxism (SB) is defined by many authors as the body’s response to obstructive sleep apnea (OSA). In the conservative treatment of OSA, mandibular advancement devices (MADs) have found their application. The aim of the study iso assess the impact of MADs on the occurrence of episodes and the intensity of OSA and SB. The study sample consisted of eight patients with OSA and SB diagnosed with these conditions on the basis of clinical examinations and polysomnography (PSG). The prospective study was designed to assess the use of MADs for OSA and SB. MADs were prepared for the patients who subsequently underwent control examinations after one week of wear, and another PSG (PSG II) with an MAD was performed in conditions resembling the first qualification examination (PSG I). The same parameters were assessed in both PSG examinations. Following treatment with the MAD, a favorable lowering of the mean values of the examined parameters was observed. The statistically significant differences were demonstrated only for the apnea–hypopnea index (AHI), the oxygen desaturation index (ODI), and the number of apneas and hypopneas, obstructive apneas, apneas in OSA, and phasic episodes of bruxism. The application of MADs in patients with OSA has a beneficial effect on the same manifestations of OSA and SB, even though only the number of phasic episodes of bruxism was statistically significant. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Open AccessEditor’s ChoiceArticle

Ecological Momentary Assessment of Awake Bruxism with a Smartphone Application Requires Prior Patient Instruction for Enhanced Terminology Comprehension: A Multi-Center Study

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J. Clin. Med. 2022, 11(12), 3444; https://doi.org/10.3390/jcm11123444 - 15 Jun 2022

Cited by 10 | Viewed by 1066

Abstract

The prevalence of awake bruxism (AB) has been reported as being 30%, with sleep bruxism (SB) at 9–15%. Most studies have focused on SB, emphasizing the importance of AB research. For epidemiological evaluations of AB, a smartphone application based on ecological momentary assessment (EMA) was introduced. The aims of this multi-center study were: (1) to investigate how well lay subjects comprehend the AB terminology used in the smartphone application, and (2) to find out whether professional instruction improved their comprehension. The study population consisted of lay subjects from Italy, Portugal, and Finland comprising 307 individuals (156 men, 151 women; 18–86 years). Subjects first completed a five-item questionnaire about the meanings of the five AB terms used in the smartphone application. Each question offered four answer options, with one being correct. Immediately afterwards, the meanings of the terms were instructed. Lastly, the subjects were re-tested with the same questionnaire. In Finland and Italy, the re-tested correct answer scores for the single terms were at 89–97% per term. Improved comprehension was seen across sex, education, and age groups. In the Portuguese data, no improvement was found. Significant differences were found between countries in the improved scores for all terms that were correct following the instruction (Finland, 16.3% to 72.1%; Italy, 32.3% to 83.8%; Portugal, 23.1% to 33.7%) (p < 0.001). In conclusion, standardized instruction on AB terminology prior to EMA is recommended to improve the reliability of collected data. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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Review

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Open AccessReview

Ecological Momentary Assessment of Awake Bruxism Behaviors: A Scoping Review of Findings from Smartphone-Based Studies in Healthy Young Adults

Anna Colonna

Alessandro Bracci

Jari Ahlberg

Mariana Barbosa Câmara-Souza

Rosaria Bucci

Paulo César Rodrigues Conti

Ricardo Dias

Alona Emodi-Perlmam

Riccardo Favero

Birgitta Häggmän-Henrikson

and

J. Clin. Med. 2023, 12(5), 1904; https://doi.org/10.3390/jcm12051904 - 28 Feb 2023

Cited by 2 | Viewed by 847

Abstract

Background: The recent introduction of ecological momentary assessment (EMA) smartphone-based strategies has allowed achieving some interesting data on the frequency of different awake bruxism (AB) behaviors reported by an individual in the natural environment. Objective: The present paper aims to review the literature on the reported frequency of AB based on data gathered via smartphone EMA technology. Methods: On September 2022, a systematic search in the Pubmed, Scopus and Google Scholar databases was performed to identify all peer-reviewed English-language studies assessing awake bruxism behaviors using a smartphone-based Ecological Momentary Assessment. The selected articles were assessed independently by two authors according to a structured reading of the articles’ format (PICO). Results: A literature search, for which the search terms “Awake Bruxism” and “Ecological Momentary Assessment” were used, identified 15 articles. Of them, eight fulfilled the inclusion criteria. The results of seven studies using the same smartphone-based app reported a frequency of AB behaviors in the range between 28.3 and 40% over one week, while another investigation adopted a different smartphone-based EMA approach via WhatsApp using a web-based survey program and reported an AB frequency of 58.6%. Most included studies were based on convenience samples with limited age range, highlighting the need for more studies on other population samples. Conclusions: Despite the methodological limits, the results of the reviewed studies provide a standpoint for comparison for future studies on the epidemiology of awake bruxism behaviors. Full article

(This article belongs to the Special Issue (Generalized) Bruxism: Current Challenges and Innovative Treatment)

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