Botulinum Toxin-Induced Parotitis: A Postoperative Complication Following Masseter Muscle Injection.

Botulinum toxin (BTX) injection is a common treatment for bruxism, but there is no literature on potential salivary gland complications. This paper presents a case of acute parotitis in a 60-year-old female following BTX injections to the masseter muscle. This case highlights the possible salivary gland complications after injection of BTX into the masticatory muscles. An electronic search of PubMed and Embase databases was conducted to create a literature review in order to delve into the etiology behind the presented case and suggest potential preventive measures to avoid salivary gland complications. Thirty-one articles are reviewed and discussed. Currently, there is no consensus on the causes of the mentioned complication. However, various factors have been proposed, encompassing anatomical, physiological, biological, and physical aspects. Several methods have been recommended for the safe injection of BTX, which, along with better medical training and knowledge, are warranted to achieve predictable results.

Autistic individuals have worse oral status than neurotypical controls: a systematic review and meta-analysis of observational studies.

OBJECTIVE: To compare dental caries, oral hygiene, periodontal status, bruxism, malocclusion, tooth loss, and salivary alterations between autistic and typical developing individuals. MATERIAL AND METHODS: Observational studies presenting clinical measures of oral outcomes between autism spectrum disorder (ASD) individuals and controls. EMBASE, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 26, 2023. Pairs of reviewers independently conducted study selection, data extraction, and assessments of methodological quality and certainty of evidence. Meta-analyses of standardized mean differences (SMD) and risk ratio (RR) were performed. RESULTS: A total of 47 studies comprising 6885 autistic individuals were included in the review. Autistic individuals had significantly higher severity of dental-caries experience in primary teeth (SMD 0.29, 95%CI 0.02, 0.56), of dental plaque presence (SMD 0.59, 95%CI 0.24, 0.94), and of gingivitis (SMD 0.45, 95%CI 0.02, 0.88). Autistic individuals showed higher probability of occurrence of gingivitis (RR 1.34, 95%CI 1.08, 1.66,), bruxism (RR 4.23, 95%CI 2.32, 7.74), overjet (RR 2.16, 95%CI 1.28, 3.64), overbite (RR 1.62, 95%CI 1.02, 2.59), crossbite (RR 1.48, 95%CI 1.02, 2.13), and openbite (RR 2.37, 95%CI 1.46, 3.85), when compared to neurotypical individuals. Most estimates showed a small effect size with very low certainty of evidence. CONCLUSION: Autistic individuals show worse oral health status than controls. CLINICAL RELEVANCE: The findings reported herein can help to build health policies to better serve autistic individuals including prevention actions and access to specialized dental care.

Benefits of the combination of digital and analogic tools as a strategy to control possible awake bruxism: A randomised clinical trial.

BACKGROUND: Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. OBJECTIVE: To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminders) tools versus digital tool alone for AB management. METHODS: Seventy-two individuals diagnosed with probable AB were divided into 3 groups: Group 1 (n = 24), used both digital and analogic tools during 30 days; Group 2 (n = 24), used only a digital tool during 30 days and Group 3 (n = 24), used only a digital tool for the first 15 days and then added the analogic tool for 15 days. The AB frequency was measured in real-time with a smartphone app, which sent alerts asking the individuals if they were doing any AB behaviours (bracing, teeth contact, clenching or grinding). Groups were compared using one-way ANOVA and before-after adding an analogic tool (group 3) by paired t-test, considering α = 0.05. RESULTS: All groups showed a decrease in AB behaviours at the end of the evaluation period. Group 1 (digital and analogic tools) showed the lowest average of AB behaviours among all groups; however, statistically significant differences were found only for the comparison between groups 1 and 2. In group 3, a significantly greater reduction in AB behaviours was found after combining both approaches. CONCLUSION: The combination of digital and analogic tools showed the greatest reduction of AB frequency and can be recommended for AB control.

Evaluation of biochemical changes and treatment efficacy in patients with bruxism following botulinum toxin or splint therapy: a randomized clinical trial.

OBJECTIVES: This clinical study aims to analyze the levels of cortisol, dehydroepiandrosterone (DHEA), and tumor necrosis factor alpha (TNF-α) in the gingival crevicular fluid (GCF) of persons with bruxism and to compare the efficacy of botulinum toxin (botox) and occlusal splint treatments through biomarkers. MATERIALS AND METHODS: A total of 40 patients with bruxism were selected according to the clinical examination and anamnesis of which 20 received occlusal splint treatment and 20 botox treatment. GCF samples were taken from the patients before and after treatment. Cortisol, DHEA, and TNF-α levels were measured by enzyme-linked immunosorbent assay test. The change in measurements between time and groups and the time-group interaction were tested by repeated measures ANOVA. RESULTS: There was a statistically significant difference between the cortisol levels before and after treatment in both groups (p = 0.001). In individuals with bruxism, a statistically significant decrease in cortisol levels was observed after both treatments (p < 0.05), while DHEA levels increased after treatment but were not statistically significant (p > 0.05). There was no statistically significant difference between TNF-α intra-group measurements (p > 0.05). CONCLUSIONS: Stress and inflammatory biomarkers were found to be associated with bruxism. Cortisol levels decreased in people with bruxism after treatment with both occlusal splint and botox. CLINICAL RELEVANCE: Both splint and botox treatments were effective for bruxism by reducing the stress levels.

Which Treatment Is Effective for Bruxism: Occlusal Splints or Botulinum Toxin?

PURPOSE: The aim of the present study was to compare the efficacy of an occlusal splint and botulinum toxin for the treatment of bruxism. PATIENTS AND METHODS: Seventy-three patients with myofascial pain due to bruxism were included in the present study. The patients were allocated into 3 groups. Group A was treated with an occlusal splint, group B was treated with botulinum toxin injections, and group C was treated with an occlusal splint and botulinum toxin injections. The Temporomandibular Disorder Pain Screener, Graded Chronic Pain Scale, Oral Behavior Checklist, Jaw Function Limitation Scale, and visual analog scale (VAS) by palpation of the chewing muscles were administered to all patients before treatment and 6 months after treatment. RESULTS: The questionnaire and VAS scores decreased in all 3 groups (P < .0001). The VAS and questionnaire scores had decreased significantly in groups B and C compared with those in group A (mean VAS score: group A, 5 [range, 3 to 7]; group B, 1.9 ± 0.97; group C, 1.79 [range, 0 to 3]). CONCLUSIONS: Occlusal splints might not be necessary for patients treated with botulinum toxin injections.

Effect of Physical Therapy in Bruxism Treatment: A Systematic Review.

OBJECTIVE: The aim of this literature review was to examine the effect of physical therapy in bruxism treatment. METHODS: The data sources used were Medline, Excerpta Medica Database, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, SPORTDiscus, Scientific Electronic Library Online, Web of Science, Cochrane Library, Scopus, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. We included randomized and nonrandomized and controlled and noncontrolled clinical trials and interventions focused on physical therapy as treatment for sleep bruxism or awake bruxism. Two reviewers independently screened the records, examined full-text reports for compliance with the eligibility criteria, and extracted data. RESULTS: The present review found 1296 articles. We excluded 766 duplicated articles and 461 irrelevant articles and selected 69 titles to read. Forty-five of these were excluded, leading to a total of 24 that met the eligibility criteria and were included in our analysis. The articles were grouped into 7 treatment methods used in physical therapy. The treatment methods were electrotherapeutic (14 articles), cognitive-behavioral therapy (3 articles), therapeutic exercises (2 articles), acupuncture (2 articles), postural awareness (1 article), muscular relaxation (1 article), and massage (1 article). Results and conclusions, methodological quality, and quality of evidence of each study were reported. CONCLUSIONS: These results suggest very low-quality evidence that diverse methods used in physical therapy improve muscle pain and activity, mouth opening, oral health, anxiety, stress, depression, temporomandibular disorder, and head posture in individuals with bruxism. This finding is mainly a result of the poor methodological quality of most of the studies.

Bruxism in children: Use of the Functional Plane of Monaco (FPM).

BACKGROUND: Bruxism is a condition that results from hyperactivity in the central nervous system, and factors such as stress or other anxious conditions increase the frequency of episodes. When bruxism occurs at a young age, tooth wear can occur. The extent of wear can lead to the need for restorative dentistry and prosthetic treatments to restore the morphological and functional integrity of the teeth, with high costs associated with such treatments. CASE REPORT: A healthy 15-year-old boy presented to the orthodontist observation. His incisal ridges appeared thin, without mamelons, and with increased translucency. For treatment, the authors used only the Functional Plane of Monaco (FPM), a device which he had to wear 16 hours during the day. CONCLUSION: The orthodontist successfully treated an orthopaedic/orthodontic case with the FPM device.

Electromyogram biofeedback training for daytime clenching and its effect on sleep bruxism.

Bruxism contributes to the development of temporomandibular disorders as well as causes dental problems. Although it is an important issue in clinical dentistry, no treatment approaches have been proven effective. This study aimed to use electromyogram (EMG) biofeedback (BF) training to improve awake bruxism (AB) and examine its effect on sleep bruxism (SB). Twelve male participants (mean age, 26·8 ± 2·5 years) with subjective symptoms of AB or a diagnosis of SB were randomly divided into BF (n = 7) and control (CO, n = 5) groups to undergo 5-h daytime and night-time EMG measurements for three consecutive weeks. EMG electrodes were placed over the temporalis muscle on the habitual masticatory side. Those in the BF group underwent BF training to remind them of the occurrence of undesirable clenching activity when excessive EMG activity of certain burst duration was generated in week 2. Then, EMGs were recorded at week 3 as the post-BF test. Those in the CO group underwent EMG measurement without any EMG BF training throughout the study period. Although the number of tonic EMG events did not show statistically significant differences among weeks 1-3 in the CO group, events in weeks 2 and 3 decreased significantly compared with those in week 1, both daytime and night-time, in the BF group (P < 0·05, Scheffé's test). This study results suggest that EMG BF to improve AB tonic EMG events can also provide an effective approach to regulate SB tonic EMG events.

Interdisciplinary treatment of bruxism with an occlusal splint and cognitive behavioral therapy.

The etiology of bruxism is associated with exogenous factors, such as occlusal interference, stress, and anxiety, as well as endogenous factors involving neurotransmitters of the basal ganglia. Due to the multifactorial etiology of bruxism, interdisciplinary treatment involving professionals from different healthcare fields has been proposed. The aim of the present study was to compare 2 groups of patients with bruxism (11 in each group) treated with either an occlusal splint combined with cognitive behavioral therapy or an occlusal splint alone. Surface electromyography of the masseter and anterior temporal muscles at rest was performed before and after treatment. The mean amplitude of activity of all muscles was lower after treatment, except for the right anterior temporal muscle in the group treated with an occlusal splint alone. Mean amplitudes were greater in the anterior temporal muscles than in the masseter muscles. Significantly greater improvement was found in the group exposed to cognitive behavioral therapy (P < 0.05; analysis of variance and Student t tests). Therefore, the combination of occlusal splint and psychological therapy was more effective at achieving muscle relaxation than occlusal splint use alone.

[Minimally invasive method for the restoration of localized anterior tooth wear. A case report]. / Minimál invazív módszer alkalmazása frontfogak területére korlátozott fogkopás helyreállításakor. Esetismertetés.

Wear localized on front teeth is quite common; the restoration of the lost tissue is generally difficult due to the lack of vertical space between the upper and lower teeth. The traditional prosthetic method would include further tooth preparation for complete crowns and for increasing the occlusal vertical dimension. By applying the Dahl concept the necessary vertical space can be created with the preservation of the tooth tissue in a relatively short period of time. Definitive restoration can be made for the replacement of lost enamel and dentine with a direct or indirect method. Due to the Dahl concept the preparation of the teeth and its potentially harmful consequences can be avoided, the treatment is non- or minimally invasive. In the presented case the lost palatal and incisal tooth tissue was replaced with palatal E.max Press ceramic laminate. After cementing the laminate the patient was advised to wear a night guard, because of bruxism, to counteract the extreme load on the laminates.

Associated factors and treatment options for sleep bruxism in children: an umbrella review.

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Coincidence and awareness of oral parafunctions in college students.

OBJECTIVE: The aim of the study was to determine the prevalence and awareness of particular types of oral parafunctions in young healthy students and any association with temporomandibular disorders (TMD). MATERIAL AND METHODS: The study was performed in a randomly selected group of 303 healthy students (mean age 18.8 years) from the vocational technical school in Wroclaw, Poland, who underwent a routine clinical examination and functional analysis of the mouth. On taking the history all subjects were asked about their awareness of various forms of parafunctional activity in their mouth. RESULTS: Almost all subjects revealed various oral parafunctions such as: bruxism, nail and pen biting, chewing gum, and biting the mucosa of lip or cheek. These habits were present singly or as double, triple or even fourfold coincidences in a single person. The most frequent oral parafunctions were habitual gum chewing and bruxism. Subjects were very seldom aware of the last parafunction. TMDs were more prevalent in the presence of bruxism than in other oral parafunctions. CONCLUSIONS: The studied students revealed various types of oral parafunctions, however most of them were not aware of clenching and grinding their teeth.

Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension.

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.

Awareness of Oral Disorders Among Community-Dwelling Elderly Spaniards.

Introduction: Oral status has a clear impact on systemic health, a key component of successful aging. Awareness of oral disorders permits early diagnoses and treatments. This study investigates oral disorders awareness among community-dwelling elders. Methods: Community-based survey through face-to-face interviews undertaken in four cities at busy commercial and administrative areas. Results: A total of 789 people were recruited, mostly nonsmoker (60.3%) males (56.9%) with basic education (65.6%). The most frequently recalled disorder was bruxism, followed by periodontal diseases and ulcerations/aphthae. Caries was mentioned by 3.91%. Dentate participants were more aware of dental-related disorders, such as bruxism (p = .001) and periodontitis (p = .010), except for caries (p = .100). Caries awareness was related to educational level (p = .018) and smoking (p = .020), as was oral cancer (p = .019) with former smokers more aware of this neoplasm. Education was strongly related with periodontal awareness (p = .001). Conclusion: Awareness of the main oral disorders is worryingly poor among the elderly population and immediate action is required by taking advantage of the position of family nurses in the treatment of systemic chronic disorders and through educational interventions on this population subgroup to ease preventive behaviors, favor early diagnoses, and promote simpler, more effective treatments with a lower financial burden.

3 mm can save your case: Making beauty function.

Understanding esthetic design is not enough if restorations are to withstand the forces of function. Dentists also must understand the relationships of incisal tables, the interincisal angle, disclusion forces, and the implications of changing those parameters when restoring the anterior dentition. While canine-protected occlusion is often a goal, it may not always be appropriate or attainable. This article describes the details of creating a functional anterior design that will not only be beautiful but will have the best chance of withstanding parafunctional activity and abnormal force.

[Severe odontalgic pain preceding migraine attacks]. / Ernstige odontogene pijn voorafgaand aan een migraineaanval.

A 30-year-old woman appeared at the gnathology department of a centre for special dentistry complaining of migraine attacks which were preceded each time by severe odontalgic pain. Furthermore, she suffered from an autoimmune disease as well as from tension headaches. The oral health care provider in charge suspected that the episodes of odontalgic pain, which lasted for several hours or even several days, were caused by bruxism. Treatment of the bruxism resulted in reduced pain as well as reduced severity of the migraine attacks.

There is more to front teeth than looks alone: diagnosis and treatment planning.

When treating high-risk parafunctional cases, patient compliance and understanding of the disease is paramount in the success and longevity of the restorations. Controlling the patient's expectations for augmenting the length and blocking out the dark color was accomplished (Figure 15 through Figure 18).

Solutions to complications of implant therapy.

Restorative dentists face challenges when implant dentistry is performed without a surgical template. Manufactured component parts (particularly screws, gold cylinders, and the implant bodies themselves) can also cause problems during these procedures. These problems will occur regardless of the mode of retention used for the prosthesis, since the same metals are involved and nearly all implant restorations have a screw somewhere. Managing these complications is essential to avoid treatment failures.