Ontology and Bruxism: Do We Have Enough Information?

The idea of classifying and defining bruxism according to ontological principles may be interesting, but currently we just do not have enough information to label in a black or white manner the many facets of bruxism. In an era in which general knowledge on bruxism by the dental communities is surely in need of improvement, efforts to clarify the road map tracked by the current panelists who drafted the definition should be appraised carefully. The recent introduction of a standardized multidimensional evaluation system (i.e., Standardized Tool for the Assessment of Bruxism [STAB]) and a screening instrument for bruxism (i.e., BruxScreen) should be viewed as the starting points to enter a new era in the discipline of bruxism, in which non-hierarchical and non-preconceived approaches are used to collect data. Artificial intelligence strategies to mine data gathered with the above instruments might help building predictive models along the etiology-status-consequences trajectory, as recently suggested in a model for awake bruxism metrics. Until then, proposals to adopt ontological principles to classify bruxism will be merely based on speculations rather than on facts.

Standardised Tool for the Assessment of Bruxism: Translation, Cultural Adaptation and Pilot Testing in Italy.

BACKGROUND: Recently, the Standardised Tool for the Assessment of Bruxism (STAB) has been developed for use in clinical and research settings. OBJECTIVES: The aim of the present study is to describe the process of forward and back translation and pilot testing of the STAB into Italian. METHODS: The English version of the STAB was adopted as a template for translation into other languages, according to a step-by-step procedure led by the expert STAB bruxism panel and mother tongue experts in the field. In detail, the translation team was made up of 12 subjects: three study coordinators, two forward translators, two back-translators and five expert panellists. Following the translation process, a pilot test in patients, dentists and dental students was performed using the 'probing' method (i.e., subjects were questioned by the examiners about the perceived content and interpretation of the items) with the aim to assess the comprehensibility of the questions and response options, and the feasibility of the tool. RESULTS: This paper describes the translation process of the STAB and provides the outcomes of the pilot testing phase and the face validity assessment. The preliminary results suggest that, from a global point of view, the STAB reflects the characteristics required in clinical and research settings. CONCLUSION: Thanks to the translation process, the Italian version of the STAB can be assessed on-field and introduced in the clinical and research field to get deeper into the study of bruxism epidemiology in Italy.

The effects of trauma-focused treatment on painful temporomandibular disorders, awake bruxism and sleep bruxism in patients with severe post-traumatic stress disorder.

BACKGROUND: Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post-traumatic stress disorder (PTSD), but the implications for treatment are unknown. OBJECTIVE(S): To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence-based trauma-focused treatment and that this decrease would be maintained at the 6-month follow-up. METHODS: Individuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre-, post-treatment and at the 6-month follow-up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed-rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed. RESULTS: In individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre- and post-treatment. Between pre-treatment and the 6-month follow-up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well. CONCLUSION: The results provide preliminary support for a trauma-sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma-focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD.

Long-Term Study on the Fluctuation of Self-Reported Awake Bruxism in a Cohort of Healthy Young Adults.

BACKGROUND: The introduction of a smartphone-based ecological momentary assessment (EMA) approach has allowed achieving data on the frequency of different awake bruxism (AB) behaviours (i.e., teeth contact, teeth clenching, teeth grinding, and mandible bracing) reported by an individual in the natural environment. STUDY OBJECTIVES: The fluctuation of AB reports over time has a certain degree of variability that has never been investigated. Therefore, the aim of this investigation was to assess the long-term fluctuation of AB behaviours in a population of young adults. METHODS: A smartphone application was used to assess a real-time report on five specific oral conditions related to AB in a sample of 77 young adults, aged 24.0 ± 0.8 years. Data were recorded over three periods of 7 days, with a three-month interval for a total of 6 months. RESULTS: The average frequency of the relaxed condition was 72.9%, 78.2%, and 80.8% at the end of the first, second, and third sessions, respectively. On average, teeth contact and mandible bracing were the most frequently reported conditions, with a mean prevalence of 12.9% and 7%, respectively, whilst the frequency of teeth clenching and teeth grinding was less than 3%. The ANOVA test showed an absence of significant differences (p < 0.05) between the three recording periods, and the frequency was in general only moderately variable from day-to-day (e.g., the coefficient of variation (CV) for the condition "relaxed jaw muscles" was 0.3). No gender differences were detected either. CONCLUSIONS: Findings suggest that in a population of healthy individuals, the frequency of AB behaviours over a six-month monitoring period is quite constant. This investigation represents a standpoint for future comparisons on the study of natural fluctuations of AB behaviours as well as on AB frequency in populations with risk/associated factors and possible clinical consequences.

Temporomandibular disorders: INfORM/IADR key points for good clinical practice based on standard of care.

OBJECTIVE: To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR). METHODS: An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points. RESULTS: The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment. CONCLUSIONS: The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

Changes in self-reported sleep and awake bruxism in relation to the management of temporomandibular disorders ("care as usual") in a specialty clinic population.

BACKGROUND: The treatment of temporomandibular disorders (TMD) often includes the management of sleep bruxism (SB) and awake bruxism (AB). However, few studies have investigated how SB and AB change after the initiation of the interventions aimed at reducing the activity of masticatory muscles in TMD patients. OBJECTIVES: The aim of the present study was to investigate changes in self-reported SB and/or AB with regard to baseline at 6 weeks after receiving TMD treatment, i.e., counseling alone or counseling combined with any other treatment, and to investigate the association between the type of TMD treatment and changes in self-reported SB and/or AB. MATERIAL AND METHODS: A total of 68 TMD patients were included in this prospective study, and they all received counseling. Thirty-three of the 68 patients received additional treatment, e.g., physical therapy, psychological therapy and/or an oral appliance, beside counseling. The self-reported SB and AB frequency values were obtained from the Oral Behavior Checklist (OBC) questionnaire at baseline (t0) and at week 6 after receiving treatment (t1). The frequency of SB and AB was assessed as SB, AB-grinding, AB-clenching, AB-bracing, and AB-combined (i.e., the maximum frequency of all AB types combined). The Wilcoxon signed-rank test was used to compare the SB and AB frequency at t0 and t1 in patients who received counseling alone and those who received counseling combined with other treatment. The χ2 test was used to investigate the association between the type of TMD treatment and changes in SB and/or AB. RESULTS: The frequency of self-reported SB and all types of AB did not change in patients who received counseling only. In contrast, there was a significant increase in the frequency of AB-bracing and AB-combined between t0 and t1 in patients who received counseling combined with other treatment. CONCLUSIONS: No changes in the frequency of self-reported SB and all types of AB were found in patients who received counseling only. However, patients who received counseling combined with other treatment showed a significant increase in the frequency of AB-bracing and AB-combined as compared to baseline.

Dental prosthesis plaque index of Augsburger and Elahi: Expansion and standardisation in community-dwelling frail older people.

BACKGROUND: Inadequate daily oral hygiene care of dental prostheses could worsen general health of frail older people. The index of Augsburger and Elahi is often recommended to assess maxillary dental prosthesis plaque (DPP). OBJECTIVE: To assess the reliability of an expanded and standardised DPP index of Augsburger and Elahi in trained and untrained examiners, and to determine the applicability of the index in community-dwelling frail older people. METHODS: Ten community-dwelling frail older persons with complete and partial removable dental prostheses (RDPs) (mean ± SD age = 87.9 ± 8.4 years) participated. Seven persons were revisited after 3 months. The index was expanded with mandibular RDPs. Standardisation was achieved with a specially designed reference sheet. The RDPs were photographed after plaque colouring. Two trained examiners scored the photographs; thereafter, two untrained examiners. One trained examiner scored the photographs again after 3 weeks. Changes in DPP over the 3-month period were assessed with Wilcoxon signed-rank test. Inter- and intra-examiner reliability was assessed with intraclass correlation coefficients (ICCs). RESULTS: The DPP scores did not change significantly over time (Z = -0.594, p = 0.553). Inter-examiner reliability was excellent in the trained examiners (ICC = 0.859-0.947), and fair-to-good in the untrained examiners (ICC = 0.671-0.703). Intra-examiner reliability was excellent (ICC = 0.941-0.962). CONCLUSION: The proposed expansion and standardisation of the DPP index has an excellent inter- and intra-examiner reliability when performed by trained examiners, and a fair-to-good inter-examiner reliability by untrained examiners. Therefore, the index could be recommended for application in dental prostheses-wearing older persons and could be useful for awareness and education of professional and informal caregivers and the older persons themselves. TRAIL REGISTRATION: The Netherlands Trail Register NTR6159.

Association between psychological traits and occlusal tactile acuity of healthy individuals.

OBJECTIVES: Tactile acuity is a somatosensory measure of the extent to which humans can discern tactile stimuli. It is influenced by how peripheral signals are processed centrally. In the oral cavity, Occlusal Tactile Acuity (OTA) is the ability to perceive minimal thicknesses between antagonist teeth. The aim of the current study was to assess the association between psychological traits and OTA of otherwise healthy individuals. METHODS: Sixty-three volunteers (32 males; mean age ± SD: 24.6 ± 2.7 years) participated in this study. Somatosensory amplification, anxiety, depression, physical symptoms and pain catastrophizing were scored using questionnaires, and subgroups of severity were created per variable based on cut-offs. OTA was measured using 9 aluminium foils with thickness (ranging from 8 to 72 µm) and one sham test (without foil). Each thickness was tested 10 times in random order, the participants were instructed to report whether they felt the foil between their molars and the mean percentage of correct answers was computed. A linear mixed model was used with OTA as a dependent variable and psychological domain as an independent variable. RESULTS: Significantly different OTA was observed among the anxiety subgroups (p = .003), supporting a decreased perception of thicknesses 24 and 32 µm (p = .018 and p < .001, respectively) in participants with moderate/severe anxiety compared to those with no/mild anxiety. Significantly different OTA was also observed among the pain catastrophizing subgroups (p = .008), showing decreased perception of thicknesses 32 and 40 µm (p < .001 and p = .007, respectively) in severe catastrophizing levels, compared to no/mild catastrophizing levels. No significant differences were observed for the other variables. CONCLUSIONS: Healthy adults with increased anxiety or pain catastrophizing levels show decreased interdental acuity as compared to participants with minor or no psychological impairment.

Practice-based research in dentistry: Exploring methodologies, benefits, and challenges.

BACKGROUND: Practice-Based Research Network (PBRN) studies typically assess the effectiveness of clinical interventions in settings that match real-world conditions. Dental PBRNs have the capacity to amass, identify, and analyze vast amounts of data from patient populations that include diverse racial, ethnic, socio-economic, and geographic backgrounds. These dental studies encompass a broad spectrum of healthcare aspects, including prevention, diagnosis, symptom and disease treatment, quality enhancement, and care coordination. METHODS: An extensive range of research methodologies can be employed within dental PBRNs to investigate these topics, including randomized controlled trials. Dental PBRNs have evolved from primarily focusing on case observations to leveraging advanced network infrastructure and collaborating across multiple regional and national sites. In addition to producing numerous high-impact peer-reviewed publications, study results have led to improved clinical care. However, PBRNs encounter challenges, such as the sustainability of research capacity (relying heavily on ongoing support from funding agencies), diverse research cultures, and an imperative to design studies that are both feasible and relevant to everyday clinical practice. Recognizing the pivotal role of real-world evidence, it is important to have sustained investment in dental PBRN infrastructure and feasible opportunities for practitioners to participate in network activities nationwide. CONCLUSION: Practice-Based Research Network studies capitalize on an important research context within which to investigate a range of clinical topics that can employ multiple research methodologies. However, sustaining productive networks requires strategic effort, ongoing financial support, and customized organizational skills.

Moving beyond bruxism episode index: Discarding misuse of the number of sleep bruxism episodes as masticatory muscle pain biomarker.

The objective of the current study was to evaluate the clinical utility of bruxism episode index in predicting the level of masticatory muscle pain intensity. The study involved adults (n = 220) recruited from the Outpatient Clinic of Temporomandibular Disorders at the Department of Experimental Dentistry, Wroclaw Medical University, during the period 2017-2022. Participants underwent medical interview and dental examination, focusing on signs and symptoms of sleep bruxism. The intensity of masticatory muscle pain was gauged using the Numeric Rating Scale. Patients identified with probable sleep bruxism underwent further evaluation through video-polysomnography. Statistical analyses included the Shapiro-Wilk test, Spearman's rank correlation test, association rules, receiver operating characteristic curves, linear regression, multivariate regression and prediction accuracy analyses. The analysis of correlation and one-factor linear regression revealed no statistically significant relationships between bruxism episode index and Numeric Rating Scale (p > 0.05 for all analyses). Examination of receiver operating characteristic curves and prediction accuracy indicated a lack of predictive utility for bruxism episode index in relation to masticatory muscle pain intensity. Multivariate regression analysis demonstrated no discernible relationship between bruxism episode index and Numeric Rating Scale across all examined masticatory muscles. In conclusion, bruxism episode index and masticatory muscle pain intensity exhibit no correlation, and bruxism episode index lacks predictive value for masticatory muscle pain. Clinicians are advised to refrain from employing the frequency of masticatory muscle activity as a method for assessing the association between masticatory muscle pain and sleep bruxism.

Oral health indicators and bone mineral density disorders in older age: A systematic review.

As we age, maintaining good oral health becomes increasingly crucial for performing daily tasks. Age-related physiological decline can disrupt various biological systems, causing a significant challenge for geriatric dentistry. A systematic review of the literature using six different electronic databases was conducted to investigate the relationship between oral health indicators and bone mineral density disorders in older adults. The study is registered as a priori protocol on PROSPERO (CRD42023403340). A minimum age of 60 years was the main inclusion criterion for all original research articles. Two independent researchers assessed the eligibility of 19,362 records against the inclusion criteria and found 12 articles fitting the eligibility requirements. Five different indicators of poor oral health [number of teeth, periodontal disease, general oral health (dental caries prevalence and dental treatment needs), masticatory function, and occlusal force)] were found related to three outcomes linked to bone mineral density disorders (osteoporosis, fractures, and decreased bone mineral density), regardless of the adopted assessment tools. The number of teeth was negatively associated with fractures and a decreased bone mineral density, while periodontal disease was positively associated with osteoporosis and a decreased bone mineral density. Masticatory function was associated only with osteoporosis, while general oral health was associated only with fractures and occlusal force only with bone mineral density. The oral health indicator most frequently associated with outcomes linked to bone mineral density disorders was the number of teeth. The present findings could help to assess the contribution of each oral health indicator to the development of bone mineral density disorders in older age.

Effects of orthodontic aligners on the ecological report of awake bruxism.

BACKGROUND: The demand for orthodontic treatment with aligners has recently increased, but their effects on awake bruxism (AB) behaviours have to be evaluated yet. OBJECTIVES: This investigation assessed if aligners can affect oral behaviours (i.e. tooth contact, teeth clenching, teeth grinding and mandible bracing) that are related with the AB spectrum. METHODS: The investigation was performed in a sample of 32 consecutively recruited healthy adult patients who required orthodontic treatment. The study protocol involved three different sessions of 1-week monitoring without aligners, with passive aligners and with active aligners, respectively. All patients underwent an orthodontic treatment with aligners and used a smartphone-based application for a real-time report (i.e. ecological momentary assessment [EMA]) of their AB behaviours. Recording time was set from 8.00 to 12.30 and from 14.30 to 22.00. Analysis of variance (ANOVA) was used to compare the average reported frequency for each activity within and between the different sessions. The coefficient of variation (CV) was assessed to evaluate daily fluctuations within the 7 days monitoring periods. RESULTS: The average reported frequency of the relaxed condition was 64.9%, 63.0% and 60.0% during the sessions without aligners, with passive aligners and with active aligners, respectively. ANOVA showed no significant differences in any of the AB behaviours within (i.e. between 7 days of evaluation) and between the monitoring sessions (i.e. before orthodontic treatment, with passive aligners, with active aligners). No sex differences were detected, except for the 'tooth contact' report that showed a higher frequency in females. CONCLUSION: The impact of our results in the orthodontic field is not negligible; clinicians can find support for the hypothesis that from a global point of view, wearing or not wearing aligners (passive and/or active) does not influence the frequency of AB behaviours at the short term.

Assessing the prevalence and risk of tooth wear in Parkinson's disease: A narrative review.

Tooth wear is an increasingly common problem that affects the quality of life. Although previous research suggested that oral health is adversely affected in individuals with Parkinson's disease (PD) compared to healthy controls, tooth wear has not been extensively studied in this context. Particularly, there is a paucity of data on the prevalence and risk factors associated with tooth wear in PD patients. The aim of this study is to review the current literature on the prevalence and risk factors of tooth wear in PD patients and to propose hypotheses for future research on this topic. A literature search was conducted in PubMed. A total of 4 publications were identified: 1 case report and 3 questionnaire-based studies. These articles suggest that tooth wear is a more significant issue in PD patients than in healthy controls. In addition, potential associations between oral health-related quality of life (OHRQoL), bruxism and temporomandibular disorder (TMD) pain on the one hand, and tooth wear on the other hand, were identified in PD patients. Due to the limited number of articles published on this topic, it is not possible to definitively conclude whether tooth wear is a common problem in PD patients. However, the following hypotheses could be formulated: 1) tooth wear is more prevalent in PD patients than in healthy controls; 2) risk factors for tooth wear observed in healthy individuals are more prevalent among PD patients; and 3) multiple risk factors for tooth wear likely coexist in people with PD, potentially influencing the prevalence and progression of tooth wear in this population.

High resolution imaging of human development: shedding light on contrast agents.

BACKGROUND: Visualizing (micro)vascular structures remains challenging for researchers and clinicians due to limitations in traditional radiological imaging methods. Exploring the role of vascular development in craniofacial malformations in experimental settings can enhance understanding of these processes, with the effectiveness of high-resolution imaging techniques being crucial for successful research in this field. Micro-CT imaging offers 3D microstructural insights, but requires contrast-enhancing staining agents (CESAs) for visualizing (micro)-vascular tissues, known as contrast-enhanced micro-CT (CECT). As effective contrast agents are crucial for optimal visualization, this review focuses on comparative studies investigating such agents for micro-vascular tissue imaging using micro-CT. Furthermore, we demonstrate the utilization of B-Lugol solution as a promising contrast agent for acquiring high-quality micro-CT images of (micro)vascular structures in human embryonic samples. METHOD: This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. PubMed database provided relevant articles, screened initially by title and abstract. Inclusion and exclusion criteria defined outcomes of interest. RESULTS: From an initial search, 273 records were identified, narrowed down to 9 articles after applying our criteria. Additionally, two articles were added through citation searching. This, a total of 11 articles were incorporated in this study. CONCLUSION: This micro-CT contrast agent review underscores the need for tailored choices based on research goals. Both Barium sulfate and Iodine-based agents showing excellent results, providing high resolution (micro) vascular content, especially in ex-vivo specimens. However, careful consideration of protocols and tissue characteristics remains imperative for optimizing the effectiveness of micro-CT imaging for the study of cranio-facial vascular development.

Protein Deposition on Sport Mouthguards and the Effectiveness of Two Different Cleaning Protocols.

Objective: To determine which salivary proteins adhere onto sport mouthguards, and to evaluate the effectiveness of different cleaning strategies in removing deposited protein. Methods: Fifteen healthy volunteers used a mouthguard for 1 h. The deposited salivary proteins were analyzed using gel electrophoresis and Western blotting techniques and compared with the protein composition of unstimulated saliva. In addition, the effectiveness of two different cleaning strategies to remove proteins from the mouthguards were compared: rinsing the mouthguards after use with cold tap water and cleaning the mouthguard with a soluble effervescent tablet. Results: Gel electrophoresis showed deposition of proteins of 50-60 kDa and 14 kDa on the mouthguards used in the mouth for 1 h. Western blotting identified these bands as amylase and lysozyme, respectively. Rinsing the mouthguard with cold tap water after use removed 91% of the total amount of deposited proteins, while cleaning with an effervescent tablet removed 99%. Conclusions: During the use of mouthguards, salivary proteins are deposited on their surface. Because salivary proteins can potentially affect bacterial adhesion to mouthguards, proper cleaning after use is recommended. Cleaning the mouthguard with cold tap water or using an effervescent tablet both seem to be effective strategies to remove proteins deposited on sport mouthguards.