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.

Qualitative suggestions for the further development of the Standardized Tool for the Assessment of Bruxism (STAB).

BACKGROUND: The Standardized Tool for the Assessment of Bruxism (STAB) has recently been published. It contains Axis A for evaluating bruxism status and its potential consequences, and Axis B for bruxism risk, etiological factors and comorbid conditions. Suggestions from daily clinical practice can contribute to the further development of the STAB. OBJECTIVES: The study aimed to investigate the experiences and attitudes of general dentists, dentists specialized in Orofacial Pain and Dysfunction (OPD) and Disability Care (DC) regarding the assessment and etiology of sleep and awake bruxism and to examine the concordance of their experiences and attitudes with the respective STAB axes and its domains. MATERIAL AND METHODS: Semi-structured interviews were conducted with 11 dentists. The main themes included bruxism assessment and etiology. Thematic analysis identified subthemes. The concordance between main themes, subthemes, and the corresponding STAB axes and domains was examined. RESULTS: Overall, there was a good correspondence between the experiences and attitudes of the interviewees and the respective STAB axes and domains. Some discrepancies were identified, but they were mainly related to the lack of appropriate tools for the DC setting. CONCLUSIONS: It is suggested that future versions of the STAB include appropriate tools for the assessment of bruxism in DC settings.

The bruxism screener (BruxScreen): Development, pilot testing and face validity.

BACKGROUND: To assess awake and sleep bruxism, the Standardised Tool for the Assessment of Bruxism (STAB) is currently being developed. The STAB will be a comprehensive tool for the detailed assessment of bruxism behaviour itself as well as of its possible consequences, causes, and comorbid conditions. OBJECTIVE: Since the STAB cannot fully meet the 'A4 principle' for a bruxism assessment tool, i.e., being Accurate (reliable and valid), Applicable (feasible), Affordable (cost-effective), and Accessible (suitable for everyday clinical use), the Bruxism Screener (BruxScreen) has been developed to be used in large-scale epidemiological research projects and, especially, in general, dental practices. METHODS: The BruxScreen consists of two parts: a questionnaire (BruxScreen-Q) to be completed by patients, and a clinical assessment form (BruxScreen-C) to be completed by dentists. RESULTS: This paper describes the development of the BruxScreen and provides the outcomes of the pilot testing phase and the face validity assessment (i.e. that the first impressions of the tool indicate that it adequately reflects the construct to be measured). CONCLUSION: The resulting BruxScreen is considered ready for more profound psychometric testing in the general dental setting.

Psychological distress and the belief that oral behaviours put a strain on the masticatory system in relation to the self-report of awake bruxism: Four scenarios.

BACKGROUND: It is assumed that other factors than masticatory muscle activity awareness could drive the self-report of awake bruxism. OBJECTIVES: To investigate the extent to which the report of awake bruxism is associated with psychological distress, and with the belief that oral behaviours put a strain on the masticatory system among TMD-pain patients. MATERIALS AND METHODS: The study sample consisted of 1830 adult patients with reported function-dependent TMD pain. Awake bruxism was assessed through six items of the Oral Behaviors Checklist. Psychological distress was assessed by means of somatic symptoms, depression and anxiety. Causal attribution belief was measured with the question 'Do you think these behaviours put a strain on your jaws, jaw muscles, and/or teeth?' RESULTS: Mean age of all participants was 42.8 (±15.2) years, 78.2% being female. Controlled for sex, positive, yet weak, correlations were found between awake bruxism and somatic symptom severity (rs = 0.258; p < .001), depression (rs = 0.272; p < .001) and anxiety (rs = 0.314; p < .001): patients with the highest scores reported approximately twice as much awake bruxism compared to those with minimal scores. Controlled for age and sex, a positive, moderate correlation was found between awake bruxism and causal attribution belief (rs = 0.538; p < .001). Patients who believed that performing awake oral behaviours put 'very much' a strain on the masticatory system reported four times more awake bruxism than patients who did not believe that these behaviours are harmful. CONCLUSIONS: Based on the results and relevant scientific literature, the theoretical background mechanisms of our findings are discussed in four scenarios that are either in favour of the use of self-report of awake bruxism being a representation of masticatory muscle activity awareness, or against it.

Clinicians' view on the management of oral health in Parkinson's disease patients: a qualitative study.

BACKGROUND: due to numerous motor and non-motor symptoms, dental treatment in patients with Parkinson's Disease (PD) can be challenging. Knowledge regarding optimal management of oral health in PD patients is lacking. AIM: to gain a deeper understanding of the experiences of dentists regarding oral health care for PD patients in the Netherlands. MATERIAL AND METHOD: semi-structured interviews were conducted with (specialized) dentists working with PD patients. A thematic analysis was performed using a framework-based approach. RESULTS: ten dentists were interviewed. They reported that dental care in PD patients requires 1) adaptation of timing and length of treatments and consultations, and 2) intensifying preventive measures. Dentists experienced the organization as bureaucratic and difficult. Moreover, differences between being institutionalized or living at home were present. Education and research are needed to improve PD patients' oral health. The experience level and affinity for treating PD patients positively influences confidence levels of the practitioner. Finally, points of improvement were suggested. CONCLUSION: managing oral health in PD patients is challenging, and interdisciplinary collaboration is needed to overcome difficulties. Reducing the bureaucratic burden and improving knowledge could help and stimulate oral health care providers to treat PD patients more effectively and, consequently, improve their oral health.

Dental sleep-related conditions and the role of oral healthcare providers: A scoping review.

Dental sleep medicine as a discipline was first described about a quarter of a century ago. Snoring, obstructive sleep apnea, sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux disease, and orofacial pain were identified as dental sleep-related conditions. This scoping review aimed to: i) identify previously unidentified dental sleep-related conditions; and ii) identify the role of oral healthcare providers in the prevention, assessment, and management of dental sleep-related conditions in adults. A systematic literature search was conducted in PubMed, Embase.com, Web of Science, and Cochrane. Studies that reported an actual or likely role of oral healthcare providers in the prevention, assessment, and/or management of sleep-related conditions were included. Of the 273 included studies, 260 were on previously listed dental sleep-related conditions; the other 13 were on burning mouth syndrome. Burning mouth syndrome was therefore added to the list of dental sleep-related conditions for the first aim and categorized into sleep-related orofacial pain. For the second aim, the role of oral healthcare providers was found to be significant in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; in the assessment and management of snoring, sleep-related orofacial pain, and oral dryness; and in the assessment of sleep-related gastroesophageal reflux condition.

Signal acquisition and analysis of ambulatory electromyographic recordings for the assessment of sleep bruxism: A scoping review.

BACKGROUND: Ambulatory electromyographic (EMG) devices are increasingly being used in sleep bruxism studies. EMG signal acquisition, analysis and scoring methods vary between studies. This may impact comparability of studies and the assessment of sleep bruxism in patients. OBJECTIVES: (a) To provide an overview of EMG signal acquisition and analysis methods of recordings from limited-channel ambulatory EMG devices for the assessment of sleep bruxism; and (b) to provide an overview of outcome measures used in sleep bruxism literature utilising such devices. METHOD: A scoping review of the literature was performed. Online databases PubMed and Semantics Scholar were searched for studies published in English until 7 October 2020. Data on five categories were extracted: recording hardware, recording logistics, signal acquisition, signal analysis and sleep bruxism outcomes. RESULTS: Seventy-eight studies were included, published between 1977 and 2020. Recording hardware was generally well described. Reports of participant instructions in device handling and of dealing with failed recordings were often lacking. Basic elements of signal acquisition, for example amplifications factors, impedance and bandpass settings, and signal analysis, for example rectification, signal processing and additional filtering, were underreported. Extensive variability was found for thresholds used to characterise sleep bruxism events. Sleep bruxism outcomes varied, but typically represented frequency, duration and/or intensity of masticatory muscle activity (MMA). CONCLUSION: Adequate and standardised reporting of recording procedures is highly recommended. In future studies utilising ambulatory EMG devices, the focus may need to shift from the concept of scoring sleep bruxism events to that of scoring the whole spectrum of MMA.

The Association Between Self-Reported Awake Oral Behaviors and Orofacial Pain Depends on the Belief of Patients That These Behaviors Are Harmful to the Jaw.

AIMS: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribution belief and the report of awake oral behaviors. METHODS: Prior to the first clinical visit, patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire. Data of 329 patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (82.4% women; mean ± SD age = 41.9 ± 14.7 years) were analyzed. RESULTS: Causal attribution belief moderated the association between awake oral behaviors and orofacial pain intensity. In addition, the relationship between causal attribution belief and self-reported oral behaviors was partially mediated by the presence of somatic symptoms (8%), depression (9%), and anxiety (16%). CONCLUSION: Awake oral behaviors were positively associated with orofacial pain, but only under the condition of a strong belief of the patients in causal attribution of these behaviors to the jaw pain complaint. No such association was present in case of a low causal attribution belief. It appeared that, within this patient cohort, the relationship between causal attribution belief and self-reported oral behaviors was (in part) the result of shared psychologic risk factors.

Associations between sleep bruxism and (peri-)implant complications: lessons learned from a clinical study.

OBJECTIVE: To report and discuss the lessons learned from the conduct of a clinical study on the associations between sleep bruxism and (peri-)implant complications, the protocol of which has been pre-published. MATERIALS AND METHODS: A single-center, double-blind, prospective cohort study with a 2 year follow-up was performed in the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. Eleven adult participants were included, where an inclusion of 98 was planned. Sleep bruxism was assessed by multiple single-channel electromyographic (EMG) recordings. Main outcomes were biological and technical complications. Results of the study are presented alongside with comments on encountered difficulties. RESULTS: Insufficient participant recruitment and failed EMG recordings were encountered. The small sample size did not allow answering the study's main aim, and was mainly attributed to the study's protocol complexity. EMG recording failures were attributed to insufficient quality of the EMG signal and detachments of the electrode. DISCUSSION: The lessons learned from the conduct of this study can be used to design successful future clinical studies. CONCLUSIONS: Adequate participant recruitment, effective EMG recordings, and a careful selection of predictor variables are important ingredients for the successful conduct of a longitudinal clinical study on the association between sleep bruxism and (peri-)implant complications.

Patient-based experiences with the use of an ambulatory electromyographic device for the assessment of masticatory muscle activity during sleep.

BACKGROUND: It is important to know how easy or difficult it is to use an ambulatory electromyographic (EMG) device for sleep bruxism assessment, and how this might affect its future utilisation. OBJECTIVE: To explore the experience of individuals using an EMG device that pairs with a smartphone app, in order to detect factors that could facilitate and/or hamper its utilisation in future scientific research. METHODS: Fifteen adults were recruited in the Orofacial Pain and Dysfunction Clinic of the Academic Centre for Dentistry Amsterdam (ACTA). Overnight recordings were performed in the home setting during one week. Time investment, feelings and thoughts, encountered difficulties and reasons for not using the device were assessed in a diary through open-ended questions and 5-point Likert scales. Content analysis of textual data was performed, and descriptives of quantitative data were calculated. RESULTS: Time investment was low (mean 10.2 minutes in the clinic, and 1.9 minutes per recording at home). Quantitative data showed an overall good experience (median of 4). Qualitative diary data showed that the desire to gain insight into one's masticatory muscle activity formed the main motivation to use the device. Device detachment and difficulty in using the app were the most prominent negative experiences. CONCLUSION: The EMG device was well accepted for multiple overnight recordings. Curiosity for gaining insight into muscle activity was the most important factor that facilitated its use, and the app addressed this need. Device detachment and difficulties in using the app were the main factors that hampered its use.

Consensus-based clinical guidelines for ambulatory electromyography and contingent electrical stimulation in sleep bruxism.

As yet, there are still no evidence-based clinical diagnostic and management guidelines for ambulatory single-channel EMG devices, like the BUTLER® GrindCare® (GrindCare), that are used in patients with sleep bruxism. Therefore, a consensus meeting was organised with GrindCare developers, researchers, and academic and non-academic clinicians experienced with the use of ambulatory EMG devices. The aim of the meeting was to discuss and develop recommendations for clinical guidelines for GrindCare usage, based on the existing clinical and research experience of the consensus meeting's participants. As an important outcome of the consensus meeting, clinical guidelines were proposed in which an initial 2-week baseline phase with the device in its inactive (non-stimulus) mode for habituation and assessment of the number of jaw-muscle activities is followed by a 4-week active phase with contingent electrical stimuli suppressing the jaw-muscle activities. As to avoid the commonly reported reduction in sensitivity to the stimuli, a 2-week inactive phase is subsequently installed, followed by a repetition of active and inactive phases until a lasting reduction in the number of jaw-muscle activities and/or associated complaints has been achieved. This proposal has the characteristics of a single-patient clinical trial. From a research point of view, adoption of this approach by large numbers of GrindCare users creates a great opportunity to recruit relatively large numbers of study participants that follow the same protocol.

To what extent is bruxism associated with musculoskeletal signs and symptoms? A systematic review.

The aim of the present systematic review was to answer the overall research question: "To what extent is bruxism associated with musculoskeletal signs and symptoms?". The review was performed in accordance with the PRISMA guidelines. A PubMed search of articles published until 23 November 2017 was conducted. The search string included both MeSH terms and text words. Results were presented in categories according to study design, study population (eg, adults, children), bruxism sub-type (awake, sleep), assessment methods for bruxism and musculoskeletal symptoms (self-report, validated test) and type of outcome (pain, non-painful musculoskeletal symptoms). It could be concluded that bruxism is to some extent associated with musculoskeletal symptoms, even though the evidence is conflicting and seems to be dependent on many factors, such as age, whether the bruxism occurs during sleep or wakefulness, and also the quality of the diagnostic methodology regarding bruxism and musculoskeletal signs and symptoms. The literature does not support a direct linear causal relationship between bruxism and such symptoms, but points more in the direction of a multifaceted relationship dependent on the presence of other risk factors. Pain is by far the most commonly assessed symptom, whereas non-painful musculoskeletal symptoms have generally not been systematically evaluated. In the light of recent findings indicating that non-painful symptoms may precede TMD pain, it is suggested to increase the scientific focus on non-painful musculoskeletal symptoms in future studies. Also, future studies should use validated methods for case definition and outcome assessments.

Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study.

OBJECTIVE: To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. MATERIALS AND METHODS: Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. RESULTS: Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure's occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician's intuition. There was little attention for awake bruxism. DISCUSSION: Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. CONCLUSIONS: There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.

Associations between sleep bruxism and (peri-) implant complications: a prospective cohort study.

OBJECTIVES/AIMS: To describe the protocol of a prospective cohort study designed to answer the question: 'Is sleep bruxism a risk factor for (peri-)implant complications?'. MATERIALS AND METHODS: Our study is a single-centre, double-blind, prospective cohort study with a follow-up time of 2 years. Ninety-eight participants fulfilling inclusion criteria (planned treatment with implant-supported fixed suprastructure(s) and age 18 years or older) will be included. Sleep bruxism will be monitored at several time points as masticatory muscle activity during sleep by means of a portable single-channel electromyographic device. Our main outcomes are biological complications (i.e., related to peri-implant bleeding, probing depth, marginal bone height, quality of submucosal biofilm and loss of osseointegration) and technical complications (i.e., suprastructure, abutment, implant body or other). RESULTS: The study is currently ongoing, and data are being gathered. DISCUSSION: The results of this prospective cohort study will provide important information for clinicians treating bruxing patients with dental implants. Furthermore, it will contribute to the body of evidence related to the behaviour of dental implants and their complications under conditions of high mechanical loadings that result from sleep bruxism activity. CONCLUSION: The protocol of a prospective cohort study designed to investigate possible associations between sleep bruxism and (peri-) implant complications was presented.