Awake bruxism report in a population of dental students with and without ecological momentary assessment monitorization-A randomised trial.

OBJECTIVE: The Ecological Momentary Assessment (EMA) concept was the basis for developing a smartphone application for the real-time report of awake bruxism (AB) activities. The aim of this study was to assess the effects of the EMA with a randomised controlled trial designed to compare the frequency of AB reported in two separate single observation points between a group of students monitored over time with an EMA smartphone application and a non-EMA monitored group. METHODS: Sixty-four (N = 64) dental students (22.3 YO [±2.6]; 52F; 12 M) answered the Oral Behaviour Checklist (OBC-1) and were randomised into an EMA-group (EG) and control group (CG). EG were monitored with a smartphone application for AB report during seven consecutive days and completed three EMA monitoring periods (EMA-1, 2 and 3) at one-month intervals. After the third period (EMA-3), both EG and CG answered again the OBC (OBC-2). Descriptive statistics were performed to characterise the sample. Pearson's chi-squared test, Fixer Exact test and post hoc Z test with Bonferroni correction were performed. The study hypothesis was that EMA could influence the AB reported by the participants because it implies an increase in the awareness, self-recognition, and self-control of bruxism behaviours. The level of significance was set at p < .05. RESULT: The percentage of participants who changed the report of the activity of clenching their teeth while awake between OBC-1 and OBC-2 was significantly higher among participants in EG, when compared to CG (p = .027). For all other behaviours reported the within- and between-group differences from OBC-1 to OBC-2 were not significant. Clenching and bracing were the most frequently reported, whilst grinding was the less frequent behaviour. CONCLUSION: A smartphone-based EMA approach demonstrated be useful to monitor AB over time, increasing individual's awareness, particularly to bracing and clenching behaviours.

Performance of the Thies Clima 3D Stereo Disdrometer: Evaluation during Rain and Snow Events.

Imaging disdrometers are widely used in field campaigns to provide information on the shape of hydrometeors, together with the diameter and the fall velocity, which can be used to derive information on the shape-size relations of hydrometeors. However, due to their higher price compared to laser disdrometers, their use is limited to scientific research purposes. The 3D stereo (3DS) is a commercial imaging disdrometer recently made available by Thies Clima and on which there are currently no scientific studies in the literature. The most innovative feature of the 3DS is its ability in capturing images of the particles passing through the measurement volume, crucial to provide an accurate classification of hydrometeors based on information about their shape, especially in the case of solid precipitation. In this paper. the performance of the new device is analyzed by comparing 3DS with the Laser Precipitation Monitor (LPM) from the same manufacturer, which is a known laser disdrometer used in many research works. The data used in this paper were obtained from measurements of the two instruments carried out at the Casale Calore site in L'Aquila during the CORE-LAQ (Combined Observations of Radar Experiments in L'Aquila) campaign. The objective of the comparison analysis is to analyze the differences between the two disdrometers in terms of hydrometeor classification, number and falling speed of particles, precipitation intensity, and total cumulative precipitation on an event basis. As regards the classification of precipitation, the two instruments are in excellent agreement in identifying rain and snow; greater differences are observed in the case of particles in mixed phase (rain and snow) or frozen phase (hail). Due to the different measurement area of the two disdrometers, the 3DS generally detects more particles than the LPM. The performance differences also depend on the size of the hydrometeors and are more significant in the case of small particles, i.e., D < 1 mm. In the case of rain events, the two instruments are in agreement with respect to the terminal velocity in still air predicted by the Gunn and Kinzer model for drops with a diameter of less than 3 mm, while, for larger particles, terminal velocity is underestimated by both the disdrometers. The agreement between the two instruments in terms of total cumulative precipitation per event is very good. Regarding the 3DS ability to capture images of hydrometeors, the raw data provide, each minute, from one to four images of single particles and information on their size and type. Their number and coarse resolution make them suitable to support only qualitative analysis of the shape of precipitating particles.

The confidence in the results of physiotherapy systematic reviews in the musculoskeletal field is not increasing over time: a meta-epidemiological study using AMSTAR 2 tool.

OBJECTIVES: To assess the confidence in the results of systematic reviews on the effectiveness of physiotherapy for musculoskeletal conditions in the past 10 years and to analyze trends and factors associated. METHODS: This is a metaepidemiological study on systematic reviews (SRs) with meta-analysis of randomized controlled trials (RCTs). MEDLINE, Cochrane Database of Systematic Reviews, CINAHL, and PEDro were searched for SRs of RCT on physiotherapy interventions for musculoskeletal disorders from December 2012 to December 2022. Two researchers independently screened the records based on the inclusion criteria; a random sample of 100 studies was selected, and each journal, author, and study variable was extracted. The methodological quality of SRs was independently assessed with the AMSTAR 2 tool. Any disagreement was solved by consensus. RESULTS: The confidence in SRs results was critically low in 90% of the studies, and it did not increase over time. Cochrane reviews are predominantly represented in the higher AMSTAR 2 confidence levels, with a statistically significant difference compared to non-Cochrane reviews. The last author's H-index is the only predictor of higher confidence among the variables analyzed (OR 1.04; 95% CI: 1.01, 1.06). CONCLUSION: The confidence in SRs results is unacceptably low. Given the relevance of musculoskeletal disorders and the impact of evidence synthesis on the clinical decision-making process, there is an urgent need to improve the quality of secondary research by adopting more rigorous methods.

Standardised Tool for the Assessment of Bruxism.

OBJECTIVE: This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences. METHODS: The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications. RESULTS: The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration. CONCLUSIONS: The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields.

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.

Assessment of awake bruxism by a novel bruxism screener and ecological momentary assessment among patients with masticatory muscle myalgia and healthy controls.

BACKGROUND: Bruxism is a masticatory muscle activity occurring during sleep or wakefulness, involving grinding and clenching of teeth and/or jaw bracing. As yet, the aetiology, epidemiology and consequences of awake bruxism (AB) are largely unknown. OBJECTIVES: The aims of the study were to AB behaviours using a novel bruxism screener (BruxScreen) questionnaire part and Ecological Momentary Assessment (EMA; BruxApp©) on AB behaviours, and to investigate AB's prevalence among masticatory muscle myalgia patients and non-patients. METHODS: Altogether, 115 participants (masticatory myalgia patients referred to a specialist clinic (n = 67) and non-patients (n = 46)) filled in a bruxism screener questionnaire to report bruxism behaviours and jaw symptoms. A selection of both groups did a week-long EMA (patients n = 12, non-patients n = 11) to report AB behaviours. The chi-squared test was used to determine group differences in categorical variables. A logistic regression model was fitted to study the probability of AB. RESULTS: According to BruxScreen, bruxism behaviours and jaw symptoms were more frequent in patients than in non-patients (p < .001). Based on EMA, 14.6% of the behaviour in patients was tooth clenching; for non-patients, this was 0.5% (p < .000). Relaxed muscles were reported by patients and non-patients at 20.6% and 56.4%, respectively (p < .021). Logistic regression, adjusted by age and sex, revealed that patients reported AB 5 times more often than non-patients (OR 4.8, 95% CI 2.1-11.2). CONCLUSION: Awake bruxism behaviours are significantly more frequent in masticatory muscle myalgia patients than non-patients and associate with frequent bruxism-related symptoms. Self-reported teeth clenching seems to be the most significant sign of AB behaviour.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies.

BACKGROUND: With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged. OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management. METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.

Smartphone application to report awake bruxism: Development and testing of the Swedish version and a pilot study to evaluate family history in young adults and their parents.

BACKGROUND: Together with psychosocial and hereditary factors, bruxism is a possible risk factor for orofacial pain. Bruxism is defined as a masticatory muscle activity characterized by repetitive or sustained tooth contact, or by bracing or thrusting of the mandible. A smartphone application to report awake bruxism (AB) has been developed and translated into more than 25 languages. OBJECTIVE(S): To translate the application into Swedish, adapt it to Swedish culture and conduct a study to evaluate the usability of the application for studies on family history and associated risk factors. METHODS: Translation and cultural adaption of the Swedish version of the application (BruxApp) was carried out in a four-step sequential process. Ten young adults (22-30 years) were recruited together with ten parents (42-67 years) and reported their AB with the application over two seven-day periods. Pain, stress and parafunctional behaviours were assessed by questionnaires. RESULTS: The back translation check showed minimal discrepancies between the translation and the English version. Participants did not report any problems with the application. Response rates for both groups were 65%. A difference in frequency of AB was shown between young adults and parents (22.0% vs. 12.5%, p < .001). A positive moderate correlation was found between AB and stress (r = 0.54, p = .017). CONCLUSION: The use of application strategies enables data collection on AB which can be used in both clinical and research settings. The results suggest that the Swedish version is ready for implementation and for studies on the relationships between AB, family history and psychosocial factors.

Translation and cultural adaptation of the Standardized Tool for the Assessment of Bruxism (STAB) and the Bruxism Screener (BruxScreen): A 12-step guideline.

BACKGROUND: Recently, the Standardized Tool for the Assessment of Bruxism (STAB) and the bruxism screener (BruxScreen) have been developed for use in research and clinical settings. OBJECTIVE: As to ascertain high-quality use of both instruments worldwide, it was our aim to develop a guideline for the translation and cultural adaptation of the STAB and the BruxScreen. METHODS AND RESULTS: This paper describes a 12-step guideline for the translation and cultural adaptation of the STAB and the BruxScreen. A format of a translation log is provided as well. Besides, a website has been created for the guidance of translation teams. CONCLUSION: Following the 12 steps, new language versions of the STAB and the BruxScreen will be ready for further testing (reliability, validity, responsiveness and interpretability) and, ultimately, application in research and clinics around the world.

Cloud and Precipitation Profiling Radars: The First Combined W- and K-Band Radar Profiler Measurements in Italy.

Clouds cover substantial parts of the Earth's surface and they are one of the most essential components of the global climate system impacting the Earth's radiation balance as well as the water cycle redistributing water around the globe as precipitation. Therefore, continuous observation of clouds is of primary interest in climate and hydrological studies. This work documents the first efforts in Italy in remote sensing clouds and precipitation using a combination of K- and W-band (24 and 94 GHz, respectively) radar profilers. Such a dual-frequency radar configuration has not been widely used yet, but it could catch on in the near future given its lower initial cost and ease of deployment for commercially available systems at 24 GHz, with respect to more established configurations. A field campaign running at the Casale Calore observatory at the University of L'Aquila, Italy, nestled in the Apennine mountain range is described. The campaign features are preceded by a review of the literature and the underpinning theoretical background that might help newcomers, especially in the Italian community, to approach cloud and precipitation remote sensing. This activity takes place in interesting time for radar sensing clouds and precipitation, stimulated both by the launch of the ESA/JAXA EarthCARE satellite missions scheduled in 2024, which will have on-board, among other instruments, a W-band Doppler cloud radar and the proposal of new missions using cloud radars currently undergoing their feasibility studies (e.g., WIVERN and AOS in Europe and Canada, and U.S., respectively).

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

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.

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

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.

Awake bruxism frequency and psychosocial factors in college preparatory students.

OBJECTIVE: To assess the frequency of reported masticatory muscles activity during wakefulness (i.e., awake bruxism [AB]), levels of anxiety, depression, stress, and the oral health-related quality of life (OHRQoL) in college preparatory students. METHODS: Sixty-nine college preparatory students participated in the study. AB was evaluated by the Oral Behaviors Checklist (OBC) and a smartphone-based ecological momentary assessment (EMA; [Bruxapp®]). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, stress was evaluated by the Perceived Stress Scale, and OHRQoL was obtained by The Oral Health Impact Profile-14. Data were analyzed by Pearson's correlation coefficient (α = 0.05). RESULTS: The average EMA-reported frequency of AB behaviors was 38.4%. Significant correlations were found between AB and the OBC, anxiety, depression, stress, and OHRQoL (p < 0.001). CONCLUSION: College preparatory students demonstrated moderate frequency of AB, which was significantly correlated with psychosocial factors.

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

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.

The development of the Standardised Tool for the Assessment of Bruxism (STAB): An international road map.

This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes.

Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations.

Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23-40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.

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

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.

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

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.

Magnetic Resonance Imaging Evaluation of Closed-Mouth TMJ Disc-Condyle Relationship in a Population of Patients Seeking for Temporomandibular Disorders Advice.

OBJECTIVE: To characterize the closed-mouth temporomandibular joint (TMJ) disc-condyle relationship in a population of individuals who sought hospital services for temporomandibular disorders (TMD). METHODS: Two hundred and twenty-four TMJ magnetic resonance images (MRIs) of 112 patients were assessed in all spatial planes to classify disc position with respect to the condyle in a closed-mouth position. RESULTS: Disc displacement (DD) was present in 62.1% and superior disc position in 29.9% of the patients. Position could not be determined in 8% of the cases. Among DD, pure anteriorized position was the most common condition (34.4%), with different combined translational and rotational displacements in all the other joints (27.7%). CONCLUSION: There is a wide biological variability in disc position in closed mouth among patients seeking for TMD advice. Getting deeper into the correlation with clinical symptoms is recommended to refine the potential relevance of any diagnostic and management strategies based on the imaging evaluation of TMJ disc position.

Psychosocial and Behavioral Factors in Awake Bruxism-Self-Report versus Ecological Momentary Assessment.

The issue of psychosocial factors and concurrent conditions associated with AB is a relatively new approach in the study of Awake Bruxism (AB). In the present study a population of 84 dental students were assessed for probable AB with two modes of AB assessment: Single point self-report (SR) and ecological momentary assessment through a designated smartphone application (BA). The two assessment modes were compared with regard to their ability to phenotype subjects as far as the following psychosocial and behavioral variables are concerned: Gender; depression; somatization; oral behaviors; chronic pain and associated pain symptoms in the head, neck and scapula. Two-way ANOVA showed main effect of SR for the following variables: Chronic Pain Intensity score (F(1,49) = 6.441, p < 0.02), migraine/headache (F(1,81) = 7.396, p < 0.01), pain in neck (F(1,81) = 6.726, p < 0.05), pain in scapula (F(1,81) = 8.546, p < 0.005) and the oral behaviors of pushing the tongue forcefully against the teeth (F(1,81) = 5.222, p < 0.05) and inserting the tongue between the upper and lower teeth (F(1,81) = 5.344, p < 0.03). The effect of SR on the habit of chewing gum was borderline (F(1,81) = 3.369, p = 0.07). Main effect of BA was found for depression (F(1,81) = 6.049, p < 0.05), while the effect of BA on somatization was borderline (F(1,81) = 3.657, p = 0.059). An interaction between SR and BA groups could be observed for the behavior of biting, chewing or playing with the tongue, cheeks or lips (F(1,81) = 4.117, p < 0.05). The results suggest that a combination of a single-point self-report referring to the past 30 days, and an ecological momentary assessment supplying information about the actual timing of the report, can help us to better assess AB, as well as increase our ability to define the phenotype of subjects with AB as far as psychosocial and behavioral factors are concerned.