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.

Reliability of multiple-degree incisal/occlusal tooth wear assessment on dental casts: findings from a fiveexaminer investigation and related clinical implications.

OBJECTIVE: The aim was to answer the clinical research question: is incisal/occlusal tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry reliable? METHOD AND MATERIALS: Five examiners with different fields of expertise in the dental profession assessed tooth wear on dental casts of 45 subjects, based on a six-degree rating of incisal/occlusal wear. After a calibration meeting, the examiners evaluated the casts individually and various issues concerning interexaminer agreement and reliability were assessed. RESULTS: A total of 872 teeth were evaluated. The five examiners agreed only for the rating of 6.6% of the teeth. The teeth with the highest percentage of agreement were the premolars. Pairwise comparison of the assessments of the examiners #1 (bruxism expert), #2 (orthodontist), #3 (temporomandibular disorders [TMD] and occlusion expert), #4 (dental nurse) showed fair to moderate agreement, with κ-values ranging from 0.306 to 0.577, whilst the examiner #5 (lab technician) achieved low interexaminer reliability values with all the other four examiners. CONCLUSION: The interexaminer reliability of tooth wear assessment on dental casts performed by five professionals with expertise in different fields of dentistry is highly variable. General practitioners should keep in mind that consensus decisions by the examiners and assessment by raters belonging to the same dental discipline are recommended strategies to increase the reliability of tooth wear evaluation in the clinical setting. CLINICAL SIGNIFICANCE: This investigation adds to the literature suggesting that, in a clinical setting, a single examiner's assessment of tooth wear on dental casts does not have optimal reliability and that it may be source of internal validity problems in the research setting.

Epidemiology of bruxism in adults: a systematic review of the literature.

AIMS: To perform a systematic review of the literature dealing with the prevalence of bruxism in adult populations. METHODS: A systematic search of the medical literature was performed to identify all peer-reviewed English-language papers dealing with the prevalence assessment of either awake or sleep bruxism at the general population level by the adoption of questionnaires, clinical assessments, and polysomnographic (PSG) or electromyographic (EMG) recordings. Quality assessment of the reviewed papers was performed according to the Methodological evaluation of Observational REsearch (MORE) checklist, which enables the identification of flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. For each included study, the sample features, diagnostic strategy, and prevalence of bruxism in relation to age, sex, and circadian rhythm, if available, were recorded. RESULTS: Thirty-five publications were included in the review. Several methodological problems limited the external validity of findings in most studies, and prevalence data extraction was performed only on seven papers. Of those, only one paper had a flaw less external validity, whilst internal validity was low in all the selected papers due to their self-reported bruxism diagnosis alone, mainly based on only one or two questionnaire items. No epidemiologic data were available from studies adopting other diagnostic strategies (eg, PSG, EMG). Generically identified "bruxism" was assessed in two studies reporting an 8% to 31.4% prevalence, awake bruxism was investigated in two studies describing a 22.1% to 31% prevalence, and prevalence of sleep bruxism was found to be more consistent across the three studies investigating the report of "frequent" bruxism (12.8% ± 3.1%). Bruxism activities were found to be unrelated to sex, and a decrease with age was described in elderly people. CONCLUSION: The present systematic review described variable prevalence data for bruxism activities. Findings must be interpreted with caution due to the poor methodological quality of the reviewed literature and to potential diagnostic bias related with having to rely on an individual's self-report of bruxism.

Influencia del desplazamiento del disco de la articulación temporomandibular sobre el crecimiento de la mandíbula / Effect of the disk displacemment of the temporomandibular Joint in The Mandibular Growth

El propósito del presente trabajo de investigación es evaluar la contribución que provoca el desplazamiento del disco de la articulación temporomandibular en el crecimiento mandibular. El objetivo del estudio está dirigido a encontrar la etiología y fisiopatología de las asimetrías faciales y retrognatismos observados en seres humanos. El protocolo empleado consistió en el desplazamiento anterior unilateral y bilateral en forma quirúrgica del disco articular en 2 grupos de conejos jóvenes albinos de Nueva Zelandia en etapa de crecimiento. El seguimiento de estos grupos fue comparado con un grupo control a fin de evaluar los efectos provocados a nivel del cóndilo mandibular y rama ascendente. Los animales fueron sacrificados a las 16 semanas y sus mandíbulas fueron radiografiadas y colocadas en el computador para efectuar mediciones entre los grupos. Las modificaciones fueron evaluadas estadísticamente por el Test de Aleatorización de Fisher para muestras independientes y Test Permutacional de Fisher para muestras apareadas. Los resultados obtenidos demostraron que cuando el disco se desplaza de la posición normal se provoca estadísticamente el acortamiento de la rama ascendente mandibular de animales en crecimiento. Cuando dicho procedimiento es efectuado en forma bilateral se obtiene alteración del crecimiento de ambas ramas ascendentes. En ambos grupos aparecen también modificaciones en la cabeza condilar y proceso mandibular. Esto sugeriría la posibilidad que en niños, los cambios discales serían responsables de provocar asimetrías mandibulares y retrognasia mandibular

La axiografía como diagnóstico en A.T.M / Axiography as a diagnosis in T.M.J

Esta publicación deberá estimular mayor interés en la investigación de la axiografía como técnica de diagnóstico. Nuestro estudio demostró que ningún individuo normal fue diagnosticado como anormal. Algunos pacientes anormales produjeron trazos normales. Los resultados demuestran que no todas las anomalías de la posición del disco articular fueron captadas por la axiografía. Esto sugiere que su uso en el diagnóstico de la disfunción de la articulación temporomandibular y su posterior tratamiento deben ser evaluados cuidadosamente