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.

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.

An Update on Temporomandibular Disorders (TMDs) and Headache.

PURPOSE OF REVIEW: To provide an overview and highlight recent updates in temporomandibular disorders (TMDs) and their comorbidity with headache disorders regarding pathophysiology and management. RECENT FINDINGS: In the last decade, there have been great advancements in the understanding of TMDs and their relationship with neurovascular pains such as headaches. Understanding of TMDs is necessary for the context of its comorbidity with primary headache disorders. The literature regarding management of these comorbidities is scarce but points to combination therapy including pharmacological and non-pharmacological approaches to optimize management. The use of CGRP receptor-targeted monoclonal antibodies or CGRP receptor antagonists should be explored for the management of chronic TMDs. It could also be used as a novel monotherapy or in combination with non-pharmacological approaches for TMDs' comorbidity with headache, particularly migraine. Research is needed to support evidence-based management protocols. A team involving neurology (headache medicine) and dentistry (orofacial pain) is critical for optimal management.

WWOM VII: Effectiveness of systemic pharmacotherapeutic interventions in the management of BMS: A systematic review and meta-analysis.

OBJECTIVES: To determine the effectiveness of systemic pharmacotherapeutic interventions compared to placebo in burning mouth syndrome (BMS) randomized controlled trials (RCTs) based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS: A systematic literature review of RCTs, concerning systemic pharmacotherapeutic interventions for BMS, published from January 1994 through October 2019, and meta-analysis was performed. RESULTS: Fourteen RCTs (n = 734 participants) were included. Of those, nine were eligible for the quantitative assessment due to the availability/homogeneity of data for at least one of the IMMPACT domains. Pain intensity was the only domain reported in all RCTs. Weighted mean changes in pain intensity, based on visual analogue scale (ΔVAS), were reported in three RCTs at 6 ± 2 weeks and only one RCT at 10+ weeks follow-ups. Quantitative assessment, based on ΔVAS, yielded very low evidence for the effectiveness of alpha-lipoic acid and clonazepam, low evidence for effectiveness of trazodone and melatonin, and moderate evidence for herbal compounds. CONCLUSIONS: Based on the RCTs studied, variable levels of evidence exist that suggest that select pharmacological interventions are associated with improved symptoms. However, the underreporting of IMMPACT domains in BMS RCTs restricts the multidimensional assessment of systemic interventions outcomes. Standardized outcome measures need to be applied to future RCTs to improve understanding of intervention outcomes.

WWOM VII: Effectiveness of topical interventions in the management of burning mouth syndrome: A systematic review.

OBJECTIVES: To assess the effectiveness of topical interventions in the management of burning mouth syndrome (BMS), based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS: A systematic literature review of RCTs on topical interventions for the management of BMS, published in PubMed, Web of Science, PsycInfo, Cochrane Database/Central, and Google Scholar through May 2021 was performed. RESULTS: Eight RCTs (n = 358 study participants) were included in this study. Due to underreporting of IMMPACT domains, publication bias, high degree of heterogeneity between studies, meta-analysis was not undertaken. Based on changes in visual analogue pain scores (ΔVAS), the most reported outcome, the effectiveness of the topical interventions was demonstrated; however, it is low level of evidence. CONCLUSIONS: High levels of variability (interventions, outcomes, outcome measurement tools, and intervention effects evaluated), heterogeneity, publication bias, and underreporting of IMMPACT domains were observed across the RCTs. This systematic review highlights the need for application of standardized outcome measures to future RCTs. At the present time, there is lack of moderate-strong evidence on short- and long-term outcomes to support or refute the use of any particular topical intervention in managing BMS. Future RCTs with standardized outcome measures are needed.

Burning mouth disorder and Parkinson's disease: A scoping review of the literature.

BACKGROUND: Burning mouth disorder (BMD) is a complex medical condition characterized by a burning sensation in the mouth of fluctuating intensity. BMD is considered a diagnosis of exclusion, as oral burning can occur secondary to local or systemic conditions. Parkinson's disease (PD) is one such condition. OBJECTIVE: To provide a scoping review of the literature by assessing all articles written in English that investigated the relationship between BMD and PD. MATERIALS AND METHODS: Various databases (PubMed, Ovid, Web of Science, Science Direct and Scopus) and a search platform (EBSCOhost) were searched following similar investigative approaches. Duplicates were removed and reference lists of original studies were scrutinized for additional articles. Any decision about the inclusion/exclusion in the review was by consensus among the co-authors. RESULTS: Twenty-five original articles and one supplemental article were included in the final review, of which 13 met the inclusion criteria. These were further divided into five categories based on the study design/article, which included Prevalence studies (n = 6), Letter to the editor (n = 1), Incidence study (n = 1), Case reports (n = 2) and Experimental studies (n = 3). Strongest data was provided by epidemiological studies, which suggest BMD and PD are poorly associated. CONCLUSIONS: A scoping review of the existing literature does not suggest that PD patients are any more at risk of developing BMD compared to the general population. While there may be a link through the dopaminergic system as determined by imaging studies, it is unlikely that the pathogenesis of PD disease shares significant commonality with BMD.

Global research trends in complex oral sensitivity disorder: A systematic bibliometric analysis of the structures of knowledge.

OBJECTIVES: A systematic bibliometric analysis of the structure of knowledge was performed to investigate the co-word analysis, the co-citation analysis, and the social network analysis regarding complex oral sensitivity disorder (COSD). METHODS: Web of Science database from 1985 to 2018 was systematically searched to identify all relevant articles using the MeSH terms "complex oral sensitivity disorder" and all synonyms used in the literature. We included original articles, review articles, letters to the editor, and book chapters in the English language and in 27 different ISI categories of medical sciences. Several bibliometric indicators were used. RESULTS: The co-word analysis identified 741 KeyWords Plus (KWP) grouped into 4 different clusters. The terms "pain," "management," "prevalence," and "efficacy" reached the highest centrality, whereas the top 10 KWP had a frequency of 7%-29% in 443 articles. Over a period of 32 years, a complex thematic evolution occurred, going from 2 to 6 different themes, and the KWP migration rate from one cluster to another ranged from 11% to 100%. The co-citation network analysis based on the complete reference list (5932 references) of 443 articles identified only 2 clusters for journals, authors, and articles. The most prominent co-cited journal was "Oral Surgery Oral Medicine Oral Pathology" (centrality: 171.75), the most co-cited author was "Grushka M" (centrality: 330.95), and the most co-cited article was "Grushka M. Oral Surg Oral Med Oral Pathol (1987) 63:30-36" (centrality: 269.79). On the other hand, the direct citation network revealed that "Scala A et al, 2003" reached both the highest global citation score (GCS = 231) and local citation score (LCS = 161). Lastly, the social network analysis revealed an isolated collaboration among groups of authors, or countries or institutions. The worldwide collaboration analysis indicated that United States-Israel and United Kingdom-Italy were the most collaborative countries. CONCLUSIONS: The structure of knowledge of publications on COSD revealed that research in this field has been dominated by few core topics and a limited collaboration among authors and institutions from different countries. More multicenter studies on COSD are warranted in the near future when launching new projects.

Global research trends in complex oral sensitivity disorder: A systematic bibliometric analysis of the framework.

OBJECTIVES: A systematic bibliometric analysis was performed to investigate trends in complex oral sensitivity disorder (COSD) research worldwide and compare the contributions of different countries/institutions, scientific journals, authors, keywords, and citations. METHODS: Web of Science database from 1985 to 2018 was systematically searched to identify all relevant articles using the MeSH terms "complex oral sensitivity disorder" and all synonyms used in the literature. We included original articles, review articles, letters to the editor, and book chapters in the English language and in 27 different ISI categories of medical sciences. Several bibliometric indicators were used. RESULTS: We identified 10 633 articles, of which only 3349 were eligible with only 443 being included for quantitative analyses. The annual percentage growth rate for article publication was 9.16 fractionalized articles with the most productive countries (reported only in 428 out of 443 articles) being Italy (n = 66, 15.42%) followed by USA (n = 61, 14.25%) and with Italy achieving the greatest number of citations (n = 1415). Similarly, the most productive institution for article publication was the University of Turku, Finland, with 39 (8.8%) published articles. Among the top 20 departments, 15 were affiliated with dental institutions. The most productive source was "Journal of Oral Pathology and Medicine" with 38 (8.58%) articles, whereas the most productive author was "Lopez-Jornet P" with 19 articles (6.52 fractionalized articles). CONCLUSIONS: There is an increasing trend for publications on COSD. Collaboration among different countries must improve in order to implement research on this disorder, which seems to be mainly a condition for the dental discipline.

World Workshop on Oral Medicine VII: Burning mouth syndrome: A systematic review of disease definitions and diagnostic criteria utilized in randomized clinical trials.

OBJECTIVE: To conduct a systematic review analyzing disease definitions and diagnostic criteria used in randomized controlled trials (RCTs) involving burning mouth syndrome (BMS). METHODS: A systematic search conducted in PubMed, Web of Science, PsycINFO, Cochrane Database/Cochrane Central, and Google Scholar that included RCTs on BMS published between 1994 and 2017 was performed. RESULTS: Considerable variability in BMS disease definitions and diagnostic criteria used created substantial heterogeneity in the selection of participants and weakened the rigor of the 36 RCTs identified. The analyzed RCTs routinely under-reported the methods used to rule in or out study participants and the number of individuals excluded from BMS RCTs. CONCLUSIONS: Our findings indicate that a large proportion of participants enrolled in these studies may have had an underlying condition that could have explained their BMS symptoms. Thus, outcomes of therapeutic interventions from these BMS RCTs should be interpreted with caution due to heterogeneous disease definitions and diagnostic criteria. In order to improve the quality of clinical trials, future research should focus on establishing consensus for a single definition of BMS that includes specific inclusion and exclusion criteria that should be used to select study participants for clinical trials.

World Workshop in Oral Medicine VII: Reporting of IMMPACT-recommended outcome domains in randomized controlled trials of burning mouth syndrome: A systematic review.

OBJECTIVES: To determine the frequency of use of the core outcome domains published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) in burning mouth syndrome (BMS) randomized controlled trials (RCTs). METHODS: This systematic review, conducted as part of the World Workshop on Oral Medicine VII (WWOM VII), was performed by searching the literature for studies published in PubMed, Web of Science, PsycINFO, Cochrane Database/Cochrane Central, and Google Scholar from January 1994 (when the first BMS definition came out) through October 2017. RESULTS: A total of 36 RCTs (n = 2,175 study participants) were included and analyzed. The overall reporting of the IMMPACT core and supplemental outcome domains was low even after the publication of the IMMPACT consensus papers in 2003 and 2005 (mean before IMMPACT consensus publication = 2.6 out of 6; mean after IMMPACT publication = 3.8 out of 6). Use of validated assessment tools recommended by the IMMPACT consensus was scarce (1.9 out of 6). None of the RCTs reviewed cited the IMMPACT consensus papers. CONCLUSIONS: The underreporting of IMMPACT outcome domains in BMS RCTs is significant. Raising awareness regarding the existence of standardized outcome domains in chronic pain research is essential to ensure more accurate, comparable, and consistent interpretation of RCT findings that can be clinically translatable.

The usefulness of YouTube™ videos as a source of information on burning mouth syndrome.

OBJECTIVES: The aim of this review was to investigate quality assessment and quantitative information on burning mouth syndrome (BMS) on YouTube™ videos. METHODS: An electronic search of YouTube™ videos on BMS was performed using subject headings, keywords and synonyms of BMS. For each video, quality information, via the quality assessment score (QAS) and quantitative information, such as the total number of results per term searched, date of upload, clip length, view count, source category (professional, personal, educational, mixed), number of likes and dislikes and YouTube™ category were evaluated. RESULTS: The search identified 3768 videos of which only 114 were included in our analysis: the quality of videos was very poor (mean ± standard deviation = 1.76 ± 1.64). The most representative categories were "educational" with 53 (46.5%) videos scoring between 0 and 4 and "mixed" with 24 (21.1%) videos scoring between 0 and 2. Significant differences were found among all four categories in relation to length in seconds (P < 0.001), number of views (P = 0.006) and interaction index (P = 0.001), as well as between "professional" and the other categories and between "educational" and "personal" in relation to length in seconds (P < 0.001), between "educational" and "personal" (P < 0.001) and "personal" and "mixed" category in relation to interaction index (P = 0.003) and between "professional" and "personal" in relation to views per day (P = 0.015). CONCLUSIONS: A large number of videos regarding BMS have published on YouTube™, with a wide range of distribution regarding their length and views. Unfortunately, they presented unreliable information which is most often scientifically inaccurate. Health care institutions and professionals should be more actively involved in improving high-quality e-information about BMS on YouTube™.

Evidence-based dentistry or meta-analysis illness? A commentary on current publishing trends in the field of temporomandibular disorders and bruxism.

The field of temporomandibular disorders (TMDs) and bruxism research has recently witnessed a publishing trend leaning towards an overuse of systematic reviews (SRs) that contribute little or nothing to current knowledge. The majority of these seem to be more methodological exercises than manuscripts prepared to provide clinicians and researchers with up-to-date information to advance knowledge. In addition, given the increasing number of researchers who have been reviewing the dental literature on various topics without seemingly having any specific clinical or scientific background in the topic under review, the ultimate value of some SRs is questionable. Some of them end up producing meta-analyses (MAs) to give "numbers" (eg, risk measures and strength of association) that do not have a biological basis, due to the clinical heterogeneity of the articles being reviewed. Based on the above, the present commentary discusses this ongoing publishing trend that is affecting the TMD and bruxism field, which does not align well with the core principles of evidence-based dentistry (EBD). Ideally, EBD should be derived from a combination of literary, clinical and patient-centred information, but relying only on the bibliographic aspects could potentially expose less expert clinicians and other readers who merely browse the literature to incomplete, misdirected or even incorrect conclusions.

Sleep bruxism etiology: the evolution of a changing paradigm.

Various definitions, classifications and theories been ascribed to bruxism. Knowledge gained through expanding research initiatives have transformed some of the concepts that were once held as truths. Sleep bruxism is no longer considered a parasomnia nor is its etiology believed to be based on purely mechanical factors or psychological Issues. It is now considered to be primarily a sleep-related movement disorder with a yet to be determined multifactorial etiology involving complex multisystem physiological processes. Dental practitioners should recognize the transformation occurring in the study of sleep bruxism, understand the evolution in both definitions and classification of this phenomenon and embrace and consider new concepts related to its etiology. This paradigm shift will certainly affect the daily practice of dentistry.

Use of oral devices in the management of oral dysesthesia: case reports and literature review.

Oral dysesthesia (OD) is a diagnosis of exclusion that manifests as an unpleasant and abnormal sensation of the oral mucosa without any noticeable oral lesions. Burning sensation is one of the manifestations of OD which may advocate for similar pharmacotherapeutic options to burning mouth syndrome (BMS), resulting in possible adverse events. The aim of these case reports was to illustrate the significance and rationale for the use of oral devices as a mechanical/physical barrier and a safe approach in the management of OD, without experiencing any antagonistic effects from pharmacotherapeutic agents. Two patients with spontaneous and evoked (following dental procedures) OD symptoms in the right posterior mandibular quadrant and anterior hard palatal areas were evaluated. Additionally, their OD symptoms were associated with hyposalivation and taste changes. A thorough history and complete head and neck examination, with the exclusion of oral lesions and systemic conditions, were performed. These patients were previously prescribed topical clonazepam rinses. An in-office trial, with application of orthodontic wax to the affected area, was performed as a preliminary test in order to justify the fabrication of an oral device for possible symptomatic relief. Conclusion: The case reports demonstrated significant improvement of OD symptoms and amelioration of pain following fabrication of oral devices in two patients with no undesirable effects from pharmacotherapy. Additionally, the oral devices aided as a mechanical/physical barrier, potentially exerting a placebo effect while facilitating an improved quality of life. Furthermore, the cost-effectiveness and ease of fabricating the oral device has been advantageous over other systemic medications. This encourages the need for a detailed prospective study.

Coronoid hyperplasia in a pediatric patient: case report and review of the literature.

Coronoid hyperplasia is a rare entity of unknown etiology due to increased and persistent bone growth that has been associated with trauma, inflammation, hormonal influence and hypervascularization. A case of coronoid hyperplasia in a pediatric patient with restriction in mandibular movements and an absence of painful symptoms initially misdiagnosed as a functional temporomandibularjoint (TMJ) abnormality is presented. Causative factors and management strategies are emphasized to enhance the recognition and understanding of mandibular hypomobilities.

Classification and Diagnosis of Temporomandibular Disorders and Temporomandibular Disorder Pain.

Designing classification systems and developing diagnostic criteria for temporomandibular disorders is difficult. An appreciation of the utility and applicability of these entities requires an understanding of the importance of each, the differences between the two, and how they may be optimally operationalized for both clinical and research activities in light of their inherent advantages and limitations. In addition, consideration for adopting newer approaches, such as following ontological and precision-based medicine principles, accounting for genetics/epigenetic and neurobiological factors, and the inclusion of biomarkers will potentially result in more thorough and comprehensive classification systems and diagnostic criteria.

Temporomandibular disorders: current status of research, education, policies, and its impact on clinicians in the United States of America.

Temporomandibular disorders (TMDs) encompass a number of different musculoskeletal disorders often accompanied by pain and dysfunction. Most TMDs are acute, but can become chronic leading to disability and quality of life issues. There is wide variation in treatment of TMDs, including both conservative/reversible therapies as well as invasive/irreversible treatments, which present difficulties for clinicians, patients, and third-party payers as to what constitutes appropriate care. Data sources: A recent report by the National Academies of Sciences, Engineering, and Medicine highlighted a number of deficiencies, most notably in the education of TMDs within United States of America dental schools at both the predoctoral and postdoctoral (dental) levels as well as addressing the historic inconsistencies in both diagnosis and treatment. New areas for research and interprofessional collaboration should assist in the understanding of TMDs, and updated clinical practice guidelines should help reduce variation in the delivery of evidence-based care. Recently, the American Dental Association recognized orofacial pain as a specialty, which should increase the level and availability of expertise in treating these issues. Summary: Based on the current best evidence, this report is an attempt to alert the profession to discontinue irreversible and invasive therapies for the vast majority of TMDs and recognize that the majority of these disorders are amenable to conservative, reversible interventions.

Numb chin syndrome: What all oral health care professionals should know.

BACKGROUND: Numb chin syndrome (NCS) is a rare sensory neuropathy involving the mental nerve. Symptoms of NCS are often overlooked because of their apparent innocent nature; however, owing to the frequent association of NCS with malignancies, the opposite should be the rule. Oral health care professionals may be the first to encounter patients with NCS and should be aware of its clinical characteristics in an effort to decrease patient morbidity and mortality. TYPES OF STUDIES REVIEWED: A search in PubMed (MEDLINE) and the Cochrane Library was performed using the terms numb chin syndrome, numb chin, mental neuropathy, mental nerve neuropathy, and malignant mental nerve neuropathy, yielding 2,374 studies. After inclusion and exclusion criteria were applied, 102 studies remained. Descriptive statistics were performed, analyzing the etiology responsible for NCS, characteristics of NCS including associated symptoms, unilateral or bilateral nature, and information on professionals visited and examinations requested to make a diagnosis. RESULTS: NCS was associated with malignancy in 29% through 53% of the published cases. Twenty-eight percent of patients initially consulted an oral health care professional with the symptom of a numb chin. Patients more likely to have NCS were those from the ages of 61 through 70 years; 74% were unilateral; and the most common symptoms reported were numbness (100%), paresthesia (18%), and pain (17%). Forty-seven percent of the NCS cases were associated with a recurrent malignancy, and the most prevalent associated diagnoses were breast cancer (32%) and lymphoma and leukemia (24%). CONCLUSIONS: Oral health care professionals should be aware of the characteristics of NCS as they may be the first health care providers consulted for these symptoms. PRACTICAL IMPLICATIONS: A thorough medical and dental history as well as a complete cranial nerve screening should be performed on all patients, especially those with numbness, as this may prevent misdiagnosis and allow a timely referral and a substantial improvement of treatment course and prognosis.