Assessment of sleep disturbance in oral lichen planus and validation of PSQI: A case-control multicenter study from the SIPMO (Italian Society of Oral Pathology and Medicine).

BACKGROUND: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. METHODS: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. RESULTS: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. CONCLUSIONS: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.

Smartphone-based application for EMA assessment of awake bruxism: compliance evaluation in a sample of healthy young adults.

OBJECTIVE: A smartphone-based ecological momentary assessment (EMA) strategy to collect real time data on awake bruxism (AB) has been recently introduced. The aim of this study was to assess the compliance with its use over 1 week in a sample of healthy young adults. METHOD: Sixty (N = 60) healthy young adults (mean age 24.2 ± 4.1 years) used a dedicated smartphone application that sent 20 alerts at random times throughout the day. Upon alert receipt, the subjects had to report in real time their condition among five possible options: relaxed jaw muscles, teeth contact, teeth clenching, teeth grinding, and mandible bracing. Compliance rate with the app was assessed at the individual and group level in terms of percentage of answered alerts as well as number of days that were needed to reach the targeted observation period of 7 days with a compliance of at least 60%. RESULTS: The mean compliance recorded with the smartphone application was 67.8% of the total alerts. On average, 9.8 ± 3.2 days (range 7-19) have been necessary to achieve the targeted goal of 7 days with a minimum of 60% alerts/day. No gender differences were detected in any compliance data. Response rate was not different during weekdays or weekends. CONCLUSIONS: This investigation is the first attempt to assess individual compliance with EMA for reporting awake bruxism. Results suggest that a smartphone-based strategy can have interesting potential. The compliance rate reported in this study will serve as a comparison standpoint for future investigations. CLINICAL SIGNIFICANCE: Based on the recent multidisciplinary focus on the study of awake bruxism, EMA has emerged as a potential approach for use in the clinical and research settings. This investigation suggests that compliance with such strategy is good, thus making it worthy of adoption for the assessment of AB and its clinical implications.

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.

An assessment of the usefulness of jaw kinesiography in monitoring temporomandibular disorders: correlation of treatment-related kinesiographic and pain changes in patients receiving temporomandibular joint injections.

BACKGROUND: The authors conducted a study in patients with temporomandibular joint (TMJ) osteoarthritis to assess whether treatment-related changes in pain levels and chewing ability coincide with a change in jaw kinesiographic (KG) parameters. METHODS: The authors selected 34 patients with a diagnosis of TMJ osteoarthritis that met Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to undergo a cycle of five weekly arthrocentesis procedures with injections of 1 milliliter hyaluronic acid. They performed a permutation test to assess the correlation between changes across time (from baseline to end of treatment) in two clinical outcome parameters-pain level and chewing ability-and changes across time in the KG outcome parameters. RESULTS: The authors observed improvement across time in both chewing ability (F = 8.328; P = .005) and pain level (F = 10.903; P = .002). The authors observed no significant changes in any KG variables. With minor exceptions, no significant correlations were shown between changes in the clinical and KG parameters during the treatment period. CONCLUSIONS: Treatment-related changes in pain levels and chewing ability in patients with TMJ osteoarthritis do not coincide with changes in KG parameters. PRACTICAL IMPLICATIONS: If one assumes pain variables to be the primary outcome measures in assessing treatment of TMJ osteoarthritis, KG recordings of the jaw are not useful for monitoring TMJ osteoarthritis in the clinical setting.