A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device.

BACKGROUND: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. METHODS: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. RESULTS: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. CONCLUSION: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

A new biofeedback approach for the control of awake bruxism and chronic migraine headache: utilization of an awake posterior interocclusal device / Uma nova abordagem via biofeedback para o controle do bruxismo de vigília e de enxaqueca crônica: utilização de um dispositivo interoclusal posterior em vigília

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.

RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.

Intelligent Occlusion Stabilization Splint with Stress-Sensor System for Bruxism Diagnosis and Treatment.

Bruxism is a masticatory muscle activity characterized by high prevalence, widespread complications, and serious consequences but without specific guidelines for its diagnosis and treatment. Although occlusal force-based biofeedback therapy is proven to be safe, effective, and with few side effects in improving bruxism, its mechanism and key technologies remain unclear. The purpose of this study was to research a real-time, quantitative, intelligent, and precise force-based biofeedback detection device based on artificial intelligence (AI) algorithms for the diagnosis and treatment of bruxism. Stress sensors were integrated and embedded into a resin-based occlusion stabilization splint by using a layering technique (sandwich method). The sensor system mainly consisted of a pressure signal acquisition module, a main control module, and a server terminal. A machine learning algorithm was leveraged for occlusal force data processing and parameter configuration. This study implemented a sensor prototype system from scratch to fully evaluate each component of the intelligent splint. Experiment results showed reasonable parameter metrics for the sensors system and demonstrated the feasibility of the proposed scheme for bruxism treatment. The intelligent occlusion stabilization splint with a stress sensor system is a promising approach to bruxism diagnosis and treatment.

[Medicine 4.0: examples of applications of electronics, information technology and microsystems in modern medicine]. / « Médecine 4.0 ¼ - Exemples d'application de l'électronique, de la technologie de l'information et des microsystèmes dans la médecine moderne.

The electronic advances of the last hundred years have made enormous contributions to medical research and the development of new therapeutic methods. In recent years in particular, it has been demonstrated that intelligent sensors, with appropriate radio interfaces, will soon allow diagnostic and therapeutic processes in medicine to be linked to one another - this will enable the development of completely new forms of therapy [1]. This new "Medicine 4.0" was the subject of a first article in the series, which presented the progress achieved through the merging of microsensor technology, microelectronics, information and communication technologies, with a particular focus on the case of personalized chemotherapy. The purpose of this new article is to present more practical applications of these new therapeutic methods.

Síndrome de boca ardiente y factores asociados: estudio retrospectivo de casos y controles / Burning mouth syndrome and associated factors: A case-control retrospective study

Antecedentes y objetivo: El síndrome de boca ardiente (SBA) puede definirse como ardor o disestesia en la lengua y/u otras áreas de la mucosa bucal, en ausencia de lesiones que puedan justificarlo. Su incidencia es mayor en pacientes de sexo femenino, de edades comprendidas entre 50 y 60 años. Estas molestias suelen recurrir diariamente, provocando un deterioro de la calidad de vida. El objetivo del estudio fue evaluar la asociación entre diversos factores patogénicos y el SBA. Pacientes y métodos: Se estudiaron de forma retrospectiva 736 historias clínicas de pacientes diagnosticados de SBA y 132 historias clínicas de pacientes control. El período de estudio se extendió desde enero de 1990 a diciembre de 2014. El protocolo incluyó: sexo, edad, tipo de molestia bucal y localización, entre otras variables. Resultados: El análisis de la asociación entre los factores patogénicos y el diagnóstico de SBA mostró significación estadística en solo 3 de ellos: factores desencadenantes (p = 0,003), hábitos parafuncionales (p = 0,006) e higiene oral (p = 0,012). No se encontraron diferencias significativas en la incidencia del SBA por sexos (p = 0,408), ni asociación entre el SBA y los factores de abuso de sustancias (p = 0,915), patología sistémica (p = 0,685) y hábitos alimentarios (p = 0,904). Conclusiones: Los hábitos parafuncionales como el bruxismo y los movimientos anormales de la lengua y labios pueden explicar la sintomatología del SBA. Hay que tener siempre en cuenta los aspectos psicológicos y los factores sistémicos. Como alteración de carácter multifactorial que es, el tratamiento del SBA debe enfocarse de manera holística (AU)

Background and objective: Burning mouth syndrome (BMS) can be defined as burning pain or dysesthesia on the tongue and/or other sites of the oral mucosa without a causative identifiable lesion. The discomfort is usually of daily recurrence, with a higher incidence among people aged 50 to 60 years, affecting mostly the female sex and diminishing their quality of life. The aim of this study was to evaluate the association between several pathogenic factors and burning mouth syndrome. Patients and methods: 736 medical records of patients diagnosed of burning mouth syndrome and 132 medical records for the control group were studied retrospectively. The study time span was from January 1990 to December 2014. The protocol included: sex, age, type of oral discomfort and location, among other factors. Results: Analysis of the association between pathogenic factors and BMS diagnosis revealed that only 3 factors showed a statistically significant association: triggers (P = .003), parafunctional habits (P = .006), and oral hygiene (P = .012). There were neither statistically significant differences in BMS incidence between sex groups (P= .408) nor association of BMS with the pathogenic factors of substance abuse (P = .915), systemic pathology (P = .685), and dietary habits (P = .904). Conclusions: Parafunctional habits like bruxism and abnormal movements of tongue and lips can explain the BMS main symptomatology. Psychological aspects and systemic factors should be always considered. As a multifactorial disorder, the treatment of BMS should be executed in a holistic way (AU)

Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial.

BACKGROUND: Bruxism is a parafunctional habit characterized by grinding and/or clenching of the teeth. It may happen while awake (awake bruxism) or while sleeping (sleep bruxism). In adults, the prevalence is 20% for the awake bruxism and 8% for the sleep bruxism. Peripheral, central, and psychosocial factors influence the disorder, which may predispose to pain in the masticatory muscles and neck, headache, decreased pain thresholds in the masticatory and cervical muscles, limitation mandibular range of motion, sleep disorders, stress, anxiety, depression, and overall impairment of oral health. The aim of this study is to compare two distinct physical therapy interventions with dental treatment in pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. METHODS/DESIGN: Participants will be randomized into one of three groups: Group 1 (n=24) intervention will consist of massage and stretching exercises; Group 2 (n=24) will consist of relaxation and imagination therapies; and Group 3 (n=24) will receive dental treatment. The evaluations will be performed at baseline, immediately after treatment, and at 2-month follow-up. Pain intensity will be assessed using the visual analogical scale, while pain thresholds will be determined using dolorimetry. Mandibular range of motion will be assessed using digital pachymeter. Sleep quality will be assessed by the Pittsburgh Sleep Quality Index, anxiety by the State-Trait Anxiety Inventory, stress by the Perceived Stress Scale-10, depression by the Beck Depression Inventory, and oral health will be assessed using the Oral Health Impact Profile--14. Significance level will be determined at the 5% level. DISCUSSION: This project describes the randomization method that will be used to compare two physical therapy interventions with dental treatment in the management of pain, mandibular range of motion, sleep quality, anxiety, stress, depression, and oral health in individuals with bruxism. The study will support the practice of evidence-based physical therapy for individuals with bruxism. Data will be published after study is completed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01778881.

Is there a link between tinnitus and temporomandibular disorders?

STATEMENT OF PROBLEM: The frequent concurrence of tinnitus and temporomandibular joint and masticatory muscle disorders (TMD) has led to the assumption that a possible relationship exists between these 2 conditions. PURPOSE: The present prospective clinical study was conducted to assess the possible association between tinnitus and TMD and to investigate the effect of stomatognathic therapy on tinnitus distress. MATERIAL AND METHODS: The prevalence of TMD and tinnitus was investigated in a consecutive series of 951 patients at the Department of Prosthetic Dentistry at the University Medical Center Regensburg, Germany. Patients with TMD and simultaneous tinnitus were included in the prospective clinical trial (n=25). Baseline examination comprised a detailed functional analysis, diagnosis of temporomandibular joint and masticatory muscle disorder, and a tinnitus questionnaire. All the participants received individual dental functional therapy (oral splints, physiotherapy). The effects of functional therapy on TMD and tinnitus symptoms were examined 3 to 5 months after the initiation of dental functional therapy. Means (standard deviations) were calculated, and 1-way ANOVA was used to investigate statistical differences (α=.05). The differences of the 2 binary outcomes were compared with the Pearson χ(2) test, and the relative risk was calculated. RESULTS: Prevalence of tinnitus was found to be 8 times higher in participants with TMD (30 of 82 [36.6%]) than in participants without TMD (38 of 869 [4.4%]). All the participants with unilateral TMD and unilateral tinnitus showed these conditions on the same side. Stomatognathic therapy improved tinnitus symptoms in 11 of 25 participants (44%). CONCLUSIONS: The results of this study and the prospective clinical trial showed a significant correlation between tinnitus and TMD. The observed treatment outcome suggests that dental functional therapy may have a positive effect on TMD-related tinnitus.

Sample of a client intake information protocol: a synopsis and rationale.

The utilization of standardized comprehensive forms in the field of orofacial myology is crucial as this profession continues to grow and establish assessment and treatment protocols. This article formally presents a comprehensive health history intake form currently in use, and highlights the rationale for each particular question within this form in an effort to explore the evidence-based theory behind each question utilized. Highlighting the importance of obtaining a thorough health history as it pertains to our profession, personally allows the clinician to ultimately best plan a therapeutic strategy and assess the individual criteria necessary for successful orofacial myofunctional habituation.

Childhood bruxism: a clinical review and case report.

The present case report refers to a patient who reported to the department with the complaint of teeth grinding (Bruxism). A brief review of the literature is reported concerning the aetiology, clinical diagnosis and the therapeutic approach of the disease.

Uso da acupuntura no manejo da dor em pacientes com alterações na articulação temporomandibular (ATM) / Use of acupuncture in the management of the pain in patients with changes in temporomandibular joint

A acupuntura, técnica bastante difundida devido às suas propriedades antiinflamatórias, ansiolíticas, miorelaxantes e ativadoras da função imunológica no organismo humano, tem sido muito utilizada como terapia coadjuvante em diversas especialidades odontológicas. O objetivo deste trabalho é apresentar o caso clínico de uma paciente com Disfunção Temporomandibular (DTM), tratada com acupuntura, e os resultados obtidos por essa técnica terapêutica no serviço odontológico da Faculdade de Odontologia de Piracicaba (FOP-UNICAMP). A paciente VASN, 34 anos, com queixa de dor na ATM, mais intensa no lado direito, com diagnóstico clínico de DTM e bruxismo, foi submetida ao tratamento por acupuntura. De acordo com a MTC (Medicina Tradicional Chinesa), foi encontrado o padrão de desequilíbrio energético da mesma e foi estabelecido um protocolo de tratamento que se demonstrou efetivo para redução dos sintomas.

Acupuncture has increasingly been used as a complementary therapy in tooh treatment for its widely acknowledged properties: antiflamatory, ansiolitic, miorelaxing and as a stimulator of the human immunity system. The aim of this paper is to report a study case with the results of a temporomandibular joint (TMD) disorder treated with acupuncture in the Dental Service Department at the Dental School of Piracicaba (FOP- UNICAMP). The 34-years-old female patient was diagnosed with TMD, more intense on the right side of her face, and bruxism. The patient was taken to acupuncture treatment, according to the Traditional Chinese Medicine, and it was found a pattern of energetic imbalance. The protocol of treatment in this therapy was effective to reduce symptoms.

Childhood bruxism: a clinical review and case report / Bruxismo infantil: revisión clínica y reporte de un caso

The present case report refers to a patient who reported to the department with the complaint of teeth grinding (Bruxism). A brief review of the literature is reported concerning the aetiology, clinical diagnosis and the therapeutic approach of the disease.

El presente reporte de caso se refiere a un paciente que acudió al departamento aquejado por el hábito de apretar y rechinar los dientes (bruxismo). Se hace una breve revisión de la literatura relacionada con la etiología, diagnóstico clínico, y enfoque terapéutico de la enfermedad.

Un enfoque holístico en el diagnóstico y tratamiento del bruxismo / A holistic approach in bruxism diagnosis and treatment

El bruxismo es una actividad parafuncional caracterizada por rechinar, apretar, trabar y masticar con los dientes, cuya etiología se considera debida a una combinación de problemas relacionados con la presencia de algún tipo de desarmonía oclusal y factores psíquicos o de origen psicosomático. Existe una compleja interacción de mecanismos centrales, psicomáticos, hábitos de movimiento y estructuras morfológicas esqueletales implicadas y concatenadas en la fisiopatología del bruxsimo. Las estructuras y sistemas formales de interacción de esta problemática multifactorial deben ser conocidos y manejados por el profesional experto en el tema para encarar una terapéutica coherente que conduzca a resultados satisfactorios. Los diagnósticos y tratamientos holísticos, los cuales contemplan el bienestar global del individuo desde el punto de vista físico, mental y emocional, son indispensables para encarar el bruxismo con un enfoque alópata y también naturista, contextual, multi y transdisciplinario y donde psicólogos, naturistas, periodoncistas, protesistas, ortodoncistas y otros especialistas médicos actúen con el único fin de sanar de forma integral al enfermo.

Un enfoque holístico en el diagnóstico y tratamiento del bruxismo / A holistic approach in bruxism diagnosis and treatment

El bruxismo es una actividad parafuncional caracterizada por rechinar, apretar, trabar y masticar con los dientes, cuya etiología se considera debida a una combinación de problemas relacionados con la presencia de algún tipo de desarmonía oclusal y factores psíquicos o de origen psicosomático. Existe una compleja interacción de mecanismos centrales, psicomáticos, hábitos de movimiento y estructuras morfológicas esqueletales implicadas y concatenadas en la fisiopatología del bruxsimo. Las estructuras y sistemas formales de interacción de esta problemática multifactorial deben ser conocidos y manejados por el profesional experto en el tema para encarar una terapéutica coherente que conduzca a resultados satisfactorios. Los diagnósticos y tratamientos holísticos, los cuales contemplan el bienestar global del individuo desde el punto de vista físico, mental y emocional, son indispensables para encarar el bruxismo con un enfoque alópata y también naturista, contextual, multi y transdisciplinario y donde psicólogos, naturistas, periodoncistas, protesistas, ortodoncistas y otros especialistas médicos actúen con el único fin de sanar de forma integral al enfermo.(AU)

Disfunción craneomandibular: integración de la instrumentación bioelectrónica en su diagnóstico y terapéutica / Cranio-mandibular dysfunction: integration of bio-electronic instruments for diagnosis and therapy

El odontólogo recibe frecuentemente la consulta de pacientes con diagnóstico de disfunción craneomandibular, disfunción temporomandibular o simplemente pacientes de ATM (SIC), cuyos síntomas podrían ser el resultado de una o múltiples entidades concomitantes que requieren un diagnóstico específico y diferencial. El dolor en el área de la articulación temporomandibular (A.T.M.) puede deberse a uno o una combinación de diversos síndromes clínicos: capsulitis crónica, artritis reumatoidea, patologías musculoesqueléticas, afecciones miogénicas, Síndrome de Ernest, neuralgia occipital menor que irradia allí y otras enfermedades sistémicas. Por otra parte, el cuadro de disfunción craneomandibular (D.C.M.) -que es su nombre correcto- suele ser tratado como sinónimo de bruxismo -actividad parafuncional que se produce como consecuencia de un aumento del tono muscular fundamentalmente de músculos maseteros, temporales y pterigoideos internos-, lo cual es un error, si bien ambas entidades pueden coexistir. El presente artículo tiene como objetivos: a) utilizando instrumentación bioelectrónica, hacer una revisión y actualización sobre la fisiopatología, el cuadro clínico, los diagnósticos diferenciales, el concepto de sistema estomatognático" y el abordaje diagnóstico, pronóstico y terapéutico de la D.C.M. desde la concepción de la odontología neuromuscular y b) resaltar la importancia de un tratamiento interdisciplinario entre odontólogos, médicos expertos en medicina del dolor y otras especialidades médicas para un eficaz diagnóstico y tratamiento de nuestros pacientes; como la D.C.M. es una patología de origen multifactorial, su detección y terapéutica oportuna requiere de toda la artillería que tenemos a nuestra disposición.

Disfunción craneomandibular: integración de la instrumentación bioelectrónica en su diagnóstico y terapéutica / Cranio-mandibular dysfunction: integration of bio-electronic instruments for diagnosis and therapy

El odontólogo recibe frecuentemente la consulta de pacientes con diagnóstico de disfunción craneomandibular, disfunción temporomandibular o simplemente pacientes de ATM (SIC), cuyos síntomas podrían ser el resultado de una o múltiples entidades concomitantes que requieren un diagnóstico específico y diferencial. El dolor en el área de la articulación temporomandibular (A.T.M.) puede deberse a uno o una combinación de diversos síndromes clínicos: capsulitis crónica, artritis reumatoidea, patologías musculoesqueléticas, afecciones miogénicas, Síndrome de Ernest, neuralgia occipital menor que irradia allí y otras enfermedades sistémicas. Por otra parte, el cuadro de disfunción craneomandibular (D.C.M.) -que es su nombre correcto- suele ser tratado como sinónimo de bruxismo -actividad parafuncional que se produce como consecuencia de un aumento del tono muscular fundamentalmente de músculos maseteros, temporales y pterigoideos internos-, lo cual es un error, si bien ambas entidades pueden coexistir. El presente artículo tiene como objetivos: a) utilizando instrumentación bioelectrónica, hacer una revisión y actualización sobre la fisiopatología, el cuadro clínico, los diagnósticos diferenciales, el concepto de sistema estomatognático" y el abordaje diagnóstico, pronóstico y terapéutico de la D.C.M. desde la concepción de la odontología neuromuscular y b) resaltar la importancia de un tratamiento interdisciplinario entre odontólogos, médicos expertos en medicina del dolor y otras especialidades médicas para un eficaz diagnóstico y tratamiento de nuestros pacientes; como la D.C.M. es una patología de origen multifactorial, su detección y terapéutica oportuna requiere de toda la artillería que tenemos a nuestra disposición. (AU)

Distúrbios internos articulares: a influência do bruxismo pesado sobre distúrbios articulares específicos / Internal joint derangements: the influence of severe buxism on specific joint disorders

Abordamos neste artigo a caracterização do bruxismo pesado, suas diferenças clínicas em relação aos distúrbios internos articulares e as implicações com o diagnóstico e tratamento

[Electromyographic changes in bruxism after auricular stimulation. A randomized controlled clinical trial]. / Variazioni elettromiografiche nel bruxismo dopo stimolazione auricolare. Uno studio clinico controllato e randomizzato.

AIM: The aim of this study was to verify in bruxism patients the possible efficacy of auricular stimulation in reducing the hypertonicity of some masticatory muscles. METHODS: Forty-three bruxism patients were randomly allocated to 3 groups: acupuncture, needle contact for 10 seconds, no treatment (control). Helkimo's clinical dysfunction index (CDI) and anamnestic dysfunction index (ADI) were used to assess the functional state of the masticatory system. The resting electrical activity of the anterior temporalis (AT), masseter (MM), digastric (DA) and sternocleidomastoid (SCM) muscles was measured, according to Jankelson, with surface electrodes at baseline, after stimulation and continually for 30 minutes (120 measurements in total). The electromyographical variations in the 3 groups were studied with t test for independent samples. RESULTS: Acupuncture and needle contact were superior to control in reducing the muscle hypertonicity of all muscles except SCM. In the comparison between acupuncture and needle contact the former showed better results only for the right TA and left DA (p = 0.000). CONCLUSION: In this study it was possible to measure the efficacy of the stimulation of only one point or area, which is an ideal model for research in acupuncture. The auricular area we chose for stimulation was never used before for the purpose of relaxing masticatory muscles. Acupuncture and needle contact for 10 seconds showed similar effects.

[Role of the psychologist in the treatment of bruxism]. / De rol van de psycholoog bij de behandeling van bruxisme.

Although there is a controversy about the importance of psychological factors in the development, enhancement and perpetuation of bruxism and other parafunctional activities, the contribution of a psychologist in the treatment of the individual patient is recommended. This contribution consists of diagnostic examination and treatment, most often a short cognitive behavior modification therapy. Because bruxism is mostly examined and treated in relation to the complaints it might cause, especially CMD-complaints, diagnosis and treatment are mostly directed at both. For the diagnosis a questionnaire is used, including a psychological test, which is followed by one or more interviews. The treatment is directed at learning to recognize bruxism activities, to practice alternative behavior, and to learn to cope better with situations that may lead to an increase of bruxism.