Efficiency of mixed and rigid occlusal stabilization splints: Randomized clinical trial.

Occlusal stabilization splints are the most common treatment for controlling the deleterious effects of sleep bruxism. This study aimed to evaluate the effectiveness of a low-cost, mixed occlusal splint (MOS) compared to that of a rigid splint. A randomized clinical trial was performed on 43 adults of both sexes with possible sleep bruxism and satisfactory dental conditions. They were divided into rigid occlusal splint (ROS) (n = 23) and MOS (n = 20) groups. Masticatory muscle and temporomandibular joint (TMJ) pain intensity (visual analog scale), quality of life (WHOQOL-BREF), indentations in the oral mucosa, anxiety, and depression (HADS), number of days of splint use, and splint wear were evaluated. All variables were evaluated at baseline (T0), 6 months (T6), and 12 months (T12) after splint installation (T0), and splint wear was evaluated at T6 and T12. Student's t-test, Mann-Whitney U test, non-parametric Friedman's analysis of variance for paired samples and pairwise multiple comparisons, Pearson's chi-square test, two-proportion z-test, non-parametric McNemar's and Cochran's Q, and Wilcoxon tests were used (p < 0.05). In both groups, there was a decrease in TMJ pain and pain intensity over time and improvements in the quality of life scores. At T6, there was a higher rate of splint wear in the MOS group than in the ROS group (p = 0.023). The MOS showed a higher rate of wear than the rigid splint but had similar results for the other variables. Therefore, the use of a mixed splint appears to be effective in controlling the signs and symptoms of sleep bruxism.

Efficiency of mixed and rigid occlusal stabilization splints: Randomized clinical trial

Abstract Occlusal stabilization splints are the most common treatment for controlling the deleterious effects of sleep bruxism. This study aimed to evaluate the effectiveness of a low-cost, mixed occlusal splint (MOS) compared to that of a rigid splint. A randomized clinical trial was performed on 43 adults of both sexes with possible sleep bruxism and satisfactory dental conditions. They were divided into rigid occlusal splint (ROS) (n = 23) and MOS (n = 20) groups. Masticatory muscle and temporomandibular joint (TMJ) pain intensity (visual analog scale), quality of life (WHOQOL-BREF), indentations in the oral mucosa, anxiety, and depression (HADS), number of days of splint use, and splint wear were evaluated. All variables were evaluated at baseline (T0), 6 months (T6), and 12 months (T12) after splint installation (T0), and splint wear was evaluated at T6 and T12. Student's t-test, Mann-Whitney U test, non-parametric Friedman's analysis of variance for paired samples and pairwise multiple comparisons, Pearson's chi-square test, two-proportion z-test, non-parametric McNemar's and Cochran's Q, and Wilcoxon tests were used (p < 0.05). In both groups, there was a decrease in TMJ pain and pain intensity over time and improvements in the quality of life scores. At T6, there was a higher rate of splint wear in the MOS group than in the ROS group (p = 0.023). The MOS showed a higher rate of wear than the rigid splint but had similar results for the other variables. Therefore, the use of a mixed splint appears to be effective in controlling the signs and symptoms of sleep bruxism.

Prevalence of awake bruxism in the adult population: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the prevalence of awake bruxism (AB) in the adult population. MATERIALS AND METHODS: Six main electronic databases and three sources of grey literature were searched to identify cross-sectional studies in which AB was assessed. The studies were independently selected by two reviewers in two phases, based on their eligibility criteria. The first one consisted of reading titles and abstracts, and the second one involved reading the full articles. The study quality assessment was obtained by using the "Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data", and the "R Statistics" software was used to perform meta-analyses. RESULTS: Seventeen out of 3086 identified studies were included. None of the studies scored high in methodological quality across all 9 items of the JBI checklist. However, "the use of valid methods to identify pathology" and "appropriate statistical analysis" were considered to have high methodological quality in all the studies. The overall pooled prevalence of the meta-analysis was 15.44% (99% confidence interval: 10.81 to 20.72%) and there was no difference for sex, sampling method and according to consensus-based classification. CONCLUSIONS: The prevalence of AB in adults was low. There was substantial methodological variability, which highlights the need for standardized guidelines. CLINICAL RELEVANCE: Prevalence data are useful for raising patients' and clinicians' awareness of the AB. Moreover, since AB can lead to possible pain and overload of the stomatognathic system, this knowledge can also guide dentists to achieve an early diagnosis of AB and to provide appropriate care management.

Assessment of awake bruxism and oral mucosa indentation in adolescents.

BACKGROUND: Oral mucosa indentations can be signs of awake bruxism (AB) in adults, but this association has not yet been verified in adolescents. OBJECTIVES: To evaluate the frequency of AB in adolescents and determine whether there is an association between AB and oral mucosa indentation. METHODS: This study enrolled 66 high school students, mean age of 16.9 (±0.54) years. Clinical inspection was performed to assess the presence or absence of tongue, cheek and lip mucosa indentation. AB was assessed by the Ecological Momentary Assessment method using the WhatsApp mobile app. Messages were sent 15 times a day, 7 days, between 8:00 AM and 7:00 PM at random times to choose one of the five oral behaviours: teeth contact, teeth clenching, teeth grinding, mandible bracing and relaxed jaw muscles. The non-parametric Mann-Whitney U-test for independent samples, Friedman test for paired samples, Friedman pairwise multiple comparisons non-parametric test, Pearson's chi-squared tests, and z-test of comparisons between two proportions were performed (p < .05). RESULTS: During the week the frequency of AB behaviours was 56.20%, teeth contact was the most frequent (37.68% ± 22.26%), significantly more frequent than other AB behaviours; there was a greater frequency of cheek indentation (27.27%) and no difference between genders in oral behaviours and indentations (p > .05). A higher frequency of AB behaviours was observed in individuals with a greater frequency of cheek indentation (p < .05). CONCLUSIONS: Teeth contact and cheek indentation were the most frequent conditions among adolescents and AB behaviours are associated with this indentation.

Disocclusion guides in occlusal splints on temporomandibular disorders and sleep bruxism: a systematic review.

OBJECTIVE: To determine the best disocclusion guidance in occlusal splints (OSs) to manage and treat temporomandibular disorder (TMD) and sleep bruxism (SB). STUDY DESIGN: The research was conducted on 7 major electronic databases and 3 gray literature sources. We included randomized trials, nonrandomized clinical trials, and before-and-after studies. The risk of bias (RoB) was assessed by Joanna Briggs Institute of Critical Appraisal Tools. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the certainty of evidence. RESULTS: Qualitative synthesis included 16 surveys reporting data from 620 participants. Canine guidance (CG) was widely searched. Bilateral balanced occlusion (BBO) and CG significantly decreased pain levels compared with the placebo splint. Comparing between OS and absence of therapy, only CG was assessed and showed significant improvements on mouth opening, pain, sleep quality, and muscle activity. When compared different guide types among themselves, no significant improvement was founded in any evaluated outcome. Three studies presented high RoB, 7 presented moderate RoB, and 6 presented low RoB. CONCLUSIONS: It is suggested there is not enough evidence to support that there are any specific kind of guidance responsible for improving evaluated outcomes on TMD and SB.

Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population. MATERIALS AND METHODS: Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses. RESULTS: From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%). CONCLUSIONS: The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR. CLINICAL RELEVANCE: Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.

Obstructive sleep apnea syndrome: how should the dental surgeon proceed? / Apnéia obstrutiva do sono: como o cirurgião-dentista deve proceder?

The aim of this study is to describe a case report of obstructive sleep apnea syndrome and to describe a logical sequence for the treatment of patients who suffer from this disease. Through an interpretation of the polysomnography examination, case history, and clinical examination and by performing cephalometric analysis for sleep apnea, a safe and effective treatment using an intraoral device was indicated. Along these lines, a mandibular advancement device, the Posicionador Luiz Godolfim (PLG), was constructed. After using the device for 4 weeks, the patient underwent another polysomnography, which showed the absence of obstructive sleep apnea. The steps followed for the treatment in this case highlight the importance of and the need for a correct and careful approach for patients with sleep apnea referred to dental office. The approach and sequence presented ensured the success of treatment in this case.

O presente trabalho tem por objetivo relatar um caso clínico diagnosticado como Síndrome da apnéia obstrutiva do sono, e expor uma sequência lógica para o tratamento de pacientes que sofrem desta doença. Através da interpretação do exame de polissonografia, da anamnese, exame clínico e, ainda, por meio da realização do traçado e análise cefalométrica para apnéia do sono, indicou-se de forma segura e efetiva a terapia com aparelho intra-oral. Desta maneira, foi confeccionado um aparelho de avanço mandibular, o PLG. Após quatro semanas de uso do aparelho, o paciente foi encaminhado à realização de uma nova polissonografia, a qual revelou ausência de apnéias obstrutivas durante o sono. As etapas seguidas no tratamento deste estudo de caso destacaram a importância e a necessidade de uma abordagem correta e criteriosa dos casos de pacientes com apnéia do sono encaminhados ao consultório odontológico. A abordagem e sequência apresentadas garantiram o sucesso no tratamento deste estudo de caso.