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.

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.

Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review.

STUDY OBJECTIVES: To evaluate the available evidence on the putative relationships between sleep bruxism (SB) and, obstructive sleep apnea (OSA) to assess the extent of research on this topic, and to formulate suggestions for future research. METHODS: A scoping review including studies examining temporal and overall association and prevalence of SB and OSA was performed. Six main databases and gray literature were searched. The studies selection was conducted by three independent reviewers. A narrative synthesis of the results was carried out. RESULTS: Thirteen studies in adults and eight studies in children were finally included. The median of concomitant conditions prevalence was 39.3% in adults and 26.1% in children. Marked methodological variability was identified among studies in adults and even more when we compared detection methods in children. No significant association between OSA and SB emerged in most studies in adults, while an association may be possible in children. CONCLUSIONS: Based on the current literature, it is not possible to confirm that there is a relationship between SB and OSA in adults. In patients under pediatric care, although this association seems plausible, there is currently insufficient supportive evidence. Standardized validated methodologies for identifying SB should be consistently used in both populations before reaching any conclusion regarding such association. Furthermore, assessment of shared phenotypes between patients with SB and patients with OSA may reveal new insights that will contribute to personalized approaches aiming to optimize the management of such comorbidities.

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.

Incidence of root resorption after concussion, subluxation, lateral luxation, intrusion, and extrusion: a systematic review.

OBJECTIVE: Traumatic dental injuries often affect the dental hard tissues, periodontal tissues, and dental pulp. Root resorption (RR) is a significantly concerning phenomenon that could lead to loss of the traumatized tooth. The purpose of this systematic review was to analyze the incidences of different types of RR after concussion, subluxation, lateral luxation, intrusive luxation, and extrusive luxation. MATERIAL AND METHODS: Seven databases were electronically and manually searched for the identification of observational studies that evaluated the incidence of RR after luxation injuries. Following study selection, data extraction, and risk of bias assessment through MAStARI checklist, the GRADE quality of available evidence was assessed. RESULTS: In total, 14 studies were included in the present systematic review. Ten and four studies presented a moderate and low RoB, respectively, and the overall GRADE quality of evidence was "very low" for all outcomes. The highest incidence rates of RR were observed for teeth with intrusive luxation, followed by those with extrusive luxation, lateral luxation, subluxation, and concussion. In general, the most common type of RR documented for all injuries was inflammatory RR, followed by replacement RR, surface RR, and internal RR. CONCLUSIONS: Our findings suggest that RR most commonly occurs in association with intrusive luxation and by inflammatory RR. Awareness regarding the incidence of RR after injuries is useful for clinicians to minimize the risk and severity of its occurrence, because a late diagnosis of RR may limit treatment alternatives and result in tooth loss. CLINICAL RELEVANCE: Knowledge about the incidence of RR in teeth with concussion and different types of luxation injuries can ensure appropriate follow-up protocols and favorable outcomes.

Prevalence of dentofacial injuries among combat sports practitioners: A systematic review and meta-analysis.

BACKGROUND/AIM: Combat sports might result in injuries to the face and teeth. However, it is unclear how often they occur and which sports presents the highest rates. The aim of this study was to investigate the prevalence of dentofacial injuries in combat sports participants. MATERIAL AND METHODS: A systematic review was performed. Six main electronic databases and three grey literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of dentofacial injuries (teeth, alveolar bone, jaw, lips, and/or cheekbones) among combat sports participants were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The software r statistics version was used to perform all meta-analyses. Cumulative evidence of the included articles was evaluated using GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: From 1104 articles found on all databases, 27 were finally included. Eighteen studies were judged at low, seven at moderate, and two at high risk of bias. The following sports were investigated: boxing, capoeira, fencing, jiu-jitsu, judo, karate, kendo, kickboxing, kung fu, muay thai, sumo, taekwondo, wrestling, and wushu. Results from the meta-analysis suggested a dental pooled prevalence of 25.2% (12.3%-40.8%, i2  = 100%) and dentofacial pooled prevalence of 30.3 (18.1%-44.1%, i2  = 100%). Considering the sports' categories individually, jiu-jitsu had the highest pooled prevalence of dentofacial injuries (52.9% [37.9%-67.8%, i2  = 92%]), while judo was the sport with the lowest pooled prevalence (25.0% [7.6%-48.2%, i2  = 98%]). Among Panamerican sports, boxing had the highest prevalence of dental injuries (73.7% [58.7%-86.3%, i2  = 0%]). For dentofacial injuries, the GRADE criteria were considered low. CONCLUSIONS: Overall pooled prevalence of dentofacial injuries in combat sports was approximately 30%. Raising awareness regarding the frequency of these injuries might encourage the use of protective devices and reduce complications related to these incidents.

Association between obstructive sleep apnea and alcohol, caffeine and tobacco: A meta-analysis.

The aim of this systematic review was to answer the focused question, "Is there an association between obstructive sleep apnea (OSA) and alcohol, caffeine or tobacco use?" Five electronic databases (Cinahl, Literatura Latth American and Caribbean, PubMed, Scopus, Web of Science) and 3 grey literature (Google Acadêmico, ProQuest, OpenGrey) were searched, as well as search on reference list of included papers and contacts with study authors. Observational studies were included. The Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool assessed the potential risk of bias (RoB) among the studies, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach determined the level of evidence. Meta-Analysis was performed with RevMan 5.3 software. Among 3,442 identified studies, 14 were included. Eleven studies were classified as moderate RoB and 3 as high RoB. Meta-analysis showed OSA has no association with tobacco and presented a positive association with alcohol. The odds ratio for OSA increased almost 1.33 times (95% confidence interval [CI]; 1.10-1.62) for alcohol users. There was insufficient published data to evaluate whether OSA is associated with caffeine. The overall quality of evidence ranged from low to very low. OSA was associated with the use of alcohol, however there is not enough evidence to confirm the association with tobacco or caffeine. Due to the very low GRADE level of evidence, caution should be applied when considering these findings.

Effect of temperature and seven storage media on human periodontal ligament fibroblast viability.

BACKGROUND/AIM: Natural resources, such as coconut water, propolis, and egg whites, have been examined as possible storage media for avulsed teeth. However, there is a lack of research focused on the efficacy of these three products together compared with Hank's balanced salt solution and milk. The aim of this study was to evaluate the capacity of seven storage media to maintain the viability of human periodontal ligament fibroblasts (PDLFs). MATERIAL AND METHODS: PDLFs were kept at 5°C and 20°C, in skimmed milk (SMilk), whole milk (WMilk), recently prepared Hank's balanced salt solution (HBSS), Save-A-Tooth® system's HBSS (Save), natural coconut water (Coconut), Propolis, and egg white (Egg) for 3, 6, 24, 48, 72, 96, and 120 h, through the analysis of tetrazolium salt-based colorimetric (MTT) assay. RESULTS: At 5°C, SMilk and WMilk were better than HBSS in maintaining cell viability, from 24 h onward. At 20°C, HBSS was the best storage medium at 96 and 120 h. At both temperatures, from 6 h onward, Coconut, Propolis and Egg were less effective than SMilk, WMilk, and HBSS. In general, the performance of Coconut, Propolis and Egg were not influenced by storage temperature. However, the lowest temperature undermined the effectiveness of HBSS from 24 h and favored SMilk and WMilk, from 96 and 48 h onward, respectively. Save and water were the worst storage media. CONCLUSION: SMilk was the best storage medium, followed by WMilk and HBSS. Coconut, Propolis, and Egg can be indicated for the conservation of PDLF up to 3 h. The lower temperature (5°C) undermined the effectiveness of HBSS and favored SMilk and WMilk.

Assessment of pulp blood flow in primary and permanent teeth using pulse oximetry.

Pulse oximetry (PO) is a well-accepted non-invasive method for assessing vascular health, based on oxygen saturation (SaO(2) ) measurements. The objectives of this study were to design and build a custom-made PO dental sensor holder, to evaluate the effectiveness of PO in determining pulp blood flow in primary and permanent teeth, and to compare the SaO(2) levels obtained in teeth and on the little finger of patients. The PO sensor adapted to the custom-made sensor holder is termed as a device to position and hold the PO sensor. This study evaluated SaO(2) readings obtained in the pulp of 123 teeth of 84 children aged 4-13years. The teeth were divided into three groups: group I - primary teeth: 23 central incisors and 28 canines; group II - permanent teeth: 25 central incisors and 28 canines; and group III - endodontically treated teeth (control): 12 permanent central incisors and seven primary central incisors. The pulp blood flow and SaO(2) were measured and were compared with readings of the patient's finger. Data were analyzed by paired t-tests and Pearson's analysis method. The PO was able to identify all the clinically normal pulps contained in the sample, and all the endodontically treated teeth (controls) showed no response. The mean SaO(2) values were 85.27% in the teeth and 92.85% in the fingers. In conclusion, PO readings were effective in determining pulp blood flow in primary and permanent teeth. However, there was no correlation between the SaO(2) values in the fingers and in the teeth of the patients (P<0.05).

Effect of HBSS storage time on human periodontal ligament fibroblast viability.

Hank's balanced salt solution (HBSS) is recommended for the storage of avulsed teeth. The objective of this study was to evaluate if the HBSS storage time influences its ability to maintain the viability of human periodontal ligament fibroblasts (PDLF) by the analysis of cell metabolic function using MTT assay. PDLF were kept at 20°C for 3, 6, 24, 48, 72, 96 and 120 h in recently prepared HBSS (HBSS), HBSS stored for 6 months (HBSS 6 M), HBSS stored for 12 months (HBSS 12 M), and in Save-A-Tooth system's HBSS (Save). Minimum essential medium (MEM) at 37°C and tap water at 20°C served as positive and negative controls, respectively. Cell viability was determined by the tetrazolium salt-based colorimetric (MTT) assay. Data were statistically analyzed by the Kruskal-Wallis and Scheffé tests (α = 5%). Starting with the 6 h time-point, HBSS was significantly more effective than HBSS 6 M, HBSS 12 M and Save in maintaining cell viability. HBSS 6 M effectiveness was similar to that of HBSS 12 M for up to 48 h, becoming higher at 72 h. In conclusion, the storage time of HBSS had a negative influence on its ability to maintain PDLF viability.