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.

Attitude of Italian dental practitioners toward bruxism assessment and management: A survey-based study.

INTRODUCTION: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. METHODS: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1-Q6); (2) Bruxism frequencies (Q7-Q11); (3) Bruxism assessment (Q12-Q15); (4) Bruxism management (Q16-Q20); (5) Occlusal splints therapy (Q21-Q26). RESULTS: A total of 384 practitioners, including specialists and non-specialists, participated in this survey. The majority of the respondents reported that 1-3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non-instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive-behavioural therapy. CONCLUSION: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management.

BACKGROUND: Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear. OBJECTIVES: The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic. METHODS: The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment. RESULTS: Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations. CONCLUSION: Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

Fatal Complication of Mouthguard Used to Treat Awake Bruxism in Patient with Frontotemporal Dementia.

Awake bruxism is an understudied manifestation of frontotemporal dementia, yet awake bruxism can have fatal consequences in the aging population. This report presents a patient suffering from awake bruxism associated with frontotemporal dementia being treated with a mouthguard, which ultimately becomes lodged in her posterior oropharynx leading to asphyxiation. The case highlights the need for investigation into the occurrence and treatment of awake bruxism among patients with dementia, and the unique risk-benefit analysis that must be performed to develop proper treatment plans for patients with dementia.

[Clinical efficiency of occlusive splints in the treatment of patients with temporomandibular joint dysfunction complicated by bruxism]. / Klinicheskaya effektivnost' okklyuzionnykh shin v lechenii patsientov s disfunktsiei visochno-nizhnechelyustnogo sustava, oslozhnennoi bruksizmom.

OBJECTIVE: Improving the effectiveness of treatment of patients with temporomandibular joint (TMJ) dysfunction complicated by bruxism. MATERIAL AND METHODS: 70 patients with signs of parafunction of the masticatory muscles were selected for the clinical study. The patients were divided into 2 groups of 35 people. Splints were made for patients from the groups using 2 different 3D printing methods. The treatment was monitored using clinical and instrumental studies, electromyography of the muscles themselves and computed tomography of the TMJ after 3, 6 and 12 months. RESULTS: The severity of hypertonicity of the masticatory muscles decreased by the end of 3 months of treatment with the help of repositioning occlusal splints. After 6 months of treatment, the mean BEA decreased in both study groups, but to a lesser extent than in the first 3 months. After wearing a splint after 12 months, the decrease in muscle tone was insignificant. CONCLUSION: The clinical use of positioning splints plays a crucial role in the stabilization of occlusion and is a mandatory stage of complex treatment of patients with pathology of the occlusal-musculoskeletal complex.

3D Printing of Thermoflexible Therapeutic Splints: Treating Bruxism More Comfortably.

Three-dimensional (3D) printing has helped drive rapid and abundant growth in the field of digital dentistry and has been largely spurred on by the development of material innovation. Thermoflexible occlusal splints represent a recent innovation in this area, as they feature a remarkably elastic behavior. Now, practitioners can provide patients with a comfortable, soft, class II medical device generated through a simple digital workflow. This article presents a case report that demonstrates the management of temporomandibular joint disorders by means of a flexible 3D-printed splint. Providing the patient relative comfort while wearing the splint to prevent the negative effects of bruxism helped enhance patient acceptance and compliance. The simple, non-invasive splint fabrication described in this report can be performed by any clinicians willing to incorporate occlusal devices into their digital workflow.

Bruxism in children: What do we know? Narrative Review of the current evidence.

BACKGROUND: Bruxism is a repetitive masticatory muscles activity whose definition is being thoroughly reviewed in recent years. As in adults, two different forms of bruxism exist in children, namely awake and sleep bruxism. Scarcity of data, however,still persists about paediatric bruxism and no clear consensus has been developed. Therefore, the current review overviews the literature on bruxism in children tries to outline the state of art about this condition METHODS: Bruxism affects from 5% to 50% of the worldwide paediatric population. Sleep disturbances, parafunctional habits and psycho-social factors emerged to be the most likely associated factors with paediatric bruxism. Bruxism is characterised by several signs and symptoms variously combined, such as tooth wear and fractures, teeth impressions on soft tissues, temporomandibular disorders, headaches, behavioural and sleep disorders. About diagnosis, the most reliable tool in children remains the report of teeth grinding by parents or caregivers which must be accompanied by oral interview and accurate clinical examination. Electromyography and sleep polysomnography, albeit suitable in the diagnostic process, are not easy-to-use in children and are not strongly recommended. Currently, no evidence exists to support any kind of therapeutic options for bruxism in children. Management should be based on the identification of the underlying condition and conservative approaches are recommendable. CONCLUSION: Notwithstanding the high prevalence, several aspects need to be further assessed in paediatric bruxism. Parental reports are still the most suitable diagnostic tool and conservative approaches are recommended in the management. Bruxism should be considered through a biopsychosocial model, and sleep, personality traits, stress and headaches are the factors towards whom research questions must be addressed to improve diagnosis and management.

Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism.

OBJECTIVE: Occlusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion. METHODS: Sixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter. RESULTS: At teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05). CONCLUSION: Modified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.

Effectiveness of Biofeedback in Individuals with Awake Bruxism Compared to Other Types of Treatment: A Systematic Review.

Excessive masticatory muscle activity is generally present in awake bruxism, which is related to increased anxiety and stress. It has been hypothesized that biofeedback could potentially manage awake bruxism, however, its effectiveness has not been empirically analyzed in a systematic manner. Therefore, this systematic review was designed to determine the effectiveness of biofeedback compared to other therapies in adults with awake bruxism. Extensive searches in five databases looking for randomized controlled trials (RCTs) that included biofeedback to manage awake bruxism were targeted. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2 tool. Overall, four studies were included in this systematic review, all of which used the electromyographic activity of the masticatory muscles during the day and night as the main endpoint. Auditory and visual biofeedback could reduce the excessive level of masticatory muscle activity in a few days of intervention. The majority of the included studies had a high RoB and only one study had a low RoB. The standardization of the biofeedback protocols was also inconsistent, which makes it difficult to establish the ideal protocol for the use of biofeedback in awake bruxism. Thus, it is proposed that future studies seek to reduce methodological risks and obtain more robust samples.

Ultrasonographic and electromyographic evaluation of three types of occlusal splints on masticatory muscle activity, thickness, and length in patients with bruxism.

OBJECTIVE: To evaluate occlusal splint type differences in patients with bruxism. METHODS: Seventeen controls and 51 patients were divided into three subgroups, each assigned to use a different occlusal splint (hard, soft, or semi-soft) for 3 months and assessed by ultrasonography and electromyography (EMG) before (BT) and 3 months after treatment (AT). RESULTS: EMG values in all of the occlusal splint groups were significantly lower AT than BT (p < 0.05). BT and AT EMG values in the control group did not differ. Mean muscle thicknesses in bruxism patients was greater than in controls, and the greatest muscle thickness changes occurred with the hard occlusal splint (p < 0.05). DISCUSSION: A decrease in EMG activity occurred with all three splint types and was most prominent in the hard occlusal splint group. Ultrasonographic measurements of muscle length and thickness should be used alongside EMG to measure muscle activity in bruxism patients.

Common therapeutic approaches in sleep and awake bruxism - an overview.

Bruxism, a common medical condition characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, can occur during sleep, when it is known as sleep bruxism (SB), or during wakefulness, when it is known as awake bruxism (AB). Although bruxism often causes headaches, temporomandibular joint pain, masticatory muscle pain, mechanical tooth wear, prosthodontic complications and cracked teeth, there is still not enough data to define and support a standardised approach to its treatment. The aim of this review was to present the pathophysiology, consequences, types and treatment methods of bruxism in order to increase readers' knowledge of this topic. Differences between awake and nocturnal bruxism are included, as well as risk factors and indicators visible during the clinical examination of affected patients. Among the causes we consider are genetics, stress, oral parafunctions and changes in the Central Nervous System (CNS). Potential and common methods of treatment are presented, along with suggested guidelines that should be followed when determining an appropriate treatment method. We draw attention to the notably dynamic development of bruxism in today's society and the importance of informational and preventive projects, especially those targeted at high-risk patients as well as those targeted at specialists, in order to better tackle the bruxism 'epidemic'.

Masseter Muscle Thickness And Elasticity in Bruxism After Exercise Treatment: A Comparison Trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of Rocabado's 6 × 6 exercises on masseter muscle thickness, muscle elasticity, and pain scores in patients with bruxism. METHODS: A total of 58 participants with bruxism were divided into 2 groups as the exercise group (EG) and control group (CG). A self-care program was applied for the participants in the CG. For those in the EG, in addition to the self-care program, an exercise treatment was performed for 6 days per week for a total of 8 weeks. Using ultrasonography, bilateral masseter muscle thickness and elasticity were assessed before and after treatment. Pain was measured using a visual analog scale. Changes over time within the groups and group-time interactions for continuous variables were assessed using mixed 2-way repeated measures analysis of variance. RESULTS: The improvement in muscle elasticity (P = .015; P = .004) and pain values (P = .049; P = .040) were greater in the EG compared with the CG. There was no significant difference between the 2 groups for masseter muscle thickness (P > .05). CONCLUSION: This study suggests that Rocabado's 6 × 6 exercises are effective in the treatment of muscle elasticity and pain values in participants with bruxism.

The dental demolition derby: bruxism and its impact - part 2: early management of bruxism.

Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, the behaviour leads to significant problems and extensive tissue damage. This is different to temporomandibular disorders. This paper will review methods of managing cases where bruxism is destructive, or potentially destructive, before needing to resort to full reconstruction.

The dental demolition derby: bruxism and its impact - part 1: background.

Bruxism may lead to changes or damage to the oral and perioral tissues. Bruxism may occur during sleep or when awake. Many patients will not require active management; however, for some, intervention is required. Control of bruxism may be difficult, if not impossible, but the need exists for preservation of the dentition and quality of life. A prediction of risk to the tissues for the planning of interventions is difficult and relies upon evidence of past damage and assessment of future risks. Treatment options may need to be imaginative and rescuable. This series of papers will review the aetiology of bruxism, its impacts and treatment strategies for persistent bruxers who are at risk of, or suffering, tissue damage.

Apical periodontitis after intense bruxism.

BACKGROUND: Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. CASE PRESENTATION: This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. CONCLUSIONS: Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

Short-term Effects of a First-Line Treatment Including Counseling and Self-Management Strategies on Chronic TMD Muscle Pain and Awake Bruxism in Women.

AIMS: To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment. METHODS: FL-A was administered to 14 women with chronic mTMD (mean age ± SD = 33.8 ± 11.1 years; 8 with Graded Chronic Pain Scale [GCPS] grade I and 6 with grade II). Its effects on facial pain, masticatory muscle tenderness, and spontaneous awake bruxism episodes were evaluated using questionnaires, surface electromyography, and quantitative sensory testing. General linear models were used to test FL-A efficacy after 1 (T1) and 2 (T2) months. RESULTS: FL-A reduced pain (from baseline [T0] to T2, P = .010), the frequency of awake bruxism episodes (T0 to T1, P = .024), and their intensity by about 30% (T0 to T1, P < .001). Pressure pain thresholds at the masticatory muscle locations increased significantly from T0 to T2 (P < .001). Patients' trait anxiety decreased significantly from T0 to T2 (P = .030). Trait anxiety measured at baseline was not correlated with relative changes in pain (T0 to T2, P = .248). CONCLUSION: In the short term, FL-A reduces facial pain, masticatory muscle tenderness, and awake bruxism in women with chronic mTMD with low disability. A conservative management strategy should be prioritized for the initial management of these patients.

Valoración del tratamiento del bruxismo mediante toxina botulínica / Assessment of the treatment of bruxism by botulinum toxin

El bruxismo se caracteriza por ser una actividad relacionada la activación de los músculos masticatorios de forma repetitiva y habitualmente durante el sueño. La relevancia de esta entidad reside en su asociación con erosiones y movilidad dentarias, fracturas dentales, mialgia e hipertrofia del músculo masetero y o artralgia característica. Si bien de etiología no clara se relaciona con multitud de factores fisiopatológicos. En la actualidad existen multitud de líneas de tratamiento para este problema de salud, tales como: terapia cognitivo-conductual, férulas de oclusión o de descarga, opciones farmacológicas como benzodiacepinas, y dopamina. Estas medidas habitualmente sirven como manejo de los signos y síntomas derivados del bruxismo, pero la eficacia de todas ella no es total. Actualmente, ante la necesidad de búsqueda de otras opciones terapéuticas al problema del bruxismo, múltiples ensayos han centrado su atención en la utilización de la toxina botulínica como alternativa, teniendo en cuenta su eficacia para una amplia variedad de patologías médicas y estéticas.El objetivo de esta puesta al día es actualizar el conocimiento a fecha actual de la evidencia existente acerca de la utilización de la toxina botulínica en el tratamiento del bruxismo. Para ello se seleccionan las revisiones sistemáticas existentes que incluyen los principales ensayos clínicos aleatorizados disponibles.Método: Revisión bibliográfica en las principales bases de datos utilizando las palabras “bruxismo” y/o “toxina botulínica” Resultados: Tras el análisis de las diferentes revisiones podemos decir que todos los resultados apuntan en la misma dirección: que las inyecciones de toxina botulínica en el masetero y / o los músculos temporales pueden ser una opción de tratamiento válida en pacientes con bruxismo, ya que pueden mejorar la calidad de vida.(AU)

Bruxism is characterized by being an activity related to the activation of the chewing muscles repeatedly and usually during sleep. The relevance of this entity resides in its association with tooth erosions and mobility, dental fractures, myalgia and hypertrophy of the masseter muscle and or characteristic arthralgia. Although its etiology is not clear, it is related to a multitude of pathophysiological factors. Currently there are many lines of treatment for this health problem, such as: cognitive-behavioral therapy, occlusion or discharge splints, pharmacological options such as benzodiazepines, and dopamine. These measures usually serve to manage the signs and symptoms derived from bruxism, but the effectiveness of all of them is not total. Currently, faced with the need to search for other therapeutic options for the problem of bruxism, multiple trials have focused their attention on the use of botulinum toxin as an alternative, taking into account its efficacy for a wide variety of medical and aesthetic pathologies. The objective of this update is to update the knowledge to date of the existing evidence about the use of botulinum toxin in the treatment of bruxism. For this, the existing systematic reviews that include the main available randomized clinical trials are selected. Method: Bibliographic review in the main databases using the words "bruxism" and / or "botulinum toxin" Results: After the analysis of the different reviews we can say that all the results point in the same direction: that botulinum toxin injections in the masseter and / or temporal muscles can be a valid treatment option in patients with bruxism, since they can improve the quality of life. With the exception of the systematic review by Ågren et al, 28 who do not see evidence through the tests that record electromyographic activity and bite force to recommend the use of botulinum toxin as a treatment for bruxism at the present time.(AU)

Procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba / Interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba

Fundamento: el enfoque científico del bruxismo resulta, en no pocas ocasiones, incongruente y obedece en lo particular a tres aspectos pendientes para la ciencia en el siglo XXI. Primero la ausencia de esquemas diagnósticos y terapéuticos definitivos, segundo la necesidad del empleo de específicos y depurados métodos de evaluación epidemiológica y clínica. Por último la integración tangente y activa de los profesionales de las Ciencias Médicas para desarrollar en un orden secuencial documentos científicos. Objetivo: diseñar un protocolo de procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba. Métodos: se realizó una investigación de desarrollo en el período de marzo de 2019 a marzo de 2020. Se conformó el universo del grupo de trabajo por nueve estomatólogos de alta especialización y el universo de investigaciones lo integraron 41, de ellas con una subsiguiente muestra de 19 investigaciones, destacadas por sus aportes y fortalezas con relación a la integración interdisciplinaria, seleccionadas por muestreo intencional. Se estructuró el documento en tres acápites que desglosan momentos, acciones específicas y condicionantes conformes a la valoración del grupo de trabajo; a través de la técnica de consenso del grupo nominal. Resultados:se establecieron consultas de evolución periódicas, valoración por etapas y procedimientos terapéuticos. Además procedimientos clínicos interdisciplinarios, según el momento de integración médica que se precisa. Se asumió el diagnóstico integral del bruxismo desde un concepto sistémico-neurológico. Conclusiones: se diseñó un documento científico que protocoliza procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba (AU)

Background: the scientific approach to bruxism is, on many occasions, incongruous and obeys in particular three pending aspects for science in the 21st century. Firstly, the absence of definitive diagnostic and therapeutic schemes, secondly, the need to use specific and refined epidemiological and clinical evaluation methods. Finally, the tangent and active integration of professionals in Medical Sciences to develop scientific documents in a sequential order. Objective: to design a protocol of interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba. Methods: a development research was carried out in the period from March 2019 to March 2020. The universe of the work group was formed by nine highly specialized dentists and the universe of investigations was made up of 41 of them with a subsequent sample of 19 researches, highlighted by its contributions and strengths in relation to interdisciplinary integration, selected by intentional sampling. The document was structured into three sections that break down moments, specific actions and conditioning factors in accordance with the assessment of the working group; through the nominal group consensus technique.Results: periodic evolution consultations were established, assessment by stages and therapeutic procedures. Besides interdisciplinary clinical procedures, according to the time of medical integration that is required. It was assumed the comprehensive diagnosis of bruxism from a systemic-neurological concept. Conclusions: a scientific document was designed that protocolizes interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba (AU)

Electromyography of diurnal bruxism during assessment and treatment.

Diurnal bruxism among individuals with intellectual disabilities is often measured on the basis of its auditory products, thereby precluding the contingent presentation of stimuli during silent bruxism events. Electromyography (EMG) offers a technological solution to the identification of all bruxism events. EMG has not been previously evaluated in nonvocal clients with intellectual disabilities in the context of functional analysis and treatment. In the current series of analyses, we suggest a set of methods to implement EMG technology with this population. In Analysis 1, we propose a strategy for systematically identifying bruxism events. In Analysis 2 we evaluate an EMG staff-training package with naïve interventionists without past experience with EMG technology. Finally, Analysis 3 presents a practical example of this method during the functional analysis and treatment of a client with frequent diurnal bruxism.

One year into the COVID-19 pandemic - temporomandibular disorders and bruxism: What we have learned and what we can do to improve our manner of treatment.

The coronavirus disease 2019 (COVID-19) pandemic has drastically changed the routine way of life and challenged the ways in which health and dental services are provided. During the 1st lockdown, practiced in most of the countries, routine dental procedures were suspended. Even after the lockdown was eased, visiting crowded dental clinics was still considered health-threatening, especially among populations at high risk of developing a severe reaction to COVID-19. Regretfully, in most cases, temporomandibular disorders (TMD) and bruxism were not included under the definition of emergency, leaving many patients without the possibility of consulting their dentists. A literature search, performed about 10 months after the declaration of the pandemic, found only a few studies dealing with TMD and bruxism during COVID-19. Most of the studies indicate adverse effects on subjects' psycho-emotional status (stress, anxiety, depression), which in turn lead to the intensification of subjects' TMD and bruxism symptoms, and increased orofacial pain. Unlike other oral pathologies, which require manual interventions, chronic orofacial pain can be addressed, at least at its initial stage, through teledentistry and/or consultation. Remote first aid for patients suffering from orofacial pain includes various kinds of treatment, such as the self-massage of tense and painful areas, stretching, thermotherapy, drug therapy, relaxation techniques, meditation, and mindfulness, all of which can be administered through the phone and/or the Internet. Relevant legal and ethical issues should be considered while using remote modes for the triage, diagnosis and treatment of chronic orofacial pain patients.