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Objective: This paper aims to present and describe the Standardised Tool for the Assessment of Bruxism (STAB), an instrument that was developed to provide a multidimensional evaluation of bruxism status, comorbid conditions, aetiology and consequences., Methods: The rationale for creating the tool and the road map that led to the selection of items included in the STAB has been discussed in previous publications., Results: The tool consists of two axes, specifically dedicated to the evaluation of bruxism status and consequences (Axis A) and of bruxism risk and etiological factors and comorbid conditions (Axis B). The tool includes 14 domains, accounting for a total of 66 items. Axis A includes the self-reported information on bruxism status and possible consequences (subject-based report) together with the clinical (examiner report) and instrumental (technology report) assessment. The Subject-Based Assessment (SBA) includes domains on Sleep Bruxism (A1), Awake Bruxism (A2) and Patient's Complaints (A3), with information based on patients' self-report. The Clinically Based Assessment (CBA) includes domains on Joints and Muscles (A4), Intra- and Extra-Oral Tissues (A5) and Teeth and Restorations (A6), based on information collected by an examiner. The Instrumentally Based Assessment (IBA) includes domains on Sleep Bruxism (A7), Awake Bruxism (A8) and the use of Additional Instruments (A9), based on the information gathered with the use of technological devices. Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid association with bruxism. It includes domains on Psychosocial Assessment (B1), Concurrent Sleep-related Conditions Assessment (B2), Concurrent Non-Sleep Conditions Assessment (B3), Prescribed Medications and Use of Substances Assessment (B4) and Additional Factors Assessment (B5). As a rule, whenever possible, existing instruments, either in full or partial form (i.e. specific subscales), are included. A user's guide for scoring the different items is also provided to ease administration., Conclusions: The instrument is now ready for on-field testing and further refinement. It can be anticipated that it will help in collecting data on bruxism in such a comprehensive way to have an impact on several clinical and research fields., (© 2023 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

To date, no comprehensive marker to monitor the immune status of patients is available. Given that Torque teno virus (TTV), a known human virome component, has previously been identified as a marker of immunocompetence, it was retrospectively investigated whether TTV viral load may also represent a marker of ability to develop antibody in response to COVID-19-BNT162B2 vaccine in solid organ transplant recipients (SOT). Specifically, 273 samples from 146 kidney and 26 lung transplant recipients after successive doses of vaccine were analyzed. An inverse correlation was observed within the TTV copy number and anti-Spike IgG antibody titer with a progressive decrease in viremia the further away from the transplant date. Analyzing the data obtained after the second dose, a significant difference in TTV copy number between responsive and nonresponsive patients was observed, considering a 5 log 10 TTV copies/mL threshold to discriminate between the two groups. Moreover, for 86 patients followed in their response to the second and third vaccination doses a 6 log 10 TTV copies/mL threshold was used to predict responsivity to the booster dose. Although further investigation is necessary, possibly extending the analysis to other patient categories, this study suggests that TTV can be used as a good marker of vaccine response in transplant patients., (© 2023 The Authors. Journal of Medical Virology published by Wiley Periodicals LLC.)

The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self-reported questionnaire-based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One-hundred-fifty-nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism-related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of φ coefficient. The highest correlations were achieved for the sleep grinding referral item (φ = 0·932) and for the awake clenching item (φ = 0·811), whilst lower correlation values were found for the other items (φ values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self-reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep-time activities., (© 2013 John Wiley & Sons Ltd.)

Aims: To perform a systematic review of the literature dealing with the prevalence of bruxism in adult populations., Methods: A systematic search of the medical literature was performed to identify all peer-reviewed English-language papers dealing with the prevalence assessment of either awake or sleep bruxism at the general population level by the adoption of questionnaires, clinical assessments, and polysomnographic (PSG) or electromyographic (EMG) recordings. Quality assessment of the reviewed papers was performed according to the Methodological evaluation of Observational REsearch (MORE) checklist, which enables the identification of flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. For each included study, the sample features, diagnostic strategy, and prevalence of bruxism in relation to age, sex, and circadian rhythm, if available, were recorded., Results: Thirty-five publications were included in the review. Several methodological problems limited the external validity of findings in most studies, and prevalence data extraction was performed only on seven papers. Of those, only one paper had a flaw less external validity, whilst internal validity was low in all the selected papers due to their self-reported bruxism diagnosis alone, mainly based on only one or two questionnaire items. No epidemiologic data were available from studies adopting other diagnostic strategies (eg, PSG, EMG). Generically identified "bruxism" was assessed in two studies reporting an 8% to 31.4% prevalence, awake bruxism was investigated in two studies describing a 22.1% to 31% prevalence, and prevalence of sleep bruxism was found to be more consistent across the three studies investigating the report of "frequent" bruxism (12.8% ± 3.1%). Bruxism activities were found to be unrelated to sex, and a decrease with age was described in elderly people., Conclusion: The present systematic review described variable prevalence data for bruxism activities. Findings must be interpreted with caution due to the poor methodological quality of the reviewed literature and to potential diagnostic bias related with having to rely on an individual's self-report of bruxism.

Objective: The purpose of this study was to determine the prevalence of temporomandibular joint disk displacement in infants and young children., Study Design: Magnetic resonance images were obtained of the temporomandibular joints in 30 infants and young children ranging in age from 2 months to 5 years (median age, 3 years; mean age, 2.5 years)., Results: All joints had normal superior disk position. The computed 95% confidence interval was 0.00-0.06, which implies a minimal probability that disk displacement would occur in this age group., Conclusions: The result contradicts previous suggestions that temporomandibular joint disk displacement could represent a congenital normal anatomic variant.

Objective: The aim of this study was to test the hypotheses that incidence of symptomatic temporomandibular joint disk displacement is evenly distributed over all ages and between genders and that there is no gender difference in pain perception., Study Design: The study population consisted of 248 consecutive patients with radiographically verified symptomatic temporomandibular joint disk displacement. The time of onset of the condition relative to age and gender was determined, as was pain level., Results: There was a statistically significant peak in incidence of symptomatic temporomandibular joint disk displacement during adolescence for both genders. Teenage girls were found to run a risk of developing disk displacement that is three times greater than the risk for teenage boys, and girls were found to run a risk during puberty that is four times greater than their risk later in life. The age at onset of the condition did not differ between genders. Both female and male subjects reported the same degree of pain level., Conclusion: The results point to a teenage preponderance and a sexual dimorphism with respect to incidence of symptomatic temporomandibular joint disk displacement.

Objective: The purpose of this study was to compare structural variations of the temporomandibular joint anatomy between symptomatic patients with temporomandibular joint dysfunction and asymptomatic controls., Study Design: There were 74 symptomatic patients with temporomandibular joint dysfunction, 29 asymptomatic volunteers with normal joints, and 6 asymptomatic volunteers with disk displacement with reduction included in this study. All subjects had bilateral high resolution magnetic resonance imaging scans performed in the sagittal (closed and opened) and coronal (closed) positions. All subjects had right and left full profile laminagraphs, one in the centric occlusal position, and one with the incisors edge to edge., Results: Student-Newman-Keuls tests demonstrated no significant angular or linear differences for depth of the articular fossa, angle of the articular eminence, horizontal and vertical overlap of the incisor teeth, and linear condylar translation., Conclusion: This study concludes that there are no significant differences in angular and linear measurements in the articular fossa of asymptomatic volunteers and symptomatic subjects with temporomandibular joint dysfunction.

There is a general assumption that temporomandibular disorders and the pain and tenderness of mastication muscles may be caused by hyperactivity. Five asymptomatic men, five asymptomatic women, and five women with temporomandibular disorders participated in this study. Multiple examinations were performed to provide information concerning the reproducibility of the rest electromyographic signals. No significant differences between groups were noted. This study supports the contention that the mean rest activity in women with pain and dysfunction is less than or equal to that of sex-matched controls.

Axiography may be useful in the evaluation of condyle motion and the effects of internal derangements on this motion. Fifty-one patients were selected by one investigator (RHT) to provide a representative sample of asymptomatic and symptomatic subjects for the following categories: (1) normal disk position, (2) disk displacement with reduction, (3) disk displacement without reduction and (4) disk displacement without reduction associated with degenerative joint disease. Axiography was performed by a separate investigator (KGP) in a blinded fashion. The diagnosis of the presence of internal derangement was based on the tracings only. All subjects had bilateral magnetic resonance imaging scans to evaluate for the presence or absence of internal derangement. The diagnostic sensitivity was 0.64, which indicated that axiography is marginal at identifying disease when present. The negative predictive value was 0.78, which indicated that axiography is accurate in the detection of normal disk condyle relationship.

In clinical work we have observed decreased signal intensity from the retrodiskal tissue in some patients with temporomandibular joint disk displacement. The frequency and clinical significance of this observation is unknown. To document the frequency and to assess its clinical significance we analyzed magnetic resonance images of the temporomandibular joints of 69 patients with temporomandibular joint displacement and 28 asymptomatic volunteers. All the subjects had a clinical examination, and their level of pain was recorded. Decreased signal intensity from the retrodiskal tissue was seen in 16 joints in the patients (12%). None of the asymptomatic volunteers exhibited this feature. It was seen in one joint with disk displacement with reduction, in nine joints with disk displacement without reduction, and in six joints with disk displacement without reduction and arthrosis. It was not seen in any joint with superior disk position. We could not appreciate an association between the decreased signal intensity from the retrodiskal tissue and the level of pain because this feature was seen in both painfree and painful joints. It was concluded that decreased signal intensity from the retrodiskal tissue was most frequently associated with later stages of disk displacement and its clinical significance remains unclear because there was no appreciable correlation to patient symptoms of pain.

This study investigated the accuracy of clinical examination in determining the status of the temporomandibular joint with respect to internal derangement and arthrosis. A series of 110 patients was given standard clinical examinations followed by bilateral imaging with arthrography and/or magnetic resonance imaging. There was agreement between the clinical diagnosis and the imaging finding in 95 joints (43%). In the other 125 joints (57%), the clinical diagnosis did not agree with imaging findings. There were false-positive clinical diagnoses in 39 joints and false-negative clinical diagnoses in 31 joints. In the other 55 joints the clinical diagnosis correctly indicated that the joint was abnormal but was incorrect about the stage of abnormality. On the basis of the overall diagnostic accuracy of 43%, it was concluded that a clinical examination is not reliable for determining the status of the joint in patients with signs and symptoms of temporomandibular joint internal derangement.

To determine the prevalence of temporomandibular joint internal derangement in patients with signs and symptoms of craniomandibular disorders, bilateral imaging was performed in a consecutive series of 115 patients with signs and symptoms of craniomandibular disorders. Ninety patients (78%) had different stages of unilateral or bilateral internal derangement, and 25 patients (22%) had normal temporomandibular joints bilaterally. Out of 230 joints, 60 showed disk displacement with reduction, 8 showed disk displacement without reduction, and 29 showed disk displacement without reduction associated with anthrosis. The study indicates that almost 80% of patients with signs and symptoms of craniomandibular disorders have different forms of internal derangement.

In an attempt to better understand the cause of different types of temporomandibular joint (TMJ) sounds, we recorded joint sounds from 27 fresh autopsy specimens, displayed the time frequency distribution of the sound as a three-dimensional graph, and correlated the sound character to morphologic observations at subsequent dissection. Eleven joints elicited sounds, and 16 joints were silent. All joints with sounds had different degrees of intraarticular changes. These ranged from disk displacement with reduction to displacement without reduction and arthrosis of the articular surfaces. Reciprocal clicking occurred both in joints with disk displacement with and without reduction, as well as in joints with arthrotic changes. Crepitation only occurred in joints with arthrosis and perforation. The sample was too small to demonstrate any statistically significant association between the joint sound classified as clicking or crepitation and joint structure types of joint pathosis in this small sample. A high frequency component to the sound appeared to be associated with arthrosis of the articular surfaces. It was concluded that joint sounds indicate joint abnormality but that the absence of joint sound does not exclude intraarticular pathosis.

To determine if the quality of spin-echo magnetic resonance (MR) images of the temporomandibular joint (TMJ) could be improved by reducing section thickness, coronal and sagittal 3.0- and 1.5-mm MR images of the same joints were evaluated. Depiction of the disk, trabecular pattern, and cortex of the condyle was better on coronal 1.5-mm images than on 3.0-mm images (P less than .01), and 1.5-mm sagittal images were better for depiction of the trabecular pattern of the condyle than were 3.0-mm images (P less than .05). The ability of MR imaging with thinner sections to reveal more anatomic details should result in improved diagnostic accuracy.

Thirty healthy geriatric subjects were studied during a single night of sleep in a sleep laboratory. Unilateral masseter muscle activity was recorded in addition to the standard polysomnographic study. The geriatric subjects in this study exhibited fewer bruxing events than other subjects reported in the literature. Certain conditions that have not been previously investigated, such as sleep position, type of bruxing event, and relationship to the state of the dentition, are reported.

Parafunctional activity (toothgrinding, toothclenching and bruxism) is a common problem which may lead to masticatory muscle and temporomandibular joint pain, and may result from sleep arousal or disturbances. Sleep apnea is another common sleep disorder which results in disrupted sleep architecture and frequent arousals. Because sleep apnea leads to sleep arousals, and because sleep arousals are thought to result in increased parafunctional activity, we undertook the present study to determine the relationship between sleep apnea and parafunctional activity. We were also interested in assessing the effects of sleep posture on sleep disordered breathing and parafunctional activity. We prospectively studied 24 patients who were referred to the clinical sleep apnea laboratory for study. They underwent standard nocturnal polysomnographic examination; in addition, masticatory activity was measured with a masseter electromyogram. Patients slept in the supine and lateral decubitus positions. Nocturnal clenching was slightly higher in patients with sleep apnea than those without (12.2 vs 7.6 clenches/hr, p = 0.18), and there was a correlation between the clench index (CI) and apnea plus hypopnea index (A + HI) by linear regression (r = 0.49, p less than 0.05). There were significant falls in both the A + HI (64.4 +/- 28.8 vs 36.5 +/- 36.7, p = 0.02) and CI (12.5 +/- 12.1 vs 7.0 +/- 8.6, p = 0.04) in the lateral decubitus vs supine sleeping positions. We conclude that there is an association between obstructive sleep apnea and parafunctional activity, that sleep position affects the incidence of both sleep disordered breathing and parafunctional activity, and that analysis of apneas and hypopneas in both supine and lateral decubitus sleeping positions may be helpful.