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Background: The demand for orthodontic treatment with aligners has recently increased, but their effects on awake bruxism (AB) behaviours have to be evaluated yet. Objectives: This investigation assessed if aligners can affect oral behaviours (i.e. tooth contact, teeth clenching, teeth grinding and mandible bracing) that are related with the AB spectrum. Methods: The investigation was performed in a sample of 32 consecutively recruited healthy adult patients who required orthodontic treatment. The study protocol involved three different sessions of 1‐week monitoring without aligners, with passive aligners and with active aligners, respectively. All patients underwent an orthodontic treatment with aligners and used a smartphone‐based application for a real‐time report (i.e. ecological momentary assessment [EMA]) of their AB behaviours. Recording time was set from 8.00 to 12.30 and from 14.30 to 22.00. Analysis of variance (ANOVA) was used to compare the average reported frequency for each activity within and between the different sessions. The coefficient of variation (CV) was assessed to evaluate daily fluctuations within the 7 days monitoring periods. Results: The average reported frequency of the relaxed condition was 64.9%, 63.0% and 60.0% during the sessions without aligners, with passive aligners and with active aligners, respectively. ANOVA showed no significant differences in any of the AB behaviours within (i.e. between 7 days of evaluation) and between the monitoring sessions (i.e. before orthodontic treatment, with passive aligners, with active aligners). No sex differences were detected, except for the 'tooth contact' report that showed a higher frequency in females. Conclusion: The impact of our results in the orthodontic field is not negligible; clinicians can find support for the hypothesis that from a global point of view, wearing or not wearing aligners (passive and/or active) does not influence the frequency of AB behaviours at the short term. [ABSTRACT FROM AUTHOR]

Background: Bruxism is a masticatory muscle activity occurring during sleep or wakefulness, involving grinding and clenching of teeth and/or jaw bracing. As yet, the aetiology, epidemiology and consequences of awake bruxism (AB) are largely unknown. Objectives: The aims of the study were to AB behaviours using a novel bruxism screener (BruxScreen) questionnaire part and Ecological Momentary Assessment (EMA; BruxApp©) on AB behaviours, and to investigate AB's prevalence among masticatory muscle myalgia patients and non‐patients. Methods: Altogether, 115 participants (masticatory myalgia patients referred to a specialist clinic (n = 67) and non‐patients (n = 46)) filled in a bruxism screener questionnaire to report bruxism behaviours and jaw symptoms. A selection of both groups did a week‐long EMA (patients n = 12, non‐patients n = 11) to report AB behaviours. The chi‐squared test was used to determine group differences in categorical variables. A logistic regression model was fitted to study the probability of AB. Results: According to BruxScreen, bruxism behaviours and jaw symptoms were more frequent in patients than in non‐patients (p <.001). Based on EMA, 14.6% of the behaviour in patients was tooth clenching; for non‐patients, this was 0.5% (p <.000). Relaxed muscles were reported by patients and non‐patients at 20.6% and 56.4%, respectively (p <.021). Logistic regression, adjusted by age and sex, revealed that patients reported AB 5 times more often than non‐patients (OR 4.8, 95% CI 2.1–11.2). Conclusion: Awake bruxism behaviours are significantly more frequent in masticatory muscle myalgia patients than non‐patients and associate with frequent bruxism‐related symptoms. Self‐reported teeth clenching seems to be the most significant sign of AB behaviour. [ABSTRACT FROM AUTHOR]

This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on‐field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject‐based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self‐reported information on bruxism status and potential consequences (subject‐based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self‐reported information (subject‐based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article offers a perspective on the past, present and future of bruxism research. It looks back at bruxism research before 1996 and outlines developments on bruxism research during the past 25 years including better design of studies, global spread of the geographical origin of publications, emerging consensus on the definition and assessment of bruxism, and paradigm shift on the link of bruxism with negative health outcome. It looks forward to bruxism research on special needs populations.

Background: The association of sleep bruxism with mortality has not been studied. Objectives: Altogether 12 040 subjects from the nationwide Finnish twin cohort were included in the analyses. We examined whether self‐reported sleep bruxism is associated with increased risk of mortality, and if so, whether the effect is independent of known common risk factors. The time span of the follow‐up was 30 years. Methods: Cox proportional hazards regression models (Hazard Ratios and their 95% Confidence Intervals) adjusted by age, sex and covariates were used to assess the effect of baseline bruxism status in 1990 on future mortality in 1990–2020. Results: The risk of mortality among all participants (n = 12 040), independent of missing covariates and adjusted by age and sex, was 40% higher in weekly bruxers than in never bruxers (HR 1.40, 95% CI 1.16–1.68, p <.001). However, when adjusted by all studied covariates, (n = 11 427) the risk was no longer observed (HR 1.04, 95% CI 0.86–1.25, p =.717). Despite the overall lack of between bruxism and mortality after adjustment for covariates, we examined the cause‐specific risks for major cause‐of‐death groups. There were no substantial associations of weekly bruxism with major disease outcomes by the fully adjusted hazard ratios for them. Conclusion: Bruxism does not kill—in line with its definition of being rather a behaviour (with all its phenotypes) than a disease. [ABSTRACT FROM AUTHOR]

Background: To assess awake and sleep bruxism, the Standardised Tool for the Assessment of Bruxism (STAB) is currently being developed. The STAB will be a comprehensive tool for the detailed assessment of bruxism behaviour itself as well as of its possible consequences, causes, and comorbid conditions. Objective: Since the STAB cannot fully meet the 'A4 principle' for a bruxism assessment tool, i.e., being Accurate (reliable and valid), Applicable (feasible), Affordable (cost‐effective), and Accessible (suitable for everyday clinical use), the Bruxism Screener (BruxScreen) has been developed to be used in large‐scale epidemiological research projects and, especially, in general, dental practices. Methods: The BruxScreen consists of two parts: a questionnaire (BruxScreen‐Q) to be completed by patients, and a clinical assessment form (BruxScreen‐C) to be completed by dentists. Results: This paper describes the development of the BruxScreen and provides the outcomes of the pilot testing phase and the face validity assessment (i.e. that the first impressions of the tool indicate that it adequately reflects the construct to be measured). Conclusion: The resulting BruxScreen is considered ready for more profound psychometric testing in the general dental setting. [ABSTRACT FROM AUTHOR]

Background: Recently, the Standardized Tool for the Assessment of Bruxism (STAB) and the bruxism screener (BruxScreen) have been developed for use in research and clinical settings. Objective: As to ascertain high‐quality use of both instruments worldwide, it was our aim to develop a guideline for the translation and cultural adaptation of the STAB and the BruxScreen. Methods and Results: This paper describes a 12‐step guideline for the translation and cultural adaptation of the STAB and the BruxScreen. A format of a translation log is provided as well. Besides, a website has been created for the guidance of translation teams. Conclusion: Following the 12 steps, new language versions of the STAB and the BruxScreen will be ready for further testing (reliability, validity, responsiveness and interpretability) and, ultimately, application in research and clinics around the world. [ABSTRACT FROM AUTHOR]

Background: Tooth wear is a multifactorial complex process related to the loss of dental tissue, due to chemical or mechanical processes, by abrasion, attrition, erosion. Restorative treatment represents an attempt to rebuild and recreate the lost structure. Objective: This scoping review aims to investigate whether restorative treatment of worn dentition (either with direct or indirect adhesive composite adhesive procedures or with prosthetic techniques) can have an impact on the masticatory performance parameters. Methods: A scoping review was conducted on multiple databases (Pubmed, Medline CENTRAL, ICTRP), following the PRISMA guidelines. Abstracts of research papers were screened for suitability, and full‐text articles were obtained for those who satisfied the inclusion and exclusion criteria. Results: Only one article meet the inclusion criteria of the review. Restorative treatment of worn dentition although have a positive impact on the self‐report ability to chew, has no effect on the masticatory performance test. Conclusion: At the moment, not enough evidence to comment on the actual therapeutic role of restorative treatment on tooth wear is available. Clinicians, before taking any clinical decision, should carefully discuss with patients the needs and expectations of the treatment plan. [ABSTRACT FROM AUTHOR]

Background: Together with psychosocial and hereditary factors, bruxism is a possible risk factor for orofacial pain. Bruxism is defined as a masticatory muscle activity characterized by repetitive or sustained tooth contact, or by bracing or thrusting of the mandible. A smartphone application to report awake bruxism (AB) has been developed and translated into more than 25 languages. Objective(s): To translate the application into Swedish, adapt it to Swedish culture and conduct a study to evaluate the usability of the application for studies on family history and associated risk factors. Methods: Translation and cultural adaption of the Swedish version of the application (BruxApp) was carried out in a four‐step sequential process. Ten young adults (22–30 years) were recruited together with ten parents (42–67 years) and reported their AB with the application over two seven‐day periods. Pain, stress and parafunctional behaviours were assessed by questionnaires. Results: The back translation check showed minimal discrepancies between the translation and the English version. Participants did not report any problems with the application. Response rates for both groups were 65%. A difference in frequency of AB was shown between young adults and parents (22.0% vs. 12.5%, p <.001). A positive moderate correlation was found between AB and stress (r = 0.54, p =.017). Conclusion: The use of application strategies enables data collection on AB which can be used in both clinical and research settings. The results suggest that the Swedish version is ready for implementation and for studies on the relationships between AB, family history and psychosocial factors. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Sleep bruxism (SB) occurring during No‐REM (nREM) sleep and increase in microarousals per hour have been described in adults, but not in children. Objective: To assess the correlation between sleep architecture and masseter muscle activity related to sleep bruxism (SB/MMA) in children. Materials and methods: Forty‐three children aged 7–12 years (mean age: 9.4 ± 1.3) with confirmed SB underwent a two‐night polysomnographic (PSG) study in a sleep laboratory, for accommodation (first night) and data collection (second night). Data on sleep architecture (total sleep duration (TSD), sleep efficiency (SE), sleep onset latency (SOL), REM and nREM sleep duration and proportion and microarousals/hour during REM and nREM sleep) and episodes/hour of SB/MMA were recorded. Single and multiple‐variable linear regression analyses were performed to assess the correlation between data on sleep architecture (predictors) and SB/MMA (dependent variable). Results: Shorter TSD, REM and nREM stage 1 sleep duration, longer SOL and more microarousals/hour during REM and nREM sleep were found to be positive predictors of SB/MMA in children in the multiple‐variable regression analysis (R2 = 0.511). Conclusion: Within the limitations of this study, it can be concluded that SB/MMA is correlated with altered sleep architecture in children (shorter total sleep duration (TSD), shorter nREM and REM sleep and higher microarousals during REM and nREM sleep). Nevertheless, the clinical significance of these findings need to be demonstrated in future studies. [ABSTRACT FROM AUTHOR]

ABSTRACT The idea of classifying and defining bruxism according to ontological principles may be interesting, but currently we just do not have enough information to label in a black or white manner the many facets of bruxism. In an era in which general knowledge on bruxism by the dental communities is surely in need of improvement, efforts to clarify the road map tracked by the current panelists who drafted the definition should be appraised carefully. The recent introduction of a standardized multidimensional evaluation system (i.e., Standardized Tool for the Assessment of Bruxism [STAB]) and a screening instrument for bruxism (i.e., BruxScreen) should be viewed as the starting points to enter a new era in the discipline of bruxism, in which non‐hierarchical and non‐preconceived approaches are used to collect data. Artificial intelligence strategies to mine data gathered with the above instruments might help building predictive models along the etiology‐status‐consequences trajectory, as recently suggested in a model for awake bruxism metrics. Until then, proposals to adopt ontological principles to classify bruxism will be merely based on speculations rather than on facts. [ABSTRACT FROM AUTHOR]

Background: Many patients with temporomandibular disorders (TMD) find it difficult to undergo dental care due to challenges caused by their condition, previous temporomandibular joint surgery or invasive dental procedures, and the impact of comorbid conditions. Managing routine dental care for some patients with TMD can be seen as challenging by some dental practitioners. Objective: The objective of this study was to work with patients experiencing TMD and clinicians to co‐produce recommendations aimed at helping general dentists to provide routine dental care for patients with TMD. Methods: A modified Delphi process was used to co‐produce recommendations. Six patients experiencing TMD, patient advocates and seven clinicians took part, including international TMD clinicians. Two meetings were held with patient participants, mediated by a trained facilitator. Recommendations suggested by patient participants were distributed to clinicians who were asked to add additional suggestions, but not to modify patients' recommendations unless to aid clarity. Additional themes were identified from the existing literature, and the recommendations were then reviewed by the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) consortium. Results: Recommendations were given to support patients before, during and after dental treatment. Participants identified specific and practical recommendations to help patients with TMD receive routine dental care, but also emphasised the need for professionals to listen sensitively to patients' concerns and work with patients in an empathetic and non‐judgmental way. Conclusion: These recommendations, co‐developed with patients experiencing TMD, should help dental professionals to provide supportive general dental care for patients with TMD. [ABSTRACT FROM AUTHOR]

The article presents a clarification about the definition of sleep and awake bruxism following the publishing of a consensus paper about bruxism assessment in 2018. Topics discussed include a comparison between sleep and awake bruxism, different motor behaviors that result from different jaw-muscle activities, and the clarification that bruxism is not the disorder but a sign of an associated or co-occurring condition.

Background: Obstructive sleep apnea (OSA) is the most common sleep disorder due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with arousals and snoring. Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals. Given the potentially severe consequences and complications of apnea, the concurrent high prevalence of SB in daily dental practice, getting deeper into the correlation between these phenomena is worthy of interest.. Study Objectives: The aim of this study was to investigate the correlation between SB‐related masseter muscle activity (MMA) and apnea–hypopnea events as well as to assess their temporal sequence. Methods: Thirty (N = 30) patients with sleep respiratory disorders and clinical suspicion of sleep bruxism (SB) were recruited. Ambulatory polygraphic recording was performed to detect apnea–hypopnea events (AHEs) and sleep bruxism episodes (SBEs). Pearson test was used to assess the correlation between apnea–hypopnea index (AHI) and SB index (SBI). A 5‐s time window with respect to the respiratory events was considered to describe the temporal distribution of SBEs. Furthermore, SBI was compared between groups of patients with different AHI severity (i.e., mild, moderate and severe) using ANOVA. Results: On average, AHI was 27.1 ± 21.8 and SBI 9.1 ± 7.5. No correlation was shown between AHI and SBI. Most of SBEs (66.8%) occurred without a temporal relationship with respiratory events. Considering OSA, 65.7% of SBEs occurred within 5 s after AHEs, while in the case of central apnea (CA) 83.8% of SBEs occurred before the respiratory event. The participants with severe apnea (N = 9) show a tendency to have higher bruxism indexes when compared to patients with mild (N = 11) and moderate apnea (N = 10). Conclusions: Findings suggest that: 1. At the study population level, there is no correlation between AHI and SBI, as well as any temporal relationship between SBEs and respiratory events. 2. Specific patterns of temporal relationship might be identified with future studies focusing on the different types of apnea–hypopnea events and bruxism activities. [ABSTRACT FROM AUTHOR]