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PURPOSE The aim of this study was to systematically review the literature to answer the question: Can children's drawings represent a helping tool so the dentist can better understand the children's pain, fear, anxiety or stress/distress and their perception concerning the dentist and/or dental treatment? METHODS A scoping review was done. Cochrane Library, EMBASE, LILACS, LIVIVO, PsycINFO, PubMed, Scopus, Web of Science, and Grey literature was searched. Cross-sectional, quasi-experimental and qualitative studies in which patients were children and adolescents were included. Two authors independently selected studies to extract data and evaluate methodological quality by using Joanna Briggs Institute tools. Data collected included: characteristics of the studies, drawing evaluation/scales, main results and conclusion. RESULTS Out of 1037 papers were identified in search, 25 studies verified the emotional state and the children's perceptions regarding dental environment and the dentist and were included in the narrative synthesis. The spontaneous drawings were useful to identify the children's emotions. Drawings might be considered a helping tool to identify children and adolescents' perception in relation to dental treatment. Few studies used validated instruments. There were methodological disparities among studies. CONCLUSIONS The drawings can be considered a useful tool in identifying children's pain, fear, anxiety or stress/distress and perceptions about the dentist and/or dental treatment. Future studies with standardized analysis of the drawings are recommended. Code https://doi.org/10.17605/OSF.IO/U5BJH . "Retrospectively registered".

Introduction The number of systematic reviews (SRs) in dentistry published each year has grown considerably, and they have been essential in clinical decision-making and health policy.Objective The objective is to critically appraise SRs of intervention in dentistry using the 'A Measurement Tool to Assess Systematic Reviews 2' (AMSTAR 2) tool published within one year.Methods A search in the Medline/PubMed database was performed. The SRs were identified in two phases. The first phase identified SRs of interventions in dentistry by title and abstract. In the second phase, the full text was read, applying the eligibility criteria. Three calibrated reviewers methodologically assessed all SRs identified using the AMSTAR 2 tool. Data were analysed descriptively, and SRs were grouped according to methodological quality as moderate/high and low/critically low. A logistic regression model was applied to explore the associations between methodological quality and the study's characteristics.Results Two hundred and twenty-two SRs were included. The methodological quality of the SRs included in this study were: critically low (56.8%), low (27.9%), moderate (14.4%) and high (0.9%), according to AMSTAR 2. There were no statistical differences between moderate/high and low/critically low methodological quality and publication year, continent, journal Impact Factor and dental speciality.Conclusion Less than 1% of recently published SRs in dentistry were classified with high methodological quality. We hope that this study will alert researchers about the need to improve the methodological quality of SRs.

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.

Background In light of previous reported associations between sleep disordered breathing (SDB) and symptoms of attention deficits, the aim of this systematic review (SR) was to evaluate this association in adults. Methods Searches were performed on seven main databases including Embase, PubMed, Web of Science, Scopus, PsyncInfo, Livivo and Lilacs; as well as grey literature through Google Scholar, Proquest and OpenGrey. Furthermore, hand-searches were conducted on the reference lists of included articles. Experts were consulted to improve search findings. Risk of Bias was gauged using the Joanna Briggs Institute Critical Appraisal Checklist. The cumulative evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Results 2009 references were identified. After phase-1 and phase-2 of screening against eligibility criteria, eight cross-sectional and one cohort studies were retained for qualitative analysis. Five studies were included for quantitative analysis, with no significant association found (p = 0.99). From the qualitative assessment, three papers showed a positive association with at least one attention symptoms. Risk of bias was judged to be low for six studies and three were classified with moderate risk of bias. Confidence in cumulative evidence was considered very low for continuous data. Conclusion Despite the plausibility of an association between SDB and symptoms of attention deficits in adults, current published evidence does not either confirm or refute such association as inferred from its low to very low certainty level.

This study evaluated whether single nucleotide polymorphisms in the melatonin receptor type 1 A gene are associated with sleep bruxism in a Brazilian population.Individuals with suspected sleep-related problems were evaluated using polysomnography, following the recommendations proposed by the American Academy of Sleep Medicine and the Research Diagnostic Criteria for Temporomandibular Disorders. Deoxyribonucleic acid (DNA) samples were collected, and three single nucleotide polymorphisms in the melatonin receptor type 1 A gene (rs13140012, rs6553010, and rs6847693) were selected and genotyped using real-time polymerase chain reaction (RT-PCR). Chi-square and odds ratio tests were used to analyze genotypes and alleles individually, while using the plink software for haplotypes. A confidence interval of 95% was considered, and statistical significance was set at p 0.05.This study included 48 individuals aged between 21 and 80 years, with 27 males and 21 females. From this sample, 17 individuals were diagnosed with sleep bruxism and 31 without bruxism. No associations were found between sleep bruxism and single nucleotide polymorphisms in either the genotypic, allelic, dominant, or recessive models (p 0.05). Haplotype genetic analysis also did not reveal any association between single nucleotide polymorphisms and sleep bruxism (p 0.05).The genetic polymorphisms rs6553010, rs13140012, and rs6847693 were not associated with sleep bruxism in the studied population.

Objective To evaluate the association of single-nucleotide polymorphisms within the catechol-O-methyltransferase and 5-hydroxytryptamine receptor 2 A genes with sleep bruxism in individuals diagnosed with obstructive sleep apnea. Design Sixty-nine individuals with suspected sleep-related problems were evaluated by polysomnography, following the recommendations of the American Academy of Sleep Medicine. Deoxyribonucleic acid (DNA) samples were collected only from 48 of the study participants because of missing polysomnographic data. DNA samples were collected and two single-nucleotide polymorphisms in the 5-hydroxytryptamine receptor 2 A encoding HTR2A gene (rs4941573 and rs6313) and two in the catechol-O-methyltransferase gene (rs165656 and rs174675) were selected to be genotyped using real-time polymerase chain reaction. The association between sleep bruxism and genetic polymorphisms was investigated by recessive and dominant models. Association analyses were performed using a 95% confidence interval and the level of statistical significance was p Results From the 69 study participants, 48 were included in the polymorphism analysis and sleep bruxism was present in 35.4%. No significant differences were observed in the dominant and recessive models (p>0.05). Haplotype and diplotype analyses revealed the predicted four haplotypes and two diplotypes were not associated with sleep bruxism. Conclusion Polymorphisms rs174675 and rs165656 in the catechol-O-methyltransferase gene and rs4941573 and rs6313 in the 5-hydroxytryptamine receptor 2 A gene were not significantly associated with sleep bruxism in individuals with obstructive sleep apnea.

Aims To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults? Materials and methods A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria. Results Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis. Conclusion Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial.

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.

The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.Nine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.

To synthesise and critically review the association between sleep bruxism (SB) and stress symptoms in adults. A systematic review was performed. The search was completed using seven primary electronic databases in addition to a grey literature search. Two reviewers blindly selected studies based on pre-defined eligibility criteria. Risk of bias of the included articles was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. RevMan 5.4 was used to perform the meta-analysis. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Ten studies were included for qualitative analysis, of which three were included for quantitative analysis. Three studies were evaluated to have low risk of bias, and seven were assessed with moderate risk of bias. Quality of evidence was classified as very low for all outcomes. Individuals with SB were found to have higher levels of some self-reported stress symptoms as assessed through questionnaires with a mean difference of 4.59 (95% CI 0.26-8.92). Biomarkers like epinephrine, norepinephrine, cortisol, adrenaline, dopamine, noradrenaline and prolidase enzyme levels also showed a positive association with SB. Although some associations were identified between probable SB and self-reported stress symptoms and biomarkers of stress in adults, given that the quality of evidence was found to be very low, caution should be exercised in interpreting these results. These findings suggest that additional and better designed studies are warranted in order to clarify the link between SB and stress.

Background The primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults? Types of Studies Reviewed The protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 7 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation. Results Eight of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 6 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 3.16; 95% CI, 1.80 to 5.54 to OR, 13.06; 95% CI, 2.79 to 61.12), migraines (OR, 5.35; 95% CI, 3.04 to 9.40 to OR, 6.22; 95% CI, 3.81 to 10.14), and chronic headaches (OR, 40.40; 95% CI, 8.67 to 188.15 to OR, 95.93; 95% CI, 12.53 to 734.27) were calculated. Articular TMDs without pain were evaluated in only 1 article, in which ORs of 1.78 (95% CI, 0.90 to 3.51) for migraines and 1.04 (95% CI, 0.53 to 2.06) for tension-type headache were reported. Three studies were classified as moderate risk of bias and 5 as low risk of bias. The certainty of evidence varied between very low and low. Conclusions and Practical Implications Recognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.

Background The purpose of this systematic review was to evaluate the association between sleep bruxism (SB) and anxiety symptoms in adults. Methods A systematic review was performed and studies assessing SB by means of questionnaires, clinical examination and/or polysomnography (PSG), and validated questionnaires to assess anxiety, were included. Search strategies were developed for seven main electronic databases. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and confidence in cumulative evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation criteria. Results Eight cross-sectional studies were included, of which five were judged with low and three with moderate risk of bias. No association with SB was observed in three studies that investigated generic levels of anxiety, while other two papers that evaluated generic anxiety levels through the State-Trait Anxiety Inventory (STAI) found a positive association with probable and definite SB in both STAI-1 and STAI-2 subscales. Only one study evaluated dental anxiety in particular and an association with probable SB was observed regarding very anxious or extremely anxious scores. Two studies assessed specific symptoms of anxiety using the panic-agoraphobic spectra evaluation (PAS-SR) questionnaire. Significantly higher PAS-SR total scores were observed in both studies with regard to SB. No study with definitive assessment of SB was identified. Conclusion Current literature is controversial regarding an association between SB and generic symptoms of anxiety in adults. It seems that some specific symptoms of the anxiety disorders spectrum might be associated with probable SB.