To investigate the effect of the Coronavirus pandemic on the report of psychological status, bruxism, and TMD symptoms.
An online survey was drafted to report the presence of psychological status, ...bruxism activities, and reported symptoms of TMDs perceived during the COVID-19 pandemic in a population of 506 individuals.
Mental health is not positive during the Coronavirus pandemic: almost half the subjects reported an increase in bruxism behaviors, while up to one-third reported an increase in their symptoms involving the TMJ and jaw muscles. Specifically, 36% and 32.2% of participants reported increased pain in the TMJ and facial muscles, respectively, and almost 50% of the subjects also reported more frequent migraines and/or headaches.
Increased psychosocial distress during the COVID-19 pandemic can increase the frequency of TMD symptoms and bruxism behaviors, which, in turn, constitute a triangle of mutually interacting factors with the psychological and emotional status.
Objective
A smartphone-based ecological momentary assessment (EMA) strategy to collect real time data on awake bruxism (AB) has been recently introduced. The aim of this study was to assess the ...compliance with its use over 1 week in a sample of healthy young adults.
Method
Sixty (
N
= 60) healthy young adults (mean age 24.2 ± 4.1 years) used a dedicated smartphone application that sent 20 alerts at random times throughout the day. Upon alert receipt, the subjects had to report in real time their condition among five possible options: relaxed jaw muscles, teeth contact, teeth clenching, teeth grinding, and mandible bracing. Compliance rate with the app was assessed at the individual and group level in terms of percentage of answered alerts as well as number of days that were needed to reach the targeted observation period of 7 days with a compliance of at least 60%.
Results
The mean compliance recorded with the smartphone application was 67.8% of the total alerts. On average, 9.8 ± 3.2 days (range 7–19) have been necessary to achieve the targeted goal of 7 days with a minimum of 60% alerts/day. No gender differences were detected in any compliance data. Response rate was not different during weekdays or weekends.
Conclusions
This investigation is the first attempt to assess individual compliance with EMA for reporting awake bruxism. Results suggest that a smartphone-based strategy can have interesting potential. The compliance rate reported in this study will serve as a comparison standpoint for future investigations.
Clinical significance
Based on the recent multidisciplinary focus on the study of awake bruxism, EMA has emerged as a potential approach for use in the clinical and research settings. This investigation suggests that compliance with such strategy is good, thus making it worthy of adoption for the assessment of AB and its clinical implications.
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.
Considering the correlation between sleep bruxism episode (SBE) and apnea‐hypopnea events (AHE) from a global point of view, there is no correlation between the two phenomena. However, if the different types of respiratory events are considered separately (i.e., central apnea, obstructive apnea, mixed apnea and hypopnea), SB occurred with different temporal sequences.
The instrumental measurement of electromyographic (EMG) activity in the natural environment is the best strategy available to collect information on bruxism. The twofold aim of this study was to (1) ...introduce and discuss a novel EMG device for the assessment of awake (AB) and sleep bruxism (SB) in the home environment over 24 h and (2) present some preliminary data.
Fifteen healthy volunteers (eight males and seven females; mean age: 48.2 ± 4.1 years) underwent 24 h EMG recording trials of their masseter muscle activity (MMA) with a miniaturized wireless device. This device allowed us to measure the durations of the different phases of the recordings (total duration, awake time, sleep time, and electrode dislodgement time) as well as the bruxism time index (BTI) and bruxism work index (BWI) for both the waking and sleeping hours.
For the healthy volunteers, on average, the bruxism work index (BWI) values were 0.4 ± 0.2 and 0.1 ± 0.1 for awake and sleep, respectively, while the mean bruxism time index (BTI) values were 0.9 ± 0.5 for awake and 0.3 ± 0.1 for sleep.
This investigation describes the technical features of a novel EMG recording device that permits the evaluation of masseter muscle activity in the home environment over 24 h. For the first time, a dedicated elaboration of the EMG signal allowed an assessment of muscle work and not just a count of purported SB/EMG events.
Based on the multidisciplinary approach in the study of bruxism, such a methodology, thanks to its peculiar features, will allow researchers and clinicians to monitor the epidemiology of MMA and delve deeper into the awake and sleep bruxism correlates for tailored management in clinical settings.
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.
Background
To describe an esthetic orthodontic treatment using aligners in an adult patient with class II subdivision associated with crowding and dental crossbite. An 18-year-old hyperdivergent male ...patient with skeletal class II from mandibular retrusion presented for an orthodontic treatment. Occlusally, the patient presents class II subdivision, crossbite at tooth 4.4, an upper midline deviated towards the left with respect to the lower and facial midlines, and slight crowding in both arches. The patient refused conventional fixed multibracket treatment in favor of aligners. Pre- and post-treatment records as well as 1-year follow-up records are presented.
Findings
Treatment objectives were achieved in 12 months, and the patient was satisfied with the functional and esthetic outcomes, which were stable at 1 year.
Conclusion
Combining aligners with appropriate auxiliaries is an efficacious means of resolving orthodontic issues such as class II, dental crossbite, and crowding in a time-frame comparable to that of conventional fixed orthodontics. Furthermore, this system is associated with optimal oral hygiene and excellent esthetics.
Objectives: This study aimed to assess frequency and multiple-night variability of sleep bruxism (SB) as well as sleep-time masticatory muscle activities (sMMA) in the home environment in healthy ...young adults using a portable device that provides electrocardiographic (ECG) and surface electromyographic (EMG) recordings from the masticatory muscles. Methods: The study was performed on 27 subjects (11 males, 16 females; mean age 28.3 ± 1.7 years) selected from a sample of healthy young students. Evaluation was carried out for four nights to record data on masticatory muscle activities using a compact portable device that previously showed an excellent agreement with polysomnography (PSG) for the detection of SB events. The number of SB episodes per sleep hour (bruxism index), and the number of tonic, phasic and mixed sMMA events per hour were assessed. A descriptive evaluation of the frequency of each condition was performed on all individuals, and gender comparison was investigated. Results: Mean sleep duration over the four recording nights was 7 ± 1.3 h. The average SB index was 3.6 ± 1.2. Most of the sMMA were tonic (49.9%) and phasic (44.1%). An ANOVA test showed the absence of significant differences between the four nights. No significant gender differences were detected for the SB index, phasic or tonic contractions; conversely, gender differences were detected for mixed sMMA events (p < 0.05). Conclusion: This investigation supports the concept that sMMA events are quite frequent in healthy adults. Differences over the four-night recording span were not significant. These data could be compared to subjects with underlying conditions that may lead to an additive bruxism activity and possible clinical consequences.
Awake bruxism (AB) is differentiated from sleep bruxism (SB) by the differences in etiology, comorbidities, and consequences related to the different spectrum of muscle activities exerted in relation ...to the different circadian manifestations. Furthermore, less literature data are available on AB than on SB. The introduction of ecological momentary assessment (EMA) strategies has allowed for collecting valuable data on the frequency of the different activities reported by an individual in his/her natural environment. This strategy has been further improved with the recent use of smartphone technologies. Recent studies have described an average frequency of AB behaviors, within the range of 23–40% for otherwise healthy young adults. An association between AB and some psychological traits has emerged, and the findings have indicated that patients with musculoskeletal symptoms (e.g., temporomandibular joint and/or muscle pain, muscle stiffness, and fatigue) report higher AB frequencies. Preliminary data suggest that muscle bracing and teeth contact are the most commonly reported behaviors, while teeth clenching is much less frequently reported than commonly believed previously. Report of teeth grinding during wakefulness is almost absent. This paper has critically reviewed the currently available approaches for the assessment of AB. In addition, some future perspectives and suggestions for further research have been provided.
The prevalence of awake bruxism (AB) has been reported as being 30%, with sleep bruxism (SB) at 9−15%. Most studies have focused on SB, emphasizing the importance of AB research. For epidemiological ...evaluations of AB, a smartphone application based on ecological momentary assessment (EMA) was introduced. The aims of this multi-center study were: (1) to investigate how well lay subjects comprehend the AB terminology used in the smartphone application, and (2) to find out whether professional instruction improved their comprehension. The study population consisted of lay subjects from Italy, Portugal, and Finland comprising 307 individuals (156 men, 151 women; 18−86 years). Subjects first completed a five-item questionnaire about the meanings of the five AB terms used in the smartphone application. Each question offered four answer options, with one being correct. Immediately afterwards, the meanings of the terms were instructed. Lastly, the subjects were re-tested with the same questionnaire. In Finland and Italy, the re-tested correct answer scores for the single terms were at 89−97% per term. Improved comprehension was seen across sex, education, and age groups. In the Portuguese data, no improvement was found. Significant differences were found between countries in the improved scores for all terms that were correct following the instruction (Finland, 16.3% to 72.1%; Italy, 32.3% to 83.8%; Portugal, 23.1% to 33.7%) (p < 0.001). In conclusion, standardized instruction on AB terminology prior to EMA is recommended to improve the reliability of collected data.
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