Summary
Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz. enamel and dentine. Tooth wear can be divided into the subtypes mechanical wear (attrition and ...abrasion) and chemical wear (erosion). Because of its multifactorial aetiology, tooth wear can manifest itself in many different representations, and therefore, it can be difficult to diagnose and manage the condition. A systematic approach is a sine qua non. In the below‐described tooth wear evaluation system (TWES), all necessary tools for a clinical guideline are present in different modules. This allows the dental clinician, in a general practitioner setting as well as in a referral practice setting, to perform a state‐of‐the‐art diagnostic process. To avoid the risk of a too cumbersome usage, the dental clinician can select only those modules that are appropriate for a given setting. The modules match with each other, which is indispensable and essential when different modules of the TWES are compared. With the TWES, it is possible to recognise the problem (qualifying), to grade its severity (quantifying), to diagnose the likely causes and to monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to determine when to start a treatment, to make the decision which kind of treatment to apply and to estimate the level of difficulty of a restorative treatment.
Summary
In 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the ...mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re‐examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non‐rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non‐instrumental approaches (notably self‐report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut‐off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism‐related masticatory muscle activities should be assessed in the behaviour's continuum.
Summary
Inspired by the international consensus on defining and grading of bruxism (Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ et al. J Oral Rehabil. 2013;40:2), this commentary ...examines its contribution and underlying assumptions for defining sleep bruxism (SB). The consensus’ parsimonious redefinition of bruxism as a behaviour is an advance, but we explore an implied question: might SB be more than behaviour? Behaviours do not inherently require clinical treatment, making the consensus‐proposed ‘diagnostic grading system’ inappropriate. However, diagnostic grading might be useful, if SB were considered a disorder. Therefore, to fully appreciate the contribution of the consensus statement, we first consider standards and evidence for determining whether SB is a disorder characterised by harmful dysfunction or a risk factor increasing probability of a disorder. Second, the strengths and weaknesses of the consensus statement's proposed ‘diagnostic grading system’ are examined. The strongest evidence‐to‐date does not support SB as disorder as implied by ‘diagnosis’. Behaviour alone is not diagnosed; disorders are. Considered even as a grading system of behaviour, the proposed system is weakened by poor sensitivity of self‐report for direct polysomnographic (PSG)‐classified SB and poor associations between clinical judgments of SB and portable PSG; reliance on dichotomised reports; and failure to consider SB behaviour on a continuum, measurable and definable through valid behavioural observation. To date, evidence for validity of self‐report or clinician report in placing SB behaviour on a continuum is lacking, raising concerns about their potential utility in any bruxism behavioural grading system, and handicapping future study of whether SB may be a useful risk factor for, or itself a disorder requiring treatment.
Summary
To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate ...a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw‐muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of ‘possible’, ‘probable’ and ‘definite’ sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Summary
The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. ...Quality assessment of the reviewed papers was performed to identify 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. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5–40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self‐reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.
Summary
There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a ...consensus‐based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long‐term aim was to establish a foundation, vis‐à‐vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.
Summary
Temporomandibular disorders (TMD) are common but seem to be largely undetected within general dental care. To improve dentists’ awareness of these symptoms, three screening questions (3Q/TMD) ...have been introduced. Our aim was to validate 3Q/TMD in relation to the diagnostic criteria for TMD (DC/TMD), while taking into account the severity level of the symptoms. The study population consisted of 7831 individuals 20–69 years old, who had their routine dental check‐up at the Public Dental Health Service in Västerbotten, Sweden. All patients answered a health declaration, including the 3Q/TMD regarding frequent temporomandibular pain, pain on movement and catching/locking of the jaw. All 3Q‐positives (at least one affirmative) were invited for examination in randomised order. For each 3Q‐positive, a matched 3Q‐negative was invited. In total, 152 3Q‐positives and 148 3Q‐negatives participated. At examination, participants answered 3Q/TMD a second time, before they were examined and diagnosed according to DC/TMD. To determine symptom's severity, the Graded Chronic Pain Scale and Jaw Functional Limitation Scale‐20 (JFLS‐20) were used. In total, 74% of 3Q‐positives and 16% of 3Q‐negatives met the criteria for DC/TMD pain or dysfunction (disc displacements with reduction and degenerative joint disorder were excluded). Fifty‐five per cent of 3Q‐positives had a TMD diagnosis and CPI score ≥3 or a JFLS‐20 score ≥5, compared to 4% of 3Q‐negatives. The results show that the 3Q/TMD is an applicable, cost‐effective and valid tool for screening a general adult population to recognise patients in need of further TMD examination and management.
To investigate, in a sample of probable sleep bruxers with and without temporomandibular disorder (TMD) pain, the presence and relationships between clinical jaw-muscle symptoms, and test their ...associations with jaw-muscle electromyographic (EMG) activity during sleep.
Pain, unpleasantness, tiredness, tension, soreness, and stiffness were scored on a 0–10 numerical rating scale (NRS) in 50 probable sleep bruxers. The sample was subdivided into two groups, i.e., with and without TMD pain. Multiple-night, single-channel EMG recordings were performed. Descriptive data, correlations between the six symptoms, and correlations between symptoms and EMG measures, i.e. EMG events/recording, EMG events/hour, and night-to-night variability in EMG events, were calculated.
In the total sample, 90% of the participants reported at least one symptom. Tiredness and tension were the most prevalent symptoms (both 78%), and pain the least (30%). In the TMD pain group, pain remained the least reported symptom (57%). Intensity of symptoms was low to moderate, with tension presenting the highest median in the total sample (NRS 4), the TMD pain group (NRS 5), and non-TMD group (NRS 3). Significant correlations between all symptoms were found in the total sample, but not in the two subgroups. No significant associations between EMG measures and muscle symptoms emerged.
Jaw-muscle symptoms other than pain were highly prevalent in a sample of probable sleep bruxers. There were no associations between these symptoms and EMG measures of jaw-muscle activity during sleep. These findings challenge the concept of simple relationships between jaw-muscle activity during sleep and clinical muscle symptoms.
Background
Temporomandibular pain and jaw dysfunction can have a negative effect on daily life, but these conditions are not well recognized in the health care systems. The general aim was to examine ...the cross‐sectional prevalence of frequent temporomandibular pain and jaw dysfunction in men and women across the lifespan.
Methods
The analysis was based on data from 137,718 individuals (mean age 35 years, SD 22.7) who answered three questions (3Q/TMD) included in the digital health declaration in the Public Dental Health care in the county of Västerbotten, Sweden; Q1: ‘Do you have pain in your temple, face, jaw or jaw joint once a week or more?’; Q2: ‘Does it hurt once a week or more when you open your mouth or chew?’; and Q3: ‘Does your jaw lock or become stuck once a week or more?’
Results
The prevalence of frequent temporomandibular pain (Q1) was 5.2% among women and 1.8% among men (p < 0.0001). The prevalence of frequent pain on jaw movement (Q2) was 2.5% among women and 0.9% among men (p < 0.0001). The prevalence of frequent locking of the jaw (Q3) was 2.7% among women and 1.2% among men (p < 0.0001).
Conclusions
The study shows that the cross‐sectional prevalence of temporomandibular pain and jaw dysfunction varies during the lifespan. For men and women, respectively, symptoms increase during adolescence, peak in middle age and then gradually diminish. The prevalence of these symptoms is significantly higher among women except from the first and last decades of a 100‐year lifespan.
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