Bruxism Research Articles

APPLICATION OF BOTULINUM TOXIN IN CONSERVATIVE TREATMENT OF MASTICATORY MUSCLES DYSFUNCTION

The purpose of this paper is to describe the application of the botulinum toxin in diseases of the temporomandibular system of a muscular type such as masticatory hypertrophy, spasm, bruxism, and tension headaches of idiopathic etiology. The masticatory system is a complex apparatus with great adaptive capacity. Still, when that capacity is exceeded, functional disorders occur followed by a series of symptoms that depend on individual, local, and systemic etiological factors. Occlusal trauma exceeding the physiological limits of the teeth, periodontium, and TMJ leads to a series of functional disorders. Temporomandibular dysfunctions (TMD) are used to describe a large, heterogeneous group of diseases of the temporomandibular joint (TMJ) and its adjacent tissues and organs. Botulinum toxin type A, hemagglutinin complex with 500 IU (DISPORT Ipsen Biopharm, UK) was used for the therapy of muscle disorders like bruxism or night teeth clenching in female patient 26 years old. Depending on the dose that was applied to the targeted muscle, a complete or partial reduction in contraction occurs with reduced function and weakening of the muscle. Two weeks after applying the neuromodulator, the patient reported a reduction in pain and episodes of teeth grinding and clenching. Bilateral hypotrophy of left and right masseter muscles was noticeable after 2 months. We concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism.

Is sleep bruxism in obstructive sleep apnea only an oral health related problem?

BackgroundThe etiology of sleep bruxism in obstructive sleep apnea (OSA) patients is not yet fully clarified. This prospective clinical study aimed to investigate the connection between probable sleep bruxism, electromyographic muscle tone, and respiratory sleep patterns recorded during polysomnography.Methods106 patients with OSA (74 males, 31 females, mean age: 56.1 ± 11.4 years) were divided into two groups (sleep bruxism: SB; no sleep bruxism: NSB). Probable SB were based on the AASM criteria: self-report of clenching/grinding, orofacial symptoms upon awakening, abnormal tooth wear and hypertrophy of the masseter muscle. Both groups underwent clinical examination for painful muscle symptoms aligned with Temporomandibular Disorders Diagnostic Criteria (DC/TMD), such as myalgia, myofascial pain, and headache attributed to temporomandibular disorder. Additionally, non-complaint positive muscle palpation and orofacial-related limitations (Jaw Functional Limited Scale-20: JFLS-20) were assessed. A one-night polysomnography with electromyographic masseter muscle tone (EMG) measurement was performed. Descriptive data, inter-group comparisons and multivariate logistic regression were calculated.ResultsOSA patients had a 37.1% prevalence of SB. EMG muscle tone (N1-N3, REM; P = 0.001) and the number of hypopneas (P = 0.042) were significantly higher in the sleep bruxism group. While measures like apnea–hypopnea-index (AHI), respiratory-disturbance-index (RDI), apnea index (AI), hypopnea-index (HI), number of arousals, and heart rate (1/min) were elevated in sleep bruxers, the differences were not statistically significant. There was no difference in sleep efficiency (SE; P = 0.403). Non-complaint masseter muscle palpation (61.5%; P = 0.015) and myalgia (41%; P = 0.010) were significant higher in SB patients. Multivariate logistic regression showed a significant contribution of EMG muscle tone and JFLS-20 to bruxism risk.ConclusionIncreased EMG muscle tone and orofacial limitations can predict sleep bruxism in OSA patients. Besides, SB patients suffer more from sleep disorder breathing. Thus, sleep bruxism seems to be not only an oral health related problem in obstructive apnea. Consequently, interdisciplinary interventions are crucial for effectively treating these patients.Trial registrationThe study was approved by the Ethics Committee of Philipps-University Marburg (reg. no. 13/22—2022) and registered at the “German Clinical Trial Register, DRKS” (DRKS0002959).

Bruxism, Lifestyle, Anxiety, and Sleep Impairment in Dental Students

AbstractThe aim of this study was to verify the correlation of self-reported sleep and awake bruxism with demographic characteristics, oral behaviors, anxiety, temporomandibular disorder (TMD) signs and symptoms, sleep quality, and orthodontic treatment history in dental students. A total of 104 students of Dentistry located in Paraná (South Brazilian State) answered the following self-administered questionnaires: Oral Behavior Checklist, State Anxiety Inventory, TMD signs and symptoms questionnaire, and the Pittsburgh Sleep Quality Index. Associations between possible awake bruxism (AB) and sleep bruxism (SB) with sleep quality, anxiety, and TMD were analyzed by Poisson Regression with robust variance. The significance level adopted was 5%. The frequency of AB and SB was 76% and 55.8%, respectively. A statistically higher frequency of AB was observed in students who had the following conditions: use of psychotropic medication, physical activity practitioners, moderate or high level of anxiety, more oral behaviors, sleep disorders, and sleep bruxism. Sleep bruxism was diagnosed more frequently in students who presented moderate or high levels of anxiety, oral behaviors, and sleep disorders. The frequency of TMD reported was higher in students with SB, as well as in those with AB. In conclusion, lifestyle, moderate and high anxiety levels, and sleep disorders are associated with a higher prevalence of AB and SB. Furthermore, AB and SB are associated with a higher frequency of TMD reporting.

Reviewing the potential of hearables for the assessment of bruxism

Abstract Bruxism is a parafunctional oral behavior that affects a large percentage of the population. Bruxism is a risk factor for temporomandibular disorders. A gold standard is still lacking for assessing bruxism while awake, whereas for sleep bruxism, polysomnography with audio and video recording is the gold standard. Wearable devices, particularly those that detect sound (hearables), are cost-effective and convenient and could fill the gap. With this systematic literature review of Livivo and PubMed, extended by individual Google Scholar searches, we aimed to assess the potential of wearable devices that use sound as a biomarker for detecting bruxism. In summary, sounds originating from oral behaviors can be recorded from the ear, and hearables have the potential to detect bruxism-like events.

16 Effects of fiber supplementation during gestation on sow and piglet performance

Abstract Our objective was to determine the effects of fiber supplementation during gestation on sow and piglet performance. A total of 200 PIC Camborough P1+ sows were used. At breeding, sows were balanced by body weight (BW) within parity and randomly allotted to 1 of 2 dietary treatments, which consisted of 1) Control; corn-soybean meal gestation diet; and 2) Fiber; inclusion of soybean hulls in the formulation at a level to yield a dietary crude-fiber content 6%. Females were housed in individual stalls throughout the entire gestation. At d 90 of gestation, serum glucose, fecal dry matter, fecal volatile fat acids (acetate, propionate, butyrate, isovalerate, and valerate), urinary traits (color, turbidity, density, pH, and presence of nitrate or blood), and frequency of stereotypic behavior (sham chewing, teeth grinding, bar biting, and floor licking) was accessed. Perineal scoring was visually evaluated at d 105 and 110 of gestation. Farrowing traits (farrowing length, and number of piglets born alive, stillborn, and mummified fetuses) and piglet vitality (meconium presence, umbilical cord integrity, oxygenation, and heart rate) were individually monitored. Individual piglet BW was obtained within 12 h of birth and after 24 h for colostrum intake, and at weaning. Sow daily lactation feed intake was registered. Data were analyzed using generalized linear mixed models with the Glimmix procedure of SAS with sow serving as the experimental unit. There was no evidence (P > 0.10) for differences in sow BW at d1, d112 of gestation, and at weaning. Sows fed the greater fiber diet showed lower levels of post-prandial glucose (-6%; P < 0.10), darker urine (+33%; P < 0.10) with greater pH (+5%; P < 0.05), and greater levels of fecal butyrate (+62%; P < 0.05) and isovalerate (+15%; P < 0.10) at the end of gestation (d 90). Feces from sows fed the control diet were drier (P < 0.05) at d 90 of gestation. Fiber supplementation reduced the frequency of teeth grinding (-52%; P < 0.10), bar biting (-74%; P < 0.05), and floor licking (-65%; P 0.10) behaviors. There was no evidence for treatment differences (P > 0.10) for perineal scores. Piglet vitality was not affected by the treatments, except for a marginal increase in blood oxygen saturation for piglets from sows fed the greater fiber diet (+1%; P < 0.10). Treatment did not impact (P > 0.10) farrowing duration, number of total piglets born, born alive, stillborn, and mummified, nor average piglet birth weight and colostrum intake. Sows fed diet with fiber supplementation during gestation had a marginal increase in average daily feed intake during lactation (+0.50kg/d; P = 0.08), which resulted in improved piglet BW gain (P < 0.05) and weaning weights (+0.20kg; P < 0.05). In summary, providing increased level of fiber supplementation via soybean hulls to gestating diets did not impact sow reproductive performance. Beneficial effects were observed for welfare lactation feed intake, piglet BW gain and weaning weights.

Quantitative evaluation of the impact of indoor relative humidity on deposition of aerosols generated during tooth grinding in a real-world clinical setting.

Exposure to aerosol particles generated from tooth grinding has a negative impact on the health of dental personnel. The aim of this study was to quantitatively analyze the impact of indoor relative humidity (IRH) on the deposition of these suspended particles in a well-controlled dental environment. In this study, a humidity control system was employed to effectively regulate and maintain indoor relative humidity (IRH). A novel computer-assisted numerical control system was developed to pre-treat the molar specimens, and accurately simulate clinical tooth grinding procedures. Each procedure was performed in triplicate, with an online real-time particle counter (ORPC; TR-8301, TongrenCo.) measuring aerosol production. All testing devices were controlled remotely. The data obtained were statistically analyzed using descriptive statistics and non-parametric tests (Kruskal-Wallis/ Dunn's post hoc test with Bonferroni correction, p < 0.05). The findings showed that with increasing IRH, the maximum peak concentration of aerosol particles decreased by 397% from 6.51 × 107 particles/m3 at 30% to 1.64 × 107 particles/m3 at 80%. The Kruskal-Wallis test results indicated a statistically significant effect of IRH on the aerosol increment (p < 0.05). Increasing the IRH level can effectively promote the deposition of aerosol particles, with a return to baseline within 15min after reaching 60% or above. Our study suggested that maintaining IRH above 70% during the cleaning process, allowing natural recovery to ambient humidity levels within 15min after cleaning, and taking basic precautions, may lead to an adequate reduction in the possible health risks of aerosol contamination.

Comparative evaluation of conventional and ultrasound assisted tube cystotomy for obstructive urolithiasis in cattle

The aim of this study was to evaluate the efficacy of conventional and ultrasound assisted tube cystotomy techniques for obstructive urolithiasis in 12 cattle by allowing two groups. Group-I, animals were subjected to conventional tube cystotomy, whereas in group- II, ultrasound assisted tube cystotomy was performed using Foley’s catheter under deep sedation with xylazine hydrochloride and local infiltration anaesthesia. Clinically, all animals showed urethral pulsation, dribbling of urine, futile attempts, bellowing, congested mucous membrane, sunken eyes, dry muzzle and teeth grinding. Non-significant changes were observed in haematological and biochemical values, however neutrophilia and alkaline pH of urine was prominent. Ultrasound assisted tube cystotomy technique consumed less time (40.00±1.29 min) with small incision and minimal bleeding as compared to conventional tube cystotomy.

Current Methods Used in the Diagnosis of Sleep Bruxism

Current Methods Used in the Diagnosis of Sleep Bruxism

Relationship between Sleep Bruxism Determined by Non-Instrumental and Instrumental Approaches and Psychometric Variables.

Sleep bruxism (SB) can be determined with different diagnostic procedures. The relationship between psychometric variables and SB varies depending on the diagnostic method. The aim of the study was to compare the association between SB and oral health-related quality of life (OHRQoL; measured by the Oral Health Impact Profile, OHIP), anxiety (measured by the State-Trait anxiety inventory, STAI), and stress (single scale variable) depending on the diagnostic method in the same sample. N = 45 participants were examined by non-instrumental (possible/probable SB) and instrumental methods (definite SB). The OHIP differed significantly between possible SB (median = 4) and non-SB (median = 0) with W = 115, p = 0.01, and probable SB (median = 6) and non-SB (median = 0) with W = 101, p = 0.01). There was no significant difference in the OHIP score between definite SB and non-SB. For the other psychometric variables, the analyses revealed no significant differences between SB and non-SB in all diagnostic procedures. The results suggest that there is a difference between possible/probable and definite SB with respect to the association with OHRQoL. Certain aspects of possible/probable SB might be responsible for the poor OHRQoL, which are not measured in definite SB.

Prevalence and risk factors of sleep bruxism in adults with primary snoring: a large-scale polysomnographic study.

To determine the prevalence and risk factors of sleep bruxism (SB) in adults with primary snoring (PS). This study included 292 adults with PS (140 males, 152 females; mean age ± standard deviation = 42.8 ± 12.2 years; mean body mass index ± standard deviation = 26.7 ± 4.7 kg/m2) without previous treatment for snoring. SB was diagnosed based on the frequency of the biomarker of SB: rhythmic masticatory muscle activity (SB when rhythmic masticatory muscle activity ≥ 2 episodes/h). Logistic regression was performed, with SB as the dependent variable and with age, sex, body mass index, and sleep- and respiratory-related polysomnographic parameters as the independent variables to identify the risk factors for SB. The prevalence of SB was 44.6% in adults with PS. Younger age (odds ratio = 0.965 [0.944, 0.987]) and shorter total sleep time (odds ratio = 0.760 [0.609, 0.948]) significantly increased the risk of SB (P < .05). SB is highly prevalent in adults with PS. Younger age and shorter sleep time are significant risk factors for SB in adults with PS. Registry: onderzoekmetmensen.nl; Name: A Large Sample Polysomnographic Study on Sleep Bruxism; URL: https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON19947; Identifier: NL8516. Li D, Lobbezoo F, Hilgevoord AAJ, de Vries N, Aarab G. Prevalence and risk factors of sleep bruxism in adults with primary snoring: a large-scale polysomnographic study. J Clin Sleep Med. 2024;20(8):1331-1337.

Temporomandibular dysfunction and bruxism in patients with early rheumatoid arthritis and at-risk patients: a cross-sectional study

What is the prevalence of temporomandibular dysfunction in patients with early rheumatoid arthritis and individuals at risk of rheumatoid arthritis? 3 groups (of 50 participants each) were examined for a possible TMD diagnosis: 1. patients with early rheumatoid arthritis, 2. at-risk individuals, and 3. healthy controls. A possible association with bruxism, determined on the basis of self-reporting and clinical features, was also examined. At-risk patients had a higher prevalence of TMD pain diagnoses compared to healthy controls (p = 0.046). Within the early rheumatoid arthritis group, seronegative patients had a higher prevalence of TMD pain diagnoses than seropositive patients (p = 0.048). No further differences in the prevalence of TMD diagnoses were found between the groups. Participants with a TMD pain diagnosis were more often diagnosed with probable sleep bruxism than those without a TMD pain diagnosis. The prevalence of TMD pain is increased in individuals at risk of rheumatoid arthritis and seronegative early rheumatoid arthritis patients, and is associated with signs of bruxism.

Gnashing of Teeth

Life is filled with objects, things, strategies, devices, ploys that may be complex or simple. A common condition impacting not only the teeth but gumjawbone complex, temporal mandibular joint, muscles, tendons, ligaments and softtissues of the oral cavity is that of “gnashing of teeth.” We in the honorable art and science of dentistry call this condition bruxism, tapping, jiggling or extra-oral movements (parafunctional habits) that may impede breathing, influence headache, or other super-pectoral painful conditions such as neuropathies. After 55 years of practice I have observed a huge rise in these condition in the past ten to fifteen years. Oral Bruxism condition is associated with snoring, clapping of teeth, airway compromise, and their attending effects—loss of sleep, quality of sleep as well as emotional implications. Upper Airway Resistance Syndrome (UARS) is the condition identified from a medical view and, related to snoring, grinding of teeth, tapping, jiggling and has led many to devices such as an electrical stimulator called “Inspire” (figure 2.) which is alleged as an alternative to Continuous Positive Airway Pressure (CPAP—see figure 1.) that works inside your body while you sleep. It’s a small electrical device placed during a same-day, outpatient procedure below the collar bone that monitors breathing and stimulates the tongue to reposition for better breathing, hopefully. Obstructive sleep apnea is the most common form of sleep apnea and occurs when the throat muscles relax and block the airway during sleep. Of course, this is theory with some facts in logic, in my humble opinion. About 18 million American adults have moderate to severe obstructive sleep apnea.Another approach in resolution of these condition are oral positioners as shown below, Figure 3 below. All of these devices are made of hard plastics that may cause more harm than good in my experience and estimation. They are often of novel colors to encourage acceptance of their many designs. Constructed to fit the upper arch and lower and work together they are complex and ill-fitting mostly.

The effect of sleep position on sleep bruxism in adults with obstructive sleep apnea.

Most of the respiratory events in adults with obstructive sleep apnea (OSA) occurs in supine position. It has been reported that the contraction of masseter muscles is dependent on the occurrence of arousals rather than on the occurrence of respiratory events. This study had two aims: (1) to compare the rhythmic masticatory muscle activity (RMMA) index in supine position (RMMA_sup) and in non-supine positions (RMMA_nsup) in adults with OSA; and (2) to determine the associations between RMMA index in both supine position and non-supine positions on the one hand, and several demographic and polysomnographic variables on the other hand. One hundred OSA participants (36 females and 64 males; mean age = 50.3 years (SD = 10.5)) were selected randomly from among patients with a full-night polysomnographic recording. RMMA_sup index and RMMA_nsup index were compared using Mann-Whitney U-test. Multivariate linear regression analyses were used to predict RMMA index both in supine and non-supine positions based on several demographic and polysomnographic variables. In patients with OSA, the RMMA_sup index was significantly higher than the RMMA_nsup index (p < .001). RMMA_sup index was significantly associated with the arousal index (p = .002) and arousal index in supine position (p < .001). RMMA_nsup index was only significantly associated with the arousal index in non-supine positions (p = .004). Within the limitations of this study, RMMAs occur more frequently in supine position than in non-supine positions in patients with OSA. In both sleep positions, RMMAs are associated with arousals.

Effect of Different Treatment Modalities on Masseter Inhibitory Reflex in Patients with Sleep Bruxism: A Case-Control Study

Background: Sleep bruxism (SB) is a parafunctional oral habit that is frequently related to sleep arousals. The masseter inhibitory reflex (MIR) causes reflex inhibition of voluntary contractions of the elevator muscles induced by intense peri- or intraoral mechanical or electrical stimulations. This study aimed to investigate the changes in MIR of patients with SB, and the effect of different treatment modalities on MIR. Methods: In this case-control study, 100 individuals were randomly assigned to four groups (n=25) of conservative treatment (G1), occlusal splint treatment (G2), low-level laser therapy (LLLT) treatment (G3); and control (G4). The MIR was tested in all participants before and one month after treatment. Results: All MIR components of the patients had longer right and left SP1 and right and left SP2 latencies (P=0.017, P=0.043, P&lt;0.001, and P=0.04, respectively), and shorter right and left SP1 and right and left SP2 durations (P=0.021, P=0.021, P&lt;0.001, and P&lt;0.001, respectively) as compared to the control group. The right SP1 and SP2 latencies were prolonged in G3 versus G1 and G2 (P=0.026 and P&lt;0.001, respectively); whereas, the left SP2 latency was prolonged in G2 compared with G1. The right and left SP2 duration was not significantly different among the three treated groups. The left SP1 duration was not significantly different among the three treated groups. Gender had no effect on MIR parameters. Conclusion: SB patients had an abnormal MIR response. LLLT was the most effective compared to other treatment modalities.

Decrypting the putative interrelation between sleep bruxism, masticatory muscle pain and sleep breathing disorders: Nosology and the role of hypoxia.

This commentary on sleep medicine explores whether the potential relationship betweensleep bruxism (SB), masticatory muscle pain (MMP) and sleep breathing disorders (SBDs)contributes to improving the management of co-occurring conditions.The paper is divided into 2 sections: (1) reviewing the debate on SB nosology; and (2)based on the publications from the Martynowicz & Wieckiewicz research group, exploringthe role of intermittent hypoxia as a putative mechanism endotype that may link such co-occurrence among individuals for whom characteristics are not yet clear.

IMPACT OF THE COVID-19 PANDEMIC ON BRUXISM AND THE DAILY LIFE OF CHILDREN AGED 7-10

Introduction: In 2020, the global pandemic of COVID-19 significantly affected our daily lives. The youngest students were most affected due to the establishment of distance education, which is associated with social isolation and increased screen time. Aim:To investigate the prevalence and specific risk factors for sleep bruxism associated with the COVID-19 pandemic in children aged 7-10 years, their eating habits and physical activity. Materials and methods: The object of the study are 267 children aged 7-10 years. The examined children underwent a clinical examination, during which the following were registered: dental status and attrition, oral hygiene and orthodontic status. Anamnestic data on nocturnal bruxism, physical activity, dietary habits, and screen exposure were obtained from 241 parents via a questionnaire. The results were statistically processed with SPSS-19. Results: The frequency of bruxism in children aged 7-10 is 21.4% (p&lt;0.05). No increase in its frequency or intensity was found during the pandemic in the studied groups. The average increase in screen exposure during the pandemic was more than 60 minutes per day (p&lt;0.05). In 1/4 of the children, physical activity during the pandemic decreased (p&lt;0.05). In 21.6% of the examined children, the intake of simple carbohydrates increased (p&lt;0.05). Conclusions: Bruxism is a common condition in school-aged children. The restrictive measures during the COVID-19 pandemic have led to a rise in some risk factors for bruxism oral and general health of children aged 7-10 years by increasing their screen exposure, consumption of simple carbohydrates and decreasing their physical activity.

Cannabidiol Intervention for Muscular Tension, Pain, and Sleep Bruxism Intensity-A Randomized, Double-Blind Clinical Trial.

Background: Temporomandibular disorders (TMDs) are the most prevalent non-dental pain issues in the maxillofacial region. Despite advancements, diagnosing and managing TMDs continues to pose challenges. This study aimed to assess the efficacy of cannabidiol (CBD) formulations, with different concentrations, in patients experiencing sleep bruxism and muscle-related TMDs, with a particular emphasis on their myorelaxant, pain-relieving, and bruxism-reducing properties. Methods: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMDs) was utilized as the diagnostic framework. Sixty patients completed the study, which followed a parallel-group, three-arm, randomized, double-blind clinical trial design, with a 1:1:1 allocation ratio across three groups: 1a, 1b, and 2. Groups 1a and 1b received CBD formulations at concentrations of 10% and 5%, respectively, while Group 2 received a placebo formulation. The trial consisted of four main visits, namely screening, baseline, first follow-up after 14 days, and second follow-up after 30 days, during which surface electromyography (sEMG), the visual analogue scale (VAS) for pain assessment, and Bruxoff examinations were conducted. Results: The reduction in pain, as measured by the visual analogue scale (VAS), among patients using the 10% CBD formulation was 57.4% (p < 0.05), accompanied by a decrease in sEMG activity by 42.1% (p < 0.05). Conversely, individuals using the 5% CBD formulation experienced a 40.8% (p < 0.05) decrease in pain. Regarding the decrease in the sleep bruxism index, users of the 10% CBD formulation saw the highest reduction of 51% (p < 0.05). These findings underscore the efficacy of the proposed treatment in both experimental groups, with a notable advantage observed in Group 1a. Conversely, the outcomes of the selected variables for the control group did not exhibit significant differences throughout the study. Conclusions: The intraoral use of CBD formulations in patients with TMDs have proven to be a successful treatment for reducing pain, muscle tension, and bruxing activity in individuals with sleep bruxism and muscle-related TMDs. Specifically, a concentration of 10% CBD has demonstrated superior results compared to 5% CBD.

Influence of occlusal appliances on the masticatory muscle function in individuals with sleep bruxism: A systematic review and meta-analysis.

This systematic review answers the question: "Does occlusal appliance use influence masticatory muscle function of dentate individuals with sleep bruxism?". The literature search included six databases, grey literature, and manual search for articles. Randomized and non-randomized clinical trials were included comparing muscle function of sleep bruxers before and after receiving occlusal appliances. Risk of bias was assessed with risk of bias assessment for randomized and non-randomized clinical trials tool. Twelve studies, three represent randomized clinical trials, were included. Risk of bias was considered low, moderate, or serious. Meta-analyses indicated that soft and hard appliances did not influence muscle activity and bite force of bruxers. Qualitative analysis showed that occlusal appliance use did not influence masticatory performance and muscle volume. However, it was effective in reducing tongue force. Certainty of evidence was considered very low for muscle activity when evaluated with hard appliances, and for bite force evaluated with both appliance materials. Low certainty of evidence was observed for muscle activity with soft appliances. Based on the findings of this meta-analysis, occlusal appliances do not affect masticatory muscle function of sleep bruxers. Regardless of appliance material, the activity of masseter and temporal, and bite force of sleep bruxers was not influenced.

Probable sleep and awake bruxism in adolescents: A path analysis.

Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes. To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents. A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis. PSB and PAB are related to each other, with moderate and positive correlation (β = .390). Poor sleep quality and higher household income had a direct effect on both PSB (β = -.138; β = .123, respectively) and PAB (β = -.155; β = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (β = -.102). Adolescents that drool on the pillow (β = .184) and/or have agitated sleep (β = .104) tend to have PSB. Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

Awareness of dental complications with oral piercings.

To investigate knowledge and awareness of dental complications with oral piercings among adults with oral piercings, a control population with no piercings and body-piercing professionals in South-East Queensland, Australia. Participants recruited from public and private dental clinics and body-piercing professionals from piercing centres in the same region completed questionnaires to assess knowledge and attitudes. Respondents comprised 54 pierced individuals, 54 controls and 35 body-piercing professionals. Only 13% of the pierced group were informed about oral piercing-related complications, and 14% of body-piercing professionals did not warn their clients about long-term complications. The latter included chipped teeth (26%) and gingival recession (15%). About 76% play with their piercing, developing teeth grinding (15%), jaw clenching (15%) and sleep disturbances (4%). Interestingly, 41% of those with oral piercings advised others against getting piercings. There is a lack of awareness about dental-related complications among pierced individuals and body-piercing professionals. A significant proportion of pierced individuals advise others against getting piercings. Body piercers do not consistently advise clients about risks associated with oral piercings. Thus, it is recommended that programmes be developed to improve awareness of oral and dental complications associated with oral piercings.