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Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (21 January 2023) | Viewed by 26834

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Prof. Dr. Ephraim Winocur

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Guest Editor

Departments of Oral Rehabilitation, Maurice & Gabriela Sch Dent Med, Tel Aviv University, Tel Aviv, Israel

Prof. Dr. Mieszko Wieckiewicz

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Co-Guest Editor

Department of Experimental Dentistry, Wroclaw Medical University, 26 Krakowska St., 50425 Wroclaw, Poland
Interests: temporomandibular disorders; bruxism; orofacial pain; dental sleep medicine, clinical dentistry; dental materials; fixed prosthodontics; removable prosthodontics; dental education
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Dear Colleagues,

Recently separate definitions for sleep and awake bruxism (SB & AB) were proposed in an international consensus meeting, Assessment of Bruxism Status, with bruxism experts from around the globe. SB is characterized as rhythmic (phasic) or nonrhythmic (tonic) activity, while awake bruxism is characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible. Both are considered as masticatory muscle activities (during sleep or wakefulness accordingly) and are not sleep or movement disorders in otherwise healthy individuals. Currently, bruxism is referred to as a behavior that can act as a risk factor for detrimental disorders, or in contrast a protective factor (1).

The relationship between pain and bruxism is controversial. Svensson et al (2) concluded a review article by saying: "For the clinicians, it may be important to understand the concept of ‘nonlinear’ relationships between bruxism and craniofacial pain to avoid oversimplification of diagnosis and management. Rather, pain and bruxism should be managed as separate problems in the individual patients". Lavigne et Palla are of the opinion that due to the fact that most SB episodes are phasic, with few tonic or sustained contractions, the probability of reports of pain is small in contrast to clenching while awake, which is characterized by more sustained contractions (3). Smardz et al (4) found that the occurrence of Temporomandibular disorders (TMD)-related pain is not related to the intensity of sleep bruxism, while On the other hand, Fernandes et all stated that SB seems to be a risk factor for painful TMD, and this in turn is a risk factor for the occurrence of higher depression and non-specific physical symptoms levels (5).

Winocur et all found that generally, the prevalence of most oral habits was higher among adolescent females than males. Most examined signs and symptoms of TMD showed a statistically significant higher prevalence among females (6).

The aim of this special issue is two folds:

To investigate and assess the relationship between sleep and/or awake bruxism and painful temporomandibular disorders
To investigate and compare the impact of sleep and/or awake bruxism among both sexes

Prof. Dr. Ephraim Winocur
Prof. Dr. Mieszko Wieckiewicz
Guest Editor

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Keywords

sleep bruxism
awake bruxism
temporomandibular disorders
pain
female
males
age

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Published Papers (9 papers)

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Editorial

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2 pages, 173 KiB

Open AccessEditorial

Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age

by Ephraim Winocur and Mieszko Wieckiewicz

J. Clin. Med. 2023, 12(4), 1364; https://doi.org/10.3390/jcm12041364 - 8 Feb 2023

Cited by 1 | Viewed by 1122

Abstract

According to the current international consensus [...] Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

Research

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12 pages, 498 KiB

Open AccessArticle

Polysomnographic Assessment of Effects of Tobacco Smoking and Alcohol Consumption on Sleep Bruxism Intensity

by Weronika Frosztega, Mieszko Wieckiewicz, Dorian Nowacki, Monika Michalek-Zrabkowska, Rafal Poreba, Anna Wojakowska, Justyna Kanclerska, Grzegorz Mazur and Helena Martynowicz

J. Clin. Med. 2022, 11(24), 7453; https://doi.org/10.3390/jcm11247453 - 15 Dec 2022

Cited by 11 | Viewed by 2930

Abstract

Background: Sleep bruxism (SB) is a common sleep-related movement behavior with a complex etiology. A recent hypothesis suggests psychoactive substance usage, tobacco smoking, and alcohol intake are risk factors for SB. This study aimed to evaluate SB intensity in tobacco smokers and alcohol drinkers. Methods: A total of 133 adults underwent full-night audio- and video-polysomnography, and the polysomnograms were evaluated using the American Academy of Sleep Medicine guidelines. The study group was divided into smoker and nonsmoker groups as well as drinker and non-drinker groups. Results: The results of the polysomnographic analysis confirmed that tobacco smoking has a significant effects on SB. Tobacco smokers showed increased bruxism intensity (5.50 ± 4.71 vs. 3.83 ± 3.26, p < 0.05), especially the mixed phenotype (0.93 ± 1.00 vs. 0.59 ± 0.59, p < 0.05), in the N1 sleep stage (22.84 ± 20.45 vs. 15.66 ± 13.60, p < 0.05) and the nonsupine position (4.93 ± 5.56 vs. 2.50 ± 2.31, p < 0.05). They also showed a higher number of bruxism episodes with arousal compared with nonsmokers (2.91 ± 2.83 vs. 1.61 ± 1.49, p < 0.05), indicating increased sleep fragmentation. However, no significant effect of alcohol on SB intensity was observed, and the bruxism episode index was similar in alcohol drinkers and nondrinkers. In addition, electrolyte disturbances and lipid disorders were evaluated. Compared with nonsmokers, tobacco smokers showed a higher concentration of plasma triglycerides (177.67 ± 106.9 vs. 129.18 ± 65.61) and lower levels of iron and magnesium (96.68 ± 43.58 vs. 123.83 ± 52.36 and 1.85 ± 0.22 vs. 1.96 ± 0.21, respectively). Conclusions: In summary, this study showed that tobacco smoking, but not alcohol consumption, is related to bruxism intensity and lipid and electrolyte disturbances in individuals with sleep disorders. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

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10 pages, 285 KiB

Open AccessArticle

Temporomandibular Disorders and Bruxism among Sex Workers—A Cross Sectional Study

by Ilana Eli, Adi Zigler-Garburg, Efraim Winocur, Pessia Friedman-Rubin, Tamar Shalev-Antsel, Shifra Levartovsky and Alona Emodi-Perlman

J. Clin. Med. 2022, 11(22), 6622; https://doi.org/10.3390/jcm11226622 - 8 Nov 2022

Cited by 8 | Viewed by 2450

Abstract

Sex workers are a highly underprivileged population which is present all around the world. Sex work is associated with negative social stigma which affects all aspects of the sex workers’ lives including healthcare, service providers and police. The stigma may result in increased stress, mental health problems, feelings of isolation and social exclusion. In the present study, 36 sex workers (SW) and 304 subjects from the general population in Israel (GP) were evaluated for the presence of bruxism and Temporomandibular disorders (TMD), with the use of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD- Axis I). When compared to the general population, sex workers presented larger maximal assisted mouth opening and higher prevalence of the following TMD diagnoses: Disc displacement with reduction, Myalgia, Myofascial pain with referral, Arthralgia (left and right) and Headache attributed to TMD. The odds of sex workers suffering from one of these diagnoses were twice to five times higher than those of the general population. The study shows that health problems of sex workers go beyond venereal diseases, HIV and mental disorders which are commonly studied. Oral health, TMD and oral parafunctions are some of the additional health issues that should be addressed and explored in this population. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

15 pages, 316 KiB

Open AccessArticle

Accuracy of Surface Electromyography in the Diagnosis of Pain-Related Temporomandibular Disorders in Children with Awake Bruxism

by Liliana Szyszka-Sommerfeld, Magdalena Sycińska-Dziarnowska, Agata Budzyńska and Krzysztof Woźniak

J. Clin. Med. 2022, 11(5), 1323; https://doi.org/10.3390/jcm11051323 - 28 Feb 2022

Cited by 10 | Viewed by 2252

Abstract

The study assessed masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related temporomandibular disorders (TMD-P) and awake bruxism (AB) and in children without TMD, as well as the diagnostic value of surface electromyography (sEMG) in diagnosing TMD-P in subjects with AB. After evaluation based on the Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 30 children diagnosed with myofascial pain were included in the myofascial pain group and 30 children without TMD diagnosis comprised the control group (mean age of 9.49 ± 1.34 years). The activity of the anterior temporal (TA) and masseter (MM) muscle was assessed bilaterally using a DAB-Bluetooth device (zebris Medical GmBH, Germany) at rest and during maximum voluntary clenching (MVC). The receiver operating characteristic (ROC) curve was used to determine the accuracy, sensitivity, and specificity of the normalized sEMG data. Statistically significant intergroup differences were observed in TA and MM muscle EMG activity at rest and during MVC. Moderate degree of sEMG accuracy in discriminating between TMD-P and non-TMD children was observed for TA_mean, left MM, and MM_mean EMG muscle activity at rest. sEMG can be a useful tool in assessing myofascial TMD pain in patients with AB. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

9 pages, 263 KiB

Open AccessArticle

Symptoms of Nocturnal Masticatory Muscle Activity among Women of Different Age Groups and Their Association to Obstructive Sleep Apnea—A Cross Sectional Study

by Alona Emodi-Perlman, Jawan Soliman, Pessia Frideman-Rubin and Ilana Eli

J. Clin. Med. 2022, 11(5), 1199; https://doi.org/10.3390/jcm11051199 - 23 Feb 2022

Cited by 6 | Viewed by 3188

Abstract

Sleep bruxism (SB), snoring, and excessive daytime sleepiness are often associated with obstructive sleep apnea (OSA). OSA, which is characterized by a repetitive collapse of the upper airway during sleep, can cause oxygen desaturation and lead to adverse medical conditions, such as cardiovascular events, hypertension, heart attack, and stroke. In the present study, 112 Arab women aged 20–40 years (Early Adulthood/Adulthood–EarlyA) and 116 Arab women aged 50 and above (Middle Age–MiddleA), were requested to complete questionnaires regarding demographic variables, symptoms of nocturnal masticatory muscle activity (possible SB, headache, and stiffness of the oral and/or neck musculature upon awakening), risk of OSA (STOP-BANG questionnaire), and daytime sleepiness (Epworth sleepiness scale—ESS). Women, who reported snoring, experienced more SB (35.8% vs. 20.6%, chi-square, p < 0.05), more headaches (33.3% vs. 19.3%, p < 0.05), and more muscle stiffness upon awakening (34.3% vs. 16.3%, p < 0.005), than their non-snoring counterparts. Out of the women who snore, 11% showed high risk for OSA, as compared to only 1% among the non-snoring participants (p < 0.000). Symptoms of nocturnal masticatory muscle activity and/or snoring can serve as initial indicators of OSA. Higher awareness of dentists to such symptoms, particularly among their middle-aged female patients, can prevent a development of harmful conditions associated with OSA. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

8 pages, 241 KiB

Open AccessArticle

by Małgorzata Gałczyńska-Rusin, Małgorzata Pobudek-Radzikowska, Krzysztof Gawriołek and Agata Czajka-Jakubowska

J. Clin. Med. 2022, 11(3), 845; https://doi.org/10.3390/jcm11030845 - 5 Feb 2022

Cited by 3 | Viewed by 2405

Abstract

It seems extremely important to know the biomechanical properties of the orofacial tissues among patients with increased activity of masticatory muscles, such as bruxism. The aim of this study was to evaluate biomechanical properties of the masseter muscle by using MyotonPRO in adults with probable bruxism and to define gender relations. This study was conducted in the Temporomandibular Disorders Department at Poznan University of Medical Sciences, Poland (June 2021–November 2021) among patients that reported bruxism symptoms The patients underwent a clinical examination, then the biomechanical properties of the masseter muscles were assessed. The MyotonPro measured masseter tone, stiffness and elasticity in 36 patients with a self-assessment of bruxism (18 women and 18 men). Data were collected from relaxed and contracted muscles. In relaxed masseter muscles there were no statistically significant differences between the sexes in muscle tone, stiffness and elasticity. During contraction significant differences were found between the sexes in the tension and the stiffness of the masseter muscles. Moreover, women often experienced headaches in the temporal region and pain in the masseter muscles during palpation. Among patients with a self-assessment of bruxism, accompanying pain was significantly more frequent in women. Male gender was associated with increased muscle tension and stiffness of the contracted masseter muscle. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

10 pages, 263 KiB

Open AccessArticle

Painful Temporomandibular Disorders, Bruxism and Oral Parafunctions before and during the COVID-19 Pandemic Era: A Sex Comparison among Dental Patients

by Orit Winocur-Arias, Efraim Winocur, Tamar Shalev-Antsel, Shoshana Reiter, Levartovsky Shifra, Alona Emodi-Perlman and Pessia Friedman-Rubin

J. Clin. Med. 2022, 11(3), 589; https://doi.org/10.3390/jcm11030589 - 25 Jan 2022

Cited by 21 | Viewed by 3990

Abstract

Aim: To evaluate the effect of the current coronavirus pandemic on the prevalence of bruxism, oral parafunctions and painful Temporo-Mandibular Disorders (TMDs) and to evaluate the influence of the pandemic on both sexes. Methods: This retrospective study included 288 dental patients who underwent complete anamnesis and examination according to the Diagnostic Criteria for TMD. The study evaluated two patient populations according to the date of examination: (a) pre-COVID-19 pandemic era (108 patients); (b) COVID 19 pandemic era, where 180 patients were examined during the pandemic. Results: A significant increase in parafunction activity was found in both men and women (p < 0.001) during the COVID-19 pandemic. Awake bruxism (AB) and sleep bruxism (SB) was more prevalent during the COVID-19 pandemic solely in women (AB-p < 0.001; SB-p = 0.014). Conclusions: Men and women were affected by the ongoing stress due to the COVID-19 pandemic, yet women showed a higher influence as compared to men. The long-term exposure to elevated levels of anxiety and stress may aggravate or trigger stomatognathic detrimental conditions. Dentists should be aware and regularly monitor their patients regarding the possible existence and consequences of bruxism and TMD. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

10 pages, 517 KiB

Open AccessArticle

Awake Bruxism—Single-Point Self-Report versus Ecological Momentary Assessment

by Alona Emodi-Perlman, Daniele Manfredini, Tamar Shalev, Ilanit Yevdayev, Pessia Frideman-Rubin, Alessandro Bracci, Orit Arnias-Winocur and Ilana Eli

J. Clin. Med. 2021, 10(8), 1699; https://doi.org/10.3390/jcm10081699 - 15 Apr 2021

Cited by 22 | Viewed by 2880

Abstract

Assessment of awake bruxism (AB) is problematic due to the inability to use continuous recordings during daytime activities. Recently, a new semi-instrumental approach was suggested, namely, ecological momentary assessment (EMA), via the use of a smartphone application. With the application, subjects are requested to report, at least 12 times per day, the status of their masticatory muscle activity (relaxed muscles, muscle bracing without tooth contact, teeth contact, teeth clenching, or teeth grinding). The aim of the present study was to test the association between a single observation point self-report and EMA assessment of AB. The most frequent condition recorded by the EMA was relaxed muscles (ca. 60%) and the least frequent was teeth grinding (less than 1%). The relaxed muscle condition also showed the lowest coefficient of variance over a seven-day period of report. Additionally, only the relaxed muscles and the muscle bracing conditions presented an acceptable ability to assess AB-positive and AB-negative subjects, as defined by single-point self-report questions. The combination between self-report and EMA may have the potential to promote our ability to assess AB. We suggest to re-consider the conditions of teeth contact and teeth grinding while using EMA to evaluate AB. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

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Review

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13 pages, 539 KiB

Open AccessReview

Cardiovascular Implications of Sleep Bruxism—A Systematic Review with Narrative Summary and Future Perspectives

by Monika Michalek-Zrabkowska, Helena Martynowicz, Mieszko Wieckiewicz, Joanna Smardz, Rafal Poreba and Grzegorz Mazur

J. Clin. Med. 2021, 10(11), 2245; https://doi.org/10.3390/jcm10112245 - 21 May 2021

Cited by 11 | Viewed by 4284

Abstract

Sleep bruxism is a common sleep-related behavior characterized as repetitive masticatory muscle activity. Genetic vulnerability to stress and anxiety is considered a basal component in the pathogenesis of bruxism events. Dysfunction of the autonomic nervous system related with an arousal during sleep is considered an underlying cause of the cardiovascular implications of sleep bruxism. Increased cardiovascular risk was previously linked with sleep conditions: for example, obstructive sleep apnea and insomnia, and sleep bruxism. The aim of present systematic review was to evaluate the current arguments on the relationship between sleep bruxism and cardiovascular diseases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We have reviewed the Embase, PubMed (Medline) and Scopus databases to identify applicable articles (1994–2021). A total of 127 records in English language were identified, then after screening and exclusion of nonrelevant records, 19 full-text articles were evaluated. Finally, we included 12 studies for synthesis. Due to the heterogeneity of the compared studies, only a qualitative comparison and narrative summary were performed. In the majority of studies, increased sympathetic activity was successfully established to escalate heart rate variability, the inflammatory process, oxidative stress, endothelial remodeling and hormonal disturbances, leading to hypertension and other cardiovascular complications. Full article

(This article belongs to the Special Issue Temporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age)

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