Retrospective Analysis of the Correlation between TMD, Headache and Bruxism

Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUmTM was performed using the search terms “TMD”, “headache”, and “sleep bruxism” to identify these patients. The inclusion criteria were patients with partial of full dentition, aged 18 to 65 years old who attended the UNLV School of Dental Medicine clinics between January 2014 and September 2018. Patients with incomplete records and those who were completely edentulous formed the exclusion criteria. Data were analyzed using the Pearson Correlation Coefficient. Results: The final sample was made up of 529 patients. The highest percentage of study subjects were in the age range of 29 - 34 (17.9%), with a statistically significant correlation to pain on opening (P = 0.0403). Females showed a statistically significant correlation to TMJ clicking (P = 0.0033). Caucasians also had a statistically significant correlation to TMJ clicking (P = 0.0001). In addition, a statistically significant correlation between pain on opening or chewing and headaches was also observed (P = 0.0081). Conclusion: Within the limitations of the present study, Caucasians, and females presented with more TMJ clicking than the other study subjects. Young adults, in particular, experienced more pain on opening or chewing.

Efficacy of biofeedback therapy via a mini wireless device on sleep bruxism contrasted with occlusal splint:a pilot study

The putative causes of bruxism are multifactorial and there are no definite measures for bruxism management.The aim of this study was to evaluate the efficacy of biofeedback therapy on sleep bruxism,compared with occlusal splint.Twenty-four volunteers with sleep bruxism were divided into two groups：the GTB group that were treated with biofeedback therapy（n 512） and the GTO group that were treated with occlusal splint（n 512）.A mini pressure sensor integrated with a monitoring circuit by use of a maxillary biofeedback splint was fabricated.To foster the relaxation of the masticatory muscles and the nervous system,the wireless device received signals from bruxism events and vibrations alerted the bruxer when the threshold was exceeded.Total episodes and average duration of bruxism events during8 hours of sleep were analyzed with the monitoring program（TRMY1.0）.After 6 and 12 weeks,the episodes（P 50.001） and duration（P,0.05） in the GTB group declined dramatically.In contrast,there were no significant differences in the GTO group after the treatment（P.0.05）.Furthermore,the episodes had significant differences between the GTB group and the GTO group after the same period of treatment（P 5 0.000）.The results suggest that biofeedback therapy may be an effective and convenient measure for mild bruxers,when compared with occlusal splint therapy.The mini wireless biofeedback method may be of value for the diagnosis and management of bruxism in the future.

Effects of sleep bruxism on functional and occlusal parameters:a prospective controlled investigation

This study was conducted to verify the results of a preceding retrospective pilot study by means of a prospective controlled investigation including a larger sample size. Therefore, the aim of this clinical investigation was to analyze the relationship between sleep bruxism and several functional and occlusal parameters. The null hypothesis of this study was that there would be no differences among sleep bruxism subjects and non-sleep bruxism controls regarding several functional and occlusal parameters. Fifty-eight sleep bruxism subjects and 31 controls participated in this study. The diagnosis sleep bruxism was based on clinical criteria of the American Academy of Sleep Medicine. Sixteen functional and occlusal parameters were recorded clinically or from dental study casts. Similar to the recently published retrospective pilot study, with a mean slide of 0.77 mm （s.d., 0.69 mm） in the sleep bruxism group and a mean slide of 0.4 mm （s.d., 0.57 mm） in the control group, the evaluation of the mean comparison between the two groups demonstrated a larger slide from centric occlusion to maximum intercuspation in sleep bruxism subjects （Mann-Whitney U-test; P=O.O08）. However, following Bonferroni adjustment, none of the 16 occlusal and functional variables differed significantly between the sleep bruxism subjects and the non-sleep bruxism controls. The present study shows that the occlusal and functional parameters evaluated do not differ between sleep bruxism subjects and non-sleep bruxism subjects. However, as the literature reveals a possible association between bruxism and certain subgroups of temporomandibular disorders, it appears advisable to incorporate the individual adaptive caoacitv of the stomatognathic svstem into future investigations.

A study of the temporomandibular joint during bruxism

A finite element model of the temporomandibular joint （TMJ） and the human mandible was fabricated to study the effect of abnormal loading, such as awake and asleep bruxism, on the articular disc. A quasilinear viscoelastic model was used to simulate the behaviour of the disc. The viscoelastic nature of this tissue is shown to be an important factor when sustained （awake bruxism） or cyclic loading （sleep bruxism） is simulated. From the comparison of the two types of bruxism, it was seen that sustained clenching is the most detrimental activity for the TMJ disc, producing an overload that could lead to severe damage of this tissue.

A preliminary study on the treatment of bruxism by biofeedback therapy

Objective: To evaluate the effect of wireless biofeedback therapy on bruxism. Methods: Fifteen bruxiers participated to be treated by this therapy. The abnormal movements of teeth during sleep were monitored by a maxillary splint with an electric resistance strain gauge. Meanwhile, the receiver device recorded these details and analyzed the data, including the value of the biting force, occurring time and duration. If the value of biting force or duration exceeds the threshold, a vibrating device like a watch style will alert the patient to relax the masticatory muscles and nervous system to stop the abnormal grinding or clenching. Data were recorded during 8 hours’ sleep and analyzed after the 12 weeks’ treatment and 24 weeks’ treatment. Results: The average episodes of bruxism have declined from (10.60 ± 1.23) to (6.60 ± 0.75) after 12 weeks’ treatment (p < 0.05), and the average duration of bruxism events was reduced from (13.2 ± 0.74) s to (6.50 ± 0.40) s (p < 0.05). The average episodes of bruxism have declined to (3.80 ± 0.64) after 24 weeks’ treatment, and the average duration of bruxism events was reduced to (3.37 ± 0.34) s (p < 0.05). Conclusions: The results suggest that biofeedback therapy can be effective for bruxism treatment.

Long-term follow-up of a patient with venlafaxine-induced diurnal bruxism treated with an occlusal splint:A case report

BACKGROUND Bruxism is a jaw-muscle activity characterized by the clenching or grinding of teeth. It can be divided into nocturnal bruxism and diurnal bruxism(DB). DB secondary to antidepressants is rare and refractory. Reports associated with antidepressant-induced DB are mostly anecdotal without long-term follow-up.The effect of drug intervention on antidepressant-induced DB is still contested.We herein report the first case of successful treatment of venlafaxine-induced DB with an occlusal splint.CASE SUMMARY This case report describes detailed 7-year follow-up of a patient with venlafaxineinduced DB treated with an occlusal splint. The patient who complained about involuntary daytime tooth grinding after taking venlafaxine for a period of 4 mo and was diagnosed with venlafaxine-induced DB. Subsequently, an occlusal splint with modified bilateral buccal-pterygoid pads was used to treat his tooth grinding and to protect the dental structures from tooth wearing. The patient reported remission of symptoms after several months of treatment. His grinding activity was gradually and stably controlled after 2 years, with an almost complete recovery from DB after 6 years.CONCLUSION The maxillary buccal-pterygoid splint can be used as a noninvasive approach to treat venlafaxine-induced DB.

Comparative study of surface electromyography of masticatory muscles in patients with different types of bruxism

BACKGROUND Bruxism is a rhythmic masticatory muscle activity that occurs involuntarily in a non-physiologically functional state.There is a lack of research classifying the functional status of masticatory muscles in patients with different mandibular movement types(centric clenching or eccentric grinding)of bruxism.AIM To assess the differences of the masticatory muscle activity in patients with different types of bruxism.METHODS A total of 21 subjects with centric bruxism(CB)and 21 subjects with eccentric bruxism(ECB)were screened from college students according to a questionnaire and their tooth wear features.Sixteen subjects with no bruxism were also recruited.The surface electromyography(EMG)signals of the temporalis anterior(TA)and superficial masseter muscle(MM)were measured in different mandibular positions and during the chewing task.The EMG amplitude and chewing cycle duration parameters were then analyzed.RESULTS The CB group showed fewer muscle maximal motor units,with the MM being more pronounced,a higher proportion of muscle contractions to be recruited for the same load of chewing activity,and a longer chewing cycle.The ECB group showed more TA maximal motor units and higher MM activity on the nonworking side in unilateral chewing.CONCLUSION CB mainly affects the MM,and patients with CB show reduced masticatory muscle contraction efficiency and chewing cycle efficiency.ECB mainly affects the TA,and patients with ECB show enhanced contraction of non-functional lateral muscle bundles.

Retrospective Analysis of the Association of Non-Carious Cervical Lesions with Bruxism

Recently, bruxism became the center of attention for the etiological research of non-carious cervical lesions (NCCLs). The present study aims to investigate the presence and types of NCCLs associated with bruxism. Retrospective keywords search of the clinical notes of all patient charts in axiUmTM was performed using the terms “bruxism”, “attrition”, “abrasion”, “erosion”, and “abfraction”. All bruxer patients 18 years and older who presented to the UNLV School of Dental Medicine (01/01/2014 to 09/30/2018) with the complete record were included. To determine the statistical analysis implications, the chi-square test was used. Commonest types of NCCL associated with bruxism were attrition and abfraction. Five hundred seventeen cases had multifactorial lesions. Anterior maxillary teeth followed by mandibular anterior were the most affected teeth. Abfraction lesions were mainly sighted in maxillary premolars, followed by maxillary canines. Within the limitation of the present investigation, it was concluded that attrition and abfraction were highly associated with bruxism.

A Study of the electronic information monitoring of bruxism

Objective：Bruxism is the term used for teeth grinding or jaw clenching. An electronic monitor of bruxism was developed to evaluate bruxism duration and frequency. Methods： Ten cases were selected in the Department of Prosthodontics of Jiangsu Stomatological Hospital to evaluate the monitor. A stabilization occlusal splint was fabricated for each of the 10 cases. The vertical dimension for each splint was 0.5 nun lower than mandibular postural position. Some sensors had been prearranged at each splint which could transfer the variation of the biting force into electronic signals. The data of sleeping duration, grinding duration and grinding frequency were recorded with this new type of bruxism monitor, which had been specifically invented to study bruxism. Results：The data from 10 bruxism cases were collected and the results were considered reliable. Subjects nocturnal duration parameters did not change significantly from night-to-night. Conclusion：The bmxism monitor can automatically measure and record bruxism data using an occlusal splint. This device is valuable for diagnosis and evaluation of bruxism.

数字化技术在酸蚀症伴重度磨耗患者功能美学缺陷修复中的应用1例

牙磨耗、磨损、酸蚀症等多因素导致的非龋性牙体缺损在口腔临床中的发病率呈上升趋势,通常伴随着不同程度的口腔美学缺陷及功能障碍。对其进行全牙列固定修复咬合重建时,不仅要恢复牙列的形态和美观,更要实现咬合关系与整体口颌系统的协调。本文报道1例酸蚀症伴重度磨耗的病例,利用多模态数字化数据(口内扫描、面部扫描、电子面弓、下颌运动轨迹描记等)构建4D虚拟患者,制定全面的修复方案,进行不同牙齿的个性化微创修复,采用唇贴面、颊贴面、贴面、高嵌体、嵌体、全冠等多种修复体,完成数字化全牙列咬合重建治疗,为该疾病的诊治提供可视化、可全程质控的全局观诊疗策略。

195名磨牙症患者临床分型的相关影响因素分析

目的:了解乌鲁木齐市三甲医院中患磨牙症的职工其临床分型受哪些因素的影响。方法:于2022年1月-2022年4月对乌鲁木齐市某三甲医院职工进行临床检查及问卷调查,确定其具体的磨牙症临床分型,并且了解其影响因素。收集的问卷结果录入Epidata 3.3软件,通过SPSS 25.0软件进行数据分析。结果:本次调查共纳入195名磨牙症患者,其中临床分型为磨牙的患者有81名,紧咬牙的患者有69名,既有磨牙又有紧咬牙的患者有45名。单因素分析结果显示,不同人员类型、咖啡摄入情况的磨牙症患者在不同临床分型构成上差异有统计学意义(P<0.05)。多元无序Logistic回归分析结果显示,人员类型(OR值=0.052,95%CI:0.006~0.447)、饮酒(OR值=0.129,95%CI:0.030~0.564)影响磨牙症的临床分型(P<0.05)。结论:人员类型与饮酒可能是磨牙症临床分型的影响因素。

夜磨牙相关研究现况

夜磨牙在生活中很常见,其发病率大致随着年龄的增长而降低。夜磨牙病因复杂多样,相关生物学机制包括焦虑抑郁、睡眠障碍等。目前不同研究之间,对夜磨牙的定义和诊断标准并不完全一致。长期磨牙可引起牙冠磨损、牙敏感、牙周炎等并发症,会导致颞下颌关节紊乱、咀嚼肌疲劳压痛、咬肌肥大、头颈疼痛等,同时磨牙可能与心血管不良事件相关。该文主要介绍夜磨牙相关研究情况,帮助正确认识该病,了解夜磨牙的影响因素、身体危害和治疗方法,关注其与睡眠情况的相互影响,突出个体化的病因干预,实施有效的多科联合治疗方案。

颞下颌关节紊乱病患者临床特征与髁突骨质变化Logistic回归分析

目的:探讨颞下颌关节紊乱病患者髁突影像学改变与临床特征的关系。方法:用CBCT对453例TMD患者行颞下颌关节扫描,并采用logistic回归分析髁突骨质变化与临床特征的关系。结果:<18岁及有疼痛、张口受限的患者更易出现髁突骨质改变。髁突骨质正常组(320例)伴发磨牙症的几率高于髁突骨质改变组(133例)。单因素logistic回归分析,磨牙症OR值为0.550,疼痛OR值为1.844,张口受限OR值为2.024。多因素logistic回归分析,由于磨牙症因素的保护作用,疼痛OR值降至1.791,张口受限OR值降至1.847。结论:发育期及有疼痛、张口受限的TMD患者更易发生髁突骨质改变,磨牙症可能是TMD患者髁突骨质改变发生的保护性因素。

青少年颞下颌关节盘前移位患者的睡眠质量及其影响因素调查

目的探讨青少年颞下颌关节盘前移位患者睡眠质量现状及其相关影响因素。方法本研究已通过单位伦理委员会审查批准,并获得患者知情同意。采用便利抽样法,应用一般资料调查表、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)、中国中学生心理健康量表(mental health inventroy of middle-school students,MMHI-60)和疼痛视觉模拟评分量表(visual analogue scale,VAS)对上海某三级甲等医院口腔外科门诊就诊的120例青少年颞下颌关节盘前移位患者进行调查,采用描述性分析、单因素分析、相关性分析及回归分析探讨相关影响因素。结果本研究中青少年颞下颌关节盘前移位患者PSQI得分为(7.77±4.63)分;不同学业压力、夜磨牙的患者其睡眠质量的差异具有统计学意义(P<0.01);PSQI得分与疼痛得分呈正相关(r=0.45,P<0.001),疼痛影响睡眠质量;与MMHI-60量表得分呈正相关(r=0.74,P<0.001),心理健康者睡眠质量较好;回归分析结果显示,学业压力(OR=2.511,95%CI=1.307~4.828)、夜磨牙(OR=3.694,95%CI=1.394~9.791)、疼痛得分(OR=2.104,95%CI=1.095~4.041)、心理得分(OR=1.039,95%CI=1.021~1.058)为睡眠质量的影响因素。结论青少年颞下颌关节盘前移位患者的睡眠质量普遍较低,学业压力、夜磨牙、疼痛和心理健康状况是睡眠质量的影响因素。

空军飞行员磨牙症患病率与咬合及心理因素相关性分析

目的:调查军事环境中飞行员磨牙症的患病情况,探讨该人群中磨牙症患病率与错[牙合]畸形及心理因素的相关性。方法:对108名空军飞行员进行口腔一般情况、心理问卷调查、生活习惯及身体状况调查以及错[牙合]畸形检查,评估空军飞行员磨牙症患病率与错[牙合]畸形及心理因素的相关性。结果:108名空军飞行员中有44名(40.7%)患有磨牙症。空军飞行员SCL-90临床症状自评量表结果显示除躯体化因子得分高于全国常模(P<0.05)、人际关系得分低于全国常模(P<0.05),其他因子无显著差异,说明空军飞行员整体心理健康情况良好。对相关错[牙合]因素分析后显示,安氏Ⅱ类错[牙合]与该人群磨牙症高度相关(P=0.002);拥挤、牙列间隙、深覆[牙合]、深覆盖、前牙开[牙合]、后牙单侧反[牙合]、中线偏斜与该人群磨牙症无相关性(P>0.05)。结论:空军飞行员心理健康情况良好。Ⅱ类错[牙合]畸形与空军飞行员磨牙症高发关系密切。

基于积分肌电值的磨牙症实时监测系统研究

目的:设计一种基于积分肌电值的磨牙症实时监测系统,为夜间磨牙症患者的磨牙监测和量化评估提供可能。方法:该系统由信号采集、信号处理、磨牙症监测等模块组成。信号采集模块主要由MyoWare肌电传感器、电极、Arduino单片机等组成,完成积分肌电信号的采集;信号处理模块采用中值滤波方法消除基线漂移,再采用基于拉依达准则的自适应阈值积分肌电包络检测算法实现磨牙包络检测,然后运用数据统计提取磨牙状态的阈值特征参数;磨牙症监测模块通过设计开发的实时监测软件实现各类磨牙指标统计以及磨牙状态监测。选取3名有过磨牙经历并清楚其磨牙方式的志愿者进行磨牙症监测功能模拟实验,验证磨牙肌电包络检测准确率和磨牙监测指标统计功能。结果:实验结果表明磨牙包络检测总体准确率为98.3%,且3名志愿者的磨牙状态指标监测结果与模拟预设情况一致。结论:该系统具有可穿戴性好、实时性高、磨牙包络检测准确率高、指标参数丰富等优点,可实现夜间磨牙监测,为磨牙症诊断提供了参考。

A型肉毒杆菌毒素治疗青年夜磨牙症的初步研究

目的研究A型肉毒杆菌毒素(botulinum toxin,BTX-A)对青年磨牙患者的临床治疗效果。方法选取2020年9月至2022年3月浙江树人大学树兰国际医学院附属树兰(杭州)医院接诊的42例夜磨牙症患者,采用随机数字表法分为对照组(n=21)和试验组(n=21)。治疗前对两组进行多导睡眠监测和疼痛视觉模拟评分(visual analog scale,VAS)评估,试验组咬肌区注射BTX-A,对照组咬肌区注射生理盐水,注射4周后再次进行多导睡眠监测和疼痛评估,比较两组治疗前后多导睡眠监测参数、咀嚼肌节律性运动(rhythmic masticatory muscle activity,RMMA)事件参数、疼痛水平和不良反应情况。结果注射4周后,两组多导睡眠监测参数比较,差异均无统计学意义(P>0.05)。试验组患者咀嚼肌节律性运动发作期间咬肌肌电爆发的峰值幅度(peak amplitude of electromyography burst in the masseter muscle during rhythmic masticatory muscle activity,RMMA.MA)及咬肌最大自主收缩时咬肌肌电爆发的峰值幅度(peak amplitude of electromyography burst in the masseter muscle during maximal voluntary clenching,MVC.MA)均低于对照组,差异均有统计学意义(P<0.05)。两组VAS均低于注射前且试验组低于对照组,差异均有统计学意义(P<0.05)。两组均未报告吞咽困难或咀嚼不良事件。结论A型肉毒杆菌毒素注射不能减少夜磨牙的发生,但其通过降低咬肌的强度能缓解夜磨牙症的牙齿磨损和咬肌酸痛,但长期效果仍需进一步观察。

上海市儿童磨牙症流行病学调查

目的:通过对上海地区儿童磨牙症流行病学调查,以期对磨牙症进行早期诊断和治疗。方法:对779名上海地区3～6岁幼儿家长做问卷调查。结果:(1)上海市儿童磨牙症的患病率为38.4%;(2)男性磨牙症151人,患病率为40.6%;女性磨牙症148人,患病率为36.4%。不同性别儿童磨牙症患病率在统计学上无显著差异(χ2=1.47,P>0.05)。(3)磨牙症儿童和无磨牙症儿童的遗传背景的差异有统计学意义(χ2=102.98,P<0.01)。结论:上海市3～6岁儿童磨牙症的患病率较高,应引起医务工作者的重视,对儿童磨牙症做好早期诊断和治疗。

牙列重度磨耗和磨牙症患者咀嚼肌肌电信号分析

目的分析牙列重度磨耗和磨牙症患者的咀嚼肌肌电图(EMG)特征。方法以无夜磨牙的牙列重度磨耗患者(牙列重度磨耗组,n=19)、夜磨牙患者(夜磨牙组,n=30)和无上述症状和体征的正常志愿者(对照组,n=30)作为研究对象。分别采集三组对象在下颌姿势位(MPP)和牙尖交错位(ICP)最大紧咬牙位时,颞肌前束(TA)、咬肌(MM)和二腹肌前腹(DA)的肌电图(EMG),对各组的峰值电位(Amp)和咀嚼肌不对称指数进行统计学分析。结果MPP时,夜磨牙组患者左侧TA和DA的Amp显著高于对照组(P<0.05);牙列重度磨耗组各咀嚼肌的Amp与对照组比较均无显著差异(P>0.05);夜磨牙组左侧TA的Amp显著高于牙列重度磨耗组(P<0.05)。ICP最大紧咬牙位时,夜磨牙组各咀嚼肌的Amp与对照组比较均无显著差异(P>0.05);牙列重度磨耗组的双侧MM和TA的Amp显著低于夜磨牙组和对照组(P<0.05)。咀嚼肌总体不对称指数,夜磨牙组与对照组和牙列重度磨耗组比较均有显著差异(P<0.05),而后两组间无显著差异(P>0.05)。结论夜磨牙症患者TA存在肌功能亢进;牙列重度磨耗患者咀嚼肌收缩力减低。

青年夜磨牙症患者经弹性牙合垫治疗前后咬合变化特征的研究

目的:测量并分析夜磨牙症患者使用弹性垫治疗前后各项咬合数据变化。方法:使用弹性垫对青年夜磨牙症患者(n=10)进行治疗,并在治疗前和治疗后6个月使用T-Scan咬合检测仪进行咬合检测,观察和记录实验组闭合时间、分离时间、力中心位置、力不对称指数的变化,与对照组(n=10)进行对比和研究,并观察临床疗效。结果:治疗前实验组闭合时间及左、右侧分离时间均比对照组长(P<0.05),治疗后均无统计学差异(P>0.05);治疗前、后2组前伸分离时间差别无统计学意义(P>0.05);治疗前实验组和对照组力中心位置左右向偏移和右侧力百分比及力不对称指数比较均有统计学差异(P<0.05),治疗后比较均无统计学差异(P>0.05)。实验组治疗后闭合时间及左、右侧分离时间均比治疗前缩短(P<0.05);实验组治疗前、后右侧力百分比值有统计学差异(P<0.05),前伸分离时间、力中心位置偏移、左侧力百分比及力不对称指数治疗前后比较均无统计学差异(P>0.05)。结论:早接触、侧方干扰、全牙列力中心的偏移等咬合因素与磨牙症有十分密切的关系。使用弹性垫治疗磨牙症,可以有效地改善上述问题,使关系更加协调和稳定。