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%. ResultsThe 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.

Bruxism is a common condition that clinicians come across in both adult and children. Prevalence rates in adults range from 22% to 30% for awake bruxism (AB) and from 8% to 16% for sleep bruxism (SB), while in children they raise up to 40% for SB. Currently, bruxism is considered an 'umbrella term' for different jaw muscle activities, occurring during sleep and/or wakefulness. They have a different aetiology, but there is agreement on their central, not peripheral, origin. In otherwise healthy individuals, bruxism can be considered a muscle behaviour, which can be harmless or represent a risk and/or protective factor for clinical consequences, rather than being a disorder per se. Nonetheless, given the merging knowledge on the interaction with several associated factors and concurrent conditions, bruxism should be investigated for being a possible sign of an underlying primary condition. Consequently, treatment should be directed to the management of the possible clinical consequences and/or to the underlying primary conditions. It is generally based on the conservative strategies. The present manuscript summarises the available knowledge on bruxism aetiology, assessment and management for both SB and AB in adults and children, with focus on the future directions to implement the clinical relevance of bruxism researches. Clinical relevance: A narrative overview summarising such a quickly evolving topic as bruxism may be useful to help clinicians understanding the complex relationship among bruxism, the possible underlying primary conditions, and the 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.

SummarySubclinical hypothyroidism and hyperthyroidism have been recognized as clinical entities with negative effects on the cardiovascular system. Moreover, the effect of treated thyroid dysfunction on parameters associated with the cardiovascular control system has been poorly investigated. In the present study we analyzed time-domain heart rate variability in coronary artery disease (CAD) patients with known thyroid diseases. Twenty-four hour ECG monitoring was performed in 344 patients with coronary artery disease (174 with thyroid dysfunction and 170 without thyroid dysfunction used as a control group), using a 3-channel tape recorder. Time domain parameters of heart rate variability (HRV) were defi nitely lower both in patients with subclinical hypothyroidism and subclinical hyperthyroidism than in the control group, with statistically signifi cant differences in SDNN, RMSSD, TINN, and mean RR for both subgroups. Furthermore, patients on L-thyroxine treatment and restored euthyroidism had generally higher HRV values than patients with subclinical hypothyroidism, nevertheless SDNN, RMSSD, SDNN index, TINN, and mean RR were signifi cantly lower when compared to those of the control group. Signifi cant differences in HRV were also found between hyperthyroid patients under treatment and control group subjects with respect to RMSSD, TINN, and mean RR values. In conclusion, patients with cardiac disease and known thyroid disease, even when the disease is in the subclinical range or despite treatment, should be regarded as patients at additional risk conveyed by thyroid hormone disturbances. (Int Heart J 2014; 55: 33-38) Key words: Hyperthyroidism, Hypothyroidism, Autonomic, Regulation, Cardiovascular risk T hyroid hormones perform a fundamental role in maintaining cardiovascular homeostasis, since they act both directly on the heart muscle and by modulating the autonomic nervous system. Typical clinical signs of hyperthyroidism such as increases in heart rate, cardiac output, systolic blood pressure, myocardial contractility, and basal metabolism and the presence of tremor suggest a hyperadrenergic state. This is possibly due to a greater sensitivity to catecholamines, since their plasmatic concentration in hyperthyroid patients is normal.1) It has been hypothesized that hyperthyroid patients could have alterations either in the number or in the affinity of adrenergic receptors.2) Hypothyroidism instead seems to evoke a hypoadrenergic state due to the presence of bradycardia, reduced cardiac output, and reduced basal metabolism. Intracellular catecholamine production from circulating lymphocytes has been found to be lower during short-term hypothyroidism in patients who have undergone thyroidectomy for differentiated thyroid carcinomas, as compared to the values found during hormone replacement therapy.3) Nevertheless, in contrast with the reduced adrenergic reactions at the cardiac, metabolic, and cellular levels, the plasmatic concentration of norepinephrine is increased in those patients.4) Through the ev...

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