Ecological Momentary Assessment of Awake Bruxism Frequency in Patients with Different Temporomandibular Disorders

Abstract

Self-reported awake bruxism (AB) has been associated with temporomandibular disorders (TMD). However, the daily amount of AB behavior has not been quantified in pain patients. Therefore, this study aimed to assess AB frequency in patients with myofascial pain and temporomandibular joint (TMJ) pain and compare it to a group of pain-free individuals. Eighty-four individuals belonging to either a TMD group (n = 54) or a healthy control group (n = 30) were selected. AB frequency was obtained by ecological momentary assessment with a dedicated smartphone application that sent sound alerts at random intervals during the day for one week. Upon receiving the alert, the volunteer reported the current muscular condition and/or the teeth position, i.e., relaxed jaw muscle, jaw bracing, teeth contact, teeth clenching, or teeth grinding. Data were evaluated by independent t-test (α = 0.05). During the seven days, AB frequency was 62.1% ± 26.8% for TMD patients and 36.2% ± 27.3% for pain-free subjects (p < 0.001). Mandible bracing was most common in the TMD group (p < 0.001), while teeth contact, clenching, and grinding did not differ between groups. Moreover, no differences were found in AB frequency between myofascial pain and TMJ pain patients. Therefore, TMD patients have higher AB frequency characterized by jaw bracing, irrespective of pain location.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies

“…Due to the extremely low frequency of teeth grinding, 35 a direct link between AB and tooth wear can be reasonably excluded in most individuals. On the other hand, patients with TMDs have reported a twofold frequency of AB activities, and mandible bracing in particular, as compared to healthy individuals 56 . These findings are in line with previous observations, when higher teeth contacting habits in patients with TMD symptoms were reported 57–59 .…”

“…On the other hand, patients with TMDs have reported a twofold frequency of AB activities, and mandible bracing in particular, as compared to healthy individuals. 56 These findings are in line with previous observations, when higher teeth contacting habits in patients with TMD symptoms were reported. [57][58][59] This suggests that repetitive, low-level, tonic activity, that is typical of teeth contact and mandible bracing, may play an important role in the onset and maintenance of musculoskeletal symptoms in the orofacial area, thus constituting a target for clinical research purposes.…”

“…Based on that, in line with similar approaches adopted for other fields of dentistry and medicine, a bruxism network can be visualised to phenotype the activity based on the aetiology and the potential consequences 139,140 . Based on the current evidence of an association between AB, TMDs, and psychological factors, 2,56 the possible bruxism network representation of a patient phenotype with high anxiety scores, poor stress coping skills, and high AB scores can be hypothesized in Figure 2, with a predominance of musculoskeletal complaints rather than damage to teeth and restorations. On the other hand, a possible phenotype of an individual with high levels of RMMA‐SB and tooth wear, with low awake bruxism scores, is hypothesized in Figure 3.…”

“…In addition, such considerations do not apply to AB, for which correlation studies between self‐reported and measurement strategies do not exist. The role of AB gained importance in the clinical setting because it may represent a main risk factor for orofacial musculoskeletal signs and symptoms, thus being the focus of several recent researches 56,62,95,110,119–122 . Data collection on AB can be more easily conceptualised than SB 34 .…”

Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis

“…An attempt at postural readjustment can be concluded from the findings of the use of an occlusal splint and therapeutic exercise guidelines in subjects with TMD over the course of 12 weeks, which included an increase in the velocity of center gravity recovery. It is possible to interpret the acceleration of the postural sway as an increase in the frequency of postural balance corrections made by the individuals [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The adjustment of the head and neck posture carried on using the occlusal splint may have caused this increase in the frequency of corrections.…”