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Journal ArticleDOI

Bruxism defined and graded: an international consensus

TL;DR: The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and proposed a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruXism.
Abstract: To date, there is no consensus about the definition and diagnostic grading of bruxism. A written consensus discussion was held among an international group of bruxism experts as to formulate a definition of bruxism and to suggest a grading system for its operationalisation. The expert group defined bruxism as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake bruxism). For the operationalisation of this definition, the expert group proposes a diagnostic grading system of 'possible', 'probable' and 'definite' sleep or awake bruxism. The proposed definition and grading system are suggested for clinical and research purposes in all relevant dental and medical domains.
Citations
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Journal ArticleDOI
28 Feb 2001-JAMA

1,258 citations

Journal ArticleDOI
TL;DR: There is a need for an updated consensus on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible to be confirmed.
Abstract: In 2013, consensus was obtained on a definition of bruxism as repetitive masticatory muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible and specified as either sleep bruxism or awake bruxism. In addition, a grading system was proposed to determine the likelihood that a certain assessment of bruxism actually yields a valid outcome. This study discusses the need for an updated consensus and has the following aims: (i) to further clarify the 2013 definition and to develop separate definitions for sleep and awake bruxism; (ii) to determine whether bruxism is a disorder rather than a behaviour that can be a risk factor for certain clinical conditions; (iii) to re-examine the 2013 grading system; and (iv) to develop a research agenda. It was concluded that: (i) sleep and awake bruxism are masticatory muscle activities that occur during sleep (characterised as rhythmic or non-rhythmic) and wakefulness (characterised by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively; (ii) in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences; (iii) both non-instrumental approaches (notably self-report) and instrumental approaches (notably electromyography) can be employed to assess bruxism; and (iv) standard cut-off points for establishing the presence or absence of bruxism should not be used in otherwise healthy individuals; rather, bruxism-related masticatory muscle activities should be assessed in the behaviour's continuum.

566 citations

Journal ArticleDOI
TL;DR: The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.
Abstract: There is a need to expand the current temporomandibular disorders' (TMDs) classification to include less common but clinically important disorders. The immediate aim was to develop a consensus-based classification system and associated diagnostic criteria that have clinical and research utility for less common TMDs. The long-term aim was to establish a foundation, vis-a-vis this classification system, that will stimulate data collection, validity testing and further criteria refinement. A working group [members of the International RDC/TMD Consortium Network of the International Association for Dental Research (IADR), members of the Orofacial Pain Special Interest Group (SIG) of the International Association for the Study of Pain (IASP), and members from other professional societies] reviewed disorders for inclusion based on clinical significance, the availability of plausible diagnostic criteria and the ability to operationalise and study the criteria. The disorders were derived from the literature when possible and based on expert opinion as necessary. The expanded TMDs taxonomy was presented for feedback at international meetings. Of 56 disorders considered, 37 were included in the expanded taxonomy and were placed into the following four categories: temporomandibular joint disorders, masticatory muscle disorders, headache disorders and disorders affecting associated structures. Those excluded were extremely uncommon, lacking operationalised diagnostic criteria, not clearly related to TMDs, or not sufficiently distinct from disorders already included within the taxonomy. The expanded TMDs taxonomy offers an integrated approach to clinical diagnosis and provides a framework for further research to operationalise and test the proposed taxonomy and diagnostic criteria.

258 citations


Cites background from "Bruxism defined and graded: an inte..."

  • ...Likewise and rightfully so, bruxism defined as a repetitive jawmuscle activity characterised by clenching or grinding of the teeth and/or by bracing of thrusting of the mandible whilst asleep and/or during wakefulness (87), has not been considered for inclusion in this taxonomy: bruxism has been suggested to be a possible causal factor for certain TMDs, and not a TMD as such (88)....

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Journal ArticleDOI
TL;DR: The etiology is complex and still not clearly understood, but several biological and psychosocial risk factors for TMD have been identified and several studies indicate that patients with TMD improve with a combination of noninvasive therapies, including behavior therapy, pharmacotherapy, physical therapy, and occlusal appliances.
Abstract: BackgroundTemporomandibular disorders (TMD) is an umbrella term for pain and dysfunction involving the masticatory muscles and the temporomandibular joints (TMJs). TMD is the most common orofacial ...

251 citations

Journal ArticleDOI
TL;DR: A very high variability in sleep Bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism, which prevented from supporting any reliable estimates of the prevalence of sleep bruXism in children.
Abstract: The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.

178 citations

References
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Book
01 Jan 1989
TL;DR: Part 1: Normal Sleep and Its Variations; Part 2: Abnormal Sleep.
Abstract: 1. Normal Sleep and Its Variations History Of Sleep Physiology And Medicine Normal Human Sleep: An Overview Normal Ageing Daytime Sleepiness And Alertness Sleep Deprivation Phylogeny Of Sleep Regulation Mammalian Sleep 2. Sleep Mechanisms Brain Electrical Activity And Sensory Processing During Waking And Sleep States Brainstem Mechanisms Generating REM Sleep Basic Mechanisms Of Sleep-Wake States Control Of Motoneurons During Sleep 3. Physiology in Sleep Physiological Regulation in Sleep Cardiovascular Physiology: Central and Autonomic Regulation Cardiovascular Physiology: The Peripheral Circulation Respiratory Physiology: Central Neural Control Respiratory Physiology: Control of Ventilation Respiratory Physiology: Breathing in Normal Subjects Respiratory Physiology: Sleep at High Altitudes Host Defense Endocrine Physiology Gastrointestinal Physiology Temperature Regulation **Sleep-related Penile Erections 4. Chronobiology Introduction: Chronobiology Circadian Rhythms in Mammals: Formal Properties and Environmental Influences Anatomy and Physiology of the Mammalian Circadian System Molecular Genetic Basis for Mammalian Circadian System The Human Circadian Timing System and Sleep-Wake Regulation **Sleep Homeostasis and Models of Sleep Regulation Circadian Rhythms in Fatigue, Alertness and Performance Melatonin in the Regulations of Sleep & Circadian Rhythms 5. Pharmacology Hypnotics: Basic Mechanisms and Pharmacology Hypnotics: Efficacy and Adverse Effects Stimulants: Basic Mechanisms and Pharmacology Stimulants: Efficacy and Adverse Effects Drugs Which Disturb Sleep and Wakefulness 6. Psychobiology and Dreaming Approaches to the Study of Dream Content: Methods Measures

4,558 citations

Journal ArticleDOI
TL;DR: A grading system of definite, probable, and possible neuropathic pain is proposed, which includes the grade possible, which can only be regarded as a working hypothesis, and the grades probable and definite, which require confirmatory evidence from a neurologic examination.
Abstract: Pain usually results from activation of nociceptive afferents by actually or potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain introduced the term neuropathic pain, defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries. Since the sensitivity of the nociceptive system is modulated by its adequate activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatosensory system was derived from a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Because of the lack of a specific diagnostic tool for neuropathic pain, a grading system of definite, probable, and possible neuropathic pain is proposed. The grade possible can only be regarded as a working hypothesis, which does not exclude but does not diagnose neuropathic pain. The grades probable and definite require confirmatory evidence from a neurologic examination. This grading system is proposed for clinical and research purposes.

2,342 citations

Journal ArticleDOI
TL;DR: A triangular, full thickness flap from the lower lip used to fill in a deficit in the upper lip for the relief of deformity due to double harelip.
Abstract: A Abbe flap \ăb# e flăp\ [Robert Abbe, New York, N.Y. surgeon, 18511928]: eponym for a lip switch operation. A triangular, full thickness flap from the lower lip used to fill in a deficit in the upper lip. Specifically applied to the midportion of the upper or lower lip— called also lip switch operation Abbe, R. A new plastic operation for the relief of deformity due to double harelip. Med Rec 1898;53:477. ab duct \ăb dŭkt#\ vt (1834): to draw away from the median plane— comp ADDUCT ab er rant \ă-bĕr#ant\ adj (ca. 1798)1: a deviation from the normal or usual course, form, or location 2: straying from the normal way ab frac tion \ăb frăk#shun\ n (1991): the pathologic loss of hard tooth substance caused by biomechanical loading forces. Such loss is thought to be due to flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading—comp ABLATION, ABRASION, ATTRITION, and EROSION ab la tion \ă-bl a#shun\ n (15c) 1: separation or detachment; extirpation; eradication 2: removal of a part, especially by cutting—see ABFRACTION, EROSION abrade \uh-br ad#\ vt (1677): to rub away the external covering or layer of a part—comp ATTRITION, EROSION abra sion \ă-br a #shun\ n (1656) 1: the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process 2: an abnormal wearing away of the tooth substance by causes other than mastication—comp ATTRITION, EROSION abra sive \uh-br a # siv, -ziv\ n (1853): a substance used for abrading, smoothing, or polishing abra sive \uh-br a # siv, -ziv\ adj (1875) 1: tending to abrade 2: causing irritation—abra sive ly adv, abra sive ness n ab ra si vity \uh-br a#siv-ı̆-t e, -ziv-ı̆-t e\ v (1998): the property of one material to wear away another material by means of frictional contact absorbed dose \ab-sôrbd#,-zôrbd# d os\: the amount of energy from ionizing radiation absorbed per unit mass of matter, expressed in Gray units ab sorp tance \ab-sôrp#tans, -zôrp#tans\ n (ca. 1931): the ratio of the radiant energy absorbed by a body to that incident upon it ab sorp tion \ab-sôrp#shun, -zôrp#-\ n (1741) 1: the uptake of substances into or through tissues, e.g., mucosa, skin, and intestine 2: in radiology, the uptake of energy by matter with which the radiation interacts—see A. of RADIATION—comp ADSORPTION absorption of radiation \ab-sôrp#shun ŭv r a#d ea#shun\: collisionlike interactions between the individual particulate or quantum components of a beam of radiation and the subatomic parts of matter that occur at random during irradiation. Each interaction may result in partial or complete transfer of energy abut ment \a-bŭt#ment\ n (1634) 1: that part of a structure that directly receives thrust or pressure; an anchorage2: a tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain a prosthesis—usage see ANGULATED A., HEALING A., DENTAL IMPLANT A., INTERMEDIATE A., ONE PIECE A., PREPARATION PIECE A., STANDARD A., TWO PIECE A. DropB

1,296 citations

Journal ArticleDOI
28 Feb 2001-JAMA

1,258 citations


"Bruxism defined and graded: an inte..." refers background in this paper

  • ...The major drawbacks of this definition are its confinement to sleep bruxism (in the accompanying text, it is only stated that bruxism can occur during waking, but that this is a different disorder with an unknown association with sleep bruxism), and the statement of its common association with sleep arousals [which is just one of several reported associations with sleep bruxism for which evidence is accumulating (1)]....

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  • ...Although associated with a number of clinical problems, including orofacial pain, tooth wear and failing dental restorative treatments (1, 2), bruxism remains difficult to manage in effective and safe ways (3)....

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  • ...Several techniques are available, all with their advantages and limitations, to operationalise the new definition (1, 2)....

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Book
01 Jan 1996
TL;DR: Introduction to orofacial pain assessment of oroFacial pain disorders diagnostic classification and management considerations for vascular and nonvascular intracranial disorders andmental disorders.
Abstract: Introduction to orofacial pain assessment of orofacial pain disorders diagnostic classification of orofacial pain disorders differential diagnosis and management considerations of vascular and nonvascular intracranial disorders differential diagnosis and management considerations of primary headache (neurovascular and tension-type headache) differential diagnosis and management considerations of neuralgias, nerve trunk pain and deafferentation pain differential diagnosis and management considerations of intraoral pain disorders differential diagnosis and management considerations of temporomandibular disorders differential diagosis and management considerations of associated structures that can produce orofacial pain differential diagnosis and management considerations of mental disorders - axis II.

983 citations


"Bruxism defined and graded: an inte..." refers background or methods in this paper

  • ...The most common bruxism definitions in current use are those formulated in the eighth edition of the Glossary of Prosthodontic Terms (GPT-8) (4), in the second edition of the International Classification of Sleep Disorders (ICSD-2) (5), and in the fourth edition of the Orofacial Pain Guidelines (OFPG-4) (6), published by the American Academy of Orofacial Pain....

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  • ...According to the OFPG-4, bruxism is a ‘diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing and grinding of the teeth’ (6)....

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