Diagnosis and prevalence of probable awake and sleep bruxism in adolescents: an exploratory analysis

Abstract The aims of this study were to perform an exploratory analysis of probable awake (AB) and sleep bruxism (SB) prevalence using of different diagnosis criteria based on the International Consensus; evaluate the associations between self-report and clinical signs/symptoms in adolescents. Participated in this cross-sectional study 403 adolescents aged 12- to 19-years-old enrolled in public and private schools from Belo Horizonte, Brazil. Parents/caregivers answered a questionnaire about sociodemographic status and adolescents' health status. Adolescents answered a questionnaire evaluating AB (e.g., grinding and clenching) and SB (e.g., grinding, bracing, and thrusting) activities and frequent headaches. A clinical examination was performed on adolescents to evaluate bruxism clinical signs/symptoms (pain upon palpation on masseter and temporal, linea alba, indentation on the tongue and attrition wear severity). Descriptive statistics and Pearson's Qui-square test were performed (P≤0.05). Adolescents mean age was 14.3±1.5 years, and 58.1% were female. Self-report of SB was identified in 31% of participants and self-report of AB in 51.6%. Almost all adolescents (99%) presented at least one tooth with attrition wear (98.5% on enamel and 0.5% on dentin), with a mean number of 12.4±5.7 teeth. Depending on the diagnosis criteria, the prevalence of probable SB and AB varied from 0- 99% and 0.2- 99%, respectively. A high inconsistency was found for the prevalence of probable AB and SB in adolescents, which were influenced by the different clinical sings/symptoms used as diagnosis criteria. Frequent headaches and pain upon palpation on masseter and temporal muscle were associated to self-report of AB and SB among adolescents.

Resumo Os objetivos deste estudo foram realizar uma análise exploratória da prevalência de provável bruxismo em vigília (BV)e do sono (BS) utilizando diferentes critérios de diagnóstico baseados no Consenso Internacional; avaliar a associação entre o autorrelato e os sinais/sintomas clínicos em adolescentes. Participaram deste estudo transversal 403 adolescentes de 12 a 19 anos de idade matriculados em escolas públicas e privadas de Belo Horizonte, Brasil. Os pais/responsáveis responderam um questionário sobre dados sociodemográficos e estado de saúde dos adolescentes. Os adolescentes relataram atividades do BV (ranger e apertar) e BS (ranger, bracing e thrusting) e dores de cabeça frequentes. Um exame clínico foi realizado nos adolescentes para avaliar os sinais/sintomas clínicos do bruxismo (dor à palpação nos músculos masseter e temporal, marcas de endentação na língua e linha alba, desgaste dentário por atrição). Análises descritiva e teste Qui-quadrado de Pearson foram realizados (P≤0,05). A média de idade dos adolescentes foi de 14,3±1,5 anos e 58,1% eram do sexo feminino. O autorrelato de BS foi identificado em 31% dos participantes e o autorrelato do BV em 51,6%. Quase a totalidade dos adolescentes (99%) apresentaram pelo menos um dente com desgaste dentário (98,5% em esmalte; 0,5% em dentina), com média de 12,4±5,7 dentes acometidos. Dependendo do critério de diagnóstico, a prevalência do provável BS e BV variou de 0- 99% e 0,2- 99%, respectivamente. Uma grande inconsistência foi identificada na prevalência de provável BV e BS em adolescentes, que foram influenciadas pelos diferentes sinais/sintomas usados como critério de diagnóstico. Dores de cabeça frequentes e dor à palpação no masseter e temporal foram associados ao autorrelato de bruxismo em crianças e adolescentes.

Tooth wear due to dental attrition among 12-year-old adolescents / Desgaste dentário por atrição entre adolescentes de 12 anos de idade

Aim: To evaluate the prevalence and distribution of tooth wear due to dental attrition among 12-year-old adolescents according to their gender, reports of tooth grinding during sleep/while awake (bruxism), and sleep features related to sleep-disordered breathing. Methods: A cross-sectional study was conducted with 172 adolescents from southeast Brazil. Parents/caregivers answered questions about sociodemographic characteristics; reports of adolescents' tooth grinding during sleep, and sleep features (e.g. sleep duration and position, snoring, drooling on the pillow) in the previous two weeks. Adolescents self-reported the occurrence of tooth clenching/grinding while awake in the previous two weeks. Tooth wear due to dental attrition was assessed by a previously calibrated researcher, using a validated 5-point analogical ordinal occlusal/incisal tooth wear grading scale, with scores ranging from 0 (no wear) to 4 (loss of crown height ≥ 2/3), depending on tooth wear severity. Descriptive statistics and the Mann-Whitney test (p < 0.05) were performed to identify differences in tooth wear due to the distribution of dental attrition, according to adolescents' characteristics. Results: Most adolescents were female (58.0%) and 81.6% of the participants presented tooth wear due to dental attrition within the enamel. Adolescents who snored had a higher number of incisors with tooth wear due to dental attrition (p = 0.035). Females showed a higher number of canines with tooth wear due to dental attrition (p = 0.020). Adolescents whose parents reported tooth grinding during sleep presented a higher number of bicuspids with tooth wear due to dental attrition (p = 0.001). Conclusion:Tooth wear due to dental attrition within the enamel was observed in most adolescents. The distribution, depending on specific groups of teeth, was higher among female adolescents, adolescents' whose parents reported tooth grinding, and adolescents who snored during sleep.

Objetivos: Avaliar a prevalência e distribuição de DDA entre adolescentes de 12 anos de acordo com o sexo, relato de ranger de dentes durante o sono e vigília (bruxismo) e características relacionadas a desordens respiratórias do sono.Método: Desenvolveu-se um estudo transversal com 172 adolescentes do sudeste do Brasil. Seus pais/responsáveis responderam um questionário contendo informações sociodemográficas, relato sobre os filhos rangerem os dentes durante o sono e hábitos do sono dos filhos (duração do sono, posição que dorme, roncar, babar no travesseiro) nas duas últimas semanas. Adolescentes relataram ocorrência de ranger/apertar de dentes durante a vigília nas duas últimas semanas. DDA foi avaliado por um pesquisador previamente calibrado através de uma escala analógica ordinal de cinco pontos de desgaste dentário para faces oclusal/incisal previamente validada, com escores variando de 0 (sem desgaste) a 4 (perda da coroa em altura ≥ 2/3), dependendo da gravidade do desgaste. Análises descritivas e teste de Mann-Whitney (p < 0,05) foram realizados para identificar as diferenças na distribuição de DDA de acordo com as características dos adolescentes.Resultados: A maioria dos adolescentes eram meninas (58,0%) e 81,6% dos participantes apresentaram DDA em esmalte em algum elemento dentário. Adolescentes que rocavam apresentavam mais incisivos com DDA (p = 0.035). Meninas apresentaram maior número de caninos com DDA (p = 0.020). Adolescentes que rangiam os dentes durante a noite apresentaram maior número de pré-molares com DDA (p = 0.001).Conclusão: Desgaste dentário por atrição em esmalte foi observado na maioria dos adolescentes. A distribuição, dependendo de grupos de dentes específicos, foi maior entre meninas, adolescentes que roncavam durante o sono e que rangiam os dentes durante o sono.

Evaluation of the association between self-reported sleep bruxism and chronotype and sleep quality among dental students / Avaliação da associação entre cronotipo, qualidade do sono e autorrelato de bruxismo do sono entre estudantes universitários de Odontologia

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

Cyberchondria and Associated Factors Among Brazilian and Portuguese Dentists / Cibercondria e fatores associados entre dentistas brasileiros e portugueses

ABSTRACT Cyberchondria is a psychopathological behavior that affects people who compulsively consult the internet, by searching the symptoms of different pathologies from which they believe they are suffering, and when influenced by what they read, are sure they have some of these diseases. The aim of this study was to assess the cyberchondria level and associated factors among Brazilian and Portuguese dentists. A total 597 Brazilian and Portuguese dentists participated in this cross-sectional study. They were contacted via WhatsApp and asked to complete an online questionnaire on the Google Forms platform, from January 17 to 31, 2021, during the COVID-19 pandemic. Sociodemographic information was collected and cyberchondria was measured using the Portuguese language version of the Cyberchondria Severity Scale. Binary logistic regression models were used to estimate the unadjusted and adjusted Odds Ratio (OR) and corresponding 95% confidence interval (CI) for the association of cyberchondria and covariates. Each covariate was individually included in the regression model, and the unadjusted OR (95% CI) was estimated. Most participants were Brazilian (62.8%), women (75.5%), married (60.5%) and with children (55.6%). Average age was 42.1 years (+ 12.5). In the final model, it was found that with each increase of one year in age, the chance of a high level of cyberchondria decreased (OR=0.97; 95% CI 0.95-0.98). Brazilian dentists were 1.85 times more likely (95% CI 1.25-2.75) to have a high level of cyberchondria than Portuguese dentists. Women were 1.62 times more likely (95% CI 1.07-2.44) to have a high level of cyberchondria than men. It was concluded that young age, Brazilian nationality, and female gender favored the high level of cyberchondria among the participants in this sample during COVID-19 pandemic.

RESUMO A cibercondria é um comportamento psicopatológico que atinge as pessoas que consultam compulsivamente a internet, pesquisando os sintomas das diferentes patologias de que acreditam estar sofrendo e, quando influenciadas pelo que leem, têm a certeza de possuir alguma dessas doenças. O objetivo deste estudo foi avaliar o nível de cibercondria e fatores associados entre dentistas brasileiros e portugueses. Participaram deste estudo transversal 597 dentistas brasileiros e portugueses. Eles foram contatados via WhatsApp e solicitados a preencher um questionário online na plataforma do Google Forms, no período de 17 a 31 de janeiro de 2021, durante a pandemia de COVID-19. Informações sociodemográficas foram coletadas e a cibercondria foi mensurada através da versão em língua portuguesa da Cyberchondria Severity Scale. Modelos de regressão logística binária foram usados para estimar a Odds Ratio (OR) não ajustada e ajustada e o intervalo de confiança (IC) de 95% correspondente para a associação de cibercondria e covariáveis. Cada covariável foi incluída individualmente no modelo de regressão, e o OR não ajustado (IC 95%) foi estimado. A maioria dos participantes eram brasileiros (62,8%), mulheres (75,5%), casados (60,5%) e com filhos (55,6%). A média de idade foi de 42,1 anos (+ 12,5). No modelo final, verificou-se que a cada aumento de um ano de vida, a chance de um nível elevado de cibercondria diminuía (OR = 0,97; IC95% 0,95-0,98). Os dentistas brasileiros tiveram 1,85 vezes mais probabilidade (IC95% 1,25-2,75) de apresentar alto índice de cibercondria quando comparados aos portugueses. As mulheres tinham 1,62 vezes mais probabilidade (IC 95% 1,07-2,44) de ter um alto nível de cibercondria em comparação com os homens. Concluiu-se que a idade mais jovem, a nacionalidade brasileira e o sexo feminino favoreceram o alto índice de cibercondria entre os participantes desta amostra durante a pandemia COVID-19.

Factors associated with dentists' search for oral health information during the COVID-19 pandemic

Abstract: The aim of this cross-sectional study was to evaluate the factors associated with the search by Brazilian and Portuguese dentists for oral health information on social networks during the COVID-19 pandemic. A total of 597 Brazilian and Portuguese dentists answered an online questionnaire between January 17 and 31, 2021. Respondents were asked about sociodemographic data, weight and height, hours of sleep per night, screen time for work and leisure, and where they sought information about general and/or oral health for themselves and for their loved ones and information about COVID-19. Descriptive statistics and binary regression were used for the statistical analysis. Most participants were Brazilian (62.8%) and 451 (75.5%) were female. Mean age was 42.1 years (± 12.5 years). For every lost hour of sleep, the chances of participants frequently or always searching for information about self-perceived oral health problems on lay websites increased by 1.33 times. For every additional hour spent on social networks or on the Internet, the likelihood of participants frequently searching for self-perceived oral health problems on lay websites increased by 17% (OR = 1.17; 95% CI: 1.06-1.30). Individuals who searched the Internet for information about COVID-19 symptoms before consulting their doctors were 3.85 times more likely (95% CI: 2.22-6.67) to frequently or always search for information about self-perceived oral health problems on lay websites. Dentists used lay websites to search for general and oral health knowledge during the COVID-19 pandemic, and shorter sleep duration favored screen use.

Impact of the COVID-19 pandemic on sleep quality and sleep bruxism in children eight to ten years of age

Abstract: This study aimed to determine the impact of the COVID-19 pandemic on sleep quality and possible sleep bruxism (SB) in children eight to ten years of age. The study hypothesis was that sleep disturbances influenced a higher occurrence of bruxism during the COVID-19 pandemic. A longitudinal study was conducted at two time points: in person prior to the COVID-19 pandemic (T1), and online during the pandemic (T2). The sample comprised 105 children. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics, the use of electronic devices, reported (vs. clinical) SB, and the Sleep Disturbance Scale for Children (SDSC) at both T1 and T2. McNemar's and Wilcoxon's tests were used to compare SB and sleep disorders at both time points. Poisson regression analysis determined the relative risk (RR) among the variables, and the incidence of possible SB (p≤0.05). The comparison of the two time points (T1 and T2) revealed a significant increase in possible SB (p<0.01) and sleep disorders (p < 0.04). Children whose parents had a lower schooling level (RR: 2.67; 95%CI: 1.19-6.01), those with their own electronic devices (RR: 1.97; 95%CI: 1.09-2.50), and those with sleep disorders during the pandemic (RR: 1.74; 95%CI: 1.35-2.24) were at greater risk of developing SB during the pandemic. Moreover, the incidence of bruxism and sleep disorders was greater during the pandemic. The factors influencing SB incidence during the pandemic were a lower level of mothers' schooling, greater access to electronic devices, and the occurrence of sleep disorders.

Pediatric Oral Health Self-reported by Caregivers of NormalHearing and Hearing-Impaired Children

Abstract Objective: To verify and compare the sociodemographic data and caregivers' self-perception of children's oral health condition, hygiene habits and seek for dental services among family units of deaf and normalhearing children. Material and Methods: A comparative cross-sectional study was conducted with 64 parents/caregivers of 16 deaf and 48 normal-hearing children of 3-14 years old, belonging to reference centers in Belo Horizonte, southeastern Brazil. Deaf and hearing children were matched according to their sex and age. Sociodemographic characteristics of the family units and self-report of oral health conditions and care were assessed using a structured questionnaire, including information regarding seeking pediatric dental services. Descriptive analysis and chi-square test were performed (p<0.05). Results: Most individuals in the sample were mothers (84.4%). Low family income (p=0.024) and higher education level of guardians (p=0.018) were associated with families of hearing children. The report of clinical treatment or toothache as the main reason for the children's last dental appointment was associated with families of deaf children (p=0.047). Conclusion: Based on caregivers' reports, hearing-impaired children demonstrated greater vulnerability to present dental pain or clinical treatment as the main reasons for their last access to dental appointments.

Validation of the Brazilian Version of the RMS Tactile Scale (B-RMS-TS)

Abstract This study aimed to validate the Brazilian version of the RMS Tactile Scale (B-RMS-TS) in children and adolescents with visual impairment. Ten visually impaired children and adolescents between 10 and 17 years old of an Educational Center for Visually Impaired People answered the verbalized Dental Anxiety Scale (DAS), and the DAS in Braille to evaluate their dental anxiety levels. B-RMS-TS construct validity was assessed by convergent and discriminant validity. Convergent validity was tested in two ways: Pearson's correlation between the B-RMS-TS and the overall anxiety question; Pearson's correlation between B-RMS-TS and verbalized DAS and DAS in Braille. B-RMS-TS reliability was measured by internal consistency (Cronbach's alfa and McDonald's omega) and test-retest reliability (ICC). B-RMS-TS was moderately correlated to the overall anxiety question (r=0.493;p=0.147). B-RMS-TS showed excellent correlation with verbalized DAS (r=0.971;p<0.001) and DAS in Braille (r=0.934;p<0.011). B-RMS-TS was able to discriminate dental anxiety levels between male and female (p=0.008). The B-RMS-TS demonstrated excellent reliability (Cronbach's alpha=0.661, McDonald's omega=0.700 and ICC=0.987; 95%CI=0.817-0.999). B-RMS-TS is valid and reliable to measure dental anxiety levels in Brazilian children and adolescents with visual impairment.

Resumo Este estudo objetivou validar a versão brasileira da escala tátil RMS (B-RMS-TS) em crianças e adolescentes com deficiência visual. Dez crianças e adolescentes deficientes visuais entre 10 e 17 anos de idade de um Centro Educacional para Pessoas Deficientes Visuais responderam a Dental Anxiety Scale (DAS) verbalizada, e a DAS em Braille para avaliar seus níveis de ansiedade odontológica. A validade de construto da B-RMS-TS foi avaliada pela validade convergente e discriminante. A validade convergente foi testada em duas maneiras: correlação de Pearson entre a B-RMS-TS e a questão geral de ansiedade; correlação de Pearson entre a B-RMS-TS e a DAS verbalizada e a DAS em Braille. A confiabilidade da B-RMS-TS foi mensurada pela consistência interna (alfa de Cronbach e ômega de McDonald).) e confiabilidade teste-reteste (CCI). A B-RMS-TS foi correlacionada moderadamente à questão geral de ansiedade (r=0,493;p=0,147). A B-RMS-TS mostrou correlação excelente com a DAS verbalizada (r=0,971;p<0,001) e com a DAS em Braille (r=0,934;p<0,011). A B-RMS-TS foi capaz de discriminar níveis de ansiedade odontológica entre meninos e meninas (p=0,008). A B-RMS-TS demonstrou confiabilidade excelente (alfa de Cronbach=0,661, ômega de McDonald=0,700 e CCI=0,987; 95%IC=0,817-0,999). A B-RMS-TS é válida e confiável para mensurar níveis de ansiedade odontológica em crianças e adolescentes brasileiros com deficiência visual.

Medo de Covid-19 e fatores associados ao possível bruxismo do sono e/ou em vigília entre universitários da região sudeste do Brasil durante a pandemia Covid-19 / Fear of Covid-19 and factors associated with sleep and/or wakefulness bruxism among university students in southeastern Brazil during the Covid-19 pandemic

Introdução: O possível bruxismo é um comportamento autorrelatado, caracterizado pelo ranger e/ou apertar dos dentes, estando associado a fatores psicológicos. A pandemia da COVID-19 tem afetado o emocional das pessoas, podendo ser associada a este comportamento. Objetivo: Analisar a associação entre o nível de medo da COVID-19, assim como outros fatores associados à prevalência de possível bruxismo entre universitários. Materiais e métodos: Participaram deste estudo transversal 311 universitários de graduação e pós-graduação de faculdades odontológicas públicas e privadas da região sudeste do Brasil. Os participantes foram contatados via WhatsApp e redes sociais através de amostragem em bola de neve para responder um questionário com avaliação sociodemográfica, presença, frequência e severidade de possível bruxismo do sono (PBS) e/ou em vigília (PBV) e a versão brasileira da fear scale of COVID-19. Análises descritivas e bivariadas foram realizadas através dos testes estatísticos de Mann-Whitney e Kruskall-Wallis (p<0,05). Resultados: A prevalência de PBS grave foi de 12,5% e PBV 23,8%. Não houve associação entre escores de medo COVID-19 nem com PBS (p=0,342) nem com PBV (p=0,912). Quando analisado o PBV, observou-se maior prevalência dentre os participantes que não trabalhavam (p=0,008), sendo maior percentual entre os universitários na segunda metade do curso (p=0,021) e, dentre os participantes da pós-graduação, o bruxismo foi mais prevalente entre alunos matriculados em programas stricto sensu comparados àqueles de programas lato sensu (p=0,036). Conclusão: Estar fora do mercado de trabalho, a fase final da graduação e a inserção em uma pós-graduação stricto sensu influenciaram na prevalência de PBV.

Introduction: The possible bruxism is a self-reported behavior characterized by grinding and/or clenching teeth and is associated with psychological factors. The COVID-19 pandemic has affected people's emotions and can be associated with this behavior. Objective: Analyze the association between level of fear of COVID-19, as well as other factors associated to the prevalence of possible bruxism among university students. Materials and methods: A total of 311 undergraduate and graduate students from public and private dental schools in Southeastern Brazil participated in this cross-sectional study. Participants were contacted via WhatsApp and social networks through snowball sampling to answer an online questionnaire with sociodemographic assessment, presence, frequency and severity of possible sleep bruxism (PSB) and/or awake bruxism (PAB) and Brazilian version of the fear scale of COVID-19. Descriptive and bivariate analyzes were performed using the Mann-Whitney and Kruskall-Wallis statistical tests (p<0.05). Results: The prevalence of severe PSB was 12.5% and PAB 23.8%. There was no association between COVID-19 fear scores or with PSB (p=0.342) or with PAB (p=0.912). When analyzing the PAB, there was a higher prevalence among participants who didn't work (p=0.008), with a higher percentage among university students in the second half of the course (p=0.021). Among graduate participants, possible bruxism was more prevalent among students enrolled in stricto sensu programs compared to those in lato sensu programs (p=0.036). There wasn't association between COVID-19 fear score and possible bruxism. Conclusion: Being out of the job market, final stage of graduation and entry into a stricto sensu graduate program influenced the prevalence of PAB.

Protocolo clínico para o bruxismo infantil: uma proposta em construção / Clinical protocol for childhood bruxism: a proposal under construction

Introdução: O bruxismo tem sido objeto de estudo no decorrer de décadas e ainda é polêmica a abordagem em diferentes faixas etárias. Objetivo: O objetivo deste manuscrito é apresentar uma proposta de protocolo clínico de bruxismo do sono e vigília para crianças e adolescentes. Materiais e Métodos: Foi realizado um protocolo clínico a partir de uma revisão crítica da literatura sobre o bruxismo do sono e em vigília em crianças e adolescentes. Foram abordados o conceito atual de bruxismo, os principais fatores associados, anamnese e principais sinais clínicos, considerando as peculiaridades das diferentes etapas da vida infantojuvenil: bebês, crianças e adolescentes. Resultados: O bruxismo precisa ser abordado de forma diferenciada por faixa etária. Uma anamnese bem detalhada, o conhecimento do desenvolvimento fisiológico do paciente infantojuvenil, seus possíveis comportamentos, a presença de dores de cabeça e dores nos músculos faciais merecem atenção especial pelo cirurgião dentista. Conclusão: O bruxismo merece cuidados distintos por faixa etária.

Introduction: Bruxism has been the object of study for decades and the approach in different age groups is still controversial. Objective: The aim of this paper is to present a clinical protocol proposal for awake and sleep bruxism in children and adolescents. Materials and Methods: A clinical protocol was carried out based on a critical review of the literature of sleep and awake bruxism in children and adolescents. The current concept of bruxism, the main associated factors, the anamnesis, and main clinical signs/symptoms were addressed considering the peculiarities of the different life stages: babies, children, and adolescents. Results: Bruxism needs to be approached differently by age group. A very detailed anamnesis, knowledge of child/adolescent's physiological development, their behavior, and the occurrence of headaches and pain in the facial muscles deserves special attention by dentist. Conclusion: Bruxism deserves different care by age group.

Características do sono no manejo do comportamento do paciente odontopediátrico: reflexões / Sleep characteristics in the management of pediatric dental patient behavior: reflections

Os distúrbios do sono podem influenciar negativamente no manejo do paciente odontológico. Uma noite mal dormida pode afetar o humor do paciente. Os transtornos de sono potencializam a irritabilidade, podem diminuir o limiar de tolerância à dor, dificultando a adesão do paciente ao tratamento odontológico. Perguntas sobre qualidade do sono devem ser incluídas na anamnese e feitas como rotina antes de cada atendimento.

Sleep disturbances can negatively influence the management of dental patients. A bad night's sleep can affect the patient's mood. Sleep disorders potentiate irritability and may reduce the pain tolerance threshold, making it difficult for patients to adhere to dental treatment. Questions about sleep quality should be included in the anamnesis and routinely asked before each appointment.

Associação entre o alfabetismo funcional e o reconhecimento da palavra bruxismo em adolescentes / Association between functional literacy and the recognition of the word bruxism in adolescents

Objetivo: Avaliar a associação entre alfabetismo funcional e o reconhecimento da palavra "bruxismo" entre adolescentes. Métodos: Foi um estudo transversal realizado em uma cidade de porte médio no Brasil. A amostra consistiu em 375 escolares de 12 anos e 368 de 15 a 19 anos selecionados aleatoriamente. Dois examinadores calibrados (Kappa > 0,80) aplicaram o instrumento de alfabetismo em saúde bucal validado para adolescentes o Rapid Estimate of Adult Literacy in Dentistry ­ BREALD-30 e o reconhecimento da palavra "bruxismo" foi utilizado como variável dependente, além de um questionário sobre o alfabetismo funcional (Índice de Alfabetismo Funcional ­INAF). Os pais/cuidadores responderam um questionário sociodemográfico. Foi realizada análise não-ajustada e regressão logística para amostras complexas(p < 0,05). Resultados: No modelo final, os adolescentes de 12 anos que tiveram mais chances de não reconhecer a palavra "bruxismo" foram os de escola pública (OR = 2,83; 95% IC: 1,79-4,46; p = 0,001), sem plano de saúde (OR = 2,02; 95% IC: 1,21-3,37; p = 0,007) e com menor nível de alfabetismo funcional (OR = 2,66; 95% IC: 1,66-4,26; p < 0,001). Adolescentes de 15 a 19 anos que tiveram maior chance de não reconhecer a palavra "bruxismo" foram os com menor nível de alfabetismo funcional (OR = 3,29; 95% IC: 1,93-5,60; p < 0,001), que residiam com mais pessoas em casa (OR = 2,04; 95% IC: 1,02-4,11; p = 0,040), que tinham pais/responsáveis com baixo nível de escolaridade (OR = 1,97; 95% IC: 1,15-3,36; p = 0,013) e que nunca foram ao dentista (OR = 3,08;95% IC: 1,26-7,52; p = 0,03). Conclusão:O reconhecimento do termo "bruxismo" entre os adolescentes de 12 anos foi influenciado pela presença deplano de saúde e por um maior nível de alfabetismo funcional. Na faixa etária maior, o maior nível de alfabetismo funcional, o menor número de pessoas em casa, a maior escolaridade do responsável e a ida ao dentista influenciaram no reconhecimento do termo.

Aim: To evaluate the association between functional literacy and the recognition of the word "bruxism" among adolescentes.Method: This was a cross-sectional study carried out in a mid-sized city in Brazil. The sample consisted of 375 schoolchildren, age 12, and 368, aged 15 to 19 years, selected at random. Two calibrated examiners (Kappa > 0.80) applied the oral health literacy instrument, validated for adolescents, the "Rapid Estimate of Adult Literacy in Dentistry" (BREALD-30) and the recognition of the word "bruxism" was used as a dependent variable, in addition to a questionnaire on functional literacy (Functional Literacy Index ­ INAF). Parents/caregivers answered a sociodemographic questionnaire. Unadjusted analysis and logistic regression were performed for complex samples (p < 0.05). Results: In the final model, the 12-year-old adolescents who were most likely not to recognize the word "bruxism" were those from public schools (OR = 2.83; 95% CI: 1.79-4.46; p = 0.001), without health insurance (OR = 2.02; 95% CI: 1.21-3.37; p = 0.007), and with a lower level of functional literacy (OR = 2.66; 95% CI: 1, 66-4.26; p < 0.001). Adolescents, aged 15 to 19, who had a greater chance of not recognizing the word "bruxism" were those with the lowest level of functional literacy (OR = 3.29; 95% CI: 1.93-5.60; p < 0.001), who lived with more people at home (OR = 2.04; 95% CI: 1.02-4.11; p = 0.040), who had parents/guardians with a low level of education (OR = 1.97; 95% CI: 1.15-3.36; p = 0.013). and who had never been to the dentist (OR = 3.08; 95% CI: 1.26-7.52; p = 0.03). Conclusion: The recognition of the term "bruxism" among 12-year-olds was influenced by the presence of a health plan and a higher level of functional literacy. In the older age group, the higher level of functional literacy, the smaller number of people at home, the higher level of education of the person in charge, and the individual's visit to the dentist influenced the recognition of the term.

Difference of Socioeconomic Factors among Mothers of Preterm and Full-Term Infant

Abstract Objective: To analyze the difference of socioeconomic factors among mothers of preterm and full-term infants. Material and Methods: A cross-sectional retrospective study was developed with 250 mothers of children aged three to five years. The sample was divided into two groups: 125 mothers of preterm infants from the referral center of a public hospital in the city of Belo Horizonte, Brazil and 125 mothers of children born full-term at a daycare center within the same city. A pre-tested questionnaire was used to collect socioeconomic data and type of breastfeeding. To verify if there was association between the dependent variable gestational age at birth and the independent variables, the chi-square test was used. A final model with multiple Poisson regression estimated prevalence ratio values for each independent variable was developed. Results: The final multiple regression model showed that mothers that have a low monthly income of up to USD 450.28 (PR = 1.979, 95% CI = 1.082-3.620), used drugs, cigarettes, or alcohol during their pregnancy (PR = 4.095, 95% CI = 2.422-6.921), and did not breastfeed (PR = 2.294, 95% CI = 1.205-4.369) were more likely to give birth to preterm infants. Conclusion: Low monthly family income, use of drugs, alcohol, or smoking during pregnancy and absence of breastfeeding were more frequent on mothers of preterm infants.

Patient-centered assessments: how can they be used in dental clinical trials?

Abstract Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.

Association of gender, oral habits, and poor sleep quality with possible sleep bruxism in schoolchildren

Abstract The aim of this study was to verify the oral habits, symptoms, and characteristics of some children aged 8 to 10 years that could be associated with possible sleep bruxism. A cross-sectional study was performed. Questionnaires were sent to parents to obtain information on sex, age, school shift, sleep quality, parents' perception of children's behavior, and children's oral habits (nail biting, object biting, and lip biting), and symptoms such as headache or earache. In addition, parents reported the frequency of sleep bruxism (no day to 7 days a week). Descriptive analysis and multinomial logistic regression were performed and the level of significance was set at 5%. A total of 1,554 parents of children aged 8 to 10 years participated in this study. Possible sleep bruxism was reported as mild for 65.7%, moderate for 25.3%, and severe for 9% of the children. In the adjusted multinomial logistic regression, boys were 79% more likely to have sleep bruxism (OR: 1.79; 95%CI 1.23-2.60) and were 2.06 more times at risk of being in the habit of lip biting (OR: 2.06; 95%CI 1.26-3.37). Children with possible severe sleep bruxism were 61% more likely to develop object biting (OR: 1.61; 95%CI 1.09-2.39), 52% more likely to have headaches (OR: 1.52; 95%CI 1.01-2.28), and 3.29 more times at risk of poor sleep quality (OR: 3.29; 95%CI 2.25-4.82). Based on the report, boys with lip and object biting habits, headaches, and poor sleep quality presented a higher chance of possible severe sleep bruxism.

Severe malocclusion negatively impacts adolescents' quality of life

Aim: To assess the impact of severe malocclusion on adolescents' oral health- related quality of life (OHRQoL). Methods: This study consisted of a sample of 117 adolescents between 11 and 12 years, who answered the Brazilian version of the short form of the Child Perception Questionnaire (CPQ 11-14 ). This questionnaire has 16 items distributed equally across four domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicate a greater negative impact on OHRQoL. Malocclusion was evaluated using the Dental Aesthetic Index. Adolescents were assigned to the following categories: no or slight malocclusion, defined malocclusion and severe malocclusion. Descriptive analysis, the Kruskal Wallis test, post hoc test, univariate and multivariate logistic regression were conducted. Results: Individuals with severe malocclusion presented significantly higher scores than those with no or slight malocclusion for the EW ( p =0.001), SW ( p =0.027) and for the overall CPQ 11-14 score ( p =0.015). Adolescents with severe malocclusion showed a 2.63 greater chance of presenting a high negative impact on OHRQoL than those with no or slight malocclusion regardless of the confounding variables (CI=1.07­6.45, p =0.035). Conclusion: Severe malocclusion negatively impacts adolescents' OHRQoL.

Objetivo: Avaliar o impacto da má oclusão severa na qualidade de vida relacionada à saúde bucal de adolescentes (OHRQoL). Métodos: Este estudo consistiu em uma amostra de 117 adolescentes entre 11 e 12 anos, que responderam à versão brasileira da forma abreviada do Child Perception Questionnaire (CPQ11- 14). Este questionário tem 16 itens distribuídos igualmente em quatro domínios: sintomas bucais (SO), limitações funcionais (LF), bem-estar emocional (BE) e bem- estar social (BS). Escores mais altos indicam um impacto negativo maior na OHRQoL. A má oclusão foi avaliada por meio do Índice Estético Dental. Os adolescentes foram alocados nas seguintes categorias: sem má oclusão/má oclusão leve, má oclusão definitiva e má oclusão severa. Análise descritiva, teste de Kruskal Wallis, teste de Dunn, regressão logística univariada e multivariada foram conduzidas. Resultados: Indivíduos com má oclusão severa apresentaram escores significativamente mais elevados do que aqueles sem má oclusão/má oclusão leve para o BE ( p =0,001), BS ( p =0,027) e para o escore total do CPQ11-14 ( p =0,015). Adolescentes com má oclusão severa apresentaram 2,63 vezes mais chance de apresentar um impacto negativo alto na OHRQoL do que aqueles sem má oclusão/má oclusão leve, independentemente das variáveis de confusão (IC=1,07-6,45, p =0,035). Conclusão: A má oclusão severa afeta negativamente a OHRQoL dos adolescentes.

Association between malocclusion severity and psychosocial issues among adolescents / Asociación entre gravedad de maloclusión y problemas psicosociales en adolescentes

Aim: To evaluate the association between malocclusion severity and psychosocial issues among Brazilian adolescents. Methods: The study sample consisted of 120 adolescents between 11 and 12 years, patients at the Dental School of the Federal University of Minas Gerais. Psychosocial issues were assessed by means of two questions, through which the adolescents were asked about whether a classmate had teased or called them names due to the condition of their teeth, or whether the adolescents had felt upset due to their teeth. The higher the response scores the greater the psychosocial impact. Malocclusion was evaluated with the Dental Aest-hetic. Index, with assignment of individuals to the following sub-groups: mild malocclusion (DAI≤25), moderate malocclusion (DAI=26­30), definite malocclusion (DAI=31­35) and severe malocclusion (DAI≥36). Results: Adolescents' mean age was 11.50 years. The more severe the malocclusion the greater the frequency of episodes of teasing or name-calling because of the condition of the teeth (p=0.010), and the greater the frequency of episodes when the adolescents had felt upset due to their teeth (p=0.001). Individuals with severe malocclusion had a higher frequency of episodes during which they were teased or called names due to the condition of their teeth when compared to individuals with mild malocclusion (p=0.013). Individuals with severe malocclusion had a higher frequency of episodes in which they felt upset due to their teeth when compared to individuals with mild malocclusion (p<0.001), individuals with moderate malocclusion (p=0.002), and those with defined malocclusion (p=0.001). Conclusion: Severe malocclusion was associated with psychosocial issues among adolescents.

Objetivo: Evaluar la asociación entre la gravedad de la maloclusión y los problemas psicosociales en adolescentes brasileños. Métodos: La muestra de estudio consistió en 120 adolescentes entre 11 y 12 años, pacientes de la Escuela de Odontología de la Universidad Federal de Minas Gerais. Los problemas psicosociales se evaluaron mediante dos preguntas, a través de las cuales se preguntó a los adolescentes si un compañero de clase se había burlado de ellos o les habían insultado debido a la condición de sus dientes, o si los adolescentes se habían sentido molestos debido a sus dientes. Cuanto mayor la puntuación de la respuesta, mayor el impacto psicosocial. La maloclusión se evaluó con el Índice de Estética Dental y se asignó los siguientes subgrupos: maloclusión leve (DAI≤25), maloclusión moderada (DAI=26-30), maloclusión definida (DAI=31-35) y maloclusión grave (DAI≥36). Resultados: la edad media de los adolescentes fue de 11,50 años. Cuanto más grave la maloclusión, mayor la frecuencia de episodios de burlas o insultos debido a la condición de los dientes (p=0.010) y mayor la frecuencia de episodios cuando el adolescente se ha sentido molesto debido a sus dientes (p=0.001). Las personas con maloclusión severa tuvieron una mayor frecuencia de episodios durante los cuales fueron objeto de burlas o se les insultó y les dio nombres debido a la condición de sus dientes en comparación con las personas con maloclusión leve (p=0.013). Los individuos con maloclusión severa tuvieron una mayor frecuencia de episodios en los que se sintieron molestos debido a sus dientes en comparación con individuos con maloclusión leve (p<0,001), individuos con maloclusión moderada (p=0,002) y aquellos con maloclusión definida (p=0.001). Conclusión: la maloclusión grave se asoció con problemas psicosociales en adolescentes.

Preterm birth, pacifier use and breastfeeding: is there a relationship?

Abstract The immaturity of born to preterm infants may predispose to sucking difficulties. This research aimed to evaluate if pacifier use is associated with preterm birth and influenced in type of infant feeding. This comparative cross-sectional study was conducted in Belo Horizonte, Brazil and evaluated 250 children aged 3 to 5 years. As a sample, two groups were established: the normal term children group (n=125) was selected at a day-care centre and the group of preterm children (125) was identified at a public university hospital with a preterm care project from birth to seven years of age. To collect data, a pre-tested questionnaire regarding information on gestational age, infant development, infant feeding and non-nutritive sucking habits was used for both groups. Bivariate and multivariate Poisson regression was used for the statistical analysis. Pacifier use was more prevalent in the preterm group (PR=1.20, 95% CI=1.02-1.42) who used the bottle (PR=1.38, 95% CI=1.15-1.64) and were breastfed for less than six months (PR=1.19, 95% CI=1.01-1.41). The majority of breastfed infants were of normal term birth (PR=1.14, 95% CI=1.04-1.20) and had monthly family income greater than USD 450.28 (RP= 1.10, 95% CI=1.01-1.20). In this study, pacifier use was more prevalent among preterm infants and associated with less than six months of breastfeeding and used of bottle. Monthly family income was associated with a prevalence of breastfeeding.

Resumo A imaturidade no nascimento para pretermos pode os predispor a dificuldades de sucção. Esta pesquisa teve como objetivo avaliar se o uso de chupeta está associado ao nascimento prematuro e ao tipo de alimentação infantil. Este estudo transversal comparativo foi realizado em Belo Horizonte, Brasil e avaliou 250 crianças de 3 a 5 anos. A amostra foi composta por dois grupos: o grupo de crianças nascidas a termo (n = 125) que foi selecionado em uma creche e o grupo de crianças pré-termo (125) que foi contatado em um hospital universitário público vinculado a um projeto de cuidados pré-termo desde o nascimento até os sete anos de idade. Para coletar dados, um questionário pretextado sobre informações da idade gestacional, desenvolvimento infantil, alimentação infantil e hábitos de sucção não nutritiva foram utilizados para ambos os grupos. Análises bivariada e Regressão de Poisson multivariada foram utilizadas para a análise estatística. O uso de chupeta foi mais prevalente no grupo pré-termo (RP = 1,20, IC95% = 1,02-1,42), que usou a mamadeira (RP = 1,38; IC95% = 1,15-1,64) e foram amamentados ao seio por menos de seis meses (RP = 1,19, 95% IC = 1,01-1,41). A maioria das crianças amamentadas ao seio nasceram a termo (RP = 1,14, 95% IC = 1,04-1,20) e com renda familiar mensal maior que USD 450,28 (RP = 1,10, 95% IC = 1,01-1,20). Neste estudo, o uso de chupeta foi mais prevalente entre os prematuros e associado com a amamentação ao seio por menos de seis meses e uso de mamadeira. A renda familiar mensal associou-se a uma prevalência de prática da amamentação ao seio.

Prevalence of self-reported awake and sleep bruxism among dental students

Objective: To evaluate the prevalence of self-reported awake and sleep bruxism and its association to sleep characteristics among dental students. Methods: A cross-sectional study was conducted with 153 students of a Brazilian Dental School. Students who accepted to participate answered a questionnaire evaluating their sex, age, place of living, paid work, nocturnal paid work, hours of sleep per night, time to fall asleep, sleep quality, if participant had a bedroom partner, if participant is quiet on bed while sleeping and intake of sleep medication. Information on intake of energy drink, if participant wake up overnight, if participant wake up tired and it has been difficult to concentrate on daily activities was also collected. Awake and sleep bruxism was based on self-report. Descriptive analysis and chi-square test were carried out. Results: Most students were female (73%) and mean age was 21 years old (±3.25). The prevalence of self-reported awake and sleep bruxism was 36.5% and 11.3%, respectively. Most participants rated their sleep quality as good (57.2%) and reported that they woke up feeling tired (52.6%). Intake of sleep medication in the last 30 days (P=0.002), waking up overnight and taking over an hour to sleep again in the last 30 days (P=0.005) and waking up feeling tired (p=0.012) were associated factors to self-reported awake bruxism. Conclusion: The prevalence of self-reported awake bruxism was higher than the prevalence of sleep bruxism among dental students. Intake of sleep medication, waking up overnight and taking over an hour to sleep again and waking up tired were can be indicators of the presence of awake bruxism in dental students.

Objetivo: Avaliar a prevalência de bruxismo em vigília e do sono e sua associação com características do sono em estudantes de odontologia. Métodos: Ao todo 153 estudantes de uma Faculdade de Odontologia brasileira foram convidados a participar desse estudo transversal, respondendo a um questionário avaliando sexo, idade, endereço, realização de trabalho remunerado e/ou trabalho noturno remunerado, horas de sono por noite, tempo para adormecer, qualidade do sono, sono agitado e a presença de um colega de quarto. A ingestão de bebida energética e pílulas para dormir, o histórico de acordar durante a noite, acordar sentindo-se cansado e dificuldades de concentração nas atividades diárias também foram avaliadas. O diagnóstico de bruxismo baseou-se no auto-relato. Foi realizada a análise descritiva e teste qui-quadrado. Resultados: A média de idade dos participantes foi de 21 anos (±3,25) e 73% eram do sexo feminino. A prevalência do bruxismo em vigília foi de 36,8% e bruxismo do sono foi de 11,3%. A maioria dos participantes, 57,2%, classificou a qualidade do sono como boa, porém 52,6% relataram que acordavam cansados. O uso de medicamento para dormir nos últimos 30 dias (P=0.002), acordar durante a noite e demorar mais de uma hora para dormir novamente nos últimos 30 dias (P=0.005) e acordar sentindo-se cansado (P=0.012) foram fatores associados ao bruxismo em vigília auto-relatado. Conclusão: A prevalência de bruxismo em vigília foi maior que a prevalência do bruxismo do sono em estudantes de odontologia. O uso de medicamento para dormir, acordar durante a noite e demorar mais de uma hora para dormir e acordar sentindo-se cansado podem ser fatores indicadores da presença de bruxismo em vigília em estudantes de odontologia.

Evaluation of the association of bruxism, psychosocial and sociodemographic factors in preschoolers

Abstract The aim of the present study was to evaluate factors associated with sleep bruxism in five-year-old preschool children. A preschool-based cross-sectional study was conducted with 761 pairs of children and their parents/caregivers. Sleep bruxism was diagnosed using a questionnaire administered to the parents/caregivers, who also answered questionnaires addressing sociodemographic data and parent's/caregiver's sense of coherence. Clinical oral evaluations of the children to determine dental caries, traumatic dental injuries, malocclusion and tooth wear were performed by two researchers who had undergone a training exercise (interexaminer Kappa: 0.70 to 0.91; intraexaminer Kappa: 0.81 to 1.00). Descriptive analysis and logistic regression for complex samples were carried out (α = 5%). The prevalence of sleep bruxism among the preschool children was 26.9%. The multivariate analysis revealed that bruxism was associated with poor sleep quality (OR = 2.93; 95 CI: 1.52-5.65) and tooth wear (OR = 2.34; 95%CI: 1.39-3.96). In the present study, sleep bruxism among preschool children was associated with tooth wear and poor sleep quality of the child. In contrast, psychosocial aspects (sense of coherence) were not associated with sleep bruxism.