Oral Habits: Prevalence and Effects on Occlusion Among 7 to 13 Years Old School Children in Aseer, Saudi Arabia

Abstract Objective: To evaluate the prevalence of deleterious oral habits and its effect on occlusion in school going children from 7 to 13 years old, in Aseer region of Saudi Arabia. Material and Methods: A cross-sectional study was conducted by clinical examination for the total sample of 750, who were attending private/ government schools in Aseer region school. Students were selected by stratified cluster random sampling. Clinical findings of each oral habits, including assessment of malocclusion, were examined involving the following parameters, i.e., crowding, spacing, open bite, crossbite and deep bite. Logistic regression analysis was conducted. Results: Boys had 26.2 % of crowded teeth, while 16.3% of girls were found to have crowded teeth; the difference was found to be significant (p=0.002). Spacing was present in 26.4% of boys and 16.7% girls; a significant difference was found between the two (p=0.002). Sleep bruxism was observed more among male subjects than females with a statistically significant difference in detrimental habits (p<0.001). Those subjects having tongue thrusting are 1.264 times at more risk of having crowded teeth than those with no tongue thrusting. Conclusion: There was a high prevalence of malocclusion associated with harmful oral habits in children. This highlighted the need to implement programs of oral care and health education for preventive orthodontic treatment at an early age.

Effect of interocclusal appliance on bite force, sleep quality, salivary cortisol levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism.

OBJECTIVE: The purpose was to evaluate the effect interocclusal appliance therapy on bite force (BF), sleep quality and salivary cortisol levels in adults with SB diagnosed by polysomnography. As a secondary aim, signs and symptoms of temporomandibular dysfunction (TMD) were evaluated. DESIGN: Forty-three adults (19-30 y/o) were divided into two groups: experimental group (GSB), composed of 28 subjects with SB, and control group (GC), without SB and TMD (n=15). GSB was treated with stabilization interocclusal splint and evaluated at time intervals: before (baseline), one month (T1) and two months (T2) after therapy began, to collect data related to BF, sleep quality (Pittsburgh Sleep Quality Index), salivary cortisol levels and TMD. GC was also examined three times and received no therapy. Data were analysed by means of normality tests, t-test/Mann-Whitney and One-way ANOVA repeated measures (Tukey post-test). Two-way ANOVA test for repeated measures was applied to verify the effect time*group interaction on the variance of each dependent variable (α=0.05). RESULTS: GSB showed an increase in BF and a positive effect on muscular symptomatology, range of mandibular movements and sleep quality; in GC these parameters did not differ. Cortisol concentration decreased between baseline and T1 in GSB (F(1,31)=4.46; test power=62%; p=0.017). The variance observed for BF, TMD and sleep quality among time points was dependent on the group (moderate effect size: partial Eta square >0.16; test power >80%). CONCLUSIONS: The results suggested that short-term interocclusal appliance therapy had a positive effect on BF, temporomandibular symptomatology, sleep quality and salivary cortisol levels in adults with SB.

Rhinitis and sleep disorders: The trigeminocardiac reflex link?

Rhinitis, allergic or non-allergic, is an inflammatory condition of the nose. It is associated with a wide range of sleep disorders that are generally attributed to nasal congestion and presence of inflammatory mediators like cytokines and interleukins. However, the pathophysiological mechanisms behind these sleep disorders remain unclear. On the other hand, the trigeminocardiac reflex (TCR) has recently been linked to various sleep disorders like obstructive sleep apnea, sleep bruxism and rapid eye movement (REM) sleep apnea. TCR can be incited by stimulation of the trigeminal nerve or the area innervated by its branches including the nasal mucosa. Trigeminal nasal afferents can be activated on exposure to noxious stimuli (mechanical or chemical) like ammonia vapors, carbon-dioxide, nicotine, hypertonic saline, air-puffs and smoke. In rhinitis, there is associated neuronal hyper-responsiveness of sensory nasal afferents due to inflammation (which can be suppressed by steroids). This may further lead to increased occurrence of TCR in rhinitis. Moreover, there is involvement of autonomic nervous system both in rhinitis and TCR. In TCR, parasympathetic over activity and sympathetic inhibition leads to sudden onset bradycardia, hypotension, apnea and gastric motility. Also, the autonomic imbalance reportedly plays a significant role in the pathophysiology of rhinitis. Thus, considering these facts we hypothesize that the TCR could be the link between rhinitis and sleep disorders and we believe that further research in this direction may yield significant development in our understanding of sleep disorders in rhinitis.

Can an NTI-tss device be effective as a first-line therapy in patients with TMD myofascial pain?

This study was conducted to evaluate whether integrating a nociceptive trigeminal inhibition-tension suppression system (NTI-tss) device with first-line therapy of myofascial pain, which includes guidance, assurance, counselling and behavioural changes, would be more effective in alleviating symptoms. This randomised controlled clinical trial included 40 patients who were clinically diagnosed with myofascial pain according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients were randomly divided into two groups: the first group comprised patients who received guidance, assurance, counselling and behavioural changes; an NTI-tss device was integrated to this protocol in the second group. Both groups exhibited reduction in pain levels and improvement of jaw function compared with baseline values, but the difference was not significant. Both groups demonstrated improvements in 6 weeks; however, the integration of NTI-tss device into the therapy protocol did not provide any additional benefit in relieving symptoms of myofascial pain.

A importância da placa estabilizadora no tratamento do bruxismo e cefaleia matinal - relato de caso / The importance of the stabilization splint in the treatment of bruxism and morning headaches - case report

Este estudo teve como objetivo relatar um caso de bruxismo e cefaleia matinal, o qual foi tratado com placa estabilizadora para impedir o desgaste dentário e reduzir a dor orofacial de origem muscular. A paciente procurou a disciplina de Clínica Integrada com queixa de dores de cabeça e na face frequentes logo ao acordar. Após anamnese, exame físico intraoral e palpação muscular, a paciente foi diagnosticada com cefaleia matutina e dor facial de origem muscular relacionadas com bruxismo noturno (atividade parafuncional). Como tratamento, foi proposta a confecção de uma placa estabilizadora para uso noturno. No primeiro retorno após uma semana, a paciente relatou melhora na cefaleia matutina, e após um mês, os sintomas praticamente desapareceram. A mesma foi instruída a continuar usando a placa para dormir com o objetivo de proteger seus dentes de um desgaste maior, mesmo que as dores cessassem ompletamente. Recomendou-se retorno após 3 meses para acompanhamento dos sinais e sintomas. Apesar da inexistência de tratamento curativo, o tratamento com placa estabilizadora apresenta-se como uma importante opção terapêutica no controle da dor muscular e prevenção dos desgastes dentários.

This study aimed to report a clinical case of bruxism and morning headaches in which the patient was treated with a stabilization splint to prevent tooth wear and reduce muscular orofacial pain. The patient complained of frequent headaches and facial pain upon waking. After anamnesis, intraoral examination, and muscle palpation, the patient was diagnosed with morning headaches and muscular orofacial pain caused by nocturnal bruxism (parafunctional activity). The patient was treated with a stabilization splint for nocturnal use. One week after the insertion of the splint, the patient reported relief in morning headache, and after a month the symptoms had almost completely disappeared. The patient was instructed to keep using the splint to sleep in order to prevent tooth wear, even if the pain ceased completely. An appointment at 3 months post-insertion was scheduled for follow-up of signs and symptoms. Despite the lack of curative treatment for sleeping bruxism, the stabilization splint therapy is an important therapeutic option for pain control and prevention of tooth wear

Suppression of sleep bruxism: effect of electrical stimulation of the masseter muscle triggered by heart rate elevation.

PURPOSE: To examine whether electrical stimulation of the masseter muscle triggered by heart rate elevation preceding sleep bruxism (SB) can actively suppress SB. MATERIALS AND METHODS: Ten volunteers who were aware of their SB habits participated in the study. Baseline electromyogram (EMG) activity of the unilateral masseter muscle and electrocardiogram (ECG) signal were recorded on the first night. The individual mean sensation and pain thresholds to electrical stimulation of the unilateral masseter muscle were determined in awake subjects before the experiment. On the second night, electrical stimulations at either of the two threshold intensities were automatically generated and delivered to the masseter muscle on the opposite side from where electrodes were placed immediately after the heart rate exceeded 110%. On the third night, electrical stimulations at the other threshold intensity were delivered. RESULTS: The numbers of SB events per night and per hour, the number of EMG bursts per SB event, and the duration of SB events decreased significantly on the nights when stimulation was applied compared with the baseline data. There were no significant differences between cases where the sensation threshold was used as the stimulation intensity and those in which the pain threshold was used as the stimulation intensity. CONCLUSION: The results suggest that electrical stimulation of the masseter muscle triggered by heart rate elevation can significantly suppress SB.

Use of the Grindcare® device in the management of nocturnal bruxism: a pilot study.

BACKGROUND: Bruxism may be described as a diurnal or nocturnal parafunction, characterised by clenching, bracing, gnashing or grinding of the teeth and jaws. The aim of the management of bruxism should be to control or reduce the level of activity where possible. A variety of treatment strategies have been employed to achieve this including hypnosis, occlusal equilibration, splint therapy, physiotherapy and acupuncture. A more recent approach is the use of biofeedback. METHOD: Nineteen consecutive patients were recruited from the temporomandibular joint dysfunction (TMD) clinic at Manchester Dental Hospital, all of whom were known bruxists. They were supplied with the Grindcare® device (Medotech) and instructed to wear it every night over the five-week observation period. By monitoring electromyographic (EMG) muscle activity, the device is able to emit low-voltage electrical impulses as it senses a clenching or grinding episode, bringing about muscle relaxation. RESULTS: Eleven of the nineteen patients (58%) reported a major reduction in the occurrence of headaches and discomfort of the masticatory muscles on waking. Female and younger subjects responded more favourably than male and older subjects respectively. CONCLUSION: The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement. No adverse effects occurred throughout the study period.

Does restriction of mandibular movements during sleep influence jaw-muscle activity?

To investigate the effect of restriction of mandibular movements during sleep on jaw-muscle electromyographic (EMG) activity. Eleven healthy subjects (four men and seven women; age, 25·9 ± 3·1 years) with self-reports of sleep bruxism participated in three randomised sessions with three different types of oral appliances: (i) full-arch maxillary and mandibular appliances which did not allow any mandibular movement, that is, restrictive oral appliance (restrict-MMOA), (ii) full-arch maxillary and mandibular oral appliances (free-MMOA) with no restrictions of mandibular movements and (iii) conventional full-arch flat stabilisation appliance, that is, maxillary oral appliance (free-MOA). Baseline recordings (1st EMG recording) of jaw-muscle activity during sleep without any oral appliance were performed and followed by 1 week of nightly use of each oral appliance (three sessions). During the last night in each session, jaw-muscle activity was recorded (2nd, 3rd and 4th EMG recordings) and compared to baseline values. All EMG data were analysed in accordance with the gold-standard diagnostic method. The average jaw-muscle activity expressed as number of EMG episodes and bursts per hour sleep was significantly reduced during any combination of appliance compared to baseline values. The inhibitory effect of the appliances was specific to the number of phasic EMG episodes and bursts (P < 0·01), with no effects on tonic EMG bursts or episodes (P > 0·30). The results indicated that restriction of mandibular movements with oral appliances do not have any major influence on jaw-muscle activity during sleep but rather that the immediate effect of any combination of oral appliances lead to a suppression of phasic EMG bursts and episodes.

Association between exposure to secondhand smoke and sleep bruxism in children: a randomised control study.

BACKGROUND: Exposure to secondhand smoke (SHS) is a serious public health threat and represents a preventable cause of morbidity among children. Sleep bruxism is characterised by teeth grinding or clenching movements during sleep and may begin in adulthood as well as in childhood. OBJECTIVES: To investigate the association between SHS exposure and sleep bruxism in children. METHODS: Sleep bruxism was investigated in 498 children (mean age: 9.2±1.9). Family members were interviewed and asked whether they smoked in the presence of their children. Children were classified according to their exposure to SHS into heavily, moderately, lightly and occasionally exposed. Children with sleep bruxism and exposed to SHS were randomly divided into two groups: children in group 1 were not exposed to SHS for 6 months, whereas children in group 2 were. RESULTS: Thirty-one per cent of the children under investigation suffered from bruxism. Among them, 116 children (76%) were exposed to SHS. Exposed children showed a higher risk of sleep bruxism (p<0.05). After 6 months, sleep bruxism was found in 38% and in 90% of children, in the first and in the second group, respectively, this difference was statistically significant (p<0.05). In group 1, changes were statistically significant in those who were heavily and moderately exposed (p<0.05) but not in those lightly and occasionally exposed (p>0.05). In group 2, changes were not statistically significant (p>0.05). CONCLUSION: The findings showed that high and moderate exposure to SHS is associated with sleep bruxism in children.

Assessment of sleep parameters during contingent electrical stimulation in subjects with jaw muscle activity during sleep: a polysomnographic study.

There is emerging evidence that feedback techniques based on contingent electrical stimulation (CES) have an inhibitory effect on the electromyogram (EMG) activity of jaw-closing muscles and therefore could be useful in the management of sleep bruxism. This polysomnographic (PSG) study was designed to investigate the effect of CES on PSG parameters in subjects with self-reported bruxism. Fourteen subjects underwent a full PSG investigation in the laboratory for three consecutive nights - one night of adaptation, one night without CES, and one night with CES - in a randomized order. During all sessions the EMG activity was recorded by a portable feedback device from the temporalis muscle. An electrical pulse, which was adjusted to a moderate, but non-painful, intensity, was applied to subjects during the session with CES, if jaw-muscle activity was detected. The total sleep time, the number of micro-arousals per hour of sleep, the time spent in sleep stages 3 and 4 and in rapid eye movement (REM) sleep, and the number of periodic limb movements, were not influenced by CES. The number of EMG episodes per hour of sleep during the nights with and without CES was not significantly different. The present study suggests that CES at non-painful intensities does not cause major arousal responses in any of the sleep parameters assessed in this study.

Fluoxetine-induced sleep bruxism in an adolescent treated with buspirone: a case report.

Sleep bruxism, the involuntary grinding and/or clenching of teeth during sleep, may occur in young children and may be secondary to medication use, especially selective serotonin reuptake inhibitors (SSRIs). The mesocortical disinhibition produced by SSRIs may lead to dopamine depletion that manifests itself as nocturnal bruxism, a specific form of akathisia. This may be prevented by using buspirone, a 5-HT1A agonist that reduces serotonergic activity and increases dopaminergic activity. This article reports on a case history of an adolescent with fluoxetine-induced bruxism that was successfully treated with buspirone. As SSRI use is on the rise for treating childhood psychiatric disorders, this case report highlights the importance of recognizing SSRI-induced bruxism and the possible related adverse dental side effects. Furthermore, this report supports the efficacy of a treatment strategy in adolescents, which has previously been reported only for adult patients.

Myofascial temporomandibular disorder pain, parafunctions and psychological stress.

Associations of evening and morning masticatory muscle pain and nocturnal electromyography (EMG) activity with psycho-behavioural factors and occlusal splint therapy were studied during a 20-week study-protocol. Over a period of almost 2 years, only eight of the 120 eligible patients were willing to enroll the study protocol. Further, four of the eight participants dropped out during the study, and approximately 20-30% of the nocturnal EMG recordings failed. Because of the impractical and unworkable nature of the protocol, the study was prematurely terminated and the results of the four remaining individuals are reported here as single-patient clinical trials. Univariate and multiple regression analyses revealed that in three of the four patients, changes in nocturnal EMG activity were associated with the period of splint therapy. However, no associations were found between the changes in nocturnal EMG activity and the observed changes in muscle pain. In two patients, the changes in muscle pain were associated with the period of splint therapy and with the changes in psychological stress. Within the limitations of single-patient clinical trials, it can be concluded that changes in chronic masticatory muscle pain seem to be more related to changes in psychological stress than to those in parafunctional activities.

Maladaptive coping strategies in patients with bruxism compared to non-bruxing controls.

BACKGROUND: Sleep bruxism is the non-functional grinding or clenching of teeth during sleep. It may lead to tooth damage and myofascial pain. Although stress is discussed as a main causal agent, there is a lack of studies concerning coping strategies in patients with sleep bruxism. PURPOSE: The aim of the present study was to investigate whether bruxers, compared to non-bruxing individuals, apply maladaptive coping strategies. METHOD: Seventy-five sleep bruxers and 38 non-bruxers were selected by dental examination and tested by a German coping questionnaire (SVF78). RESULTS: A significant difference in positive coping strategies was observed between the two groups. Bruxers reported less positive coping strategies, mainly less "reaction control" and "positive self-instructions." In general, males reported less negative coping strategies. CONCLUSION: The reported effects demonstrate a deficit of functional coping strategies in bruxers, whereas strategies that enhance stress do not seem to be associated with sleep bruxism. Findings do not admit the conclusion that there is a causal association of maladaptive coping and bruxism. However, they support the approach of a multidisciplinary therapy involving psychological treatment.

The design of non-occlusal intraoral appliances on hard palate and their effect on masseter muscle activity during sleep.

This study aimed to reveal whether masseter muscle activity during sleep is affected by the difference in design of non-occlusal intraoral appliances on hard palate. Eight healthy Japanese participants were selected and wore each of the four types of appliances (horse shoe, thin, thick and medium thick) during sleep for one week with a one week interval without appliance during sleep. A masseter muscle electromyograph (EMG) was recorded during sleep. The EMG activities were analyzed by calculating the number of bursts per hour, episodes per hour, and bursts per episode. The EMG parameters with the thick type appliance were significantly lower than the baseline condition without appliance. In this study, it is suggested that a thick type appliance has an active effect on suppression of masseter muscle activity.

Reduction of sleep bruxism using a mandibular advancement device: an experimental controlled study.

PURPOSE: The objective of this experimental study was to compare the effect on sleep bruxism and tooth-grinding activity of a double-arch temporary custom-fit mandibular advancement device (MAD) and a single maxillary occlusal splint (MOS). MATERIALS AND METHODS: Thirteen intense and frequent bruxors participated in this short-term randomized crossover controlled study. All polygraphic recordings and analyses were made in a sleep laboratory. The MOS was used as the active control condition and the MAD was used as the experimental treatment condition. Designed to temporarily manage snoring and sleep apnea, the MAD was used in 3 different configurations: (1) without the retention pin between the arches (full freedom of movement), (2) with the retention pin in a slightly advanced position (< 40%), and (3) with the retention pin in a more advanced position (> 75%) of the lower arch. Sleep variables, bruxism-related motor activity, and subjective reports (pain, comfort, oral salivation, and quality of sleep) were analyzed with analysis of variance and the Friedman test. RESULTS: A significant reduction in the number of sleep bruxism episodes per hour (decrease of 42%, P < .001) was observed with the MOS. Compared to the MOS, active MADs (with advancement) also revealed a significant reduction in sleep bruxism motor activity. However, 8 of 13 patients reported pain (localized on mandibular gums and/or anterior teeth) with active MADs. CONCLUSIONS: Short-term use of a temporary custom-fit MAD is associated with a remarkable reduction in sleep bruxism motor activity. To a smaller extent, the MOS also reduces sleep bruxism. However, the exact mechanism supporting this reduction remains to be explained. Hypotheses are oriented toward the following: dimension and configuration of the appliance, presence of pain, reduced freedom of movement, or change in the upper airway patency.