André Luís Porporatti

Validity of different tools to assess sleep bruxism: a meta-analysis

This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of questionnaires, clinical assessment and portable diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism (SB). Two reviewers searched electronic databases for diagnostic test accuracy studies that compared questionnaires, clinical assessment or portable diagnostic devices for SB, with the reference standard method PSG, comprising previous studies from all languages and with no restrictions regarding age, gender or time of publication. Of the 351 articles, eight met the inclusion criteria for qualitative, and seven for quantitative analysis. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The studies were divided and analysed over three groups: three studies evaluating questionnaires, two regarding the clinical assessment of tooth wear and three covering portable diagnostic devices. The MA indicated that portable diagnostic devices showed the best validity of all evaluated methods, especially as far as a four-channel EMG/ECG recording is concerned. Questionnaires and the clinical assessment can be used as screening methods to identify non-SB individuals, although it is not that good in identifying subjects with SB. The quality of evidence identified through GRADEpro, was from very low-to-moderate, due to statistical heterogeneity between studies.

Headache Attributed to Masticatory Myofascial Pain: Clinical Features and Management Outcomes.

AIMS To describe the characteristics of headaches attributed to temporomandibular disorders (TMD) and assess the effects of two management strategies used for the management of TMD on headache intensity and frequency. METHODS The initial sample (n=60) of this randomized controlled trial comprised patients with masticatory myofascial pain according to the Research Diagnostic Criteria for TMD (RDC/TMD), and headache. The patients were divided into two groups: group 1 received only counseling for behavioral changes, and group 2 received counseling and an occlusal appliance. A 5-month follow-up period included three assessments. TMD-related headache characteristics, eg, headache intensity (scored on a visual analog scale [VAS]) and frequency were measured by a questionnaire. Two-way analysis of variance, chi-square, Friedman, and Mann-Whitney tests were used to test for differences considering a 5% significance level. RESULTS The main clinical features of headache attributed to masticatory myofascial pain were the long duration (≥4 hours), frontotemporal bilateral location, and a pressing/tightening quality. Forty-one subjects (group 1, 17 subjects; group 2, 24 subjects) were included in the final analysis. There was a reduction in headache intensity and frequency, with no significant differences between groups (P>.05). The mean (±SD) baseline VAS was 7.6 (±2.2) for group 1 and 6.5 (±1.6) for group 2; final values were 3.1 (±2.2) (P<.001) and 2.5 (±2.3) (P<.001), respectively. CONCLUSION Headache attributed to masticatory myofascial pain was mainly characterized by long duration, frontotemporal bilateral location, and a pressing/tightening quality. Also, counseling and behavioral management of masticatory myofascial pain improved headache, regardless of the use of an occlusal appliance.

Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis

The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice. In this context, the aim of this systematic review was to answer the following focused questions: (i) What is the frequency of acceptable technical quality of root fillings, assessed radiographically, performed by undergraduate students? (ii) What are the most common errors assessed radiographically and reported in these treatments? For this purpose, articles that evaluated the quality of root fillings performed by undergraduate students were selected. Data were collected based on predetermined criteria. The key features from the included studies were extracted. GRADE-tool assessed the quality of the evidence. MAStARI evaluated the methodological quality, and a meta-analysis on all studies was conducted. At the end of the screening, 24 articles were identified. Overall frequency of acceptable technical quality of root fillings was 48%. From this total, 52% related to anterior teeth, 49% to premolars and 26% to molars. The main procedural errors reported were ledge formation, furcation perforation, apical transportation and apical perforation. The heterogeneity amongst the studies was high (84-99%). Five studies had a high risk of bias, eight had a moderate risk, and 11 had low risk. The overall quality of evidence identified was very low. The conclusion was that technical quality of root fillings performed by undergraduate students is low, which may reveal that endodontic education has limited achievement at undergraduate level. A plan to improve the quality of root fillings, and by extrapolation the overall quality of root canal treatment, should be discussed by the staff responsible for endodontic education and training.

Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis

CONTEXT: Symptoms associated with the primary tooth eruption have been extensively studied but it is still controversial. OBJECTIVE: To assess the occurrence of local and systemic signs and symptoms during primary tooth eruption. DATA SOURCES: Latin American and Caribbean Health Sciences, PubMed, ProQuest, Scopus, and Web of Science were searched. A partial gray literature search was taken by using Google Scholar and the reference lists of the included studies were scanned. STUDY SELECTION: Observational studies assessing the association of eruption of primary teeth with local and systemic signs and symptoms in children aged 0 to 36 months were included. DATA EXTRACTION: Two authors independently collected the information from the selected articles. Information was crosschecked and confirmed for its accuracy. RESULTS: A total of 1179 articles were identified, and after a 2-phase selection, 16 studies were included. Overall prevalence of signs and symptoms occurring during primary tooth eruption in children between 0 and 36 months was 70.5% (total sample = 3506). Gingival irritation (86.81%), irritability (68.19%), and drooling (55.72%) were the most frequent ones. LIMITATIONS: Different general symptoms were considered among studies. Some studies presented lack of confounding factors, no clear definition of the diagnostics methods, use of subjective measures and long intervals between examinations. CONCLUSIONS: There is evidence of the occurrence of signs and symptoms during primary tooth eruption. For body temperature analyses, eruption could lead to a rise in temperature, but it was not characterized as fever.

Comparative analysis of imaging techniques for diagnostic accuracy of peri-implant bone defects: a meta-analysis

OBJECTIVE The aim of this study was to systematically review the literature regarding diagnostic accuracy of imaging techniques in detecting peri-implant bone defects. STUDY DESIGN The search was performed in 8 electronic databases from April to May 2016 and updated in September 2016. Studies that assessed imaging techniques to detect peri-implant bone defects were analyzed. RESULTS The search yielded 680 articles published from 1991 to 2016. Of these, 12 studies were considered eligible for this review. The selected studies evaluated the use of cone beam computed tomography (CBCT), intraoral radiography (IR), computed tomography, and panoramic radiography. The sensitivity for CBCT was 59%, whereas the specificity was 67%. For IR, the sensitivity was 60%, and the specificity was 59%. Area under the curve values in receiver operating characteristic (ROC) analysis were 69% for CBCT and 63% for IR. For CBCT, the highest value for positive predictive value was 0.94, negative predictive value was 0.98, positive likelihood ratio was 21.3, and negative likelihood ratio was 1.28. For IR, the highest positive predictive value was 1.0, negative predictive value 1.0, positive likelihood ratio 50.0, and negative likelihood ratio 0.70. The highest diagnostic odds ratio was 80 for CBCT and 4.45 for IR. No conclusion could be drawn for additional techniques. CONCLUSIONS Both CBCT and IR showed a clinically acceptable performance for assessing peri-implant bone defects.

Association between signs and symptoms of bruxism and presence of tori: a systematic review

ObjectiveThis systematic review aims to answer the question: “Is there an association between any specific signs and symptoms of bruxism and the presence of tori?”Material and methodsObservational studies, which evaluated the association between signs and symptoms of bruxism and tori, were selected. Signs and symptoms of bruxism (such as teeth grinding, jaw clenching, abnormal tooth wear, facial muscle hypertrophy, pain, or fatigue) had to be determined by questionnaire or anamnesis and tori within clinical assessment. Search-strategies were developed for five databases, in addition to three gray literature’s databases. The risk of bias was evaluated using the “Meta-Analysis of Statistics Assessment and Review Instrument”. A summary of overall strength of evidence was estimated using GRADE’s Summary of findings table.ResultsAmong 575 studies, five were included. Two studies were categorized as moderate risk of bias and three as high risk of bias. Self-report of teeth grinding and/or clenching presented contradictory results. Presence of abnormal tooth wear increased the odds of having tori, mainly for torus mandibularis. The overall quality of evidence ranged from low to very low.ConclusionBased on available evidence, the presence of abnormal tooth wear might be associated with tori, mainly torus mandibularis. There is no sufficient evidence to credit or discredit the association of tori and other signs and/or symptoms of bruxism.Clinical relevanceBruxism diagnosis is a challenge. The association between signs and symptoms of bruxism and tori could help clinicians on the recognition of patients susceptible to bruxism. This knowledge might also aid to the understanding of tori’s development and stimulate new relevant research.

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

Background The evaluation of possible differences in the distribution or characteristics of palpation-induced pain in the masticatory muscles could be valuable in terms of diagnostic assessment. The aim of this study was to evaluate the impact of different combinations of anterior temporalis (AT) and masseter palpation-induced pain in the diagnostic of temporomandibular disorder (TMD), primary headaches and bruxism. Material and Methods A total of 1200 dental records of orofacial pain adult patients were analyzed. The outcomes were dichotomously classified (presence/absence) as following: a) AT and/or masseter palpation-induced pain; b) myogenous TMD; c) temporomandibular joint (TMJ) arthralgia (arthrogenous TMD); d) migraine; e) tension-type headache (TTH); f) self-reported bruxism. Binomial logistic regression model (α = 5%) was applied to the data considering the palpation-induced muscle pain as the dependent variable. Results Mean age (SD) were 35.7 years (13.4) for 635 included dental records (83% females). Myogenous and arthrogenous TMD, migraine, TTH and bruxism were mainly associated with, respectively, masseter palpation-induced pain (p<0.001 - OR=5.77, 95%CI 3.86-8.62), AT or masseter palpation-induced pain (p<0.001 - OR=2.39, 95%CI 1.57-3.63), bilateral AT palpation-induced pain (p<0.001 - OR=2.67, 95%CI 1.64-4.32), masseter and AT palpation-induced pain (p=0.009 - OR=1.62, 95%CI 1.12-2.33) and bilateral masseter palpation-induced pain (p=0.01 - OR=1.74, 95%CI 1.13-2.69). Conclusions Palpation-induced pain in the masticatory muscles may play a role in the differential diagnosis among painful TMD, primary headaches and bruxism. Key words:Diagnosis, temporomandibular joint disorders, migraine, tension-type headache, bruxism.

Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review

The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with “unhealthy” DP and positively associated with “healthy” DP. In cross-sectional studies from HHDC, higher income is negatively associated with “unhealthy” DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with “unhealthy” DP and there is no association between the SE and “healthy” DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with “unhealthy” and “healthy” DPs in MHDC and LHDC.

Association of sleep bruxism with ceramic restoration failure: A systematic review and meta-analysis

Statement of problem. Ceramic restorations are popular because of their excellent optical properties. However, failures are still a major concern, and dentists are confronted with the following question: is sleep bruxism (SB) associated with an increased frequency of ceramic restoration failures? Purpose. The purpose of this systematic review and meta‐analysis was to assess whether the presence of SB is associated with increased ceramic restoration failure. Material and methods. Observational studies and clinical trials that evaluated the short‐ and long‐term survival rate of ceramic restorations in SB participants were selected. Sleep bruxism diagnostic criteria must have included at least 1 of the following: questionnaire, clinical evaluation, or polysomnography. Seven databases, in addition to 3 nonpeer‐reviewed literature databases, were searched. The risk of bias was assessed by using the meta‐analysis of statistics assessment and review instrument (MAStARI) checklist. Results. Eight studies were included for qualitative synthesis, but only 5 for the meta‐analysis. Three studies were categorized as moderate risk and 5 as high risk of bias. Clinical and methodological heterogeneity across studies were considered high. Increased hazard ratio (HR=7.74; 95% confidence interval [CI]=2.50 to 23.95) and odds ratio (OR=2.52; 95% CI=1.24 to 5.12) were observed considering only anterior ceramic veneers. Nevertheless, limited data from the meta‐analysis and from the restricted number of included studies suggested that differences in the overall odds of failure concerning SB and other types of ceramic restorations did not favor or disfavor any association (OR=1.10; 95% CI=0.43 to 2.8). The overall quality of evidence was considered very low according to the GRADE criteria. Conclusions. Within the limitations of this systematic review, the overall result from the meta‐analysis did not favor any association between SB and increased odds of failure for ceramic restorations.

Headache Exacerbates Pain Characteristics in Temporomandibular Disorders

AIMS To evaluate the impact of headache in adults with masticatory myofascial pain (MMP) on the outcome variables clinical pain (ie, self-reported pain intensity and pressure pain sensitivity), sleep quality, and pain catastrophizing. METHODS A total of 97 patients with MMP were diagnosed with co-existing headache (MMPH group, n = 50) or without headache (MMP group, n = 47) according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The outcome parameters were the Pittsburgh Sleep Quality Index (PSQI); the Catastrophizing Thoughts subscale of the Pain-Related Self-Statement Scale (PRSS-C); pressure pain thresholds (PPTs) of the masseter and anterior temporalis muscles; and self-reported facial pain intensity measured on a 0- to 10-cm visual analog scale (VAS). Student t test for independent samples (α = 1.2%) and factorial analysis of variance (ANOVA) (α = 5%) were used to analyze the data. RESULTS The MMPH group showed significantly impaired sleep quality (mean ± standard deviation [SD] PSQI score 9.1 ± 3.5) compared with the MMP group (7.2 ± 3.4; P = .008). Subscale scores on the PRSS-C were significantly higher in the MMPH (2.1 ± 1.2) than in the MMP group (1.6 ± 1.4, uncorrected P = .048). Also, the PPTs (kgf/cm²) of the masseter and anterior temporalis muscles were significantly lower in the MMPH group (1.52 ± 0.53; 1.29 ± 0.43, respectively) than in the MMP group (2.09 ± 0.73; 1.70 ± 0.68, respectively; P < .001), with no differences in self-reported facial pain intensity. Factorial analyses further indicated that chronic migraine was associated with poorer sleep quality (P = .003) and that tension-type headache patients had lower PPTs in the anterior temporalis muscle (P = .041) in comparison with non-headache patients. CONCLUSION Co-existence of headache further exacerbates clinical characteristics in patients with painful TMD, which implies involvement of common mechanisms and pathways of vulnerability in these patients.