Frank Lobbezoo

Diagnostic accuracy of portable instrumental devices to measure sleep bruxism: a systematic literature review of polysomnographic studies

This study systematically reviews the sleep bruxism (SB) literature published in the MEDLINE and Scopus databases to answer the following question: What is the validity of the different portable instrumental devices that have been proposed to measure SB if compared with polysomnographic (PSG) recordings assumed as the gold standard? Four clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches (i.e. Bitestrip, electromyography (EMG)-telemetry recordings and Bruxoff) with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. Findings showed contrasting results and supported only in part the validity of the described diagnostic devices with respect to PSG. The positive predictive value (PPV) of the Bitestrip device was 59-100%, with a sensitivity of 71-84·2%, whilst EMG-telemetry recordings had an unacceptable rate of false-positive findings (76·9%), counterbalanced by an almost perfect sensitivity (98·8%). The Bruxoff device had the highest accuracy values, showing an excellent agreement with PSG for both manual (area under ROC = 0·98) and automatic scoring (0·96) options as well as for the simultaneous recording of events with respect to PSG (0·89-0·91). It can be concluded that the available information on the validity of portable instrumental diagnostic approaches with respect to PSG recordings is still scarce and not solid enough to support any non-PSG techniques employ as a stand-alone diagnostic method in the research setting, with the possible exception of the Bruxoff device that needs to be further confirmed with future investigations.

Functional status of masticatory system, executive function and episodic memory in older persons

Findings from human experimental studies suggest that mastication positively influences cognitive function. The participants in those studies were relatively young. The goal of this study was to examine the relationship between the functional status of the masticatory system, episodic memory, and executive functions in elderly people. The participants, elderly people living independently at home, were divided into two groups. One group had a full complement of natural teeth (n = 19) and the other group had full dentures (n = 19). The functional status of the masticatory system was assessed by measuring mandibular excursions (i.e. the distances over which the mandible can move in the open, lateral, and forward directions), bite force, number of occluding pairs and complaints of the masticatory system (facial pain, headaches/migraine). Executive functions and episodic memory were assessed by neuropsychological tests. Backward regression analysis showed that only in the group of elderly people with full dentures, 22% of executive functions were predicted by complaints of the masticatory system and 19.4% of episodic memory was predicted by masticatory performance (composed of mandibular excursions and bite force). The conclusion of this study is that only in older persons with full dentures the relationship between mastication, episodic memory, and executive function becomes evident when the functional status of the masticatory system decreases.

Dental status and oral health-related quality of life: a population-based study

Oral health-related quality of life (OHRQoL) is associated with tooth wear and tooth loss. This study investigated the association between OHRQoL and dental status (in terms of natural dentition, partial or complete dentures, or edentulism). Sixteen hundred and twenty-two persons who participated in a large-scale Dutch dental survey were interviewed. Dentate persons (n = 1407) were additionally invited for a clinical examination (response rate: 69%). Dental status was based upon the combined data from this clinical examination and the questionnaire (seven dental status groups were defined). OHRQoL was measured by the Dutch translation of the short version of the Oral Health Impact Profile, the OHIP-NL14. Kruskal-Wallis tests and Mann-Whitney U tests were used to investigate differences in OHRQoL between the dental status groups. For all OHIP-NL14 scales, differences in OHRQoL were found between the dental status groups (all P-values <0·001). The Mann-Whitney U tests revealed no differences between persons with a complete natural dentition and persons with a fixed prosthetic replacement. The latter group, however, did show a significantly better OHRQoL as compared to persons with a removable partial denture. Surprisingly, edentulous persons with an overdenture had a more impaired OHRQoL than edentulous persons with non-supported complete dentures. The results demonstrated that impaired dental status is associated with deteriorations in OHRQoL, especially concerning functional limitations, physical pain and social disability.

Comorbid disorders and sociodemographic variables in temporomandibular pain in the general Dutch population

AIMS (1) To determine the prevalence of temporomandibular disorder (TMD)-pain complaints in the general Dutch population; (2) to investigate its relationship with age, sex, educational attainment, and country of birth; (3) to determine its association with other pain complaints; and (4) to determine whether there are TMD subgroups (ie, with regard to their sociodemographic variables) that are more vulnerable for comorbid pain complaints. METHODS Data from two large-scale population studies were available: 975 randomly selected adults, who were interviewed by an examiner from the Institute for Applied Scientific Research (TNO), and 11,948 adults who were registered in the Netherlands Twin Register and responded to a survey questionnaire. Chi-squared tests and regression analyses were used to determine whether there were any associations between the presence of TMD pain and the various sociodemographic or comorbid variables. RESULTS The prevalence of TMD-pain complaints was 7.2% to 8.0%, and around twice as high in women than in men. The results were inconclusive for association with age, and no evidence was found for an association with country of birth or educational attainment. TMD-pain complaints were strongly related to the presence of other pain complaints. Interestingly, the number of reported comorbid complaints was related to all of the studied sociodemographic variables. CONCLUSION In the general Dutch population, women more often report TMD-pain complaints than men, and patients with TMD-pain complaints more often show other pain complaints than persons without TMD pain. In contrast to common beliefs, no clear association with age was found. Furthermore, widespread pain complaints were more common in non-native Dutch and lower-educated females.

The Prevalence of Tooth Wear in the Dutch Adult Population

This study aimed to assess the prevalence of tooth wear in different age groups of the Dutch adult population and to determine this tooth wear distribution by gender, socioeconomic class, and type of teeth. Results were compared with the outcomes of a previous study in a comparable population. As part of a comprehensive investigation of the oral health of the general Dutch adult population in 2013, tooth wear was assessed among 1,125 subjects in the city of ‘s-Hertogenbosch. The data collected were subjected to stratified analysis by 5 age groups (25-34, 35-44, 45-54, 55-64, and 65-74 years), gender, socioeconomic class, and type of teeth. Tooth wear was assessed using a 5-point ordinal occlusal/incisal grading scale. The number of teeth affected was higher in older age groups. Men showed more tooth wear than women, and subjects with low socioeconomic status (low SES) showed on average higher scores than those with high SES. Tooth wear prevalence found in this study was higher in all age groups than in the previous study. The present study found prevalences of 13% for mild tooth wear and 80% for moderate tooth wear, leading to the conclusion that these are common conditions in the Dutch adult population. Severe tooth wear (prevalence 6%) may however be characterized as rare. A tendency was found for there to be more tooth wear in older age groups, in men as compared with women, in persons with lower SES, and in the present survey as compared with the previous one.

Chew the Pain Away: Oral Habits to Cope with Pain and Stress and to Stimulate Cognition

The acute effects of chewing gum on cognitive performance, stress, and pain have been intensively studied in the last decade. The results have been contradicting, and replication studies proved challenging. Here, we review some of the recent findings of this topic and explore possible explanations for these discrepancies by incorporating knowledge derived from studies into oral habits and bruxism. Both stress and cerebral functional specialization (i.e., the involvement of specific brain structures in distinctive cognitive processes) are hypothesized to play a major role in the underlying physiological mechanisms of the diverse effects of chewing gum on cognition, stress, and pain.