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目的探讨稳定垫对于夜磨牙的短期疗效。方法对四川省人民医院口腔科2008年1—11月收治的夜磨牙患者10例,使用多导睡眠监测技术记录戴用垫前与戴用2周后的磨牙事件、微觉醒次数及睡眠结构,并进行比较分析。结果使用稳定垫2周后,每小时磨牙事件比治疗前有所减少,微觉醒指数、睡眠结构变化差异无统计学意义。结论稳定垫对夜磨牙患者的牙齿磨动有所改善,但对于睡眠结构和睡眠微觉醒的发生无影响。     

Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism

AIMS: To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. METHODS: Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. RESULTS: Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. CONCLUSION: The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.     

The effect of oral splint devices on sleep bruxism: a 6-week observation with an ambulatory electromyographic recording device

This study investigated the effect of stabilization splint (SS) and palatal splint (PS), which had the same design as SS except for the elimination of the occlusal coverage, on sleep bruxism (SB) using a portable electromyographic (EMG) recording system. Sixteen bruxers participated in this study. The EMG activities of the right masseter muscle during sleep were recorded for three nights each in the following five recording periods: before, immediately after, and 2, 4 and 6 weeks after the insertion of the splint. The crossover design, in which each splint was applied to each subject for 6 weeks with an interval of 2 months for a washout period, was employed in this randomized-controlled study. The number of SB events, duration and total activities of SB were analysed. The number of SB events before the insertion of splints (baseline) was 2.98 +/- 1.61 times h(-1). Both splints significantly reduced SB immediately after the insertion of devices (P < 0.05, one-way repeated-measures anova followed by Dunnett); however, no reduction was observed in 2, 4 or 6 weeks (P > 0.05). There was no statistical difference in the effect on SB between the SS and PS (P > 0.05, two-way repeated-measures anova). Both splints reduced the masseter EMG activities associated with SB; however, the effect was transient.     

Do sleep hygiene measures and progressive muscle relaxation influence sleep bruxism? Report of a randomised controlled trial

The aim of this study was to assess the effects of sleep hygiene measures combined with relaxation techniques in the management of sleep bruxism (SB) in a double‐blind, parallel, controlled, randomised clinical trial design. Sixteen participants (mean ± s.d. age = 39·9 ± 10·8 years) were randomly assigned to a control group (n = 8) or to the experimental treatment group (n = 8). Participants belonging to the latter group were instructed to perform sleep hygiene measures and progressive muscle relaxation techniques for a 4‐week period. Two polysomnographic recordings, including bilateral masseter electromyographic activity, were made: one prior to the treatment and the other after the treatment period. The number of bruxism episodes per hour, the number of burst per hour and the bruxism time index (i.e. the percentage of total sleep time spent bruxing) were established as outcome variables. No significant differences could be observed between the outcome measures obtained before and after the 4‐week period, neither for the sleep bruxism variables nor for the sleep variables. Within the limitations of this study, it was concluded that there is no effect of sleep hygiene measures together with progressive relaxation techniques on sleep bruxism or sleep over a 4‐week observation period.     

Evaluation of sleep bruxism by polysomnographic analysis in patients with dental implants

PURPOSE: The aims of the present study were to use polysomnographic analysis to confirm sleep bruxism (SB) and to evaluate clinical findings of dental implant treatment in SB patients. MATERIALS AND METHODS: The present study comprised the retrospective analysis of 368 patients with a total of 838 endosseous implants. Nineteen patients who experienced mechanical complications, such as implant or abutment fractures, loosened gold screws, or occlusal surface wear or damage, were selected for polysomnographic analysis to monitor sleep symptoms. Six patients in the study group were identified as having SB, and this was confirmed by polysomnographic analysis. RESULTS: The SB electromyographic episodes were at least 20% of the patients' maximum voluntary contractions while awake and were scored. Most of the bruxism episodes (80%) were seen in light sleep stages. Only 5% of bruxism episodes were detected during rapid-eye-movement sleep. Sleep stage recordings were similar in all individuals. Bruxism episodes did not cause arousals. Patients were unaware of their nocturnal parafunctional habits. Despite protection with night guards, all patients were reported to have continued bruxism. DISCUSSION: Since possible occlusal parafunctional habits may be evident in any stage of dental treatment, treatment outcome risks must be considered. CONCLUSIONS: Polysomnographic study was evaluated as an effective, low-cost method to confirm occlusal parafunctional habits during sleep. Precautions against SB in patients having dental implant treatment have not been properly clarified. However, night guard protection appears to have some validity in patients having sleep bruxism.     

NTI-tss和稳定咬合板治疗磨牙症的多导睡眠监测研究

目的比较NTI-tss咬合板和稳定咬合板（OS）对于磨牙症的短期疗效。方法10例磨牙症患者采用随机自身交叉对照试验,戴用NTI-tss和OS治疗各1周,于戴用咬合板前一晚、戴用当晚和戴用1周后进行多导睡眠监测,计算磨牙指数和睡眠微觉醒指数,数据采用SAS 9.1混合效应模型进行分析。结果两种咬合板在戴用前、戴用当晚、戴用1周后的睡眠微觉醒指数均无明显差异（P>0.05）。两种咬合板戴用后,磨牙指数均降低。NTI-tss戴用前、戴用当晚和1周后的磨牙指数分别为（7.50±1.11）、（3.45±1.22）、（3.51±1.03）次·h-1,戴用当晚与戴用前、戴用1周与戴用前的差异均有统计学意义（t=26.52,t=26.12,P<0.01）。OS戴用前、戴用当晚和1周后的磨牙指数分别为（7.44±1.23）、（2.97±0.91）、（6.43±1.02）次·h-1,戴用当晚与戴用前、戴用1周与戴用前的差异也有统计学意义（t=16.79,t=3.79,P<0.01）,但与NTI-tss相比,降低程度较小。结论NTI-tss和OS对于睡眠微觉醒的发生无影响,两者都可以降低磨牙指数,但前者对于夜磨牙症的短期疗效可能更稳定。     

Reliability of a portable device for the detection of sleep bruxism

Objectives

The aim of the study was to assess the repeatability in detecting sleep bruxism (SB) episodes by combined surface electromyography and heart rate (HR) signals recorded by a compact portable device (Bruxoff®). SB episodes are preceded by a sudden HR change. Thus, HR detection increases the precision of automatic detection of SB.

Materials and methods

Ten healthy subjects (five women and five men; 30.2?±?11.02 years) were selected for the study. Rhythmic masseter muscle activities, constituting the basic pattern of SB, were detected during three nights of recording during three different weeks with the Bruxoff device.

Results

The two-way ANOVA was not significant for SB episodes per night, SB episodes per hour, and heart frequency: no significant differences were observed during the three different nights of recording for each of the abovementioned variables (P?>?0.05). The intraclass correlation coefficient showed a good reproducibility for SB episodes per night (69 %), SB per hour (74 %), and heart frequency (82 %). A poor reproducibility was revealed for the number of masseter contractions (53 %). The Pearson analysis showed the absence of a significant correlation between the number of masseter contractions per night and the number of SB episodes per night (r?=??0.02, P?=?0.91).

Conclusions

The Bruxoff device showed a good reproducibility of measurements of sleep bruxism episodes over time.

Clinical relevance

These findings are important in the light of the need for simple and reliable portable devices for the diagnosis of SB both in the clinical and research settings.     

Long‐term use of occlusal appliance has impact on sleep structure

Acrylic occlusal appliances (OAs) have been used for temporomandibular disorders and sleep bruxism, but the effects of the treatment are still insufficiently evaluated. Two all‐night polysomnographic recordings were made in a sleep laboratory on 14 bruxists (9 females and 5 males with mean age of 27·5 years). The measurement included basic polysomnography with additional masseter muscle electromyogram and movement recording (static charge‐sensitive bed method) using randomisation. The base night recording was followed by the second study night after 8 weeks regular use of OA. The OA was made on the occlusal surface of the teeth of the upper jaw, and it was used at night time during the study period. With the OA, rapid eye movement sleep changed from 23·3% to 19·6% (P = 0·078), and slow wave sleep increased significantly from 10·2% to 14·7% (P = 0·039). Masseter contraction (MC) episodes occurred with similar frequency (9·7 vs. 10·5 episodes per hour, P = 0·272). The intensity of the rhythmic MC bursts within an episode decreased from 5·5 to 4·4 (P = 0·027). The groups were post hoc divided into responders and non‐responders using a 20% change in MC episode per hour as a cut‐off point. The results indicated that 43% of bruxists increased activity (negative responders), while 36% decreased (positive responders), and in 21%, there was no change in the level. It is concluded that OA does not have significant feedback inhibition on masseter muscle motor activity during sleep. However, OA may increase slow wave sleep.     

The effects of stabilization splint treatment on the volume of masseter muscle in sleep bruxism patients

Objective: The aim of this study was to evaluate, quantitatively, the volumetric effects of stabilization splint therapy on the masseter muscle of sleep bruxism (SB) patients.

Methods: The magnetic resonance (MR) images of 16 SB patients diagnosed by polysomnography (PSG) who used stabilization splints for four months were obtained before and after the therapy. The masseter muscle volume was calculated using Cavalieri’s principle on the MR images.

Results: After the splint therapy, the mean volume of the masseter muscle did not reduce significantly. The fat and/or water content of the muscles did not change either.

Discussion: The stabilization splint therapy had no effect on the volume, fat and/or water content of the masseter muscle; however the discomfort was reduced in the patients. Although the effect of splint therapy is not fully understood, the non-invasive and reversible stabilization splint can be used in SB patients because of its relaxation effect on muscles.     

软性垫和硬性垫治疗夜磨牙或紧咬牙的临床效果观察

目的：观察硬性垫和软性垫治疗夜磨牙或紧咬牙的临床效果。方法对58例夜磨牙或紧咬牙患者随机采用硬性垫或软性垫进行治疗,28例使用硬性垫,30例使用软性垫。患者每天佩戴垫8h以上,睡眠时佩戴,佩戴垫后1个月、2个月、3个月、6个月复诊,问诊并记录肌肉酸痛症状,以及夜磨牙或紧咬牙习惯与佩戴前是否有变化。对佩戴垫6个月时的治疗有效率用SPSS 17.0软件行卡方检验。结果治疗6个月时软性垫和硬性垫的治疗有效率分别为93.33%、82.14%,差异无统计学意义（c2=1.709,P=0.191）。结论硬性垫和软性垫的临床治疗效果均较好,软性垫因制作简便、佩戴舒适,更易被患者接受。     

The effect of intermittent use of occlusal splint devices on sleep bruxism: a 4‐week observation with a portable electromyographic recording device

This randomised controlled study investigated the effect of intermittent use of occlusal splints on sleep bruxism compared with that of continuous use by measuring masseter muscle electromyographic activity using a portable electromyographic recording system. Twenty bruxers were randomly allocated to the continuous group and intermittent group. Subjects in the continuous group wore stabilisation splints during sleep for 29 nights continuously, whereas those in the intermittent group wore splints during sleep every other week, that is they used splints on the 1st–7th, 15th–21st and 29th nights. Electromyographic activity of the masseter muscle during sleep was recorded for the following six time points: before (baseline), immediately after, and 1, 2, 3 and 4 weeks after the insertion of a stabilisation splint. The number of nocturnal masseter electromyographic events, duration and the total activity of sleep bruxism were analysed. In the continuous group, nocturnal masseter electromyographic events were significantly reduced immediately and 1 week after the insertion of the stabilisation splint, and duration was reduced immediately after the insertion (P < 0·05, Dunnett's test), but no reduction was observed at 2, 3 and 4 weeks after insertion. In the intermittent group, nocturnal masseter electromyographic events and duration were significantly reduced immediately after and also 4 weeks after insertion of the stabilisation splint (P < 0·05, Dunnett's test). The obtained results of the present exploratory trial indicate that the intermittent use of stabilisation splints may reduce sleep bruxism activity for a longer period compared with that of continuous use.     

Short Communication Motor activity in sleep bruxism with concomitant jaw muscle pain. A retrospective pilot study

In a controlled polysomnographic (PSG) study that we recently performed in our laboratory, we noticed that some patients with a chief complaint of sleep bruxism reported concomitant non-myofascial pain in their masticatory muscles. To study the influence of such pain on the pattern of bruxism motor activity, we re-assessed the 2nd out of 2 consecutive PSG and masseter electromyographic (EMG) recordings of 7 bruxers without pain and 6 bruxers with concomitant jaw muscle pain. Among others, the selection of these patients was based on reports of current jaw muscle pain intensity, using 100-mm visual analogue scales. In our sample of bruxism patients with pain, levels of pain intensity did not differ significantly between bedtime and awakening in the morning. Although there were no significant differences between both subgroups of bruxers in the number of bruxism bursts per episode and the root-mean-squared EMG level per bruxism burst, bruxers with pain had 40% less bruxism episodes per hour of sleep. This suggests that non-myofascial jaw muscle pain decreases the number of initiations of bruxism episodes, but leaves their contents unaffected.     

Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects

The efficacy of occlusal splints in diminishing muscle activity and tooth-grinding damage remains controversial. The objective of this study was to compare the efficacy and safety of an occlusal splint (OS) vs. a palatal control device (PCD). Nine subjects with sleep bruxism (SB) participated in this randomized study. Sleep laboratory recordings were made on the second night to establish baseline data. Patients then wore each of the splints in the sleep laboratory for recording nights three and four, two weeks apart, according to a crossover design. A statistically significant reduction in the number of SB episodes per hour (decrease of 41%, p = 0.05) and SB bursts per hour (decrease of 40%, p < 0.05) was observed with the two devices. Both oral devices also showed 50% fewer episodes with grinding noise (p = 0.06). No difference was observed between the devices. Moreover, no changes in respiratory variables were observed. Both devices reduced muscle activity associated with SB.     

Detection of sleep bruxism: comparison between an electromyographic and electrocardiographic portable holter and polysomnography

Recent polysomnographic (PSG) studies showed that the sleep bruxism (SB) event is preceded by a sudden shift in autonomic cardiac activity. Therefore, heart rate could be the simplest‐to‐record parameter for use in addition to portable home EMG monitoring to improve the accuracy in automatic detection of SB events. The aim of the study was to compare the detection of SB episodes by combined surface electromyography and heart rate (HR) recorded by a compact portable device (Bruxoff^®), with the scoring of SB episodes by a PSG recording. Twenty‐five subjects (14 ‘probable’ bruxers and 11 non‐bruxers) were selected for the study. Each subject underwent the Bruxoff and the PSG recordings during the same night. Rhythmic masseter muscle activities (RMMAs) were scored according to published criteria. Correlation coefficients and the Bland–Altman plots were calculated to measure the correlation and agreement between the two methods. Results showed a high correlation (Pearson's r = 0·95, P < 0·0001) and a high agreement (bias = 0·05) between Bruxoff and the PSG. Furthermore, the receiver operating characteristic curve analysis showed a high sensitivity and specificity of the portable device (92·3% and 91·6%, respectively) when the cut‐off was set at 4 SB episodes per hour according to published criteria. The Bruxoff device showed a good diagnostic accuracy to differentiate RMMA from other oromotor activities. These findings are important in the light of the need for simple and reliable portable devices for the diagnosis of SB both in the clinical and research settings.     

夜磨牙症患者咀嚼肌节律性运动特征与睡眠周期的关系

目的:研究夜磨牙症(sleep bruxim,SB)患者睡眠期咀嚼肌节律性运动(RMMA)的发生特征及其与睡眠周期的关系.方法:对30名SB患者、30名正常人进行连续2夜的多导睡眠监测,统计睡眠结构、睡眠效率、微觉醒指数以及磨牙指数.分析RMMA事件成群性,RMMA分布与睡眠周期的相关性.结果:SB患者微觉醒指数与正常...     

Validity of self‐reported sleep bruxism among myofascial temporomandibular disorder patients and controls

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro‐facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time‐consuming, most research testing this belief has relied on patient self‐report of SB. The current case–control study examined the accuracy of those self‐reports relative to laboratory‐based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self‐reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self‐report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self‐reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self‐report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self‐report to assess SB must be viewed with extreme caution.     

Sleep bruxism in patients with sleep-disordered breathing

The aim was to test the hypothesis of a direct association between sleep-disordered breathing and sleep bruxism. The frequency of masseter contraction (MC) episodes and rhythmic jaw movements (RJM) was measured in patients with mild and moderate obstructive sleep apnoea (OSA). The diagnosis of sleep bruxism was made from a combination of questionnaire, clinical observation and all-night polysomnographic recording which included masseter electromyography. A total of 21 patients (19 males/two females, mean age 40.0 years+/-9.2 SD) were randomly selected from a provisional diagnosis of snoring and OSA by a sleep physician. In the patients with mild OSA [n=11, mean apnoea hypopnoea index (AHI)=8.0+/-4.1 SD, body mass index (BMI)=29.1+/-5.0], the diagnosis of sleep bruxism was made in six out of 11 patients (54%); similarly, four out of 10 patients (40%) with moderate OSA (n=10, mean AHI=34.7+/-19.1, BMI=30.6+/-5.0) were identified as bruxists. Although the combination of clinical, subjective estimation and nocturnal electromyographic recording of masseter muscle might provide a more solid base for the diagnosis of sleep bruxism, the result is biased by the variation in the bruxing activity. MC episodes were associated with the termination of apnoea or hypopnoea episodes in only 3.5% of the mild group and 14.4% of the moderate group (p<0.05). It appears that sleep bruxism is rarely directly associated with apnoeic events, but is rather related to the disturbed sleep of OSA patients.     

The relationship between selective sleep deprivation, nocturnal jaw-muscle activity and pain in healthy men

The relationship between nocturnal jaw-muscle activity and temporomandibular disorders (TMD) is still controversial. The aim of this study was to investigate the effect of selective slow wave sleep (SWS = non-rapid-eye-movement (NREM) stage 3 + 4) deprivation on jaw-muscle activity using a new automatic system. Ten healthy men without signs of symptoms of TMD participated. The subjects slept in the laboratory for six continuous nights including one adjustment night, one baseline night, three nights with experimental sleep deprivation and one recovery night. Polysomnographic recordings of electroencephalography (EEG) and electromyography (EMG) were obtained for recognition of sleep stages and masseter muscle activity. During the three experimental nights, computer-controlled sound stimulation (60--90 dB(A), 1000 Hz) were given as long as the subjects were in SWS. Maximum voluntary occlusal force (MVOF), pain pressure threshold (PPT) and visual analogue scales (VAS) were used to assess the state of the masseter muscles every morning and evening during the study period. The results showed that the time spent in SWS was significantly decreased during the first sleep deprivation night, but there were no significant effects on nocturnal EMG activity (i.e. the numbers of bruxism episodes per hour of sleep, bruxism bursts per episodes bruxism bursts per hour of sleep), MVOF, VAS or PPT. Furthermore, the automatic system only deprived the SWS in five subjects for the following two nights although the sound stimulation was given at the maximum intensity. These results suggest that deprivation of SWS may not interact immediately with nocturnal jaw-muscle activity and jaw-muscle pain.     

Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine

Sleep bruxism (SB) is a common sleep-related motor disorder characterized by tooth grinding and clenching. SB diagnosis is made on history of tooth grinding and confirmed by polysomnographic recording of electromyographic (EMG) episodes in the masseter and temporalis muscles. The typical EMG activity pattern in patients with SB is known as rhythmic masticatory muscle activity (RMMA). The authors observed that most RMMA episodes occur in association with sleep arousal and are preceded by physiologic activation of the central nervous and sympathetic cardiac systems. This article provides a comprehensive review of the cause, pathophysiology, assessment, and management of SB.     

肌位板对磨牙症伴颅颌功能紊乱症状作用的临床与肌电图研究

目的 :观察肌位板对磨牙症伴颅颌功能紊乱 (CMD)症状者最大紧咬时咀嚼肌肌电图及临床症状的影响。方法 :对 31例患者戴板前 ,即刻戴入板后 ,采用EM2肌电仪分别测试最大紧咬时双侧颞肌前束、后束、嚼肌及二腹肌前腹的肌电活动大小。嘱患者夜间戴板 3～ 6月 ,记录临床症状与体征的变化。结果 :肌位板能明显减少升颌肌的肌电活动 (p <0 0 5 ) ,提高嚼肌活动的对称性 (p<0 0 5 )。戴板后仅 4例紧咬牙习惯消失而不能终止夜磨牙 ,但戴板期间CMD症状持续缓解甚至消失。结论 :肌位板可明显减小磨牙症伴CMD症状者升颌肌异常过度活动 ,且提高嚼肌肌电活动的对称性 ,从而使CMD症状持续性缓解