Sleep Bruxism: Validity of Clinical Research Diagnostic Criteria in a Controlled Polysomnographic Study

Abstract

The clinical validity of diagnostic criteria for sleep orofacial motor activity-more specifically, bruxism-has never been tested. Polysomnographic recordings from 18 bruxers and 18 asymptomatic subjects, selected according to American Sleep Disorders Association criteria, were analyzed (1) to discriminate sleep bruxism from other orofacial motor activities and (2) to calculate sensitivity, specificity, and predictive values of research criteria. Clinical observations and reports revealed that all 18 bruxers reported frequent tooth-grinding during sleep. Tooth wear was noted in 16 out of 18 bruxers and jaw discomfort reported by six of them. These findings were present in none of the controls. The analysis of polysomnographic data showed that the asymptomatic subjects presented a mean of 1.7 ± 0.3 bruxism episodes per hour of sleep (sustained or repetitive bursting activity in jaw closer muscles), while bruxers had a significantly higher level of activity: 5.4 ± 0.6. Controls exhibited 4.6 ± 0.3 bruxism bursts per episode and 6.2 (from 0 to 23) bruxism bursts per hour of sleep, whereas bruxers showed, respectively, 7.0 ± 0.7 and 36.1 (5.8 to 108). Bruxism-like episodes with at least two grinding sounds were noted in 14 of the 18 bruxers and in one control. The two groups exhibited no difference in any of the sleep parameters. Based on the present findings, the following polysomnographic diagnostic cut-off criteria are suggested: (1) more than 4 bruxism episodes per hour, (2) more than 6 bruxism bursts per episode and/or 25 bruxism bursts per hour of sleep, and (3) at least 2 episodes with grinding sounds. When the polysomnographic bruxism-related variables were combined under logistic regression, the clinical diagnosis was correctly predicted in 81.3% of the controls and 83.3% of the bruxers. The validity of these clinical research criteria needs now to be challenged in a larger population, over time, and in subjects presenting various levels of severity of sleep bruxism.

Keywords

bruxism sleep diagnostic sensitivity and specificity motor activity

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References

Dao Ttt , Lund JP , Lavigne GJ (1994). Comparison of pain and quality of life in bruxers and patients with myofascial pain of the masticatory muscles. J Orofac Pain 8:350-356.

Dawson-Saunders B. , Trapp RG (1994). Basic and clinical biostatistics. Norwalk, CT: Appleton and Lange.

Dettmar DM , Shaw RM , Tilley AJ (1987). Tooth wear and bruxism: A sleep laboratory investigation . Aust Dent J 32:421-426.

Glaros AG (1981). Incidence of diurnal and nocturnal bruxism. J Prosthet Dent 45:545-549.

Goulet JP , Lund JP , Montplaisir J. , Lavigne G. (1993). Daily clenching, nocturnal bruxism, and stress and their association with TMD symptoms. J Orofac Pain 7:120. Hulley SB , Cummings SR (1988). Designing clinical research. Baltimore: Williams and Wilkins.

Johansson A. , Haraldson T. , Omar R. , Kiliaridis S. , Carlsson GE (1993). A system for assessing the severity and progression of occlusal tooth wear. J Oral Rehabil 20:125-131.

Kondo K. , Clark GT (1991). A method for detecting a bruxism event. J Dent Res 70:1969.

Lavigne GJ , Montplaisir J. (1994). Restless legs syndrome and sleep bruxism: prevalence and association among Canadians. Sleep 17:739-743.

Lavigne GJ , Montplaisir J. (1995). Bruxism: epidemiology, diagnosis, pathophysiology, and pharmacology. In: Orofacial pain and temporomandibular disorders. Fricton JR, Dubner RB, editors. New York: Raven Press, pp. 387-404. Lavigne G. , Velly-Miguel AM , Rompre PH , Guitard F. , Montplaisir J. (1992). The validity of ASDA diagnostic criteria for sleep bruxism behavior. J Dent Res 71:1228. Lavigne G. , Rompre P. , Guitard F. , Gosselin A. , Montplaisir J. (1994). Sleep bruxism: validity of ASDA criteria tested in a controlled descriptive study. Sleep Res 23: 279.

10.

Marbach JJ , Raphael KG , Dohrenwend BP , Lennon MC (1990). The validity of tooth grinding measures: etiology of pain dysfunction syndrome revisited. J Am Dent Assoc 120:327-333. Mohl ND , Ohrbach R. (1994). Clinical decision-making . In: Temporomandibular joint and masticatory muscle disorders . Zarb GA, Carlsson GE, Sessle BJ, Mohl ND, editors. Copenhagen: Munksgaard, pp. 563-583. Montplaisir J. , Godbout R. , Pelletier G. , Wames H. (1994). Restless legs syndrome and periodic limb movements during sleep. In: Principles and practice of sleep medicine. Kryger MH , Roth T, Demet WC, editors. Philadelphia: Saunders , pp. 589-597.

11.

Okeson JP , Phillips BA , Berry Dtr , Cook Y. , Paesani D. , Galante J. (1990). Nocturnal bruxing events in healthy geriatric subjects. J Oral Rehabil 17:411-418.

12.

Pierce C. , Close J. , Krause A. (1996). Relation between wear faceting and EMG-measured bruxing activity (abstract). J Dent Res 75:1588.

13.

Reding GR , Rubright WC , Zimmerman SO (1966). Incidence of bruxism. J Dent Res 45:1198-1204.

14.

Reding GR , Zepelin H. , Robinson JE Jr , Zimmerman SO , Smith VH (1968). Nocturnal teeth-grinding: All-night psychophysiologic studies. J Dent Res 47:786-797. Rechtschaffen A, Kales A, editors (1968). A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects. Los Angeles: UCLA Brain Information Service / Brain Research Institute.

15.

Rugh JD ( 1978). In Weinstein P , ed: Electromyographic analysis of bruxism in the natural environment. In: Advances in Behavioral Research in Dentistry. University of Washington Press: Seattle , pp. 67-83.

16.

Rugh JD , Harlan J. (1988). Nocturnal bruxism and temporomandibular disorders . In: Advances in neurology. Jankovic J , Tolosa E , editors. New York: Raven Press, pp. 329-341.

17.

Sackett DL , Haynes RB , Jugweel P. (1985). Clinical epidemiology: a basic science for clinical medicine. Boston/Toronto: Little, Brown and Company.

18.

Thorpy MJ , editor (1990). American Sleep Disorders Association: Parasomnia: International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN: ASDA, pp. 142-185.

19.

Velly-Miguel AM , Montplaisir J. , Rompre PH , Lund JP , Lavigne GJ (1992). Bruxism and other orofacial movements during sleep . J Craniomandib Dis Fac Oral Pain 6:71-81.

20.

Ware JC , Rugh JD ( 1988). Destructive bruxism: Sleep stage relationship. Sleep 11:172-181.

21.

Widmer CG , McCall WD , Lund JP ( 1994). Adjunctive diagnostic tests. In: Temporomandibular joint and masticatory muscle disorders. Zarb GA , Carlsson GE , Sessle BJ , Mohl ND , editors. Copenhagen: Munksgaard, pp. 510-525.

22.

Wruble MK , Lumley MA , McGlynn FD (1989). Sleep-related bruxism and sleep variables: A critical review. J Craniomandib Dis Fac Oral Pain 3:152-158.