Journal of Craniomandibular Function, 02/2023

Purpose: This study compared different methods of bruxism diagnosis used in clinical practice. The purpose of this study was to investigate the agreement between two diagnostic tools for bruxism (questionnaires and portable EMG measuring device). Methods: Seventy-six (76) subjects without craniomandibular dysfunction (CMD) were examined for their bruxism behavior in a clinical study over an observation period of 5 weeks. Measurements of episodes per hour were performed in the home setting using the GrindCare (GC) portable EMG device. The period was divided into 3 intervals (1 week – 2 weeks – 3 weeks). A minimum of 5 h of recorded sleep was a prerequisite for all participants. In addition, sleep (SB) and awake bruxism (AB) self-reports were collected at baseline and the end of the study using questionnaires, including the Oral Behavior Checklist (OBC). Results: There is a significant correlation between increased jaw activity (diagnosed by OBC) and SB/AB self-reports, as well as between SB and AB self-reports, but not between questionnaires and instrumental (GC) diagnostics. Conclusion: Questionnaires cannot replace EMG measurements in bruxism diagnostics. Dentists should always use a combination of self-reports in the form of validated questionnaires and instrumental diagnostics to detect bruxism. Keywords: teeth grinding, diagnostics, sleep bruxism, awake bruxism, electromyography

A recent analysis of dental websites in Germany has shown that the so-called phase 1 / phase 2 concept for the therapy of patients with temporomandibular disorders (TMDs), which dates back to the 1970s, remains relatively widespread. At the same time, summary critical reviews of this therapeutic strategy are scarce and widely scattered in the dental literature. This can be disadvantageous for readers who want to know what the current expert opinions are in regard to this topic. In addition, it creates problems in the preparation of expert reports that may be required for insurance reviews or for various medicolegal situations. In this article, a brief description of this therapeutic concept is followed by a critical evaluation of it. It becomes clear that this clinical approach lacks scientific support and that its continued implementation is fraught with ethical concerns. Finally, two explanations are presented as to why the two-phase concept is still offered by some dentists. Keywords: temporomandibular joint disorders, mandible, oral splints, malocclusion, prosthodontics, orthodontics, overtreatment, economic factors, dental ethics, evidence-based dentistry

Mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea (OSA) have been part of contractual dental care since 2022 and are becoming more widespread in dental practices. Based on the corresponding specifications of the S1 guideline from 2021 of the Association of the Scientific Medical Societies in Germany (AWMF), the clinical steps required for this in collaboration with medical sleep medicine are explained on the basis of a case study. Non-adherence to positive pressure therapy has triggered a dental treatment cascade resulting in the successful treatment of OSA. Special attention is given to the assessment of the dental risk profile and the management of the potential side effects. MAD therapy in the context of dental sleep medicine consequently reinforces the integration of dentistry into general medicine. Keywords: therapeutic jaw relation, obstructive sleep apnea, snoring, mandibular advancement splint