Pages 201-216, Language: English, GermanReissmann, Daniel R. / John, Mike T. / Aigner, Annette / Schön, Gerhard / Sierwald, Ira / Schiffman, Eric L.
Aims: To explore whether awake bruxism (AB) and sleep bruxism (SB) interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive.
Methods: In this case-control study, all participants (n = 705) were part of the multicenter Validation Project and were recruited as a convenience sample of community cases and controls as well as clinic cases. Logistic regression analyses were applied to test for the association between self-reported bruxism (AB and/or SB) and the presence of painful TMD. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed. Regression models included an interaction term to test for multiplicative interaction. Additive interaction was calculated as the relative excess risk due to interaction (RERI).
Results: Based on logistic regression analyses adjusted for age and gender, the main effects for both AB (OR = 6.7; 95% CI: 3.4 to 12.9) and SB (OR = 5.1; 95% CI: 3.1 to 8.3) were significant. While the multiplicative interaction (OR = 0.57; 95% CI: 0.24 to 1.4) was not significant, the results indicated a significant positive additive interaction (RERI = 8.6; 95% CI: 1.0 to 19.7) on the OR scale.
Conclusion: This study has demonstrated that AB and SB are associated with an increased presence of painful TMD, and that both types of bruxism are not independently associated, but interact additively. As such, the presence of each factor amplifies the effect of the other.
Keywords: awake bruxism (AB), interaction effect, pain, sleep bruxism (SB), temporomandibular disorders (TMD)
Pages 217-228, Language: English, GermanBracci, Alessandro / Lange, Matthias / Djukic, Goran / Guarda-Nardini, Luca / Manfredini, Daniele
Possible developments and clinical usefulness of a smartphone applicationBackground: Awake bruxism (AB) is a condition that possibly mirrors some psychological disorders and can lead to several dental and medical consequences. While the frequency of AB could be described based on the so-called ecological momentary assessment (EMA) methodology, which enables real-time reporting of the condition under study (eg, tooth contact, tooth grinding, jaw clenching), the transfer process of this approach from the research to the clinical setting has not yet been performed.
Methods: An EMA for AB based on a smartphone application (app) has the potential to be an interesting strategy for introducing the advantages of EMA for bruxism evaluation. This article describes a new app that is dedicated to EMA/AB evaluation, and which may be useful as a cognitive-behavioral strategy for AB management.
Results: The app has been used preliminarily to show about a 28% frequency of AB behaviors in a sample of healthy young adults over a 7-day recording period.
Conclusions: The use of smartphone technology may introduce several benefits in the field of EMA-based bruxism research and clinical practice, helping to set values of normal frequency. Such data could be compared to populations with risk-associated factors, with possible clinical consequences.
Keywords: awake bruxism, ecological momentary assessment, smartphone, bruxism
Pages 229-238, Language: English, GermanSteinbock, Christoph
Logical and semantic considerations of a dentistry termIn dental functional analysis and therapy, the concept of centric occlusion/centric relation has been an issue - and partly a myth - for almost a century. Numerous attempts have been, and are still being, made to define the 'correct' or 'ideal' spatial classification of the jaw in static occlusion. However, the results to date are unsatisfactory. What could be the reasons for this? A logical and semantic analysis of three of the key definitions of centric reveals that all the approaches to date have been bound to fail. What is being referred to - the reference object (the 'ideal' maxillomandibular relation) - either cannot be identified or the definition is contrary to fundamental dentistry principles. There can never be an 'ideal' jaw relation, but only a set of physiologically equivalent jaw relations. For this reason, in the author's opinion, we should cease using the term centric in dental discussions.
Keywords: centric, centric relation, centric condylar position, physiological centric, extension, reference object, linguistic analysis
Pages 239-248, Language: English, GermanKravchenko-Oer, Alexandra / Koch, Mara / Nöh, Kristina / Ostermann, Charlott / Winkler, Luzie / Kordaß, Bernd / Hugger, Sybille / Schindler, Hans Jürgen / Hugger, Alfons
The aim of this study was to analyze the effect of occlusal modifications on the muscular activity of the masseter and anterior temporalis muscles. The study included 41 healthy dentate subjects who were examined in relation to the muscle activity of the masseter and anterior temporalis muscles recorded by surface electromyography (EMG) bilaterally in two different sessions. Occlusal plastic strips (thickness: 0.4 or 0.8 mm) were placed on different mandibular teeth to simulate different bite constellations (unilateral, bilateral transversal, and bilateral diagonal). Controlled by visual feedback, the subjects performed submaximum occlusion at 10% and 35% of maximum voluntary contraction (MVC). The activity ratios of the muscles were analyzed by two-way repeated measurement analysis of variance (ANOVA), and the reliability of muscle activity data was determined by intraclass correlation coefficient (ICC) analysis. The activity ratios of the masseter muscles were not significantly different under various biting conditions. In contrast, the anterior temporalis muscles showed significant differences (P < 0.001) between unilateral configurations and the other biting conditions (bilateral transversal or diagonal), in particular during biting at 10% MVC. In general, ICC values revealed low to moderate reliability of the measurements of muscle activity. Under controlled submaximum occlusal loading, the activity behavior of the masseter muscles remained stable, whereas the anterior temporalis muscles reacted differently to distinct occlusal biting configurations. The results support the assumption that the anterior temporalis muscles might operate as fine-tuning muscles when asymmetric bite force distributions occur, for instance during chewing, caused by food fragments between the teeth.
Keywords: activity ratio, clenching, electromyography (EMG), masticatory muscles, occlusal interference, occlusal modification, visual feedback
Pages 249-257, Language: English, GermanRaff, Alexander
Die Weiterentwicklung der fachlichen Grundlagen der Funktionsdiagnostik betrifft auch die Einbindung und das Verweben dieses Bereiches der Zahnheilkunde mit Fragestellungen aus anderen medizinischen Fachgebieten, wie beispielsweise die Psychosomatik oder die Orthopädie. Es existieren mittlerweile zahlreiche wissenschaftliche Untersuchungen, in denen Tests zur Aufdeckung eventuell vorliegender Kofaktoren bei Patienten mit kraniomandibulären Dysfunktionen entsprechende Zusammenhänge mit diesen medizinischen Fachbereichen nachweisen. Die im Gebührenverzeichnis der deutschen Gebührenordnung für Zahnärzte aufgeführten Leistungen sind 2012 bei der GOZ-Reform im Bereich der Funktionsdiagnostik gegenüber der Vorgängerversion von 1988 fast unverändert geblieben. Da andererseits Zahnärzte in Deutschland nach dem Zahnheilkundegesetz verpflichtet sind, die Zahnheilkunde nach aktuellem Stand der Wissenschaft auszuüben, wäre das allein mit den in dem mithin inhaltlich veralteten Gebührenverzeichnis der GOZ katalogisierten Leistungen nicht möglich. Der Gesetzgeber hat dafür in der neuen GOZ allerdings gezielt die Möglichkeit verankert, nicht im Leistungskatalog enthaltene selbstständige Leistungen entsprechend nach Art, Kosten- und Zeitaufwand sowie Schwierigkeit vergleichbarer Leistungen abzurechnen ("Analogleistungen"). Der vorliegende Beitrag schildert am Beispiel der Tests zur Aufdeckung psychischer Kofaktoren einer Funktionsstörung des kraniomandibulären Systems die rechtlichen und fachlichen Hintergründe sowie die Konsequenzen für die Umsetzung in der Praxis.
Keywords: kraniomandibuläre Dysfunktion (CMD), Tests zur Aufdeckung psychischer Kofaktoren, klinische Funktionsanalyse, Gebührenordnung, GOZ, Analogberechnung