Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008
Relationen mellem bruksisme og temporomandibulær dysfunktioner: en systematisk oversigt over litteraturen fra 1998 til 2008: Mål - Et systematisk review af forholdet i publiceret litteratur mellem temporomandibular dysfunktioner (TMD) - bruksisme fra 1998 til 2008. Studiedesign - En systematisk gennemgang af National Library of Medicine’s PubMed database blev gennemført med henblik på at identificere alle in vivo-studier for at vurdere forholdet mellem TMD symptomer og bruksisme diagnoseret ud fra forskellige fremgangsmåder. De udvalgte publikationer blev vurderet uafhængigt af 2 forfattere i overensstemmelse med en struktureret læsning af artikel formatet (PICO). Resultater - Totalt blev 46 publikationer inkluderet i diskussionen i dette review. De 46 publikationer blev grupperet i spørgeskema/selvrapportering (n = 21), klinisk vurdering (n = 7), eksperimentelle (n = 7), tandslid (n= 5), polysomnografiske (n= 4), eller elektromyografiske (n= 2) studier. I flere studier var evidensniveauet negativt påvirket af det lave specificitetsniveau ved vurderingen af forholdet mellem bruksisme og TMD på grund af den lave prævalens af alvorligt ramte TMD patienter i stikprøvestørrelserne og på grund af diagnosticering ved selvrapportering, som giver en risiko for diagnostisk skævvridning. Konklusioner - Undersøgelser baseret på selvrapportering eller en klinisk bruksismediagnose viste en positiv korrelation med TMD smerte, men disse undersøgelser er karakteriseret af en mulig skævhed på diagnostisk niveau (fx smerte som kriterium for bruksismediagnose). Studier baseret på mere kvantitative og specifikke metoder til at diagnosticere bruksisme viste mindre korrelation med TMD symptomer. Anteriort tandslid var ikke en stor risiko faktor for TMD. Eksperimentel vedvarende tandpres kan fremkalde akut muskelømhed, men ømheden er ikke analog med myogen TMD smerte, således vil disse studier ikke hjælpe med at afklare det kliniske forhold mellem bruksisme og TMD.
Objectives - The present paper aims to systematically review the literature on the temporomandibular disorders (TMD)-brux-ism relationship published from 1998 to 2008. Study design - A systematic search in the National Library of Medicine’s PubMed database was performed to identify all studies on humans assessing the relation- ship between TMD symptoms and bruxism diagnosed with any different approach. The selected articles were assessed independently by the 2 authors according to a structured reading of articles format (PICO). Results - A total of 46 articles were included for discussion in the review and grouped into questionnaire/self-report (n = 21), clinical assessment (n = 7), experimental (n = 7), tooth wear (n = 5), polysomnographic (n = 4), or electromyographic (n = 2) studies. In several studies, the level of evidence was negatively influenced by a low level of specificity for the assessment of the bruxism-TMD relationship, because of the low prevalence of severe TMD patients in the studied samples and because of the use of self-report diagnosis of bruxism with some potential diagnostic bias. Conclusions - Investigations based on selfreport or clinical bruxism diagnosis showed a positive association with TMD pain, but they are characterized by some potential bias and confounders at the diagnostic level (e.g., pain as a criterion for bruxism diagnosis). Studies based on more quantitative and specific methods to diagnose bruxism showed much lower association with TMD symptoms. Anterior tooth wear was not found to be a major risk factor for TMD. Experimental sustained jaw clenching may provoke acute muscle tenderness, but it is not analogous to myogenous TMD pain, so such studies may not help clarify the clinical relationship between bruxism and TMD.
