Management of sleep bruxism in adults: a qualitative systematic literature review

This paper updates the bruxism management review published by Lobbezoo et al. in 2008 (J Oral Rehabil 2008; 35: 509–23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio–video (AV) recordings, or with any other approach measuring the sleep‐time masticatory muscles' activity, viz., PSG without AV recordings or electromyography (EMG) recorded with portable devices. Fourteen (N = 14) papers were included in the review, of which 12 were randomised controlled trials (RCTs) and 2 were uncontrolled before–after studies. Structured reading of the included articles showed a high variability of topics, designs and findings. On average, the risk of bias for RCTs was low‐to‐unclear, whilst the before–after studies had several methodological limitations. The studies’ results suggest that (i) almost every type of oral appliance (OA) (seven papers) is somehow effective to reduce SB activity, with a potentially higher decrease for devices providing large extent of mandibular advancement; (ii) all tested pharmacological approaches [i.e. botulinum toxin (two papers), clonazepam (one paper) and clonidine (one paper)] may reduce SB with respect to placebo; (iii) the potential benefit of biofeedback (BF) and cognitive–behavioural (CB) approaches to SB management is not fully supported (two papers); and (iv) the only investigation providing an electrical stimulus to the masseter muscle supports its effectiveness to reduce SB. It can be concluded that there is not enough evidence to define a standard of reference approach for SB treatment, except for the use of OA. Future studies on the indications for SB treatment are recommended.     

Oro‐facial functions in experimental models of cerebral palsy: a systematic review

Children who suffer from cerebral palsy (CP) often present comorbidities in the form of oro‐facial dysfunctions. Studies in animals have contributed to elaborate potential therapies aimed at minimising the chronic disability of the syndrome. To systematically review the scientific literature regarding the possible effects that experimental models of CP can have on oro‐facial functions. Two independent authors conducted a systematic review in the electronic databases Medline, Scopus, CINAHL, Web of Science and Lilacs, using Mesh and Decs terms in animal models. The motor and sensory parameters of sucking, chewing and swallowing were considered as primary outcomes; reactivity odour, controlled salivation, postural control, head mobility during feeding and the animal's ability to acquire food were secondary outcomes. Ten studies were included in the present review. Most studies used rabbits as experimental models of CP, which was induced by either hypoxia‐ischemia, inflammation or intraventricular haemorrhage. Oro‐facial functions were altered in all experimental models of CP. However, we found more modifications in hypoxia‐ischemia models overall. On the other hand, the model of inflammation was more effective to reproduce higher damage for coordinating sucking and swallowing. All of the CP experimental models that were assessed modified the oral functions in different animal species. However, further studies should be conducted in order to clarify the mechanisms underlying oro‐facial damage in order to optimise treatment strategies for children who suffer from CP.     

Botulinum toxin in the management of temporomandibular disorders: a systematic review

The aim of this review was to critically investigate and assess the evidence relating to the use and efficacy of botulinum toxin (BTX) in the management of temporomandibular joint disorders (TMD) and masticatory myofascial pain. A comprehensive search was conducted of PubMed, Scopus, Embase, and Cochrane CENTRAL, to find relevant studies from the last 30 years up to the end of July 2018. Seven were identified. Three showed a significant reduction in pain between the BTX and placebo groups and one showed a clinical, but not a significant, difference. In one that compared BTX with another novel treatment, myofascial pain reduced equally in both groups, and in the remaining two there was no significant difference in pain reduction between the BTX and control groups. Of the four studies that assessed mouth opening, two reported that BTX had resulted in a slight improvement; one reported no improvement, and the other a worsening of the condition. A meta-analysis was not possible because of the considerable variation in the studies’ designs, the heterogeneity between the groups, and the different assessment tools used. Despite showing benefits, consensus on the therapeutic benefit of BTX in the management of myofascial TMD is lacking. Further randomised controlled trials with larger sample sizes, minimal bias, and longer follow-up periods are now needed.     

Specific infections as the etiology of destructive periodontal disease: a systematic review

Destructive periodontal disease has been primarily defined and investigated as an infectious disease. The aim of this study was to systematically search for cohort studies where microbiological diagnoses were performed before the onset of destructive periodontal disease and where statistically significant associations were identified. A search was executed in PubMed. The results showed that three studies published after 2005 supported the infection hypothesis for one putative periodontal pathogen: Aggregatibacter actinomycetemcomitans. These three studies were conducted in predominantly non‐Caucasian pediatric populations living in geographic areas with an elevated child‐mortality rate. These studies did not obtain physical or laboratory markers of health, making it possible that A. actinomycetemcomitans was not a cause but a marker for poor environmental or systemic health. No cohort studies were identified supporting the infection hypothesis in adults, Caucasians or in a population residing in areas with child‐mortality rates reflective of healthy population goals. While the possibility cannot be excluded that A. actinomycetemcomitans has an etiological role in certain specific pediatric populations, there are no cohort studies supporting an infectious etiology of destructive periodontal disease in adults.     

老年人咀嚼前后脑血流变化的对照研究

目的；通过对老年人咀嚼前后脑血流变化的对照研究，探讨咀嚼运动对脑血流的影响。方法：应用经颅多普勒超声诊断仪探测老年人大脑中动脉的收缩期峰流速、舒张期末峰流速及平均峰流速，SPSS10．0统讣软件进行重复测量数据的方羌分析。结果：咀嚼5分钟和10分钟后的收缩期峰流速、舒张期末峰流速及平均峰流速均高于咀嚼前，有硅著性差异（P〈0．05）。结论：咀嚼运动可明显提高老年人大脑中动脉的血流速度，增加栩应脑区的供血量。年龄因素虽然被证实可以降低大脑中动脉的血流速度，但是咀嚼功能正常可以减少这种影响。     

The influence of oral health on patients' food perception: a systematic review

Oral food perception depends on somatosensory information that includes taste and can be modified by oral components and/or functions such as mastication. The purpose of this study was to describe the interplay between oral health, mastication and taste. A review according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist was conducted on 615 publications found by both PubMed and backward research. Thirty‐one studies have been included. The results showed that the decline in taste ability observed during the healthy ageing process could be potentiated by the deterioration of oral health and poor oral hygiene. Prosthetic treatment could modify taste ability and oral food perception. A palatal covering with removable dentures can have an impact on taste perception which may depend on taste modality. During the mastication sequence, taste is apparently scattered throughout the oral cavity, probably through saliva. The deterioration of masticatory function modifies taste perception. Oral health and oral care should consider factors influencing patients' food perception and relations between taste and mastication. Therefore, dentists may modulate these factors to improve food perception and patients' eating pleasure and quality of life.     

Effect of a new treatment protocol called Functional Chewing Training on chewing function in children with cerebral palsy: a double‐blind randomised controlled trial

Cerebral palsy (CP) is a group of permanent sensorimotor impairments. Children with CP have various feeding difficulties including chewing disorder, which may affect their nutritional status. Functional Chewing Training (FuCT) was designed as a holistic approach to improve chewing function by providing postural alignment, sensory and motor training, and food and environmental adjustments. This study aimed to investigate the effect of FuCT on chewing function in children with CP. This study was designed as a double‐blind, randomised controlled trial. Eighty CP children with chewing disorder were randomised and split between the FuCT group (31 males, 19 females; mean age 3·5 ± 1·9 years) and the control group (16 males, 14 females; 3·4 ± 2·3 years) receiving traditional oral motor exercises. Each group received the training programme for 12 weeks with weekly follow‐up and with two evaluations at baseline and end of 12 weeks. Chewing function was evaluated by analysing video recordings and scored with the Karaduman Chewing Performance Scale (KCPS). The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to evaluate feeding behaviours of children. A significant improvement was observed in KCPS scores at 12 weeks after training in the FuCT group (P < 0·001), but no change was found in the control group (P = 0·07). A significant improvement was detected in all parameters of BPFAS at 12 weeks after training in the FuCT group (P < 0·001) and in four parameters of BPFAS in the control group (P = 0·02, P = 0·02). FuCT is an effective method to improve chewing function compared with traditional oral motor exercises.     

Use of antidepressive agents as a possibility in the management of periodontal diseases: A systematic review of experimental studies

Antidepressant agents have anti‐inflammatory functions that could be interesting as adjuvants in periodontal therapy. The aim of the present study was to analyze the effect of antidepressive drugs in the management of periodontal disease. The MEDLINE, Scopus, Embase, LILACS, and SciELO databases were searched. To be included, the studies had to be experimental studies; randomized, controlled; double‐blinded; or blinded studies. A total of 565 articles were initially searched, of which five were selected for the systematic review. All studies used rats, and three different drugs were evaluated: tianeptine, venlafaxine, and fluoxetine. Two of these studies evaluated the effect of antidepressive agents in rats submitted to both ligature‐induced periodontitis and depression models, showing that depressive rats had greater alveolar bone loss (ABL). Only the venlafaxine study was not able to find any significant ABL reduction in the group that used this antidepressive drug. The other four studies showed statistically‐significant differences, favoring the group with the antidepressant agent. Treatments that are able to modulate the brain‐neuroendocrine‐immune system could be used as an adjuvant to periodontal disease management. However, studies on humans and animals are scarce, limiting the conclusion of a positive effect in the present systematic review.     

The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review

Background/Aim

Pulp necrosis is a frequent complication following dental trauma. The diagnosis of the state of the dental pulp can be challenging as most commonly used diagnostic tools are subjective and rely on a response from the patient, potentially making their use unreliable, especially in the child population. The aim of the study was to systematically review the evidence on the use of laser Doppler flowmetry in the assessment of the pulp status of permanent teeth compared to other sensibility and/or vitality tests.

Methods

A systematic literature search, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov and www.controlled-trials.com , in addition to citation and manual reference list searches, was conducted up to 15^th January 2018. A risk of bias assessment was performed using the quality assessment for diagnostic accuracy studies tool (QUADAS‐2) with all steps performed independently by two reviewers.

Results

Four studies with a high risk of bias were included in the final analysis. Laser Doppler flowmetry was reported to be more accurate in differentiating between teeth with normal pulps and pulp necrosis with a sensitivity of (81.8%‐100%) and specificity of 100% in comparison to other vitality tests such as pulp oximetry (sensitivity = 81.3%, specificity = 94.9%) and sensibility tests such as electric pulp testing (sensitivity = 63.3%‐91.5%, specificity = 88%‐100%).

Conclusion

Despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut‐off ratios over which a tooth could be diagnosed as having a normal pulp.     

Strategies to improve dental health in elderly patients with cognitive impairment: A systematic review

Background

Cognitive impairment is the gradual loss of one’s ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining.

老年人和青年人咀嚼前后脑血流变化的对照研究

目的：通过对老年人和青年人咀嚼前后脑血流变化的对照研究,观察咀嚼运动对脑血流的影响。方法：应用经颅多普勒超声诊断仪探测老年人和青年人大脑中动脉的收缩期峰流速、舒张期末峰流速及平均峰流速,进行方差分析。结果：两组受试者在咀嚼5min后、咀嚼10min后的收缩期峰流速、舒张期末峰流速及平均峰流速均高于咀嚼前,并有显著性差异（P〈0．05）。在各时间段上,老年人除在舒张期峰流速均数低于青年人外,在收缩期峰流速均数和平均峰流速均数与青年人无显著性差异。结论：老年人正常咀嚼功能时脑血流指标趋向与青年组脑血流指标相似,提示咀嚼运动对老年人脑血流量增加同样有促进作用。     

Reliability and validity of the Karaduman Chewing Performance Scale in paediatric neuromuscular diseases: A system for classification of chewing disorders

Chewing disorders can be seen in children with neuromuscular diseases (NMDs), which may cause swallowing difficulties such as choking, retching and food stuck feeling in the throat. Due to these effects, it is important to determine chewing disorders early with appropriate assessment methods to plan appropriate therapies in NMDs. The aim of this study was to investigate reliability and validity of the Karaduman Chewing Performance Scale (KCPS) in children with NMDs. Age, sex and diagnosis were recorded. Children were asked to chew a standardised biscuit while video‐recording. Two physical therapists scored each video according to the KCPS. The correlation between the KCPS scores of 2 therapists was analysed for interobserver reliability. One therapist rescored the recordings after an interval of 2 weeks for intra‐observer reliability. The Pediatric Version of the Eating Assessment Tool (PEDI‐EAT‐10) was used for criterion‐based validity. Sixty‐eight children with a mean age of 8.34 ± 3.73 (min = 2.5, max = 14.5) years were included, of which 94.1% were male. Karaduman Chewing Performance Scale scores were found to be level 0 in 20 cases, level 1 in 35 cases, level 2 in 12 cases and level 3 in 1 case. A positive, very strong correlation was detected between 2 therapists (r = .93, P < .001) and between 2 examinations of 1 therapist (r = .83, P < .001). A good correlation between the KCPS and PEDI‐EAT‐10 was detected (r = .62, P < .001). Chewing function, especially food processing phase, deteriorated in children with NMDs. The KCPS could be used as a reliable and valid instrument in determining chewing performance level for children with NMDs.     

Khat chewing habit produces a significant adverse effect on periodontal,oral health: A systematic review and meta‐analysis

Although there is a general agreement that a khat chewing habit produces clinicopathological changes in the oral mucosa. However there is no reliable evidence of the effects of a khat chewing habit on the periodontal tissues. Thus, authors aimed to investigate the influence of khat chewing habits on periodontal, oral health, by comparing khat chewers to non‐chewers in respect of gingival recession, periodontal pocketing depth and loss of attachment. A systematic review and meta‐analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We searched PubMed, the Cochrane Library, Web of Science, Scopus and grey literature. The inclusion criteria were all studies with aims of comparing khat chewers and/or sides to non‐chewers and/or sides in respect of gingival recession, periodontal pocketing depth and loss of attachment. For continuous data, we computed weighted mean difference or standard mean difference analyses. An odds ratio using a random effect model was used if heterogeneity was detected; otherwise, a fixed effects model with a 95% confidence interval was used for continuous data. Two subgroups were analysed: khat chewers vs non‐chewers and khat chewer sides vs non‐chewer sides of the chewer's individuals. A total of 6373 participants were enrolled in 12 studies (khat chewers=3812, non‐chewers=2561). There were statistically significant differences between khat and non‐chewers in both subgroup analyses regarding gingival recession, periodontal pocketing depth and loss of attachment (P<.05). The odds ratios for khat chewers compared to non‐chewers, in respect of depth of periodontal pocket and gingival recession were 4.797 and 6.853 respectively. The results of this meta‐analysis have shown that the khat chewing habit produces a destructive and adverse effect on periodontal, oral health.     

The alveolar bone protective effects of natural products: A systematic review

ObjectivesThis systematic review was carried out to identify which naturally-occurring agents and constituents isolated therefrom have effects in preventing bone loss in a ligature-induced periodontitis model.Materials and methodsEight databases were systematically searched for studies of experimental periodontitis. The data were extracted, analyzed, and the treatment outcomes were given scores based on the level of bone destruction as compared to their untreated induced-periodontitis control.Results294 articles were found, of which 15 met the inclusion criteria. The selected studies tested a multi-herbal formulation; extracts (leaves, barks or fruit) of different plant species; and propolis. The most usual dosing protocol consisted of 3-times-a-day, 11-day treatment. The combined gel of Myracrodruon urundeuva (5%) and Lippia sidoides (0.5%) was the most active treatment, reducing 45–65% bone loss in the region of molars as compared to 73.4% of doxycycline (gold-standard). Ginkgo biloba extract (28–56 mg/kg) and propolis (100–200 mg/kg) prevented bone destruction by 50% and 40–44%, respectively. The other tested samples showed intermediate/weak activity in modulating bone resorption.ConclusionsThe gel of M. urundeuva and L. sidoides, and G. biloba and propolis extracts showed strong alveolar bone protective effectiveness in induced-periodontitis in rats. Further translational research should bridge the gap between the rat study outcomes and the clinical efficacy and long-term toxicity of these formulations in humans. The compilation of the vast literature database presented herein may drive further in vivo and clinical studies with the selected efficacious formulations to subsidize their pharmaceutical application.